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

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day's tasks, " living for the day and for the da/s work," with
a wonderful belief in his f ellowmen, never losing faith because
some had failed him, giving without stint his best to everyone
with no thought that some might prove unworthy of the trust.
He felt with Goethe that "the classical is health, and the
romantic disease,'^ and he strove for the one with the Greek
love of perfection, while for the other he had the passion of
the truly adventurous spirit sailing on uncharted seas. To
us who were his students in the early days of The Johns Hop-
kins Medical School, his memory is so vivid, so fresh, that it
seems but as of yesterday when he worked and played in our

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56 Sir William Oslee, Bart.

midst, and we have but to close our eyes to see him in fancy,
almost as clearly as we saw him in fact in the late 90's, the
great teacher and the great student in his manifold relations
to his students. Now we see him riding to the hospital in the
Monument Street car, and to the group about him prophesying
with keen yet ever kindly vision the ills — physical, mental and
spiritual of the derelicts en route to the dispensary; here in
the wards demonstrating the complex psychology of Giles de
la Tourette's disease, as exemplified by a poor bit of sodden
humanity whose coprolalia but exemplified — in a way a bit
embarrassing at times it is true — the symptom-complex he was
discussing, or in an alcove off the ward playing with little
Theophilia as she was emerging from the night of cretinism
into the day of normal happy childhood under his skillful
guidance; now in the class-room of the dispensary — for he
loved the polyclinic, and believed in its wonderful potentiality
as a teaching factor — with one deft touch solving a case of
great complexity, or bringing from his vast storehouse of
knowledge the one last link needed in a disease-picture
hitherto poorly understood, listening, suggesting, directing,
teaching, guiding both student and patient, and all the while
filling countless scraps of paper with the names of one of the
three great teachers of his youth ; now in the clinical laboratory
studying a blood specimen, and suggesting to the student some
line of original investigation which might, perhaps, light into
flame the dormant investigator and research worker; now in,
the autopsy room studying in death the puzzles that he had
helped to unravel during life ; now walking through the wards
and corridors of the hospital with a smile or an epigram for
every doctor and nurse who passed, a kindly word, and his
ever-stimulating psychotherapy — encouragement, optimism,
hope — to every patient he saw ; in his myriad activities always
making each student feel that he also was but a student of
health and of disease, of men and of morals, and yet such a
student as to fire our minds, our souls and our bodies to re-
newed efforts so that we might, in some measure at least, prove
worthy of this fraternity. To us who were privileged to be his



OSLER AND THE STUDENT 57

students — his fellow students in those days, he was — and still
is — always our inspiration and always our model. In him the
fire burned so brightly that no dross nor tinsel could survive
its pure flame, and he was ever " our cloud by day, our pillar
of fire by night." With Bossuet he taught that " le bon sens
est le genie de Fhumanite," and he gave to us " a golden age
which never rusts, a spring which never fades, eternal youth.''*
Always true to himself and to others, he made us think daily
of words of his beloved Plato " Whence has the progress of
cities and nations arisen if not from remarkable individuals
coming into the world we know not how and from causes over
which we have no control ? "

Is not the greatest tragedy of growing older the loss of our
illusions — the discovery sooner or later that so many of the
gods of our youth, Jove-like Olympians of those days when
our world was young and pregnant with possibilities, have,
after all, but feet of clay ? But with ^^ the chief " this could
never be. The more we learned, the more wonderful his bound-
less knowledge seemed ; the wider our vision, the more limitless
his appeared.

Everyone who has ever been his student is, as it were, still
studying with him, or peripatetically following his footstepsi
as he journeys through life, always teaching some new lesson
of medicine or of living. Every honor that has befallen him
has enriched us and made us prouder of our brotherhood;
every step upward or onward of his has made our paths easier
and the heights seem not so far away. We have rejoiced in his
happiness and in his honors, and perhaps he has been helped
in his sorrows by the knowledge that they are ours as well, for
he has shown us how work could be made play, and how the
real could be made ideal. Because of him our lives have been
better, our successes more real, our failures less hard to bear,
for through the tangled skein that spells life each of us knows
that in him he has, and will always have, a teacher, a friend,
and a true fellow student to the end of the chapter.



