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thrombus at the mitral orifice, which also was the first recorded
case.

He was very much interested in comparative pathology, and
performed many autopsies on lower animals with that keen
veterinarian, Clements, who later went to Baltimore, where he
died an untimely death from myocardial disease.

Many of Osier's students of this period are scattered
throughout Canada and the United States, and they look back
with pleasure and profit to the training and stimulus they
received under him at McGill. One of the powerful influences
he possesses was manifested, even in these early years, through
his readiness to report interesting observations before local
medical societies and provincial medical associations, and to
encourage others to do likewise.

Osier's contributions to medical literature while at McGill,
and his papers read before medical societies in the United
States, naturally attracted a great deal of attention, and, when
in 1884 the University of Pennsylvania was seeking the best
trained man to fill the chair of professor of clinical medicine.
Osier was its choice. While in Philadelphia he was brought



Medicine in Canada and the United States 71

into close association with such men as Weir Mitchell, William
Pepper, Tyson, Musser, Keen, Wilson and others. His influ-
ence on medicine in the United States was very marked even
during this Philadelphia sojourn from 1884 to 1889. He was
one of the original members of the Association of American
Physicians, which was organized in 1886 with Francis A.
Delafield as its first president. He always took an active
interest in the annual meetings of the association, contributing
numerous original papers and entering into the discussions.
He was himself its president in 1895.

While at the University of Pennsylvania, Osler^s contribu-
tions to medical literature were numerous and important.
Much of his material for his monograph on the " Cerebral
Palsies of Children,^' published in 1889, was gathered during
this period. His experience at Blockley, that wonderful store-
house of clinical and pathological material, provided him with
a mass of data later freely utilized in the preparation of his
text-book.

In 1889, as the construction of The Johns Hopkins Hospital
was nearing completion, the trustees of the university and
hospital, seeking the best man to fill the chair of professor of
medicine in the university, and the position as physician-in-
chief to the hospital, at once thought of Osier, who was then
considered the most brilliant clinician available. The offer
was tendered and accepted, and he was on duty when the first
patient was admitted to the hospital on May 10, 1889.

It was during his period of residence in Baltimore from
1889 to 1905 that Osier's influence on medicine in the United
States and Canada was chiefly exerted. In making appoint-
ments to his hospital staff, graduates of medical schools in both
the United States and Canada shared the privilege of working
under him. Owing to his close affihations with teachers in the
Canadian medical schools, it was only natural that these men
should be appealed to from time to time to supply assistants
for its interne staff. His first resident physician was Lafleur,
of McGill, who during his tenure collaborated with Council-
man in the publication of their important monograph on



73 Sir William Osler, Baet.

amoebic dysentery. Lalleur, as have other assistants, returned
to Canada and carried with him to McGill and the Montreal
General Hospital the stimulus and methods acquired while
under Osier. Hewetson, also of McGill, soon followed Lafleur
as an assistant. The unfortunate development of tuberculosis
prevented him from pursuing what promised to be a brilliant
career. Thayer, of Harvard, who now holds the chair in
medicine on the whole-time basis, succeeded Lafleur as resi-
dent physician and served until 1901.

J. E. Graham, who was for many years professor of medicine
at Toronto University, an excellent clinician and a man much
beloved by his students, was a close personal friend of Osier,
Through him several Toronto University graduates became
assistants of the latter. Among these may be mentioned.
Barker, Parsons, Thomas McCrae, the late John McCrae —
the immortal composer of ^^ In Flanders^ Fields," Gwyn, and
the writer. It may be of interest to note that all these, with
one exception, were previously resident physicians during the
summer months at the Eobert Garrett Hospital for Children
at Mt. Airy, Md., which was under the direction of Dr. Walter^
B. Piatt. Barker, later succeeded Osier, as professor of medi-
cine. The writer, and Thomas McCrae, in turn succeeded
Thayer as resident physicians. W. G. MacCallum, now the
professor of pathology at Johns Hopkins, although a medical
graduate of this university, but a graduate in the academic
department of the University of Toronto, was, after gradua-
tion, an assistant on Osier's staff. Mention is made of these
various Canadians to point out how Osier acted as a magnet to
draw them from across the border to Baltimore, and to empha-
size the fact that they have, through their " chief,'' indirectly
constituted an important hnk helping to keep up intimate
associations between the profession on both sides of the line.

