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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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same journal on the study of a second case. Another article
on the same subject, in which he was associated with Dr. Bell,
appeared in the Transactions of the Canadian Medical Asso-
ciation, and here he gives Addison the credit for having first
recognized and described the disease under the name of
idiopathic anaemia. There is a final article in the following
year, " Entwickelung von Blutkorperchen im Knochenmark



42 Sir William Osler, Bart.

bei pemicioser Anamie/^ Centralblatt f. d. med. Wissensch.,
1878, in which he confirms Neumann's results of the study of
blood formation in the marrow.

During this period also he wrote a number of articles on
comparative pathology, the first on " Verminous Bronchitis in
Dogs, with Description of a New Parasite " was published in
the Veterinarian, London, 1877. He found this parasite in
the bronchi in an epidemic among dogs in Montreal. He gives
an accurate description of the parasite, and the points of
differentiation. It has been accepted as an original descrip-
tion and credited to him, the name Filaria osleri being one of
its synonyms. The only mistake he made was in classing the
organism among the strongyli and not the filariae, the main
difference being that the strongylus is oviparous and the para-
site described by him produces living embryos. The lobular
pneumonia which he found, associated with the presence of
the parasites in the bronchi, he referred to the inhalation of
inflammatory products produced by them. The paper closes
with a discussion of the mode of infection which he thought
was by the direct inhalation of the dried embryos and it would
have been more valuable had he subjected this theory to experi-
mental test. There is also a paper on Trichina spiralis
(Canadian Journal of Medical Sciences, 1876) which gives
a good description of the disease and the life history of the
organism, but which does not add anything new, and there are
a number of other articles which appeared at intervals up to
the time he left Montreal for Philadelphia. In the last article,
" An Investigation into the Pork Supply of Montreal," which
was conducted in association with one of his students in the
veterinary school, A. W. Clement, who was afterwards well
known in the early days of the pathological laboratory of The
Johns Hopkins, he speaks of having made 900 autopsies in
Montreal, in four of which trichina were found.

There are two interesting addresses in the period. The first
was to the graduating class in medicine in 1875. It was prob-
ably the habit of the faculty to place the burden of such an
address upon the youngest member. Eeading over this address.



Early Medical Work 43

one is conscious that Osier had very little interest in it. Prob-
ably he looked over other addresses given on similar occasions
and they must have been a very poor lot. He gives the usual
good advice to the students, telling them to keep up their
reading, to observe patients well, and even at this early period
introduces Sir Thomas Browne, but he does not use him
effectively. It seems by far the worst thing he ever published ;
there is no trace of humor in it, and no indication of the
remarkable power he showed in his later addresses.

The second address is of a totally different character. It
represents much more work and care in preparation, as though
Osier had concluded that giving addresses was to be part of his
future work and that they should be good. There are a num-
ber of quotations, many of them apt, the usual good advice to
students, and some really inspiring sentiments, well expressed.
For instance, " You will have moments when the way appears
rugged, and the outlook dark, but never fear; others have
succeeded in the face of the same difficulties, and with patience
and perseverance you will do so too. Banish the future. Live
only for the hour and its allotted work. Think not of the
amount to be accomplished, the difficulties to be overcome, or
the end to be attained, but set earnestly at the little task at
your elbow, letting that be sufficient for the day, for surely our
plain duty is ^ not to see what dimly lies at a distance, but to
do what lies clearly at hand.^ ^' It is difficult to give a student
better advice than this. Of the family physician he says " But
while the soldier and the statesman win honor and fame, the
family physician will draw to himself the love and gratitude
of manifold hearts; he will have no enemies, martial or
political; and his labors, if directed by a wise and prudent
skill, will be for the welfare and benefit of all."