OSLEE AND PATIENT
By Thomas McCrab

In all the relations of physician to patients there are two
sides — the strictly medical and the personal. Some have a
blind spot for the latter, but taking the profession as a whole
these are in the minority. ISTo one could work in close associa-
tion with Sir William Osier without realizing that both sides
were well developed in him. There was always the desire to do
the best for the patient in a medical way, but the personal
aspect was never forgotten. Patients were patients and not
cases. Interest in the personal side was much in evidence and
it was the exception for his patients to fail in appreciating this.
There was always a great charity for the weakness of human
nature and there were neither unkind nor hasty judgments.
We know how often in his addresses he has emphasized the
importance of this quality.

To the writer was given the opportunity of knowing the
relation of Sir William Osier to the patient both by personal
experience and by the observation of others. The former
came by my having an attack of typhoid fever while a house
officer in The Johns Hopkins Hospital. After the passage
of years it is difficult to estimate in detail one's feelings to-
wards his physician, but the main impression left on my mind,
after a long interval is that of absolute confidence. His visits
were usually short, but when he had gone there was a feeling
that everything was all right. The visit was nearly always
marked by some cheering saying or amusing quip.

One incident comes to memory with regard to the impres-
sion made by him on a patient many years ago ; it is also an
example of curious coincidence. Back in the eighties one of
my father's friends was stricken with a malady of which I
heard some of the details discussed without realizing that they

59



60 Sir William Osler, Bart.

were to be remembered. The patient had Addison's disease
with an unusual degree of pigmentation which attracted great
attention and was naturally commented on by his friends. I
remembered hearing that he had gone to the United States to
consult a physician and had come back realizing that he could
not recover. These matters had apparently been completely
forgotten, but were recalled when 25 years later the friend who
accompanied the patient on the Journey said to me: "I
wonder if you could help me to identify the physician whom
Mr. X consulted in Philadelphia. His name made little im-
pression on me at the time.'^ This seemed rather a difficult
undertaking, but I asked what he remembered of the visit.
He gave the following details : " The examination was very
thorough ; he stripped Mr. X and went over him from head to
foot. He said very little. (At this point the thought of Sir
William came to my mind.) When Mr. X asked him as to the
outlook, he said, ^ Do you think you have enough of the grace
of Grod to make a clergyman,' or something like that. At any
rate Mr. X understood the meaning which was intended and
commented with approval on the way in which it was con-
veyed." Afterwards I asked Sir William if he was the physi-
cian, and found that he was and that he remembered the
patient very well.

This brings up another of his characteristics with regard
to patients — the marvellous memory which he has of the details
regarding many of them. On one occasion a physician brought
a patient to consult him. The physician began to give the
history when Sir William said : '^ I saw Mr. — before with so
and so " — mentioning the diagnosis. Both the physician and
the patient deified this until Sir William showed them the
notes of the previous visit. It seems almost impossible to
imagine that both should have forgotten the consultation, but
such was the case. On many occasions patients came back to
the clinic after an interval of years and Sir William could give
the details of the history at once.

In one of his essays, which gives the title to a book, " Aequa-
nimitas," he dwells on the importance of not permitting one's



OsLBR AND Patient 61

poise to be disturbed or allowing the expression to show what
would be better concealed. He practised this in his daily
work and many who came in contact with him never realized
how much anxiety he often felt, but rarely displayed over
patients. This was particularly true if it was a case in which
a diagnosis had not been made and in which, therefore, the
best treatment was a question of doubt. One such instance
comes to mind of a young man with typhoid fever and severe
hemorrhages. In this case, of course, we were suspicious of
perforation. Sir William made a special trip to the hospital
at my request to try and settle this point. The decision was
that there was no positive evidence of perforation and explora-
tion was delayed, but the signs of general peritonitis next day
showed our error. I remember well his words on the fallibility
of human judgment and of the sorrow that one felt when he
had judged wrongly.

