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Minnie Wright Blogg.

Sir William Osler, bart. Brief tributes to his personality, influence and public service online

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time throughout the hour to report on laboratory tests and
X-ray findings, or to give his opinion of the significance of
some datum. The pupil-teacher thus grew accustomed to fac-
ing a large audience and to thinking and speaking on his feet,
an admirable preparation for some of the contingencies of later
professional life. The student-assistantships in the out-patient
department (in the third year) and the clinical-clerkships and
all that they implied (in the fourth year) were, then, vital
parts of the organization of The Johns Hopkins Medical
Clinic.

Though the organization of the clinic in Baltimore pre-
sented, as we have seen, an interesting combination of novel
features, no organization, no matter how well planned and
installed, can function effectively without the skilful applica-
tion of the art of management, and in the art of management
the director of this clinic was to prove that he was a master.
Thoroughly familiar himself with the principles, methods and
problems of internal medicine, enthusiastic about, and for his
time well trained in, the preclinical sciences that are funda-
mental, he possessed that personal experience in his subject
and that superior ability that are always prerequisites to
competence as a manager and to the command of the respect of
those that are to be managed. He understood human nature
and loved it, despite its faults and its frailties; no chief ever
secured in greater measure the good-will and loyalty of his
staff. Though he could be firm on occasion, he rarely found
need to act as a strict disciplinarian. He was always cognizant
of the good qualities of those about him, and though not blind
to their defects he had learned that great lesson of successful
management that, for most subordinates, a word of apprecia-
tion is of far greater value as a stimulus to good work than a
volume of carping criticism. He possessed to an extraordinary
degree the capacity of making you feel that he was interested
in you and in your personal welfare ; to come into contact with
him meant, for most, the birth of a genuine affection for him.



30 Sir William Osler, Baet.

He had an orderly mind and manner; he landed punctuality
in a doctor and was always punctual himself. He seemed,
never to be in a hurry and yet he wasted no time. Many a man
recalling an interview that seemed leisurely when it occurred
has been surprised, on analyzing it afterward, to find how brief
it had been. He belonged to the first of the two groups — the
" larks ^' and the "owls" — into which men have been play-
fully divided. He retired early and was an early riser. At
one time he lived for some months in the hospital and it is
asserted that men learned to set their watches at 10 p. m. by
the sound of his boots as they dropped on the floor outside his
door. His more important work was done in the morning
hours ; for him " great business must be wrought ere noon " ;
private consultations were relegated to the later hours of the
day. His power immediately to grasp the significance of situa-
tions, his ability to make quick decisions, his unfailing tact
and discretion, together with his wide sympathies and his
lively sense of humor made it a pleasure to transact business
with him. His ideals he kept ever before him and was am-
bitious to realize them, and these ideals and this ambition
were alluring also to those whom he led. Much might be
written, were there space, of the ways in which he overcame
obstacles and met important emergencies, of the motives he
appealed to when he desired to excite men to action or to
arrive at a decision, and, in general, of those traits of character
that act " directly by presence, and without means,'^ or what
is sometimes called " personal magnetism." Many of the
qualities that make for successful management, though easy
enough to recognize when they exist, are difficult of analysis
and perplexing to the understanding. Some men are able to
secure control without contest ; " whether they stand or walk
or sit or whatever thing they do," they can place men under
their power. Of such character-control and of prestige-control
Professor Osier had his full share. But, more important than
these, he had grasped, as it were intuitively, the newer prin-
ciples of association and of group organization. A man of
many selves, he could enter into helpful association with many



As Chief of a Medical Clinic 31

different groups, letting his mind interact with the other
minds of each group for the purpose of arriving at ideas, feel-
ings and impulses in common. More than most he had learned
how to live with other men, to discuss without antagonism, to
secure co-operation by the subtle psychic process of reciprocal
penetration. In this lay the secret of his co-ordinating power.
He knew not only how to bring the various activities of his
clinic into proper relation with one another, but also how to
link the clinic with other departments of the university, with
the medical profession, with the public near and far, and
with national and international associations of different kinds.
Through his power as an organizer and as a manager Professor
Osier might, then, have truthfully said, as did one of old, " I
magnify mine office.^^ And it is precisely capacity for such
magnification of office that, along with ability to plan and to
direct, is a distinguishing criterium of the superior executive.