From 1872 to 1878 was a great period in medicine; it Just
preceded the bacteriological era in which the nature of infec-
tion was established; Pasteur had completed his studies on
fermentation and the silk-worm disease and was in the midst
of his revolutionary work on anthrax; Koch, an obscure
country physician, was beginning his studies on bacteria and



44 Sir William Osler, Bart.

developing the methods which made their scientific study
possible; Virchow was at the height of his fame; Cohnheim
and Weigert had begun in Breslau and in Leipsie their remark-
able work ; a new university in Strasburg had just been estab-
lished which became famed through its products ; physiology,
in England and under Ludwig in Leipsie, had taken a new
life; Lister in England was in the midst of the work which
revolutionized surgery; the modern medical clinic was slowly
being established, and medicine was becoming scientific, its
procedures based upon knowledge and not conjecture; new
ideals and methods in medical teaching were being everywhere
introduced ; America was feeling the enormous stimulus of the
promise given in the establishment of The Johns Hopkins
University. Osier was under the stimulus of all the new life.
He could easily have become a great scientist, but he chose the
path which led to the formation of the great clinician which
he became ; a worthy associate of the great men who have made
English medicine famous.



OSLEE AS A PATHOLOGIST
By William G. MacCallum

The statement may be safely ventured that no clinician in
English-speaking countries has had at his command such a
wide and detailed knowledge of morbid anatomy as Osier.
There may be different opinions as to the reasons for his great-
ness as a teacher, as a man among men and in other ways, but
hardly more than one opinion as to the foundation of his
greatness as a clinician.

In the two small volumes of Pathological Eeports printed
at the McGill University, in a complete collection of reprints
of his papers beginning in 1877, and in the first edition of his
Practice of Medicine, the development of his knowledge of
pathological anatomy may be clearly traced. Throughout
there is no diminution in his keen enthusiasm and little change
in the character of his interests, but there is an extraordinary
advance in the clarity of his ideas keeping pace with the dis-
coveries of the European and other workers in the field of
pathology.

During a period of more than 40 years — years that have
witnessed the most phenomenal advances in medicine — his
attention was very largely devoted to these studies which were
constantly maintained as the basis of his more purely clinical
work.

Osier's training lay not in chemistry — the growth of bac-
teriology found him a spectator and experimental methods
seem to have had little attraction for him. ISTor did he attempt
any protracted researches in pathology for its own sake. In-
stead his interest was and has always been in the observation of
rather gross and striking anatomical alterations, usually on
account of the symptoms which they produced and not with
the aim of investigating their minute details or their ultimate

45



46 Sir William Osler, Bart.

causes. In all this he has shown himself critical and sane and
quite unwilling to pursue what seemed a fantastic theory
unless convinced by definite proofs. He was skeptical of the
malarial organisms of Laveran for a time until he became
familiar with them himself and demonstrated them in this
country. He would not believe that the micrococci found in
acute endocarditis were anything more than accidental in-
vaders until he had convinced himself by actual studies of the
valves.

But in his early days he did not wait for others to unearth
new facts. He pressed ahead alone in the investigation of
unexplained phenomena and was perhaps the first to see clearly
the blood platelet which he described in 1874 as the third
corpuscle of the blood.

He was early in the field with his studies of the bone-marrow
in pernicious angemia and evidently recognized megaloblasts
and other cells at a time when such recognition must have been
very difficult.

But from the beginning he appears to have been more readily
interested in the physical aspects of morbid anatomy, especially
in so far as there could be traced a chain of events. In the
first volume of the McGill reports he describes a case of
idiopathic hypertrophy of the heart, the topography, and effects
of various aneurysms, cases of phthisis, pneumonia, cancer,
ulcer of the duodenum, typhoid fever with perforation, incar-
ceration of the ileum, etc. In the second volume is found a
series of similar miscellaneous cases. Some of these were
remarkable as, for example, the instance of aneurysm of the
hepatic artery. It is to be noted that even in his discussion of
these cases he showed that the special literature of foreign
countries was quite at his command. He met with a case of
hypertrophic cirrhosis of the liver — the first in his experi-
ence — and while he was studying it there appeared Hanot's
thesis, the importance of which in relation to his own case he
recognized at once. From this period at McGill University
where he performed a great many postmortem examinations
and supervised them in the hands of students he acquired much



As A Pathologist 47

of his familiarity with morbid anatomy. It is his spirit of
serious research which has remained to inspire the splendid
work in pathology carried on ever since in that school and his
preparations formed the foundation of their magnificent
museum of pathological anatomy.

