Osler on typhoid fever: Differentiating typhoid from typhus and malaria

Abstract

One can only marvel at Osler's ability at the bedside to differentiate the causes of seemingly undifferentiated fevers that were baffling to most physicians [42]. Osler has much to teach the current generation of physicians regarding identifying key clinical findings that have important diagnostic implications. Osler was careful to differentiate between findings that were consistent with the diagnosis and findings that were characteristic of the diagnosis. He used this approach with great effectiveness and accuracy in differential diagnostic problems. His ability to distinguish typhoid fever from typhus and malaria illustrates his clinical acumen and method [20-22,27]. As Osler said, "the value of experience is not in seeing much, but in seeing wisely" cannot be overly stressed. Today's physicians are often too laboratory-test-oriented and have the potential to overlook important significant clinical information by careful evaluation of the key physical and laboratory findings. Differential diagnostic abilities can be improved. Using an Oslerian approach, it is important to realize that some clinical findings have more diagnostic significance than others. Clinical diagnostic problems should be approached from an Oslerian perspective, because failure to do so invites imprecise diagnosis. Differential diagnosis remains the hallmark of the master clinician. Today's clinicians would benefit greatly from reading Osler's description of typhoid fever. As Osler himself suggested, "But when you have seen, read. And when you can, read the original descriptions of the masters who, with crude methods of study, saw so clearly.".