Sir William Osler PDF Print

Sir William Osler (1849-1919) was perhaps the most famous practitioner of clinical medicine in the world at the turn of the nineteenth century. He described several well-known diseases, was one of the founders of modern medical education, and remains admired within medicine for his humanist attitudes.

He held the position of Regius Professor of Medicine at Oxford from 1905 to 1919. The neurosurgeon Harvey Cushing wrote a superb biography, from which the majority of this brief summary is derived. Osler's writings, personality and humanistic philosophy are dealt with particularly well by Golden in his JAMA article (See Bibliography) at the whonamedit website (See Bibliography), where there is also an extensive list of his publications.

Osler in Canada

William Osler was born on 12 July 1849, in the village of Bond Head, Tecumseth County, in what was then Upper Canada. He was the seventh child of Featherstone Lake Osler and his wife Ellen Free Pickerton. Featherstone Lake Osler was a former naval officer who studied for the ministry at St Catharine's Hall, Cambridge, and was ordained and sent to Bond Head in 1837. The family moved to nearby Dundas in 1857. Here William Osler attended the local grammar school, at least until he was expelled for a practical joke in June 1864. He was then schooled at Barrie, and next Weston, where he met the Rev. William Arthur Johnson who was Warden of the School, a naturalist, and an important influence on Osler through his love of science. In 1867 Osler went up to Trinity College in Toronto, taking an arts course and probably intending to study for the ministry. In his first year he met James Bovell - an English-trained doctor - through their shared interest in algae and protozoa. He was the second great influence in Osler's life, and Osler had access to his well-stocked medical and scientific library. A few days into his second year he changed to study medicine.

In 1870 Osler began clinical work at McGill Medical School in Montreal, where Palmer Howard, the third early influence on Osler, was professor of medicine. His interest in morbid anatomy, and its correlation with general medical and surgical problems, was communicated to Osler through his inspiring teaching.

After graduation in 1872, Osler moved to London, where he worked in the laboratory of John Burdon Sanderson at University College Hospital and was also able to attend lectures and visit the London teaching hospitals. He was offered and declined the Chair of Botany at McGill in Montreal, and did some important and novel research on platelets. In 1873 Osler travelled to Berlin, attending lectures by Virchow, and to Vienna, returning to London in 1874 where his research was presented to the Royal Society.

Osler returned to Canada in 1874, and worked for a short time in Dundas and Hamilton. He then became a lecturer in medicine at McGill University, in the Institutes of Medicine, and then Professor in 1875. He also performed post-mortems and some medical work at the Montreal General Hospital, taking charge of the smallpox wards and indeed contracting the disease in 1876. In May of that year he became the first Pathologist to the hospital and began his study of morbid anatomy that continued for almost 13 years. He continued teaching, as well as research in zoology - on polyzoa and animal parasites. He started a journal club and a students' society at the University. In 1878 he was appointed physician to the Montreal General, and travelled to the UK to take his Membership of the Royal College of Physicians examinations and refresh his clinical practice. In 1880 he wrote the first of his articles under the pseudonym 'Egerton Yorick Davis' - an occasional series of sometimes scurrilous pieces with which he would try to tease friends or puncture an editor's excessive pomposity. He went on teaching, practising medicine and researching, and became a Fellow of the Royal College of Physicians in June 1883.

In 1884 the Chair of Clinical Medicine at the University of Pennsylvania became vacant, and Osler was invited to apply. He was successful, and at the age of 35 he moved to Philadelphia.

Osler in the USA

In Philadelphia, Osler lectured and taught on the wards and in the laboratory, and although practising little continued his series of post-mortem examinations at the 'Blockley' Hospital. He met Dr Samuel W. Gross and his circle of friends. In 1885 he delivered the Goulstonian Lectures in London - a duty traditionally falling to the youngest Fellow of the Royal College of Physicians - on the subject of endocarditis. He published his series of autopsies from Montreal - totalling over 1000 cases.

From 1886 onwards he began to do more medical work as a consultant, notably treating the poet Walt Whitman. He became interested in malaria - the Plasmodium protozoa had just been described by Laveran - and published on his microscopic findings. He wrote a large number of book reviews, editorials and chapters for Professor Pepper's textbook, and published on duodenal ulcers, portal vein thrombosis, the treatment of typhoid and cerebral palsy. In the autumn of 1888 he accepted the post of Physician in Chief to the Johns Hopkins Hospital in Baltimore, offered to him by John S. Billings, the medical adviser to the Johns Hopkins Trustees. In March 1888 Palmer Howard died, soon followed by Samuel W. Gross in April 1889.

