1.
From Hippocrates toFrom Hippocrates to
Osler to FOAMOsler to FOAM
Joe Lex, MD, FACEP, MAAEMJoe Lex, MD, FACEP, MAAEM
Department of Emergency MedicineDepartment of Emergency Medicine
Temple University School of MedicineTemple University School of Medicine
Philadelphia, PA USAPhiladelphia, PA USA
joe@joelex.net @JoeLex5joe@joelex.net @JoeLex5

2.
No CommercialNo Commercial
Interests to DeclareInterests to Declare

3.
460 – 370 BC460 – 370 BC

4.
HippocratesHippocrates
• Trained at the asklepieion of KosTrained at the asklepieion of Kos
• Took lessons from Thracian physicianTook lessons from Thracian physician
Herodicus of SelymbriaHerodicus of Selymbria
• InIn PhaedrusPhaedrus, Plato says “Hippocrates, Plato says “Hippocrates
the Asclepiad” thought that athe Asclepiad” thought that a
complete knowledge of the nature ofcomplete knowledge of the nature of
the body was necessary for medicinethe body was necessary for medicine

5.
Hippocratic OathHippocratic Oath
To hold him who has taught me this artTo hold him who has taught me this art
as equal to my parents and to live myas equal to my parents and to live my
life in partnership with him …and tolife in partnership with him …and to
regard his offspring as equal to myregard his offspring as equal to my
brothers … and tobrothers … and to teach them this artteach them this art
– if they desire to learn it –– if they desire to learn it – without feewithout fee
and covenant…and covenant…

6.
980? – 1037980? – 1037

7.
Abū ‘Alī al-Abū ‘Alī al-
usayn ibnḤusayn ibnḤ
‘Abd Allāh‘Abd Allāh
ibn Sīnā –ibn Sīnā –
AKAAKA ‫سينا‬ ‫پور‬‫سينا‬ ‫پور‬,,
AvicennaAvicenna

8.
AvicennaAvicenna
• Most famous Persian physicianMost famous Persian physician
• Also wrote on philosophy, astronomy,Also wrote on philosophy, astronomy,
alchemy, geology, psychology, logic,alchemy, geology, psychology, logic,
Islamic theology, mathematics, andIslamic theology, mathematics, and
physicsphysics
• And he wrote poetryAnd he wrote poetry
• Sort of like Leonardo de VinciSort of like Leonardo de Vinci

9.
Avicenna on EducationAvicenna on Education
• Education must prepare someone forEducation must prepare someone for
a profession whereby he cana profession whereby he can
contribute to the social structurecontribute to the social structure
• Society is built entirely on cooperationSociety is built entirely on cooperation
and specialization of each individualand specialization of each individual
• In other words, get along with yourIn other words, get along with your
consultantsconsultants

10.
Avicenna on EducationAvicenna on Education
If the teacher transmitsIf the teacher transmits
knowledge with care andknowledge with care and
feeling, then the student willfeeling, then the student will
copy his manners and hiscopy his manners and his
virtues, effortlessly and withoutvirtues, effortlessly and without
realizing it, in the process ofrealizing it, in the process of
“learning by imitation”“learning by imitation”

11.
Edgar A. Guest in 1920sEdgar A. Guest in 1920s
And the lecture you deliver may be veryAnd the lecture you deliver may be very
wise and true,wise and true,
But I’d rather get my lessons byBut I’d rather get my lessons by
observing what you do;observing what you do;
For I might misunderstand you and theFor I might misunderstand you and the
high advice you give,high advice you give,
But there’s no misunderstanding howBut there’s no misunderstanding how
you act and how you live.you act and how you live.

12.
1493 – 15411493 – 1541

13.
ParacelsusParacelsus
• TheophrastusTheophrastus
Phillippus AureolusPhillippus Aureolus
Bombastus vonBombastus von
HohenheimHohenheim
• Contemporary ofContemporary of
Martin Luther,Martin Luther,
Copernicus, daCopernicus, da
VinciVinci

14.
ParacelsusParacelsus
““No man becomes master whileNo man becomes master while
he stays at home, nor finds ahe stays at home, nor finds a
teacher behind the stove.teacher behind the stove.
Diseases wander here andDiseases wander here and
there the whole length of thethere the whole length of the
world. He who wouldworld. He who would
understand them must wander.”understand them must wander.”