SOME OF THE EAELY MEDICAL WORK OF SIR
WILLIAM OSLER

By W. T. Councilman

William Osier, the son of the Rev. F. L. Osier, was born
in Tecumseh, Ontario, in 1849. He was one of a large family,
and his ancestors were a vigorous, long-lived race. He gradu-
ated from Trinity College, Toronto, in 1868, began the study
of medicine in the University of Toronto, and after two years
went to McGill University, Montreal, where he received the
M. D. degree in 1872. From 1872 to 1874 he studied abroad,
working in the various London clinics, in the laboratory of
University College, London, and in the laboratories and
clinics of Berlin and Vienna. He came in contact with many
eminent men, studied methods of work and of teaching, and
the influence of this period of European study is seen in his
after career. In 1873 he obtained the licentiate of the
College of Physicians of London, in 1878 he was made a
member of the college, and in 1884 was elected to the fellow-
ship. In 1874 he returned to Montreal, was made lecturer
on the institutes of medicine, and shortly afterwards was
given the professorship. Under the institutes of medicine
were comprised the courses in physiology and pathology, the
latter limited to 20 lectures. At the end of 1874 he was made
physician to the Small-pox Hospital, and in the following year,
owing to the interest which he showed in comparative anatomy,
the professorship of helminthology, in the Veterinary School
of the university, was taken into his already full hands. I
shall discuss here only his early work, extending through the
first four years of the Montreal period.

Beyond the bare facts, we know but little of his early
education. In his various writings there are only scanty
allusions to it save in the Toronto address, in which he men-
tions three men who were his early teachers and to whom he
3 33



34 Sir William Oslkr, Bakt.

says he owes everything he has attained in life. These were
the Eev. W. A. Johnson, of Weston, Ontario; Dr. James
Bovell, of Trinity College, later professor of the institutes of
medicine in Toronto University, and Prof. Eobert Palmer
Howard, of Montreal.

I have been able to learn but little of the Rev. W. A. John-
son, but it is evident that he was one of the many clergymen of
the Church of England who have sought in various scientific
pursuits a wider range of intellectual activity than is given by
their profession.* I have gained this conception of the
Eeverend Johnson from two passages in the early writings of
Dr. Osier. In the first article published by him (Canadian
Diatomaceae, Canadian N'aturalist, 1870) when he was a
student in Toronto, he thanks him for assistance in the use of
books and microscopical apparatus. In this article there is an
admirable description of the structure, mode of division and
propagation of the diatom, which is evidently based upon
observation. The mode of motion of the organisms is dis-
cussed and he is inclined to accept the hypothesis advocated by

* The Scottish Church has produced very few of these men,
and they have been rare in America. However singular this may
seem, the reasons are obvious. The clergy of the Church of
England possessed a liberal education, and the taking of orders
did not demand any extensive preparation for the examinations.
Most of them had an assured living in pleasant country surround-
ings, and the dogma was simple, fixed, and did not admit of con-
troversy. Proselyting was not actively pursued in the English
church, and the souls of their simple parishioners were not a
serious care. They must have found little intellectual stimulus
in the society of the country squires, and many of them were
perforce driven into the study of botany and other branches of
natural science. The Scottish church, on the other hand, de-
manded long and arduous preparation for the ministry, and most
of its members did not have the background ol a liberal educa-
tion. Like the Scottish character, the church was a fierce,
aggressive force, its dogma logical and uncompromising, and
its defence and extension involved a constant controversy, which
left little time for the calm study of nature. In this country
the conflicts of the sects give suflBcient intellectual diversion.