The Johns Hopkins Hospital opened in May 1889. Osler, aged 40, was the first Physician in Chief, with three assistants. There was, however, no medical school at that time. He travelled around Europe in the summer of 1890, and at the end of the year began his textbook 'The Principles and Practice of Medicine' - finishing it in 1892. He was invited to Professorships of Medicine in Philadelphia and Boston, but turned them down. In May 1892 he married Grace Revere Gross, the widow of Samuel W. Gross, and great-granddaughter of Paul Revere, without giving any advance warning to his friends. On their honeymoon, in Devon and Cornwall, he found time to attend the British Medical Association meeting in Nottingham. When they returned, they bought a new house at No. 1 Franklin St, Baltimore, which was to become well known over the next 14 years as a centre for his medical circle and for the number of guests he accommodated there. He was also active in campaigning about the public health concerns of Baltimore and the whole of Maryland.

In 1893 the first group of medical students entered the new medical school at Johns Hopkins - three of whom were women - thanks to the large donation by four feminists that made the medical school a reality. He spent the next few years teaching, observing, and recording, having organised the clinical medical teaching at Johns Hopkins into what was essentially the prototype of all modern medical education. The first edition of his textbook, which was primarily aimed at medical students, sold an impressive 23,000 copies. An unforeseen consequence of producing a comprehensive but still comprehensible work was that in 1897 his textbook was read by a member of John D. Rockefeller's philanthropic staff - leading quite directly to the foundation of the Rockefeller Institute of Medical Research.

The Oslers' first child died soon after birth in 1892, and their second, Edward Revere, was born on 28 December 1895. He was a source of the greatest happiness to his father, who loved children, and he is constantly mentioned in Osler's letters - his death in the First World War was certainly Osler's greatest sorrow.

In 1899 Osler was admitted to the Royal Society, and in 1900 was encouraged to apply for the Chair of Medicine at Edinburgh. After much thought he did apply for the post, one of the most celebrated in medicine, but then withdrew. Over the next few years, as well as teaching and researching, and in addition to writing and campaigning on tuberculosis, he visited London and Paris and was able to speak at numerous universities and conferences in the United States.

In 1904, Sir John Burdon Sanderson, the Regius Professor of Medicine at Oxford, and Osler's former supervisor in London, wrote to Osler to sound him out as to whether he would accept the post of Regius Professor after his own retirement. He invited him to stay at his house for the duration of the British Medical Association meeting that year, which was to be held in Oxford. While he was in Oxford for the meeting, Osler also had the degree of Doctor of Science conferred upon him by the University. When he had difficulty in deciding, Osler corresponded with his wife who famously sent him the telegram: 'Do not procrastinate, accept at once. Better go in a steamer than go in a pine box.' His suitability and willingness was conveyed to the Prime Minister, Arthur Balfour, and Osler received the letter offering him the post before he left the UK. He accepted, while asking that the fact not be made known for 2 weeks to allow him to inform friends and colleagues himself.

Before leaving the United States in May 1905, he gave an address to the Johns Hopkins University in which he inadvertently caused national uproar by saying that by the age of forty men were comparatively useless, and that by the age of sixty they should be compulsorily retired - his additional, jocular, suggestion that they be chloroformed was picked up by the national press and reported as serious. He weathered this storm, however, to give another address in Montreal, which was later reprinted in his book of essays 'Aequanimitas', and a final address at his farewell dinner in New York, where he was bade farewell by over five hundred of the most notable American medics. After finishing the sixth edition of his textbook in Baltimore, he departed for Oxford.

Osler in Oxford

William Osler arrived in Oxford on 27 May 1905. He moved into a borrowed house, belonging to Professor Muller, at 7 Norham Gardens, and into rooms in Christ Church, where he became a 'student' (essentially a fellow of the college). He matriculated and graduated MD on the same day - 13 June - in the Divinity School. The position of Regius Professor was one of 5 professorships founded at Oxford by Henry VIII in 1546, and the post also made him a curator of the Bodleian Library and Master of the Alms-house at Ewelme, a village in Oxfordshire 14 miles from Oxford. He took the last duty no less seriously than the others, and visited the thirteen occupants of the almshouse regularly.

He began sitting for a portrait along with Halsted, Welch and Kelly, painted by John Singer Sargent, of the founding clinicians of the Johns Hopkins Hospital. He was able to visit Cambridge and his counterpart Regius Professor Sir Clifford Allbutt - with whom he became good friends. He also accepted the post of Thomas Young Lecturer in Medicine at St. George's Hospital, London - a post that allowed him to lecture in clinical medicine to students, as Oxford had no clinical school at that time. He also visited doctors with other interests - notably James Mackenzie in Burnley (with A. G. Gibson, who recorded the visit in his diary) before he became famous for his studies of the physiology of the heart. As well as all this, he had time to go fishing with his son Revere, who had become a keen angler, and to take a holiday in Scotland.

Later that year, Osler began his Sunday morning ward-rounds at the Radcliffe Infirmary, at which he taught visiting practitioners and students. He also visited Norwich for the unveiling of a statue of Sir Thomas Browne, the great humanist physician whose works Osler frequently cited and drew inspiration from. During this he was encouraging Sir John MacAlister in the amalgamation of the various medical societies of London to form the Royal Society of Medicine - an event which eventually occurred two years later. He became a delegate of the Oxford University Press, and was able to travel and lecture in London and Paris. His move to England, which he had presented to friends and colleagues as a chance to slow down, seemed to leave him even busier than before.

In December 1905 Osler returned to the United States, visiting Boston, Philadelphia, New York and Baltimore, where he stayed for some time. He also visited family in Toronto. Back in Oxford, he was key to the formation of the Association of Physicians of Great Britain and Ireland, and their publication the Quarterly Journal of Medicine. In August the Oslers bought 13 Norham Gardens, one of the largest houses in North Oxford, although it needed significant alterations including the installation of four bathrooms. He gave the Harveian Oration at the Royal College of Physicians on the 18 October, entitled 'The Growth of Truth as illustrated in the Discovery of the Circulation of the Blood'. At the end of the year he returned to Canada for his mother's hundredth birthday celebration on 6 December.

Osler moved to 13 Norham Gardens on 27 January 1907. The house became known as the 'Open Arms' as a result of the number of guests who visited - guests from all over the world, from the famous such as Rudyard Kipling and Mark Twain (to the excitement of Revere) to American medical students and visiting scholars. In the meanwhile, Osler remained busy, lecturing throughout the country, meeting on University business or on that of one of the associations or societies he was a member of, giving evidence to the Royal Commission on Vivisection, or attending conferences and congresses abroad.

Osler spent the winter of 1908 and the start of the next year in a 'brain-dusting' where he travelled widely in Europe and America to meet those at the forefront of research and to familiarise himself with practice elsewhere. He also stood for the Rectorship of Edinburgh University - a contest entirely run by undergraduates - after he was asked to by some students. He was not affiliated to any political party, but did surprisingly well and came within 200 votes of success.

Revere went to Winchester College in 1910, and was described by Osler as 'no student, but an ardent fisherman' and his constant companion during vacations. He was talented in etching and photography, but not academically inclined. William Osler was awarded a baronetcy on the Coronation of King George V in 1911. His interests also extended to the history and bibliography of medicine, and he had by this time acquired an extensive library of historical medical texts, becoming an authority on the subject. He gave evidence on the organisation of medical schools at Lord Haldane's Commission on University Education, in which he laid out his conception of the medical unit as it had worked in Baltimore. In the following years there were great controversies over the reform of medical education on both sides of the Atlantic, and Osler vigorously stressed the importance of University-Hospital links, although he opposed the introduction of full-time medical teachers as he believed that this would insulate them from the realities of practice. He continued working for some years in the attempts of the Oxfordshire branch of the Tuberculosis Association to have a specialised TB sanatorium built in Oxford.

Immediately on the outbreak of war in 1914, Osler headed the British Medical Association's War Emergency Committee. In Oxford, a hospital was set up in the Examination Schools, which swiftly contained 500 beds. Osler campaigned hard to get newly enlisted troops vaccinated against typhoid, seeing that infectious diseases could be disastrous for the newly mobilised army, an endeavour in which he was vehemently opposed by anti-vaccinarians. He had been an honorary Colonel in the Territorial Army since 1908, and was much in demand for medical advice. Revere, who went up to Christ Church as an undergraduate that year, joined the Oxford Training Corps. Lady Osler set up and ran a workshop that produced clothes for hospitals throughout the war.

Revere failed to get a commission in 1915, but was accepted as an orderly to Colonel Birkett, the commander of the McGill Unit, on Osler's suggestion. He was posted to the Canadian Military Hospital at Cliveden, and then to Camiers near Boulogne. Osler advised the military on the epidemics that had arisen in camps on Salisbury Plain, and on the standardisation of army medical records. Jack McRae, author of 'In Flanders Fields' and formerly one of Osler's House Staff at Baltimore, stayed at the 'Open Arms' on leave. In September Osler visited the McGill Unit in France, and also went up to the front line. Later in the year he persuaded the War Office to set up the specialist centre for Cardiology at Mount Vernon, Hampstead.

In 1916 Osler was involved in arranging the visit of American military doctors to England and France to observe the organisation of medical services. Wilder Penfield and Harvey Cushing were both guests at the 'Open Arms'. Revere transferred to the Royal Field Artillery. He finished training and was sent back to France, to Mouquet Farm on the Somme, in October. Meanwhile Osler advised the Royal Commission into University Education in Wales, and also the Canadian Medical Corps. In 1917, after the USA had entered the war, Revere was killed by a shell which hit his battery at Ypres on 29 August. By coincidence, he was treated by the American surgeon Harvey Cushing, a good friend of Osler, but despite an operation and blood transfusion he died before sunrise on 30 August. Osler's grief was not shown publicly - rather his incredible restraint was noted. To distract himself, he began the revision of his textbook, and continued cataloguing his library.

