Vol. 77 No. 1 — Winter 1996 —
Magnificent Physician
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He was the most famous doctor of his time,
a tireless worker who revolutionized medical education and
virtually created the modern hospital. Here, a look at the
achievements of Sir William Osler as part of our occasional
series on great Canadians of the past...
Sir William Osler probably would been a great man whatever
his country of birth, but he may have been rendered just that
much greater by the fact that he was born in Canada. He was
above all a man of character, and the solid character that
made him a hero to the world was primarily moulded by the
rugged challenges of his early life on the Canadian frontier.
He never lost the perseverance, the pioneering spirit, the
common touch, nor the free and easy manners he acquired while
growing up on the fringes of the Precambrian wilderness. Though
his parents were English, "Willie" Osler, as he called himself,
was typically Canadian in attitude and personality.
The child who would become the leading medical man of his
age was born July 12, 1849, in Bond Head, a pioneer village
of 200 souls in the Lake Simcoe area of what is now Ontario.
He was the son of Featherstone Lake Osler and the former Ellen
Free Pickton, the eighth and last child in a brood that produced
one of Canada's most prominent lawyers and one of its leading
financiers.
The senior Oslers had emigrated from Cornwall in 1837 to
take charge of the Anglican parishes of Techumseth and West
Gwillimbury, Upper Canada. Willie's distinctive olive complexion
and blazing black eyes were attributed to his mother's "black
Celt" Cornish ancestry.
Living in a rambling wooden parsonage which posed only a
faulty defence against the winter cold, the family depended
on farming to stretch out Canon Osler's sparse income. Willy
began doing farm chores at an early age, an experience that
evidently helped to develop his astonishing capacity for hard
work.
But the minister's son was no Goody Two Shoes: once he was
expelled from the village school for playing a prank that
disrupted classes. The practical jokes he would practise all
his life were an outlet for an extraordinary store of imagination
and energy. While heading his class and excelling at sports,
he found time in his youth to read widely and pursue a hobby
that proved a key stepping-stone to his life's work.
This was zoology, a popular pastime among Victorian gentlemen
in that golden age of amateur scientists. The lad ranged the
nearby woods, streams and ponds, collecting frogs, fish and
insects for examination under the microscope of his mentor,
an eccentric teacher named William Johnson. Osler became adept
at dissecting, examining, mounting, noting and cataloguing
specimens.
Microscopes were a novelty in those days, and Osler was
thrilled by the secrets revealed by their lenses. He found
"surpassing beauty" in organisms invisible to the naked eye.
Soon he was collecting and analyzing microscopic parasites
from the flesh and blood of animals.
Osler was 19 and a second-year scholarship Arts student
in Toronto when he chose to become a doctor. He threw himself
single-mindedly into his courses and assisted a friendly physician
in his practice. He spent long hours alone dissecting cadavers.
As a first-year medical student he discovered a parasite in
the muscles of a body which no one else had detected. It confirmed
his feeling that many of the mysteries of medicine could be
unravelled through assiduous searches for the hidden causes
of disease.
In 1870 he moved to Montreal to study at McGill University.
There he interned at the Montreal General Hospital, "an old
coccus- and rat-ridden building, but with two valuable assets
for the student - much acute disease and a group of keen teachers,"
as he wrote.
He taught not only medicine, but the
philosophy of medicine
While pneumonia, sepsis and dysentery raged around him,
he served as a dresser and clerk to the qualified doctors
and did his share of night nursing. The clerking entailed
reporting on cases of special interest in the local medical
monthly. This duty gave him a strong appreciation of the importance
of spreading information among the medical profession as a
kind of strategic intelligence in the war against disease.
At McGill he found a role model in the person of Dr. Palmer
Howard. What impressed Osler about his new mentor was that
he was both a teacher and a constant student, ever open to
fresh ideas. When Osler graduated as an MD in 1872, Dr. Howard
encouraged him to continue his studies. Thus Osler became
a precursor of a now- familiar figure around the world: the
Canadian post-graduate student seeking knowledge in foreign
universities.
He did the rounds of the venerable medical schools of Dublin,
Glasgow and Edinburgh before settling into studies at the
Physiology Laboratory at University College, London. There
he made one of his most far-reaching discoveries -the presence
of platelets in blood.
He then went off to study histology (the science of human
tissue) and pathology in Berlin and Vienna. Wherever he roamed,
he conscientiously reported on his observations to Canadian
medical publications. Here he displayed another trait that
would help him win distinction: he was an excellent writer
who could combine scientific precision with readability.
In 1874 he returned to McGill as a lecturer and later professor
of histology and physiology. He regarded the preparation of
lectures as a "ghastly task," but his students would remember
them to their dying days. For he did not simply teach medicine;
he taught the philosophy of medicine. One of his biographers,
Edith Gittings Reid, summarized the creed he propagated in
the lecture room: "You must treat the man as well as the disease.