Osier was impressed from the beginning with the usefulness
of considering together a group of series of similar cases.
There is something statistical about this plan, but since no two
cases of any disease are precisely alike in all details, much
light comes from the study of a series. This method may be
traced through the work of his later years and in that of all of
his pupils. It is apparent in all the papers of his Philadelphia
and Baltimore periods and reveals his careful method of pre-
serving minute notes on all he saw, for some of the recent
studies refer back to cases encountered in the Montreal days.

Comprehensive papers on endocarditis, tuberculous pleurisy,
peritonitis, pericarditis and abdominal tumors, followed and
later similar analyses of long series of cases of typhoid fever,
meningitis, erythema multiforme, Addison^s disease, myx-
oedema, splenic anaemia, malaria and many other conditions.
In these there is a sustained and constant interest in the
pathological anatomical changes, but rather in their relation
to the general history and symptomatology of the disease than
for their own sake. The details of the causes and development
of the lesions are discussed only briefly, but an important out-
come of such studies was in several instances the more definite
outlining of disease entities from the recognition of the re-
peated occurrence of the same group of symptoms and patho-
logical alterations.

This has long been the first great step in the study of disease
and it is for this reason that many of the great names in
medicine are associated with the diseases in which they have
been the first to discern the constancy of the association of
several features. The ability to see these relations and to
connect a group of phenomena with a common cause is given to
few. It is only less difficult than to discover the hidden cause
of disease.



48 Sir William Osler, Bart.

On the other hand, with diseases well recognized by every-
one, Osier's interest in new manifestations and new combina-
tions of symptoms or lesions has been unfailing. After the
long period of observation and study of typhoid fever in which
he associated with himself all the men on his staff he analyzed
the disease from every point of view. However, in these
studies only the grosser anatomical changes are considered and
there was no special advance in the knowledge of the bacteri-
ology or immunity reactions of the disease.

Syphilis has always claimed much of his attention and
interest, although he has written little on it except in the form
of text-book articles and papers concerning aneurysms. Never-
theless, the multifarious manifestations of this disease have
formed a prominent subject in his teaching and he believed
that there was much in the statement that he who knew all of
syphilis knew nearly all of medicine.

In his later years he worked no longer at actual dissections
and no longer studied the details of pathological anatomy with
the microscope, but he never slipped into that state of con-
fidence in unaided clinical diagnosis which would allow him
to remain away from the autopsy room. Instead he came there
not only to follow minutely the dissection of cases from his own
hospital service, but to learn what he could from those belong-
ing to the surgical and other services. His presence was an in-
spiration that led us to great efforts toward careful work, and
his long experience and unfailing memory, which enabled him
to recall the conditions found in a whole series of similar cases,
gave us a background upon which the case under investigation
stood out.

The pathological anatomy of his text-book is of this quality
and it is for that reason that the students in pathology are told
to read it. No one has written more systematically, or more
concisely of the changes underlying the manifestations of
disease ; no one has recognized more clearly the boundary line
between the known and the unknown or sifted more judiciously
and unerringly the truth from error. His long habit of con-
sidering each disease on the basis of knowledge gained from



As A Pathologist 49

the analysis of a large series of cases has allowed him to esti-
mate justly the relative frequency and importance of each
feature and to state them in the most helpful and orderly
sequence. This clearness of vision with regard to the actual
natural history of disease, always referring to a well-remem-
bered series of cases, helped to make his teaching a memorable
delight to his students. His actual contributions to our knowl-
edge of pathology are many and important, but even more
valuable to the science of medicine in general is his example,
in that he has built his clinical medicine solidly on a founda-
tion of pathological anatomy.




1913.



OSLER, THE TEACHER
By W. S. Thayer

Observe, record, tabulate, communicate.