His influence over patients was marked and especially over
those unfortunates whose nervous systems had suffered. As a
general rule he did not spend a great deal of time over them in
the hospital. However, the results came; in many cases no
doubt, largely by faith in him. It has been said by some that
Sir William was not particularly interested in psychotherapy,
but one might say that he did not need to be — he practised it,
not- always consciously, perhaps, but always effectively. He
had extraordinary patience with querulous patients and it was
very rarely that he ever became irritated with them. With the
patient who was ready to fight and be disagreeable he never
argued : " Glad to see you come and glad to see you go ^^ was
a favorite answer.

Many interviews with patients come to memory. In one the
center of the stage was occupied by a nervous woman, to whom
something had been said in a very kindly way of the need of
self-control. With the tears flowing freely and a handkerchief
in active use she said: "Oh, Dr. Osier you misjudge me
cruelly." He, standing at the foot of her bed, replied with a
serious tone to his voice and a twinkle in his eye : " Madam,
I learned early in life never to judge any woman and that rule



62 Sir William Osler, Bart.

I have strictly kept. Therefore, I cannot have misjudged you.
Good morning '^ — and he was away before she could frame a
reply. Later in the day the brunt of his hasty exit fell on me.

In a large private ward service it was not possible for him
to spend a long time with each patient. To his house officers
it was always a source of interest and a good lesson to observe
how he could get into and out of a patient's room without
giving a chance for the flood-gates of talk to open. Many
patients would lament that they had not been able to tell him
this or that. But with this he had a remarkable ability in
discerning when the patient needed a special interview and he
was always ready to give it.

There was one subject on which he would never listen to a
patient, and that was when something was said which reflected
on another physician. When the patient began any such state-
ments he showed his displeasure at once and if this was not
enough a very sharp rebuke followed. In fact this was about
the only thing which made him lose patience and was the rare
occasion of his showing sternness. The talkative patient was
a trial to him — and of whom is this not true? He used to
have a very characteristic look when he escaped and I can
remember his delight, after a particularly trying interview of
the kind, when I quoted to him from '^ Kim '' : " The husbands
of the talkative will have a great reward hereafter.'^ However,
he was rarely caught twice by the same person.

Of one class of his patients a word may be said — the doctors.
He was consulted by many of the profession and especially in
the latter years in Baltimore. This had grown to be a heavy
burden, but one which he carried willingly. He never spared
himself or thought of his own convenience when something
was to be done for a physician or a member of a physician^s
family.

Of the attitude of patients towards Sir William much might
be said. Perhaps the most striking characteristic was absolute
confidence. There was the cert-ainty that there would be no
failure from lack of skill or interest on his part. His cheer-
fulness had much to do with this and the ability to give the



OsLEK AND Patient 63

desire to fight to those who had lost courage and hope. He
was always careful in giving an opinion to put matters simply,
so that the chance of misunderstanding would be as slight as
possible. In the consideration of what a patient should do he
always had in mind what he could do. It was a good lesson
to observe the care which he took to avoid saying anything in
the hearing of a patient which might cause disturbance or
increase anxiety. This was especially marked when the out-
look was being discussed and seemed unfavorable. He never
forgot to be sure that the patient was not within hearing. In
all the giving of advice he was sparing of words and might be
described as one of those " who have not the infirmity, but the
virtue of taciturnity, and speak not out of the abundance, but
the well-weighed thoughts of their hearts."



OSLER AND THE TUBEECULOSIS WORK OF
THE HOSPITAL

By Louis Hamman

Dt. Osler^s interests were so universal that I fear I run grave
risk of contradiction in saying that he showed a particular
interest in tuberculosis. I came in contact very intimately
with his enthusiasm for tuberculosis study and perhaps for this
reason I exaggerate the position it held for him. Certainly
he never tired of reiterating to students the importance of a
thorough knowledge of the two great infectious diseases, tuber-
culosis and syphilis. From the beginning of his career as
physician-in-chief to this hospital he studied the tuberculous
patients with minute care. The first patient admitted to his
medical service on May 16, 1889, was suffering from tubercu-
lous peritonitis and one of the first clinical papers he published
was upon this aspect of tuberculous disease. In 1903 I under-
took at his request a study of all the cases of serous membrane
tuberculosis that had been in the hospital up to that date and I
noted that many of the histories have copious notes dictated
by him.