15.
ParacelsusParacelsus
““He stands like a tree with spreadingHe stands like a tree with spreading
branches, and with each year thatbranches, and with each year that
passes the leaves he puts forth seempasses the leaves he puts forth seem
richer and greener. Always andricher and greener. Always and
everywhere living and active in hiseverywhere living and active in his
power to fructify our souls, he is stillpower to fructify our souls, he is still
living among us today.”living among us today.”
- Jolande Szekacs Jacobi- Jolande Szekacs Jacobi

16.
1514 – 15641514 – 1564

17.
Andreas VesaliusAndreas Vesalius
31 Dec 1514 – 15 Oct 156431 Dec 1514 – 15 Oct 1564

18.
Andreas VesaliusAndreas Vesalius
• Customary anatomy teaching: sit inCustomary anatomy teaching: sit in
an elevated chair, read from a text ofan elevated chair, read from a text of
Galen and watch while an unskilledGalen and watch while an unskilled
barber-surgeon conducted thebarber-surgeon conducted the
dissectiondissection
• Vesalius descended from the chair,Vesalius descended from the chair,
handled body, dissected organshandled body, dissected organs

19.
1668 – 17381668 – 1738

20.
Baron Jan Gerrit vanBaron Jan Gerrit van
Wassenaer heer vanWassenaer heer van
Rosenberg, PrefectRosenberg, Prefect
of Rhineland andof Rhineland and
Grand Admiral of theGrand Admiral of the
Dutch FleetDutch Fleet

21.
Baron Jan Gerrit van WassenaerBaron Jan Gerrit van Wassenaer

22.
Herman BoerhaaveHerman Boerhaave
• Dutch botanist, humanist, physicianDutch botanist, humanist, physician
• Founder of clinical teaching and ofFounder of clinical teaching and of
modern academic hospitalmodern academic hospital
• Demonstrated relation of symptomsDemonstrated relation of symptoms
to lesionsto lesions
• His motto:His motto: Simplex sigillum veriSimplex sigillum veri
(Simplicity is the sign of truth.)(Simplicity is the sign of truth.)

23.
Occam’s RazorOccam’s Razor
• Entia non sunt multiplicanda praeterEntia non sunt multiplicanda praeter
necessitatemnecessitatem
• Lex parsimoniae: aLex parsimoniae: among competingmong competing
hypotheses, the one that makes thehypotheses, the one that makes the
fewest assumptions should befewest assumptions should be
selectedselected

24.
1825 – 18931825 – 1893

25.
CharcotCharcot
ReplacedReplaced
traditionaltraditional
hospital roundshospital rounds
at Salpêtrièreat Salpêtrière
with clinicalwith clinical
demonstrationsdemonstrations
and patientand patient
interviews ininterviews in
the hospital…the hospital…

26.
CharcotCharcot
……completecomplete
with curtains,with curtains,
lighting, etc…lighting, etc…
……and heand he
opened themopened them
to the public.to the public.

27.
Jean-Martin CharcotJean-Martin Charcot
• By the way, that’sBy the way, that’s
Joseph BabinskiJoseph Babinski
supporting thesupporting the
patientpatient
• Other students:Other students:
Sigmund Freud,Sigmund Freud,
Gilles de la TouretteGilles de la Tourette

28.
1849 – 19191849 – 1919

29.
Osler on TeachingOsler on Teaching
““Observe, record, tabulate,Observe, record, tabulate,
communicate. Use your fivecommunicate. Use your five
senses. Learn to see, learn tosenses. Learn to see, learn to
hear, learn to feel, learn tohear, learn to feel, learn to
smell, and know that bysmell, and know that by
practice alone you canpractice alone you can
become expert.”become expert.”

30.
Osler on TeachingOsler on Teaching
““I desire no other epitaph…thanI desire no other epitaph…than
the statement that I taughtthe statement that I taught
medical students in the wards,medical students in the wards,
as I regard this as by far theas I regard this as by far the
most useful and important workmost useful and important work
I have been called upon to do.”I have been called upon to do.”

31.
Osler on TeachingOsler on Teaching
““No bubble is soNo bubble is so
iridescent or floatsiridescent or floats
longer than that blownlonger than that blown
by the successfulby the successful
teacher.”teacher.”

32.
1982 – 19861982 – 1986

33.
UTHSC @ San AntonioUTHSC @ San Antonio

34.
UTHSC @ San AntonioUTHSC @ San Antonio
I was 34 years old…I was 34 years old…
……without a college degreewithout a college degree
……but with 4 years as an Army medicbut with 4 years as an Army medic
……and 4 years as an ER techand 4 years as an ER tech
……and 3 years as an ER nurseand 3 years as an ER nurse
……and they took a chanceand they took a chance
But Why FOAM?But Why FOAM?

35.
UTHSC @ San AntonioUTHSC @ San Antonio
My tuition for the first two years was…My tuition for the first two years was…
USD$300 / yearUSD$300 / year
It went up to $1200 / yearIt went up to $1200 / year
by the time I graduatedby the time I graduated

36.
2000 – present2000 – present

37.
American Academy ofAmerican Academy of
Emergency MedicineEmergency Medicine

38.
American Academy ofAmerican Academy of
Emergency MedicineEmergency Medicine
• ~5000 members~5000 members
• Membership USD$425 / yearMembership USD$425 / year
• Annual Scientific Assembly: FREE toAnnual Scientific Assembly: FREE to
membersmembers

39.
2010 – present2010 – present

40.
www.FreeEmergencyTalks.netwww.FreeEmergencyTalks.net

41.
www.FreeEmergencyTalks.netwww.FreeEmergencyTalks.net