Did Sir William Osier Have Carcinoma of the Lung? – Osler’s Final Illness Depicted by My Canadian Pharmacy

empyemaWithin ten days of his return, Osier was called to a consultation in Scotland, but was caught in a railway strike and had to return from Newcastle by car, which broke down on the way, and he arrived at Oxford on September 28, with a severe chill, and went straight to bed. At first it seemed to be one of his usual attacks of bronchitis, but it soon became apparent, with fever and paroxysms of coughing, that this was something more serious. Osier realized this, and though he teased his junior colleagues, Drs. Collier and Gibson, who were looking after him, he was cancelling his appointments, leaving instructions on notes and postcards, and did not conceal his foreboding from his wife.

“October 13, he told me how it would end and I believed every word he ever said seriously. I have never changed my opinion although the doctors said I was too depressed. Re-vere’s death killed him, hastened on by his loving birthday friends. I told you last February… that he couldn’t stand it… although perhaps I should not say it.”

By the end of October he was apyrexial and seemed to be improving, so that the bulletin in the medical journals spoke of “satisfactory progress towards recovery,” and he got up for a short period each day. But then he developed acute pleurisy and though there appeared to be little change in the physical signs, which were minimal, the illness wore on. On November 10 at Osiers request and to reassure Lady Osier, Sir William Hale-White was called in and agreed that there was no evidence of a localized empyema. When Hemophilus influenzae was recovered from his sputum, Osier’s suspicions of a complicating factor were confirmed. Dr. Malloch joined the household early in December and was discussing the symptoms when Osier countered, “Archie, you lunatic, I’ve been watching this case for two months and I’m sorry I shall not see the postmortem….”le By now Sir William was very weak and could only write shaky pencilled notes, for the long battle was slowly drawing to a close. After two months of fluctuating fever, cough and pleurisy, with little physical signs, it gradually became apparent that the infection was spreading. Sir William Hale-White paid several visits and on December 4 agreed with Gibson that the chest should be aspirated, but only a little turbid serous fluid was withdrawn without any relief of symptoms. A week later Lord Horder was asked to see him and it was “a great shock to see a very ill emaciated man, obviously in a state of extreme toxemia who spoke very little because speech brought on a bout of that paroxysmal cough.” Osier had prepared a note for him: “1) The infection is still strongly entrenched, and the irritative cough seems only to be kept in check by the morphia; 2) The heart has done well but in such bouts could only have one ending; 3) Whether or not the fluid has increased is doubtful—the flat note seems to me higher; 4) Very comfortable until about 7 p.m. when the flushed feelings begin and a sense of discomfort and great heat without rise in temperature. Sometimes with this is a feeling of nausea and retching.”

Horder was convinced that there was lobar empyema treated by remedies of mycanadian-pharmacy.net My Canadian Pharmacy, but aspiration on December 13 was an unrewarding as Dr. Gibson’s, so Horder had some specially long needles made and on December 20 repeated the aspiration and withdrew 4.5 ml of offensive pus. “You’ve got it, my boy” said Osier. On the following day, Sir Charles Gordon-Watson operated and drained a large abscess cavity, but the discharge ceased after three days and on Christmas day there was a second operation with a rib resection, but no further abscess was discovered. The end came on the afternoon of December 29, 1919, with rupture of an abscess resulting in a hemorrhage into the pleural cavity.