Use your five senses. The art of the practice of medicine is
to be learned only by experience; 'tis not an inheritance; it
cannot be revealed. Learn to see, learn to hear, learn to feel,
learn to smell, and know that by practice alone can you become
expert. Medicine is learned by the bedside and not in the class-
room. Let not your conceptions of the manifestations of
disease come from words heard in the lecture room or read
from the book. See, and then reason and compare and control.
But see first. No two eyes see the same thing. No two mirrors
give forth the same reflection. Let the word be your slave and
not your master.

Live in the ward. Do not waste the hours of daylight in
listening to that which you may read by night. But when you
have seen, read. And when you can, read the original descrip-
tions of the masters who, with crude methods of study, saw
so clearly.

Record that which you have seen ; make a note at the time ;
do not wait. " The flighty purpose never is o'ertook, unless
the deed go with it."

Memory plays strange pranks with facts. The rocks and
fissures and gullies of the mountain-side melt quickly into the
smooth, blue outlines of the distant panorama. Viewed
through the perspective of memor}^, an unrecorded observation,
the vital details long since lost, easily changes its countenance
and sinks obediently into the frame fashioned by the fancy of
the moment.

Always note and record the unusual. Keep and compare
your observations. Communicate or publish short notes on
anything that is striking or new. Do not waste your time in
compilations, but when your observations are sufiicient, do
not let them die with you. Study them, tabulate them, seek
the points of contact which may reveal the underlying law.

51



53 Sir William Osler, Baet.

Some things can be learned only by statistical comparison. If
you have the good fortune to command a large clinic, remem-
ber that one of your chief duties is the tabulation and analysis
of the carefully recorded experience.

The collection and study of your own observations is much,
but he who works in his own small compartment leads, after
all, a restricted and circumscribed life. Go out among your
fellows, and learn of them. The good observer is not limited
to the large hospital. The modest country doctor may furnish
you the vital link in your chain, and the simple rural prac-
titioner is often a very wise man.

Eespect your colleagues. Know that there is no more high-
minded body of men than the medical profession. Do not
judge your confreres by the reports of patients, well meanings
perhaps, but often strangely and sadly misrepresenting. Never
let your tongue say a slighting word of a colleage. It is not
for you to judge. Let not your ear hear the sound of your
voice raised in unkind criticism or ridicule or condemnation
of a brother physician. If you do, you can never again meet
that man face to face. Wait. Try to believe the best. Time
will generally show that the words you might have spoken
would have been unjust, would have injured a good man, and
lost you a friend, and then — silence is a powerful weapon.

When you have made and recorded the unusual or original
observation, or when you have accomplished a piece of research
in laboratory or ward, do not be satisfied with a verbal com-
munication at a medical society. Publish it. Place it on
permanent record as a short, concise note. Such communica-
tions are always of value.

Mix with your colleagues; learn to know them. But in
your relations with the profession and with the public, in
everything that pertains to medicine, consider the virtues of
taciturnity. Look out. Speak only when you have something
to say. Commit yourself only when you can and must. And
when you speak, assert only that of which you know. Beware
of words — they are dangerous things. They change color like
the chameleon, and they return like a boomerang. Do you
know the story of the young physician, about to enter practice,



The Teacher 53

who was sent by his father to his old friend, Sir William
Stokes, for advice ? A pleasant conversation, and, at the door-
way, a last word : " Charley, don^t say too much." Then, at
the gate, a voice : *^ Charley, come back a minute ; I'm very
fond of you, my boy ; don^t do too much."

" Don't do too much." Remember how much you do not
know. Do not pour strange medicines into your patients.
Our greatest assistance is given by simple physical and mental
means, and by the careful employment of such drugs as have
been adequately studied, with regard to the action of which we
have real information. Do not rashly use every new product of
which the peripatetic siren sings. Consider what surprising
reactions may occur in the laboratory from the careless mixing
of unknown substances. Be as considerate of your patient and
yourself as you are of the test-tube.