Early Medical Work 35

Professor Schultze, of Bonn. At the close he gives a list of
105 diatoms which he had collected and classified, giving also
the localities where they were found and their frequency. He
must have been for a long time interested in the subject and
the organisms were collected over an extensive area. He gives
credit to Mr. Johnson for having given him several of the
specimens. He refers also to another clergyman, the Eev. Mr.
Eeade, who had invented a prism by the use of which the
shell markings could be studied to better advantage, and which
was loaned to him by Professor Bovell. The article shows
familiarity with the microscope and capacity to use literature.
The second reference to Mr. Johnson I have found in an
article 12 years later (On Canadian Fresh Water Polyzoa,
Canadian Naturalist, 1882) which was read before the Natural
History Society. There is here also an admirable description
of the organisms with the differentiation of the species, but its
main interest is in showing how early Osier — probably through
the influence of Mr. Johnson — became interested in the study
of nature. " In the summer of 1867, during a visit of my
friend, the Eev. W. A. Johnson, of Weston, I showed him the
masses (the gelatinous aggregates of the Pectinatella mag-
nifica of Leidy) and we agreed to subject them to examination
by the microscope, not having any idea as to their real nature.
Judge of our delight when we found the whole surface of the
jelly was composed of a collection of tiny animals of surpassing
beauty, each of which thrust out to our view in the zoophyte
trough a crescent-shaped crown of tentacles.'^ A foot-note
speaks of another clergyman, the Eev. Thomas Hincks, as the
distinguished authority on British polyzoa.

His second teacher, Dr. James Bovell, seems to have been
an interesting character. He was born in Barbados in 1817,
went to England in 1834, studied at Guy's Hospital, and took
the medical degree in Glasgow in 1838. He then went to
Dublin, studied under Stokes and Graves for several years and
after a severe attack of typhus fever, against the advice of his
friends, who predicted a brilliant medical career, returned to
Barbados. From there he went to Canada in 1848 ; took part



36 Sir William Osler, Bart.

in the establishment of the medical faculty of Trinity College,
became dean and professor of the institutes of medicine, and
also professor of natural theology. After the disruption of
this medical school he held a similar medical position in
Toronto University. In 1870 he returned to the West Indies
where he remained until his death. While there he took
orders in the English Church and published a book on Natural
Theology. He was regarded as an impractical, improvident
man, was loved by his students and friends and took great
delight in metaphysical discussions. Osier came under his
influence in Trinity College, and in Toronto University, and
he has dedicated to him the first pathological report of the
Montreal General' Hospital. It is not improbable that, through
these two men and the atmosphere of his home. Osier acquired
the interest in biblical and ecclesiastical literature which was
such a prominent characteristic of his later life.

The third of these men was Dr. Robert Palmer Howard,
professor of medicine in McGill University, whom Osier speaks
of as his second father. He was a greatly respected teacher
and practitioner of medicine and exerted a wide influence, but
he was not a prolific writer.

While in London, Osier published two articles from the
laboratory of University College. The first, " On the Action
of Atropia, Physostigma, and Curare on the Colorless Blood
Corpuscles,^^ was read before the Eoyal Microscopical Society
in 1873, and published in its journal. Such a paper as this
was rather unusual at the meetings of the society which were
mostly taken up with descriptions of microscopes, methods of
preparation of microscopic objects, etc. The object of the
investigation was to determine whether the antagonism be-
tween atropia and physostigma, which Fraser had shown to
exist, could be demonstrated in the behavior of colorless cor-
puscles under the microscope, and the result was negative. It
was interesting to find in the same volume with the paper of
Dr. Osier a long, interesting and scathing review of Bastian's
Beginnings of Life which had just appeared.