That this interest in tuberculosis extended beyond the
details of clinical observation is shown by the establishment in
1898 of a special fund for the study of tuberculosis, the
initiative for its inauguration and much of the money coming
from Dr. Osier himself. Dr. Charles D. Parfitt was appointed
to conduct the work and a laboratory was equipped to afford
him suitable opportunity for investigation. Unfortunately
after an active year, which gave promise of substantial con-
tributions to the study of tuberculosis. Dr. Parfitt was taken
ill and the work was abandoned to be resumed some years later
in the laboratory of the Phipps dispensary.

A further evidence of Dr. Osier's unfailing interest in tuber-
culosis, and his zeal for the dissemination of tuberculosis

5 65



66 Sir William Oslee, Bart.

knowledge amongst the students, is the foundation of the
Laennec Society in 1900. This was the first society in this
country and, as far as I know, the first in the world to devote
itself to the study of tuberculosis. I remember clearly the first
meeting of the society held in the fall of 1900 in the basement
under Ward G. Dir. Osier presided, outlining the aims of the
society and explaining the appropriateness of its name; a re-
view of Laennec's life and work followed. Since this date the
society has continued to hold regular meetings and it has
proved itself an important and stimulating center of tuber-
culosis interest in the hospital. Unfortunately, there are no
records of the early meetings of the society, but I remember
Dr. Osler^s unfailing attendance at all the meetings and his
brilliant and stimulating discussions.

Shortly after the establishment of the Laennec -Society
Dr. Osier with his peculiar prescience of coming events in-
augurated the home visiting of tuberculous patients registering
in the dispensary. At first this work was undertaken by
medical students, Blanche N". Epler, Adelaide Dutcher and
Elizabeth H. Blauvelt successively giving it their service. The
study of Miss Dutcher reported before the Laennec Society
and published in the Philadelphia Medical Journal, December
1, 1900, is, I believe the first contribution in this country to
lay the proper emphasis upon the importance of the home in
the spread of tuberculosis. From this modest beginning grew
the subsequent study and care and supervision of tuberculous
patients in the dispensary. Dr. Osier soon enlisted the interest
of Mr. Victor Bloede in the work and through his generous
support a nurse was employed to visit and instruct patients
in their homes. At the same time under his guidance the first
steps were taken towards establishing a special clinic for the
tuberculous. Although no separate rooms were available for
this purpose, all tuberculous patients were put under the care
of Dr. Herman Bruelle for detailed study and advice.

It would give a very incomplete impression of Dr. Osier's
tuberculosis interests to omit reference to his activities outside
of the hospital. He was always deeply concerned about the



Tuberculosis Work of the Hospital 67

social applications of medical knowledge and he played a
prominent part in furthering and directing the awakening
interest in the control of tuberculosis as a disease of the masses.
For instance, he took a very active interest in the Tuberculosis
Exposition held in January, 1904, under the auspices of the
State Board of Health, the first exposition of the kind held in
this country. Under his influence a remarkable collection of
books on tuberculosis were displayed, illustrating the develop-
ment of our knowledge of the disease from Hippocrates to
modern times. Before the collection was dispersed Dr. Osier
reviewed it with the medical students, illuminating each epoch
with his surprising knowledge of the historical aspects of the
subject.

In 1903 Mr. Henry Phipps learned of the work Dr. Osier
was trying to do with such modest equipment and generously
sent $10,000 to support his endeavors. The check came quite
unexpectedly and was the means for Dr. Osier to plan at once
to materialize one of his dreams. With great enthusiasm he
began to develop a special department for the study of tuber-
culosis and the care of tuberculous patients. Mr. Phipps'
additional gift of over $20,000 made it possible to remodel
the old stable standing between the dispensary and pathological
department buildings into a two-story structure with four
rooms on each floor. The building was formally opened at a
special meeting of the Laennec Society on February 21, 1905,
and the first patients were received on the first of March of the
same year.

Dr. Osier left the hospital the year the tuberculosis dis-
pensary was opened, but his interest in the department never
ceased. Messages of encouragement and appreciation came at
irregular intervals. Whenever an article appeared by a mem-
ber of the staff, usually the first and always the dearest recog-
nition was a postal or a brief note dashed off in his character-
istic way. As the dispensary gradually grew into a recognized
place in the medical clinic, at every turn of fortune there came
his cheering congratulation. It is impossible for me to look
back upon those years without the deepest emotion. I do not



68 Sir William Osler, Bart.

know if Dr. Osier ever appreciated what these crisp, kindly
messages flashed from abroad really meant for us, nor am I
able adequately to express all we felt. Certainly this much is
true, they were always the brightest ray of encouragement to
our work, the most comforting reward that made us forget the
long, dreary hours of labor and the discouragement and doubt
that often assailed us.

Since the first few years the tuberculosis dispensary has
grown steadily in importance. Further gifts from Mr. Phipps
allowed the hospital to add to the building in 1908, doubling
its capacity. Eecently the generosity of Mr. Kenneth Dows
has further improved the building and has put the research
department of the dispensary upon a sound footing. The
tuberculosis clinic is a very different department now from the
modest dispensary arrangements of a physician without a room
to work in and with no other equipment but his stethoscope.
But this is the fruit that has grown from that tiny seed of
interest and enthusiasm planted by Dr. Osier many years ago.



INFLUENCE ON THE RELATION OF MEDICINE IN
CANADA AND THE UNITED STATES

By Thomas B. Futcher

Sir William Osier has done more than any other member of
our profession to bring about cordial and intimate relation-
ships between its members in the United States and Canada.
A Canadian by birth, a graduate of McGill University,
Canada's most distinguished medical representative, and a
man with a most magnetic personality and great breadth of
sympathies and interests, it is only natural that he should
have exerted a most potent influence in encouraging close asso-
ciations between the members of the profession in the two
countries. Particularly was this the case after his call to
Philadelphia in 1884, and to Baltimore in 1889. While this
bond has naturally been more intimate between internists, his
influence indirectly brought about a closer contact between the
members of the other specialties.

Although Osier was graduated in medicine from McGill
University, he was born at Tecumseh, Ontario, on July 12,
1849, and was educated at Trinity College, Toronto. Various
members of his family, leaders in their respective professions,
have resided in the latter city. As his reputation grew, it was
only natural that his influence on the profession in the two
older provinces of Canada should have been very great.

After his graduation from McGill in 1872, he spent the next
two years in research work abroad, at University College,
London, and at Berlin and Vienna, where he formed associa-
tions with such men as E. A. Schafer, Virchow, Nothnagel
and others. While abroad, he published in 1873 his researches
on the blood platelets in which he established their corpuscular
character. Upon his return to Montreal in 1874, he was
appointed professor of the institutes of medicine, at McGill

69



70 Sir William Osler, Bart.

University, a position he filled until 1884. During this period,
he was brought into intimate association with his old teacher,
Eobert Palmer Howard, who was professor of medicine and
dean of the medical faculty, and with those able clinicians,
Eoss and MacDonnell. His natural bent for research and
investigation, had been further stimulated by his experiences
abroad. A full appreciation of the importance of the micro-
scope in medical research led, upon his return, to its more
extensive adoption in the laboratories of McGill. While there.
Osier laid the foundation of his keenness as a clinician^ through
his recognizing the great importance of following the fatal
cases to the autopsy room, performing many of the necropsies
himself. These investigations resulted in the publication of
numerous important contributions to medical literature.
Among these may be mentioned his paper in which mycotic
aneurisms in association with ulcerative endocarditis were
described for the first time, and his account of the ball-valve


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Online LibraryMinnie Wright BloggSir William Osler, bart. Brief tributes to his personality, influence and public service → online text (page 5 of 14)