Osler's changing influence. Based on the Osler oration given at the Royal College of Physicians in 1990.

Over 20 years in North America William Osler transformed the pattern of medical education for both undergraduates and specialists. He wrote a textbook that not only was a stimulus to medical students and young doctors, but also inspired the railway baron J D Rockefeller to devote his wealth to the advancement of medical research and education. He encouraged the creation of medical associations and societies because he believed, rightly, that these enhanced not only the quality of medicine but also the relationship of the members of the profession, one with another.

Osler's influence on haematology.

Osler's influence in haematology was twofold: as an original observer both in the laboratory and the ward, and his encouragement of the establishment of clinical laboratories with the consequent development of clinical and laboratory haematologists. In 1870, when Osler entered McGill Medical School at the age of 21, he was already an experienced microscopist from his school days, but now his interest shifted from pond life to parasites and clinical microscopy. His post-graduate year with Burdon-Sanderson was to have been a study of leucocyte function, but instead came his research on platelets, continued and expanded when he returned to Montreal in 1874, together with much of his laboratory haematology--his comprehensive studies of pernicious anaemia and work on leukaemia, Hodgkin's disease etc.

Atypical multicentric reticulohistiocytosis with paraproteinemia.

Two women had multiple subcutaneous nodules that showed features of multicentric reticulohistiocytosis (MR). Neither had joint symptoms. Both had a raised erythrocyte sedimentation rate, an immunoglobulin G paraproteinemia, and raised levels of nonhepatic serum alkaline phosphatase.

Multiple myeloma: development of plasma cell sarcoma during apparently successful chemotherapy.

Three patients with multiple myeloma who developed a plasma cell sarcoma during apparently successful chemothapy are described. It is postulated that the chemotherapy induced the sarcomatous change.