Early Medical Work 37

The second article, "An Account of Certain Organisms
Found in the Liquor Sanguinis/' was published in 1874,
appearing in the Proceedings of the Eoyal Society. This
forms one of the most important of Dr. Osier's contributions
to medicine and demands a more detailed description in order
to do justice to the originality shown in this article. From
the massive literature on the subject four articles may be
singled out, each of which was an important contribution to
knowledge. In 1865, in the article of Max Schultze on the
blood, certain bodies afterwards known as blood plates were
for the first time adequately described; the second was the
article by Osier, the third by Bizzozero in 1882, in which he
gave a new method for their study and showed the part they
played in thrombus formation, and the fourth by J. H. Wright
in 1910, who demonstrated their histogenesis. The name
blood plates, given to the bodies by Bizzozero, has been adopted.
It would be difficult to say who first saw and described them.
At this period the fresh unstained blood was being actively
examined by many with a view to the discovery of micro-
organisms which might be the cause of infectious diseases.
Zimmermann, in Eust's Magazin f . d. gesammte Heilkunde in
1846, and again in Virchow's Archives, Vol. 18, 1860, saw and
described the bodies as small globules which he regarded as the
elementary corpuscles from which the blood cells develop, but
his description was very vague and he did not sharply separate
them from other granules in the blood. The very remarkable
article on the blood cells by Max Schultze conceals by its title
" Ein Heizbare Objecttisch und seine Verwendung bei Unter-
suchungen des Blutes " (Arch. f. Mikro. Anatomic, Bd. I,
1865), the subject of the article much better than usually
happens, in spite of the ingenuity which is often displayed in
doing this. After a description of the varieties of the white
corpuscles, the accuracy of which excites our admiration even
now, he says " In the blood no constituent is without impor-
tance, and in conclusion I will call attention to a normal form
constituent of the human blood which up to the present has
been entirely neglected. I find in my blood and in the blood



38 Sir William Osler, Bakt.

of numerous persons of different ages more or less abundant,
irregular masses of colorless globules, the masses varying in
size according to the number of globules which compose them.
The globules themselves are from one to two micra in diameter
and also occur separately in the blood. I have found three,
four and even hundreds joined together, forming plaques of
irregular size, 80 or more micra in diameter. These structures,
on account of their irregular size and shape, give the impres-
sion of broken up tissue elements.'' *

This was the condition when young Osier was probably given
the subject for investigation in the laboratory. He showed
that these granular masses of Schultze were not present in the
circulating blood, but were formed at the moment of examina-
tion by a rapid aggregation of the single bodies. He showed
this by microscopic study of the blood, and also by the direct
examination in salt solution of small clippings from the
connective tissue of the rat in which he found the single bodies
and not the masses of them, within the small blood vessels.
He also showed that the conception of their presence in the
blood in aggregations was untenable because the masses could
not pass through the capillaries. He described the small
bodies as exhibiting amoeboid activity and saw filaments form
in connection with them, which were probably fibrin. The
article is admirable, clear and concisely expressed, with full
literature references. The next reference to the blood plates
is in an article "Infectious Endocarditis" (Seguin's Arch.,
1881), and here he anticipates Bizzozero's view of the part
they play in thrombus formation. ^' In one case of mitral
stenosis a fresh vegetation when teased showed many closely
packed spherules, some of which were larger than those met

* I have quoted from this article for one reason because it was
used as a reference in the course of physiology given by Newell
Martin in 1878, and the plate when I opened the volume appeared
as a familiar friend. No one appreciated more than did Doctor
Osier the importance of familiarizing students with the original
sources of knowledge, and this was always done in Martin's
laboratory.



Early Medical Work 39

with in the ulcerative form. [These were the masses of
micrococci.] I was greatly struck with the resemblance which
certain of these bodies, in this instance, bore to the individual
elements of Schnitzels granule masses — those peculiar, granu-
lar clumps common in the blood of some animals and of
impoverished * persons.^^ In 1882 there appeared a further
article, "Ueber den dritten Formbestandteil des Blutes," in
the Centralblatt f. d. med. Wissensch., ^o. 30, in which he
emphasized the part they played in the formation of thrombi
and a final article " On the Third Corpuscle of the Blood,"
Medical News, 1883, a rather popular presentation of the
subject.