The poor you have always with you and you must consider them
above all others." Osler liked to quote the 17th century physician-philosopher
Sir Thomas Browne: "No one should approach the temple of science
with the soul of a money- changer."
Medical professors were expected to subsidize their teaching
with the proceeds of private practices, but Osler was too
absorbed in the study of disease to want to keep office hours.
Besides, he made little income during his brief foray into
family medicine. If his patients were poor, he would give
them money instead of letting them pay him.
So he gave up his practice in favour of treating smallpox
patients, work which could prove fatal if a doctor was infected.
In the crowded ill-lit wards, surrounded by dying people,
he noted the nurses' lack of training and lowly status. The
experience made him a lifelong exponent of nursing education.
The anti-vaccination riots which broke out in Montreal during
the smallpox epidemic of 1876 steered Osler's attention towards
public health, a cause he was to pursue purposefully thereafter.
Not the kind of medical doctor who looked down on veterinary
science, he worked with veterinarians at McGill on studies
of trichinosis in the pork supply, promoting more-thorough
inspection of meat.
He used his position as a smallpox specialist to perform
autopsies on fatal victims of the disease. This enabled him
to do ground- breaking research into such unrelated conditions
as endocarditis, tuberculosis and "miner's lung." He spent
the $600 he earned in the smallpox wards on 15 microscopes
from France for the use of his students. In so doing, he established
Canada's first physiological laboratory.
One might think that the grim work of cutting up dead bodies
would make for a grim personality, but Osler was the soul
of cheerfulness and bonhomie. He lived in rooms among other
medical men, a merry group who revelled in boisterous meetings
of their dining club. A notably witty man ("Save the fleeting
moment. Learn gracefully to dodge the bore," he once advised),
he wrote playful letters to his beloved nephews and nieces.
One niece has left a verbal picture of Osler in a silk hat
and a flower in his lapel, humming and whistling his way down
Ste. Catherine Street. Medicine was never far from his mind,
however. He gave his overcoat to an alcoholic panhandler on
the street in return for a promise that the man would bequeath
him his liver for research.
His sunny disposition was part and parcel of his healing
technique. "The effect of his debonair manner and ready banter,
his quick step and radiant vitality," wrote Edith Gittings
Reid, "were like oxygen in a sick room." When he was appointed
[Chief] Physician of the Montreal General in 1879, a colleague
recounted, "Older doctors looked at him with bated breath,
expecting disastrous consequences. He began by clearing up
his ward completely. All unnecessary semblance of sickness
and treatment was removed; it was turned from a sickroom into
a bright, cheerful room of repose. Then he started in on the
patients. Very little medicine was given. To the astonishment
of everyone, the chronic beds instead of being emptied by
disaster, were emptied rapidly through recovery."
His thinking was usually far in advance of his colleagues
Activating his belief that physicians can learn more at
the bedside than in the lecture room, he had his students
do his rounds with him. He impressed upon them that illness
always had a psychological side. Though a consummate scientist,
he believed that the practice of medicine was an art - an
art "working with science, in science, and for science." The
physician must "generalize the disease and individualize the
patient." The generalization was science; the individualization
was art.
In this as in many of his other views, Osler's thinking
was far in advance of his colleagues. The old world of medicine
was dying hard, as he found when he visited Berlin on a sabbatical
in 1884. There anti-Semitism was blocking Jewish doctors off
from medical faculties. Osler sprang to their defence in a
letter to a Canadian medical journal. If Jews were deprived
of advancement, he wrote, "there is not a profession which
would not suffer the serious loss of its most brilliant ornaments
and in none more so than our own."
Near the end of that German sojourn he received a cable
offering him the Chair of Clinical Medicine at the University
of Pennsylvania in Philadelphia, then the leading medical
centre in North America. It was a measure of Osler's prestige
at the comparatively young age of 35 that the university reached
beyond the United States to recruit him. Torn between his
loyalty to McGill and the opportunity to work in the continent's
premier medical school, he flipped a coin which came down
on the side of Philadelphia.
At Johns Hopkins, he was able to build the
hospital of his dreams
He left Montreal having done much to put it on the map of
the world's top-ranking medical cities. A partial list of
his accomplishments in his 10 years of teaching at McGill
includes introducing modern methods of teaching physiology,
editing the first clinical and pathological reports from a
Canadian hospital, writing "epoch-making" papers, amassing
a vast collection of pathological specimens, and reporting
on almost 1,000 autopsies in five large volumes of intensely
detailed notes.
With his move to Philadelphia, Osler became a precursor
of another common Canadian type - the "star" in one field
or another who gains international recognition by leaving
Canada. He was a bit disappointed by what he found in the
oldest medical school in the United States. There was no laboratory
for clinical research, so he promptly set one up in a hospital
amphitheatre. To teach dissection, he had to take his students
to a dead house adjoining a potter's field.