Following Thomas McCrae, the resident physicians, with the
exception of B. A. Cohoe, a medical graduate of Toronto
University, who served from June to September, 1908, have
all been graduates of The Johns Hopkins Medical School.
They have been in succession, Eufus I. Cole, Charles P. Emer-



Medicine in Canada and the United States 73

son, Thomas E. Boggs, Frank J. Sladen, Paul W. Clough and
the present occupant, Arthur L. Bloomfield. Cole was the only
one of these who served as resident physician during Osler^s
occupancy of the chair of medicine, although Emerson and
Boggs were assistant resident physicians under him before he
left for Oxford, in 1905. Osier's ideals and influence have
been disseminated by this group of resident physicians in the
various fields in which their activities have been cast.

The first edition of Osier's " Principles and Practice of
Medicine " appeared in 1892. This, and the subsequent seven
editions, have been the standard text-book in medicine used
by students and practitioners in both the United States and
Canada. The influence of this work, with the fascinating and
practical way in which the various diseases were treated, has
been very great on the professions of both countries. The same
can be said for the two editions of "Modern Medicine," of
which he was chief editor, Thomas McCrae being associated
with him.

Throughout Osier's professorship at Johns Hopkins, courses
to post-graduates were given yearly. The medical school was
not opened until 1893, and uncler-graduate instruction in
medicine consequently did not begin until 1895, so that, up to
that year, post-graduate instruction was the only teaching
conducted in the medical wards. Osier's ward clinics and
clinical lectures were attended by physicians from all parts of
the United States and Canada. Members of the profession
rubbed shoulders, gained invaluable clinical experience, and
formed professional ties and friendships which have continued
ever since.

Although domiciled in the United States, the Canadian
profession always felt that it had a personal claim on Osier.
His trips to Canada to see his family in Toronto, to consult
with physicians, to read papers before societies in various parts
of the Dominion, and often to spend his vacation on the lower
St. Lawrence, enabled him to keep in close touch with the
profession of his native land and to exert a strong influence on
its members north of the border.



74 Sir William Oslek, Bakt.

Almost as important a sphere of influence as The Johns
Hopkins Hospital was Osler^s home at 1 West Franklin Street,
where physicians from both sides of the line were always wel-
come, and where they were ever made to feel at home by the
" chief " and his gracious wife, now Lady Osier.

In 1905 Osier was called to Oxford to occupy the chair of
Eegius Professor of Medicine in that university. His interest
in the medical profession of both countries has not a whit
abated. The home of Sir William and Lady Osier, at 13 l^or-
ham Gardens, has been almost a daily rendezvous for the
khaki-clad medical officers of the American and Canadian
Expeditionary Forces during the last two years of the world's
war.



OSLEE AS A CITIZEN AND HIS RELATION TO THE
TUBERCULOSIS CRUSADE IN MARYLAND

By Henry Barton Jacobs

Though Osier like Nathan Smith, Austin Flint and Marion
Sims and the philosophers of old is essentially a peripatetic,
a medical nomad, yet wherever his feet may take him, there
he establishes and identifies himself, interests himself in local
conditions and undertakes the responsibilities of citizenship.

In the course of his wanderings Baltimore has had the
privilege and the profit of halting his onward steps for fully
sixteen years. Here he came in the vigor of his promising 40
years, trained and ready, not to say anxious, to jump into the
life of his new surroundings. Many paths there are which lead
to useful citizenship — Osier chose one peculiarly his own, and
followed it consistently and unfailingly, guided only by the
unswerving conviction that whatever he might do to advance
and improve conditions in the profession to which he was
allied, in that way alone could he be of the greatest benefit,
not only to those immediately under his tutelage or care, but
to the city and to the nation at large. In his final address on
leaving Baltimore he says " I have lived my life in my beloved

profession I have never departed from my ambition to

be first of all a servant to my brethren."

The advancement and improvement of medicine and ser-
vice to his fellows, therefore, is the primary path of his en-
deavor. The wayside results of such a course pursued with
intensity, with kindness, with sympathy, with laughter and
Joke, with good fellowship and hospitality, also with hard
study and thought and work, diligently and persistently, year
by year, are quite unusual, and lead as is only natural to
wide friendships, extraordinary and general influence, both

with individuals and with peoples.

75



76 Sir William Osler, Baet.

Scarcely had he arrived in Baltimore in the spring of 1889
when he was asked by the officers of the State Medical Asso-
ciation, the old Medical and Chirnrgical Faculty of Mary-
land, to deliver the oration at the annual meeting of the
society to be held in April of that year. This invitation he
accepted, choosing for his topic " The License to Practice/^
At this period it should be recalled there were in Baltimore
no less than four or five medical schools with two-year courses
of study for a degree to practice, and this degree the only
license required. The argument Dr. Osier made in his ad-
dress was so cogent, so direct, so illustrative of the evil con-
ditions existing that immediate steps were taken by the
leaders of the medical profession of the city and state to have
prepared a legislative Bill for the appointment of medical
examiners whose duty it should be to examine candidates, and
to issue to the successful ones licenses to practice. This was
Dr. Osier's first effort in Maryland toward the advancement
and improvement of medicine, and coincidently his first pro-
nounced effort in good citizenship. As a farther resultant the
Dniversity of Maryland decided to lengthen its course of
medical study and to raise its standard. Moreover, the seed
was growing so fast that in February, 1890, a meeting of
representatives of all the medical schools of Baltimore de-
cided to request delegates, from the medical schools of the
country, to meet in Nashville with the idea of raising the
standard of medical schools all over the United States. At
this conference an agreement was reached for a three-year
course and other reforms.