Osier returned to Montreal in 1874, bringing to his future
work a remarkable equipment. He was 25 years old, possessed
a vigorous healthy body, and a well-trained mind. His family
was well and favorably known in the community, which gives
no small advantage in a conservative society. He had received
a valuable education, probably more valuable though different
from that which men are now receiving. He had come into
close contact with men of high ideals and good methods of
work, he possessed the methods by which knowledge is obtained
and had already made important contributions which gave him
a reputation. He further had enthusiasm and the art of
inspiring this in his students, native kindness of heart, a
candid, open disposition, a great capacity not only for making
friends, but for arousing the feeling of affection, and a fine
sense of humor, never used to hurt, which made him a sought
and delightful companion. He wrote well and easily, ex-
pressed himself simply and clearly, leaving no doubt as to the
meaning, and the matter was well arranged. In spite of the
number of these early articles, they all show care in prepara-
tion. He had also great capacity for work, and ambition, with
a definite end in view. For such a man there are always

* Osier did not usually use such ambiguous expressions ; tlie
presence of such masses in the blood might be regarded as one
of the disadvantages of economic poverty.



40 Sir William Osler, Bart.

opportunities waiting, and Osier found them in Montreal, as
he would have found them anywhere, even with his friend
Bo veil in Nevis.

In the latter part of 1874, in addition to his position in the
university, he was made physician to the Small-pox Hospital,
which gave him opportunities for clinical study and an interest
in the disease which he has always retained. With the salary
which the position gave he purchased microscopes for teaching
in the medical school. In 1876 he published in the Canadian
Medical and Surgical Journal three articles on small-pox:
(1) "The Initial Eashes of Small-pox ''; (2) "On Hemor-
rhagic Small-pox ^^; (3) "A Form of Hemorrhagic Small-
pox/^ which are valuable contributions to our knowledge of
the disease. They show accurate observation, good clinical
judgment and a marked power of differentiation of conditions
both clinical and pathological. He had studied skin diseases
with Tilbury Fox in England, and the influence of these
studies is shown here. It was an important work for him, for
in the Small-pox Hospital he first acquired the power of close
observation of skin lesions and the ability of differentiation
and description which was afterwards such a marked feature
in his clinical work.

A very interesting article appeared in the same journal in
1876, " On the Pathology of Miner's Lung.^' It is based upon
the examination of the lungs of a coal-miner who died in the
Small-pox Hospital, and in whom the condition was very
marked, and several other cases showing various degrees of the,
same condition. It is a good piece of work, shows much
originality, and is to be regarded as the best article in English
on the disease, which was first described by Pearson in 1813.
In this article for the first time the large mononuclear phago-
cytes were differentiated from the smaller corpuscles, and
Osier showed that the large cells were those most actively con-
cerned in the phagocytosis of the carbon. He says : " One
most curious specimen was observed. On an elongated piece
of carbon three cells were attached, one on either end and a
third in the middle, so that the whole had a striking resem-



Early Medical Work 41

blance to a dumb-bell. I could hardly credit this at first, until
by touching the top cover and causing the whole to roll over,
I quite satisfied myself that the ends of the rods were com-
pletely embedded in the corpuscles and the middle portion
entirely surrounded by another/^ His description of the
position of the carbon in the lungs and its relation to the
lymphatics is accurate. He gives a figure of a microscopic
piece of coal which was found and which showed the scalari-
f orm tissue of ferns, thus proving its origin, and another piece
with two holes representing the dotted cells of firwood. In
conclusion, there is an experimental study of the effect of
foreign bodies in the tissue made by the injection of india ink
into the axillae and lungs of kittens.

The study of the blood plates gave him a familiarity with
blood examination which he utilized in the study of anaemia,
and there are several papers on this in 1877. The first of
these, " A Case of Progressive Pernicious Anaemia," was pub-
lished in association with Dr. Gardner in the Canadian Medi-
cal and Surgical Journal. It is probable that Osier wrote the
paper and was responsible for the blood examination and the
description of the autopsy, which showed the usual conditions
found in the disease. It is a good type of medical paper, the
descriptions of the blood and of the marrow changes are
accurate, and the relation between the blood changes and the
marrow, which had been described by Cohnheim in the same
year, is confirmed. An abstract of this article, with detailed
measurements of the various blood cells " Ueber die Beschaf-
fenheit des Blutes und Knochenmarkes in d. progressiven
pernicioser Anamie " was published in the Centralblatt f . d.
med. Wissensch., 1877, No. 15, and a second article in the


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Online LibraryMinnie Wright BloggSir William Osler, bart. Brief tributes to his personality, influence and public service → online text (page 3 of 14)