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Sir William Osler MD (1849 - 1919)

January 28, 2019

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History of Medicine
Source:

Sir William Osler, M.D.By Unknown - [1], CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=33071914
The Four Doctors by John Singer Sargent, 1905, depicts the four physicians who founded Johns Hopkins Hospital. The original hangs in the William H. Welch Medical Library of Johns Hopkins University. From left to right: William Henry Welch, William Stewart Halsted, William Osler, Howard Kelly
Graphic credit: By John Singer Sargent - unknown, Public Domain,
https://commons.wikimedia.org/w/index.php?curid=634488

Sir William Osler (1849 - 1919) was a Canadian physician and one of the founding professors at Johns Hopkins Hospital and the founder of the hospital's Medical Service. Dr. Osler, a superb diagnostician and clinician, was greatly esteemed by his peers around the world. In 1905 he accepted the Regius Professorship of Medicine at Oxford University, at the time the most prestigious medical appointment in the English-speaking world. He left Maryland with warm feelings for Hopkins knowing that his sixteen years spent had laid a solid foundation for the future of Hopkins medical education. Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training. He has frequently been described as the “Father of Modern Medicine“ and one of the “greatest diagnosticians ever to wield a stethoscope.“ Osler was a person of many interests, who in addition to being a physician, was a bibliophile, historian, author, and renowned practical joker. One of his achievements was the founding of the History of Medicine Society of the Royal Society of Medicine, London.

William's great-grandfather, Edward Osler, was variously described as either a merchant seaman or a pirate. One of William's uncles (Edward Osler; 1798-1863), a medical officer in the Royal Navy, wrote the Life of Lord Exmouth and the poem The Voyage, which was written at sea in the West Indies. William Osler's father, Featherstone Lake Osler (1805-1895), the son of a shipowner at Falmouth, Cornwall, was a former Lieutenant in the Royal Navy who served on HMS Victory. In 1831 Featherstone Osler was invited to serve on HMS Beagle as the science officer on Charles Darwin's historic voyage to the Galapagos Islands, but he turned it down because his father was dying.

William Osler was born in Bond Head, Canada West (now Ontario) on July 12, 1849, and raised after 1857 in Dundas, Ontario. (He was called William after William of Orange, who won the Battle of the Boyne on July 12, 1690.) His mother, who was very religious, prayed that Osler would consecrate to God's service and, in 1867, her son announced he would follow his father's footsteps into the ministry. He was educated at Trinity College School (then located in Weston, Ontario) and entered Trinity College, Toronto (now part of the University of Toronto) in the autumn of 1867. At the time, however, he was becoming increasingly interested in medical science, under the influence of James Bovell, and Rev. William Arthur Johnson, who both became major influences for Osler at this time, encouraging him to switch his career. In 1868, Osler enrolled in the Toronto School of Medicine, a privately owned institution, not part of the Medical Faculty of the University of Toronto. Following post-graduate training under Rudolf Virchow in Europe, Osler returned to the McGill University Faculty of Medicine as a professor in 1874. Here he created the first formal journal club. During this time, he also showed interest in comparative pathology and is considered the first to teach veterinary pathology in North America as part of a broad understanding of disease pathogenesis. In 1884, he was appointed Chair of Clinical Medicine at the University of Pennsylvania in Philadelphia and in 1885, was one of the seven founding members of the Association of American Physicians, a society dedicated to “the advancement of scientific and practical medicine.“ When he left Philadelphia in 1889, his farewell address, “Aequanimitas“, was on the imperturbability (calm amid storm) and equanimity (moderated emotion, tolerance) necessary for physicians.

In 1889, he accepted the position as the first Physician-in-Chief of the new Johns Hopkins Hospital in Baltimore, Maryland. Shortly afterwards, in 1893, Osler was instrumental in the creation of the Johns Hopkins School of Medicine and became one of the school's first professors of medicine. Osler quickly increased his reputation as a clinician, humanitarian, and teacher. He presided over a rapidly expanding domain. In the hospital's first year of operation, when it had 220 beds, 788 patients were seen for a total of over 15,000 days of treatment. Sixteen years later, when Osler left for Oxford, over 4,200 patients were seen for a total of nearly 110,000 days of treatment. In 1905, he was appointed to the Regius Chair of Medicine at Oxford, which he held until his death. He was also a Student (Fellow) of Christ Church, Oxford. In 1911, he initiated the Postgraduate Medical Association, of which he was the first President. In the same year, Osler was named a baronet in the Coronation Honors List for his contributions to the field of medicine.

