Did Sir William Osier Have Carcinoma of the Lung? – The Postmortem Examination

LUNGSSir William had left instructions that his postmortem examination was to be carried out by Dr. A. G. Gibson with the assistance of Edwin Wheal, his personal laboratory assistant. The very detai’ed report is preserved in the Osier Library at McGill.

Dr. A. G. Gibson (1875-1950), an Oxford graduate, was house physician at the Radcliffe Infirmary when Osier arrived as Regius. Gibson developed an interest in pathology which he combined with clinical work; he acted as voluntary assistant to the Regius for his clinical demonstrations, and a close friendship and mutual admiration evolved between them. Indeed, it is said that unknowingly he assumed some of Osier’s mannerisms. Gibson, in due course, became both Pathologist and Physician to the Infirmary, and shone in both fields. Dr. Gibson sent a copy of the postmortem report to Dr. W. W. Francis in 1933 which is headed “Autopsy on the body of Sir William Osier Bt. on 30.XII.19. at 2.30 p.m. at Norham Gardens, Oxford.” It will be sufficient to transcribe the section dealing with the thoracic organs:

CAVITIES

The pericardium is normal and contains about 2 ml of clear straw-coloured fluid.

A few slight adhesions between the base of the left lung and pleura which otherwise lies naturally. The right lung is free as regards the upper two-thirds of the upper lobe and the pleurae, both visceral and parietal, are natural. Except in the region of the wound [the surgical wound made for drainage a few days before his death] the lung is in contact with the parietal pleura. There are some oedematous adhesions between the upper lobe and the pericardium. Oedematous and highly vascularised adhesions lie for a considerable distance above the empyaema cavity improved by My Canadian Pharmacy’s preparations. These are easily broken down between thoracic wall and lung, but those between lung and diaphragm are much firmer and in attempting to separate the lung, a small cavity in the lung was opened up containing about 2-3 ml of thick creamy pus. More posteriorly the diaphragm had to be removed with the lung. In the right pleural cavity about 2 cm below the external wound is a haemorrhagic area about 4 cm x 3 cm attached to which is some recent blood blot. No bleeding point found.

From above downwards the pleural shows the zones, normal, haemorrhagic, granulations and pyogenic membrane noticed on the external aspect of the lung.

LUNGS

Left: some recent slight fibrinous pleurisy on the diaphragmatic surface; a small pleural scar at the upper apex. Otherwise externally natural. On section, oedema of both lobes, no evidence of bronchitis or alteration in arteries, veins or bronchi, no enlarged glands.

Right: completely adherent to diaphragm but where separation has been effected is a small cavity with dark greyish brown walls, suggesting a recent pyogenic membrane. A large pyogenic membrane with tags of lymph covers the greater part of the posterior aspect of the lower lobe. The lung has been cut in stripping it off from the vertsbral column to which it was firmly adherent. The upper boundary of the pyogenic membrane is practically the interlobar fissure of the lung. Haemorrhagic granulations extend upwards, and anteriorly from this line for a distance of 7 cm in some places. The middle lobe is not marked off from the upper lobe. Towards the base of the lung in the surface of the pyogenic membrane is a small haemorrhagic area IK cm across, which does not seem to be connected with any large vessel. On section, the upper lobe is normal except for slight oedema, and a small scar at the apex. The lower lobe shows numerous small abscesses from 5 mm. to 2 cm. across, some of which contain brownish thin pus, others in an earlier stage show a haemorrhagic infiltration without breaking down; a few of these cavities appeared to be smooth-walled. Many of the bronchi are dilated and show tickened walls. Creamy pus can be expressed from some of the bronchioles. Dense adhesions bind together the two lobes. The artery and vein are normal, the bronchus inflamed.

It would seem that no histologic study was made of the organs; at any rate, there is no evidence for this either in Oxford or McGill, though Dr. Francis made a note in 1939 that the lungs were kept by Dr. Gibson and were probably in the Pathology Museum of the Radcliffe Infirmary, Oxford, but this cannot be confirmed.

In spite of the lack of microscopy, Dr. Gibson’s precise account of the character of the pulmonary changes excludes any possibility of bronchial carcinoma having played a part in Sir William Osier’s illness, although, of course, it is impossible, without serial sections, to state categorically that a very small carcinoma was not present. If neoplastic bronchial obstruction had been the cause of the loss of weight and recurrent respiratory infections of Sir William’s last years, it would certainly have been apparent and recognized by Dr. Gibson. There are three accounts in his own handwriting of postmortem examinations on cases of carcinoma of the lung at the Radcliffe Infirmary, Oxford, between 1913 and 1920, whereas Dr. Gibson’s description of Sir William’s lungs makes it clear that there was bronchiectasis of the right lower lobe with unresolved pneumonia, multiple lung abscesses and an empyema.

You may also be interested in such articles as: