HISTORY OF MEDICINE : GREAT MEDICAL MEN AND THEIR TIMES

Sir William Osler

GB Jain*, DG Jain**
Osler remains one of the finest and greatest figures in modern medicine. He was a great scholar, physician and bibliophile, beloved and revered by his colleagues at McGill, Philadelphia, Johns Hopkins, and later at Oxford University. William Osler was born July 12, 1849, in a parsonage at Bond Head, Upper Canada, and was THE VERNON PLAQUE the youngest son in Paris, 1903 a family of nine. After his schooling at Weston School, he joined Trinity College and the Toronto Medical School and then went to the McGill Medical School. In medical school he was much influenced by his teacher Dr. James Bovell, MRCP, and would spend countless hours at Dr. Bovell's residence, studying the various Entozoa under the microscope. So great and sincere was the influence of Dr. Bovell on the young Osler, that he never forgot his teacher till his death. In an address nearly 33 years later in 1903, Osler paid a tribute of filial affection to his teacher where he said: There are men here today who feel as I do about Dr. James Bovell that he was of those finer spirits, not uncommon in life, touched to finer issues only in a suitable environment. Yet, withal his main business in life was as a physician, much sought after for his skill in diagnosis, and much beloved for his loving heart. When in September, 1870 he wrote to me that he did not intend to return from the West Indies, I felt that I had lost a father and a friend; but in Robert Palmer Howard of Montreal, I found a step-father, and to these two men, and to my first teacher, the Rev. W.A. Johnson of Weston, I owe my success in life if success means getting what you want and being satisfied with it. In his last year at the Toronto Medical School, Osler laid the foundations of what were to be his subsequent habits of life. The most important habit was work and the finding of it a pleasure. To this he added three qualities, of which he spoke in a later address to the medical students: 1. 2. 3. The ART OF DETATCHMENT, The VIRTUE OF METHOD, and The QUALITY OF THOROUGHNESS.

To these, he added a fourth quality as being essential to performance i.e., the GRACE OF HUMILITY. About himself, Osler is known to have said, I started in life I may as well own up and admit with just an ordinary, everyday stock of brains. In my school days, I was much more bent upon mischief than upon books I say it with regret now but as soon as I got interested in medicine I had only a single idea, and I do believe that if I have had any measure of success at all, it has been solely because of doing the days work that was before me just as faithfully and honestly and energetically as was in my power. My message is but a word, a way, an easy expression of a plain man whose life has never been worried by any higher philosophy. I wish to point a path in which the wayfaring man, though a fool, cannot err; not a system to be worked out painfully only to be discarded, not a formal scheme, simply a habit, as easy or as hard to adopt as any other habit, good or bad. Life is a habit, a succession of actions that become more or less automatic. In a word, habits of any kind are the result of actions of the same kind; and so what we have to do is to give a certain character to these particular actions. What each day needs that shalt thou ask, Each day will set its proper task. Osler further remarks : Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand. The chief worries of life arise from the foolish habit of looking before and after. Just as a patient with double vision from some transient unequal action of the muscles of the eye finds magical relief from well-adjusted glasses, so returning to the clear binocular vision of today, the overanxious finds peace when he looks neither backward to the past nor forward to the future. Happy the man and Happy he alone, He who can call today his own, He who is secure within can say, Tomorrow, do thy worst for I have lived today. At another occasion Osler has said : It may be well of a physician to have pursuits outside his profession, but it is dangerous to let them become too absorbing. This remark assumes a greater significance today in a society where distractions, attractions, materialism and consumerism have corroded the steel frame-work of humanity and humanism.

* Emeritus Physician & Trustee, Tirath Ram Shah Hospital, Delhi ** Sr. Consultant Physician & Pulmonologist, Department of Medicine, Jessa Ram Hospital, New Delhi

On the study of literature, Osler used to say : As the soul is dyed by the thoughts, let no day pass without contact with the best literature in the world. Mankind, it has been said, is always advancing, man is always the same. The love, hope, fear, and faith that make humanity, and the elemental passions of the human heart, remain unchanged, and the secret of inspiration in any literature is the capacity to touch the chord that vibrates in a sympathy that knows not time nor place. At the young age of seventeen, Osler read the great book Religio Medici by Sir Thomas Browne for which he developed a deep love and respect. This book turned out to be an important thread which, from this point onwards, wove its way through Oslers story to the end. So much so, that the 1862 edition of the Religio his second book purchase, was the very volume which lay on his coffin fifty-two years later. Sir William Osler was known for his kindness. A well known example of his kindness of heart and also of how strangely peoples paths sometimes cross in this world, is the story of his Montreal days. In the autumn of 1875, Osler had joined the Metropolitan Club, where he was accustomed to dine. Since he was usually alone, he occasionally sat with an attractive young Englishman who happened to be in Montreal on business, and was putting up at the club. One evening, observing that he appeared ill, Osler questioned him, and suspicious of the symptoms, got him to his room and to bed, where it was soon evident that he had malignant smallpox. The disease proved fatal after an illness of three days, and having learned the youngmans name, and address of his father in England, he wrote a letter telling all about the illness, the medical aid given, and the last rites performed. Thirty years later almost to the day since Osler wrote this letter, he was the newly appointed Regius Professor of Medicine in Oxford, when he chanced to meet at dinner a Lady S , who, attracted by his name, said that she once had a brother who had gone out to Montreal and been cared for during a fatal illness by a doctor named Osler, who had sent a sympathetic letter that had been the greatest possible solace to her parents : that her mother, who was still living in the south of England, had always hoped she might see and talk with the man who had written it. Later, on his way to Cornwall, Osler paid a visit to this bereaved mother, taking with him a photograph of her boys grave, which he had sent for and obtained from Montreal. On the question of medical teachers and professors, Osler was of the opinion that these men should be placed above the worries and problems of practice, whose time will be devoted solely to investigating the subjects they profess. On the general medical practice Osler remarked: There are two main types of practitioners the routinist and the rationalist neither common in the pure form. Into the clutches of the demon routine, the majority of us ultimately come. At the age of thirty-five, Osler left McGill University for Philadelphia and so McGill lost what Howard called its potent

ferment. Thus closed Oslers Canadian period. Years later, in an address given at McGill, while admitting that the dust of passing time had blurred the details, even in part the general outlines, of the picture, Osler spoke of this formative period of his medical career as on during which he had become a pluralist of the most abandoned sort, and concluded his interesting and amusing recollections by saying: After ten years of hard work I left this city a rich man, not in this worlds goods, for such I have the misfortune or the good fortune lightly to esteem; but rich in the goods which neither rust nor moth have been able to corrupt, in treasures of friendship and good fellowship, and in those treasures of widened experience and a fuller knowledge of men and manners which contact with the bright minds in the profession ensures. My heart has stayed with those who bestowed on me these treasures. Many a day I have felt it turn towards this city to the dear friends I left there, my college companions, my teachers, my old chums, the men with whom I lived in closest intimacy, and in parting from whom I felt the chordae tendinae grow tense. At the Philadelphia University School, Oslers disinclination for a general practice, for which a university position was coveted as a portal of entry, and his determination to limit himself largely to consultations, was mystifying to his medical colleagues, most of whom were accustomed to hold afternoon office hours and to engage actively in house-tohouse practice. On the contrary, he would spend his afternoons with a group of students, making post-mortem examinations instead of sitting in his office awaiting patients. In 1888, Osler accepted the invitation to join the now renowned Johns Hopkins Hospital, and was amongst a select few present at the birth of this great institution in 1889. In fact, he is one of The Four Physicians who have been immortalised in the famous painting by Sir John Singer Sargent, which now reposes in the great hall of the Welch Memorial Library Building at Hopkins. The opening of Johns Hopkins in 1889 marked the begining of a new era in medical education in the United States. In a letter, Osler writes : It was not the hospital itself, as there were many larger and just as good; it was not the men appointed, as there were others quite as well qualified; it was the organisation. On the medical training of those days in the United States, Osler once remarked : It makes ones blood boil to think that there are sent out year by year scores of men, called doctors, who have never attended a case of labour, and who are utterly ignorant of the ordinary everyday diseases; men who may have never seen the inside of a hospital ward and who would not know Scarpas space from the sole of the foot...... Is it to be wondered, considering this shocking laxity, that quacks, charlatans and imposters possess the land? Dr. Bernheim has given a graphic description of Oslers ward rounds and clinics at Johns Hopkins : I wish you could have seen Osler come into the Hospital of a morning. It was the grand entrance of a grand showman and it became a ritual.

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With Old Ben, Negro factotum, bowing and scraping as he opened the doors of the main building on Broadway, and residents, interns, even the superintendent of nurses milling around to take his coat, hat, and books, and get the cheery greeting and wave of the hand, it was a sight fit for Hollywood. Falling in step with his resident, hed immediately start around the great marble statue of Christ standing in the rotunda and make for the long corridor leading to his wards all others falling in line. A middle-sized man, with swarthy olivecoloured skin, high forehead, drooping black moustache hed have made a wonderful-looking pirate, properly costumed hed set sail, coat-tails flying, talking animatedly in easily heard tones, greeting men and women he passed and often taking them by the arm as the cavalcade, pleasantly noisy and laughing at the Osler quips, went happily on its way to the grand rounds. We who were students, would be waiting on our respective wards, charts and everything ready, while nurses nervously set things to right and orderlies flicked imaginary specks of dirt off tables and beds. Even the sickest patients perked-up, knowing well that a great event was about to take place. And a great event it was as Osler passed through the doors smartly held open by the resident, greeted the nurses incharge, and immediately proceeded to the first patient the cavalcade in hushed silence now gathering around the bed. As I recall, hed never burst right into examination but would indulge in some sort of extraneous talk while patting the patient on the shoulder or otherwise reassuring him. Then came the history, given by a student, then the great physician would make his meticulous examination and talking. Osler really made bedside teaching of medicine come alive. Everything about him was interesting, especially his manner of handling the sick. He could teach and he knew his stuff. His ward rounds were the pinnacle of perfection and simplicity, and to this day I have never seen their equal. From bed to bed he'd go, from ward to ward, from one illness to another, and never did I see a man or woman leave before Osler completed his rounds. He used to say the four Fs give you typhoid fever : fingers, food, flies, filth. Morphine was G.O.M. Gods own medicine. If you knew syphilis and T.B., you could come pretty near practicing medicine successfully. Syphilis was the greatest simulator and would fool you. And so on and so on. Great teaching by an inspired teacher who literally oozed personality and had no truck with anything but truth. They called him the Chief. They never called anybody else that at the Hopkins before or afterwards. Osler never tired of repeating to the medical audience the following lines : Knowledge and wisdom, far from being one, Have oft-times no connection. Knowledge dwells In heads replete with thoughts of other men; Wisdom in mind attentive to their own. Knowledge is proud that he has learned so much;

Wisdom is humble that he knows no more. One remarkable quality that Osler possessed was that he always honoured his seniors, praised his colleagues, and encouraged his juniors. He did this with all sincerity. On Virchows 70th birthday, Oslers address was one of the few tributes that have ever been paid a member of the medical profession to equal those paid Virchow at this time, when, to use Oslers words : as the shadows lengthen, and the twilight deepens, it has seemed right to his many pupils and friends the world over, to show their love by a gathering in his honour. Osler was a therapeutic conservative, a therapeutic sceptic, though by no means a nihilist. His greatest professional service was that of a propagandist of public health measures. His celebrated textbook The principles and practice of medicine was first published early in 1892. In his book, he observed that excess eating has a lot to do with an attack of asthma and, therefore, attributed asthmatic attacks to gastric distention caused by overeating. Osler was an extremely hospitable person too! his house was always full of guests, students and colleagues, so much so that at Oxford his house was known as Open Arms. In his lifetime Osler advanced the science of medicine, enriched literature and the humanities; yet, individually he had a greater power. He became the friend of all he met he knew the workings of the human heart physically as well as sentimentally unlike most modern day cardiologists! He joyed with the joys and wept with the sorrows of the humblest of those who were proud to be his pupils. He stooped to lift them up to the place of his royal friendship, and helped many of them in the rugged paths of life. He achieved many honours and many dignities but the proudest of all was his unwritten title, the Young Mans Friend (Sir A.S. McNaulty). The death of Oslers only son Revere, who had joined the army and died in 1917 during the war hastened Oslers physical downfall. He had been accustomed to read it himself to his son Revere on Christmas Eve : The days of our age are three score years and ten......so soon passeth it away, and we are gone. As if prophetically, Oslers end came at 4-30 on the afternoon of December 29, 1919 (at the age of 70) quietly and without pain. Harvey Cushings description of the night of Oslers death is vivid and unsurpassed : So they the living left him overnight; alone in the Lady Chapel, lying in the scarlet gown of Oxford, his bier covered with a plain velvet pall on which lay a single sheaf of lilies and his favourite copy of the Religio. This was just a brief glimpse into the life and teachings of Sir William Osler a great physician and a great humanist. The sweep of his mind and interests embraced every phase of human activity, and his example of how to live should inspire the lives of all men and women even today.

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