The largest collection of Osler's letters and papers is at the Osler Library of McGill University in Montreal and a collection of his papers is also held at the United States National Library of Medicine in Bethesda, Maryland. Perhaps Osler's greatest influence on medicine was to insist that students learn from seeing and talking to patients and the establishment of the medical residency. The latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a teaching hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years. While at Hopkins, Osler established the full-time, sleep-in residency system whereby staff physicians lived in the administration building of the hospital. As established, the residency was open-ended, and long tenure was the rule. Doctors spent as long as seven or eight years as residents, during which time they led a restricted, almost monastic life.

He wrote in an essay “Books and Men“ that “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.“ His best-known saying was “Listen to your patient, he is telling you the diagnosis,“ which emphasizes the importance of taking a good history. The contribution to medical education of which he was proudest was his idea of clinical clerkship - having third- and fourth-year students work with patients on the wards. He pioneered the practice of bedside teaching, making rounds with a handful of students, demonstrating what one student referred to as his method of “incomparably thorough physical examination.“ Soon after arriving in Baltimore, Osler insisted that his medical students attend at bedside early in their training. By their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta. He reduced the role of didactic lectures and once said he hoped his tombstone would say only, “He brought medical students into the wards for bedside teaching.“ He also said, “I desire no other epitaph than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.“ Osler fundamentally changed medical teaching in North America, and this influence, helped by a few such as the Dutch internist P.K. Pel, spread to medical schools across the globe.

Osler was a prolific author and a great collector of books and other material relevant to the history of medicine. He willed his library to the Faculty of Medicine of McGill University where it now forms the nucleus of McGill University's Osler Library of the History of Medicine, which opened in 1929. The printed and extensively annotated catalogue of this donation is entitled “Bibliotheca Osleriana: a catalogue of books illustrating the history of medicine and science, collected, arranged and annotated by Sir William Osler, Bt. and bequeathed to McGill University“. Osler was a strong supporter of libraries and served on the library committees at most of the universities at which he taught and was a member of the Board of Curators of the Bodleian Library in Oxford. He was instrumental in founding the Medical Library Association in North America and served as its second president from 1901-1904. In Britain he was the first (and only) president of the Medical Library Association of Great Britain and Ireland and also a president of the Bibliographical Society of London (1913).

Osler's public speaking and writing were both done in a clear, lucid style. His most famous work, 'The Principles and Practice of Medicine' quickly became a key text to students and clinicians alike. It continued to be published in many editions until 2001 and was translated into many languages. It is notable in part for supporting the use of bloodletting as recently as 1923. Though his own textbook was a major influence in medicine for many years, Osler described Avicenna as the “author of the most famous medical textbook ever written“. He noted that Avicenna's Canon of Medicine remained “a medical bible for a longer time than any other work“. Osler's essays were important guides to physicians. The title of his most famous essay, “Aequanimitas“, espousing the importance of imperturbability, is the motto on the Osler family crest and is used on the Osler house-staff tie and scarf at Hopkins.

Osler is well known in the field of gerontology for the speech he gave when leaving Hopkins to become the Regius Professor of Medicine at Oxford. “The Fixed Period“, given on February 22, 1905, included some controversial words about old age. Osler, who had a well-developed humorous side to his character, was in his mid-fifties when he gave the speech and in it he mentioned Anthony Trollope's The Fixed Period (1882), which envisaged a college where men retired at 67 and after being given a year to settle their affairs, would be “peacefully extinguished by chloroform“. He claimed that, “the effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty“ and it was downhill from then on. Osler's speech was covered by the popular press which headlined their reports with “Osler recommends chloroform at sixty“. The concept of mandatory euthanasia for humans after a “fixed period“ (often 60 years) became a recurring theme in 20th century imaginative literature - for example, Isaac Asimov's 1950 novel Pebble in the Sky. In the 3rd edition of his Textbook, he also coined the description of pneumonia as “the old man's friend“ since it allowed elderly individuals a quick, comparatively painless death. Coincidentally, Osler himself died of pneumonia.

Osler died at the age of 70, on December 29, 1919 in Oxford, during the Spanish influenza epidemic, most likely of complications from undiagnosed bronchiectasis. His wife, Grace, lived another nine years but succumbed to a series of strokes. Sir William and Lady Osler's ashes now rest in a niche in the Osler Library at McGill University.

Osler was a founding donor of the American Anthropometric Society, a group of academics who pledged to donate their brains for scientific study. Osler's brain was taken to the Wistar Institute in Philadelphia to join the Wistar Brain Collection. In April 1987 it was taken to the Mutter Museum, on 22nd Street near Chestnut in Philadelphia where it was displayed during the annual meeting of the American Osler Society. In 1925, a biography of William Osler was written by Harvey Cushing, who received the 1926 Pulitzer Prize for the work. A later biography by Michael Bliss was published in 1999. In 1994 Osler was inducted into the Canadian Medical Hall of Fame.

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