Familiarize yourself with the work of others and never fail
to give credit to the precursor. Let every student have full
recognition for his work. Never hide the work of others under
your own name. Should your assistant make an important
observation, let him publish it. Through your students and
your disciples will come your greatest honor.

Be prompt at your appointments; that is always possible.
Many are always late at a consultation; few miss a train.
There is no excuse for tardiness.

Live a simple and a temperate life, that you may give all
your powers to your profession. Medicine is a jealous mis-
tress ; she will be satisfied with no less.

Save the fleeting minute; do not stop by the way. Learn
gracefully to dodge the bore. Strike first and quickly, and
before he has recovered from the blow, be gone; 'tis the only
way

If you can practice consistently all this, .... and then, if
you can bring into corridor and ward a light, springing step,
a kindly glance, a bright word to every one you meet, arm
passed within arm or thrown over the shoulder of the happy
student or colleague; a quick, droll, epigrammatic question,
observation or appellation that puts the patient at his ease or
brings a pleased blush to the face of the nurse ; an apprehen-



54 Sir William Osleu, Bart.

sion that grasps in a minute the kernel of the situation, and
a memory teeming with instances and examples that throw
light on the question ; an unusual power of succinct statement
and picturesque expression, exercised quietly, modestly and
wholely without sensation; if you can bring into the lecture
room an air of perfect simplicity and directness, and, behind
it all, have an ever-ready store of the most apt and sometimes
surprising interjections that so light up and emphasize that
which you are setting forth that no one in the room can forget
it ; if you can enter the sick-room with a song and an epigram,
an air of gaiety, an atmosphere that lifts the invalid instantly
out of his ills, that produces in the waiting hypochondriac so
pleasing a confusion of thought that the written list of ques-
tions and complaints, carefully compiled and treasured for the
moment of the visit, is almost invariably forgotten ; if the joy
of your visit can make half a ward forget the symptoms that it
fancied were important, until you are gone; if you can truly
love your fellow, and, having said evil of no man, be loved by
all ; if you can select a wife with a heart as big as your own,
whose generous welcome makes your tea-table a Mecca ; . . . .
if you can do all this, you may begin to be to others the teacher
that " the chief '' is to us !

An eye whose magic wakes the hidden springs

Of slumbering fancy in the weary mind,

A tongue that dances with the ready word

That like an arrow seeks its chosen goal,

And piercing all the harriers of care.

Opens the way to warming rays of hope.

A presence like the freshening breeze that as

It passes, sweeps the poisoned cloud aside.

An ear that 'mid the discords of the day

Swings to the basic harmonies of life.

A heart whose alchemy transforms the dross

Of dull suspicion to the gold of love.

A spirit like the fragrance of some flower

That lingers round the spot that this has graced,

To tell us that although the rose be plucked

And spread its perfume throughout distant halls

The vestige of its sweetness quickens still

The conscience of the precinct where it bloomed.



OSLER AND THE STUDENT
By Thomas R. Brown"

In a lay sermon delivered before the Yale students a few
years ago in which Dr. Osier offered them " A way of life " —
" a path in which the wayfaring man cannot err, a life in day-
light compartments, the main business of which is not to see
dimly at a distance, but to do what lies clearly at hand/^ and
which had been the starting point of his life-habit — he began
with two words which show more plainly than many pages
could his real relation to the student — for these two words
were " fellow students/^ In these words lay the real reason
for his unique and lasting influence upon all who studied with
him, for he, with his vast experience, his wonderful insight,
his profound knowledge, his poetic vision, his deep sympathy,
was still always at heart the student, always studying, always
delving more deeply into the mysteries of health and of disease,
giving always, yet always ready to receive, teaching, yet ever
ready to learn.

To those privileged to be his students in the early days of
the medical school — a truly golden age to each and every one
of the small, though ever-growing group, he preached, as he
lived, a glorious philosophy of life, a joy in work, doing the


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Online LibraryMinnie Wright BloggSir William Osler, bart. Brief tributes to his personality, influence and public service → online text (page 4 of 14)