He had the temerity as an outsider to criticize the American
system of medical education. "How it is that such a shrewd,
practical people as those in the United States should have
drifted into such a loose, slipshod way of conducting medical
schools, is unintelligible," he said. After four years at
the University of Pennsylvania in which his eminence in clinical
research grew steadily (much of his celebrated work on angina
pectoris was done in Philadelphia) he was offered an ideal
opportunity to put his educational ideas into effect.
In 1876 an merchant grocer in Baltimore named Johns Hopkins
had died and bequeathed $7.5 million to establish a university
and hospital in his home city. The university was already
a going concern in 1888 when Osier was asked to become chief
physician at the yet-unbuilt hospital. He knew that he was
on the road to organizing the institution of his dreams when
the head of the university, Dr. Gilman, asked him to meet
him in a New York hotel where the manager was a friend of
Gilman. They inspected every department, each with a chief
reporting to an overall director. " This," Gilman told Osler,
"is really a hospital and we shall model ours upon it."
When Johns Hopkins Hospital opened the following year, Osler
organized it along lines that are followed to this very day
throughout North America. He designed it on a German model,
with each section under a house physician. A system of long-term
residents as well as short-term interns was introduced. Well-
equipped laboratories were dedicated to research. The medical
school, which Osler was to head, was considered an integral
part of the hospital, and vice-versa. A school of nursing
was opened, the first to be incorporated into a hospital in
North America.
Writing the bible of medical education around the world
For several years Osler had been giving public lectures
touching on medicine and education, which had found their
way into books of essays. His literary fame led to an approach
to write a textbook to be called The Practice of Medicine.
He set about doing this with characteristic energy, drawing
heavily on his Montreal experiences for vivid accounts of
diseases and treatments. It was published in 1891 and quickly
became the bible of medical education around the world.
The book was scarcely complete when, at 41, he married Grace
Linzee Revere, the widow of a colleague in Philadelphia. Their
cosy home became a haven for out-of-town students of Johns
Hopkins, including several Canadians who had followed their
hero south and were to go on to prominence in their own right.
"Dr. Osler" became a household name in the English-speaking
world. His speeches and writings drew wide public attention,
and the opinions he expressed in them might be considered
progressive even today. Though he could not abide quacks,
he was tolerant of alternative medicine as long as the practise
of it had honest intentions. He believed there was such a
thing as faith healing, but that the faith dwelt within the
patient. "Phenomenal, even what could be called miraculous,
cures are not very uncommon," he said. He preached that medication
should be applied sparingly. As a former student wrote, "He
used drugs not empirically but scientifically, and in his
teaching laid great stress on the general management of the
disease."
Such was his fame that, when he suggested in a speech in
1905 that all men should be retired at 60, it caused an international
sensation. The press played his remark as a call for mass
euthanasia, sparking a hot and prolonged debate. By that time
he had been invited to become Regius Professor of Medicine
at Oxford University. It was unprecedented that someone from
outside of Great Britain should be called to the post, arguably
the most prestigious in all medicine. In it, Osler found himself
in the familiar Canadian role of acting as an interpreter
between the British and the Americans.
He had never forsaken his Canadian roots. Throughout his
many years as an expatriate, he continued to contribute to
Canadian medical journals and visited his homeland frequently.
When he was offered a baronetcy in 1911, he was reluctant
as a democrat to take it, but said, "I think I'll have to
accept - Canada will be so pleased." His never-ending love
of children came to full flower in his relationship with his
son Revere. Like his father, Revere became an ardent and knowledgeable
book collector and amateur librarian.
Osler's years of tranquillity in Oxford were interrupted
by World War I. Though he loathed war, he felt he had a duty
to do, using his influence to ensure that Allied soldiers
were properly protected against diseases and that unfit men
were not enlisted. When Canadian troops arrived in Britain,
he agreed to act as physician-in-chief at their hospitals;
ultimately there were four of these. He found himself supervising
the treatment of a sad, steady flow of casualties.
He was busy with war work when the news came in August 1917
that his son had been killed at the front at the age of 19.
He never really recovered from the realization of his deepest
fear. He died of bronchial pneumonia at 70 on Dec. 29, 1919,
having bequeathed his magnificent collection of medical books
to McGill to form the unique library known as Bibliotheca
Osleriana. He specified in his will that his ashes be
placed among the bookcases there.
At his death, a colleague, Professor Adami of Liverpool,
called Osler "the greatest physician in history," a large
claim made on the reasonable grounds that no physician had
ever done so much in so many facets of his profession. He
had pioneered clinical research in North America, revolutionized
medical teaching, and left a permanent mark on every town
and city on the continent by organizing hospitals along modern
lines.
He had done much to improve public health everywhere, and
written textbooks that guided the treatment of illness for
generations. Above all, he had a strong moral influence on
modern medical practice through his philosophical writings
and, indeed, his very person. Canadians can be proud to call
this marvellous man one of their own.
Published by RBC Financial Group. All editions from the RBC
Letter collection are available on our web site at www.rbc.com/responsibility/letter.
Our e-mail address is: rbcletter@rbc.com.
Publié aussi en francais.
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