After the war Osler remained busy with the influenza pandemic of 1918, in which he caught influenza and recovered. He gave his support to the National Campaign against Venereal Disease. Through his correspondence with Prof Wenckebach of Vienna Osler was able to put pressure on the British Government to provide medical supplies and food for the city. In April he again fell ill with pneumonia. For his seventieth birthday a commemoration volume was prepared in his honour and there were numerous editorials in papers and medical journals. He became very unwell in October 1919, with a distressing cough, and it was ascertained that he was suffering from an empyema. This was operated on, but he developed a pulmonary abscess and he had a second operation. He went into a slow decline, during which he was able to write, to specify the destination of his library, to instruct as to who should conduct his post-mortem, and even to promise his brain to the Wistar Institute. He died on 29 December 1919 at his home in Norham Gardens.

Oxford after Osler

After Osler's death, Lady Osler continued to live at 13 Norham Gardens, while Osler's extensive library was catalogued (and the lengthy catalogue published as the 'Bibliotheca Osleriana'). On her death, the collection was moved to McGill University, where it formed the nucleus of the Osler Library of the History of Medicine.

The Oxfordshire tuberculosis sanatorium, which was named the 'Osler Pavilion', was opened in Headington in 1927, and the foundation stone was laid by Lady Osler. The site is now occupied by Oxford's principal hospital, the John Radcliffe Hospital.

The Observer's House at the Radcliffe Observatory, adjoining the Radcliffe Infirmary, was renamed to Osler House in 1930 by the Nuffield Institute Trust deed that determined the future use of the site. It was occupied by the Observer until 1935 and then by hospital staff. When clinical students arrived in 1939 - evacuees from the London teaching hospitals - they were initially accommodated at Somerville College, to the south of the Infirmary. In 1946 Osler House was acquired by the Clinical School as its administrative and social centre - creating the clinical medical students' society - the Osler House Club. In 1979, when Green College was founded and took over the Observatory site, the Osler House Club was displaced, and for a year occupied the Osler Cubicle - a room in the main part of the John Radcliffe Hospital at Headington. Fortunately, Green College then purchased a house in the grounds of the John Radcliffe Hospital to provide premises for the club. The house, now renamed William Osler House but formerly known as the Dower House, was built in the 1930s for the administrator of the Radcliffe Infirmary, Arthur Sanctuary, and featured in The Architectural Review' of June 1934. The building was extended in 1985-86 and again in 2001, and provides social facilities for clinical students and members of Green College.

Osler's Oxford home, the 'Open Arms' at 13 Norham Gardens, was left to Christ Church by Lady Osler, as a residence for the Regius Professor of Medicine. It was not used for this purpose, however, and instead came into the possession of the University, with half the house being used for the Oxford University Newcomers' Club, and the rest serving as medical school offices. Some years later, however, Sir George Pickering and Sir Richard Doll did live in the house while they held the position. The house is currently owned by Green College and contains the Oxford University Newcomers' Club, the Reuters Foundation Fellowship Programme and the Osler-McGovern Centre, which contains an archive on Osler in his former library.

 

Bibliography

  • Bliss M. William Osler at 150. Canadian Medical Association Journal 161:831-4 (1999)
  • Bliss M. William Osler: a life in medicine. University of Toronto Press, Toronto (1999)
  • Bynum, W. F. Osler, Sir William, baronet (1849-1919). Oxford Dictionary of National Biography, Oxford University Press (2004)
  • www.oxforddnb.com/view/article/35340
  • Cushing, H. The Life of Sir William Osler. The Clarendon Press, Oxford (1925)
  • Golden, R. L. William Osler at 150. Journal of the American Medical Association 282:2252-2258 (1999)
  • McKnight A. Sir William Osler in Oxford (DVD), Creative Gold, Oxford (2005)
  • Robb-Smith A. H. T. A Short History of the Radcliffe Infirmary. The Church Army Press, Oxford (1970)
  • Recent Acquisition: an Anonymous Medical Manuscript. Sphaera Issue 10 (1999)
  • http://www.mhs.ox.ac.uk/sphaera/index.htm?issue10/articl8
  • http://www.whonamedit.com/doctor.cfm/1627.html

Authorship

Angus McKnight, Christ Church, Oxford. February 2006.

Acknowledgements

Thanks to Colin Chu, New College, Oxford for proof-reading and comments.

Attachments:
 Osler In Oxford