The Legislature of 1890 passed the Bill for the appoint-
ment of a board of medical examiners, a bill which looked
to the betterment of medical practice in Maryland and to
the general elimination of the numerous quacks and char-
latans who had been permitted to carry on their trade in the
state. Unfortunately Governor Jackson did not give his ap-
proval, and so two years had to go by before its final adoption
by a new Legislature, and the signature of Governor Brown.



Tuberculosis Crusade in Maryland 77

This was but the beginning of Dr. Osier's efforts for better
state and municipal laws.

The almost unrestricted prevalence of typhoid fever in the
United States, particularly in Baltimore, was a source of
deep aggravation to him, and called for the use of all his
powers of voice and pen to bring light into the darkness, that
rational legislative measures might be inaugurated to re-
strict its incidence.

Baltimore at this time was without a general system for the
disposal of its sewage. Backyard privy vaults were nearly
universal. Dr. Osier was strongly of the belief that typhoid
fever would be greatly reduced with the introduction of a
proper and adequate sewerage system and a pure water supply.
Note how vividly and forcefully he spoke at the meeting of
the Maryland Public Health Association held on November
13, 1897, upon the subject of mortality from typhoid fever
as related to these important city improvements :

The penalties of cruel neglect have been paid for 1896; the dole
of victims for 1897 is nearly complete, the sacrifices will number
again above 200. We cannot save the predestined ones of 1898, but
what of the succeeding years? From which families shall the
victims be selected? Who can say? This we can predict — they
will be of the fairest of our sons and of our daughters; they will
not be of the very young, or of the very old, but the youth in its
bloom, the man in the early years of his vigor, the girl just waken-
ing into full life, the young woman just joying in the happiness of
her home. These will be offered to our Minotaur, these will be
made to pass through the fire of the accursed Moloch. This, to
our shame, we do with full knowledge, with an easy complacency
that only long years of sinning can give.

Such writing as this is not only convincing, but is intensely
moving, and must have played no small part in securing the
desired end which happily came before he was to leave our
city, a boon and a convenience to every member of the com-
munity, not to speak of the aesthetics of the new order when
street and sidewalk gutters were no longer redolent with the
morning's dishwashings.

Whatever gives promise of adding to the stock of medical
knowledge immediately arouses Dr. Osier's enthusiasm.



78 Sir William Osler, Baet.

Early he became interested in the amoebic theory of malaria.
Well do I remember his coming to the Massachusetts Gen-
eral Hospital in Boston to demonstrate amoebae in blood cor-
puscles to Dr. Fred Shattuck, then the young medical at-
tendant to that hospital. This must have been in 1887 or
1888. No effort of his for good citizenship, or for the advance-
ment of medicine was more remunerative than the stimulus
he gave in this country to the solving of the problem of the
causation, cure and prevention of malaria, a disease which
had so sorely afflicted the people of states south of Mason
and Dixon's line. Baltimore became the prime center for its
study outside France and Italy, and Thayer's book written
in The Johns Hopkins Hospital from Osier's clinic marks a
salutary epoch in the history of this mosquito-borne infection.

Never was it out of Dr. Osier's mind that a better educated
and more widely read medical profession made for better liv-
ing conditions of the people, greater civic comfort and dimin-
ished suffering and death, so in all ways possible he en-
couraged students and practitioners alike to greater learning.
To this end he insisted upon greater comradeship and larger
attendance upon medical societies where experience could be
interchanged and interesting cases seen and discussed; he
also insisted upon enlarged library facilities, and adequate
supplies of current medical magazines and standard books.
Under his inspiration and leadership the old state society of
Maryland took on a new life, and its library so long moulder-
ing on its shelves sprang into usefulness. To him more than
to any single man does the medical profession of Maryland
owe its present faculty building with its large and growing
library — a library in which he took no less interest than in
his own. To this extent, then, we must think of him as
contributing enormously to the welfare of the community
through an enlightened profession influencing public opinion
in matters pertaining to health, sanitation, and general,
hygiene.

iSTot less than his trenchant writing and speaking was Dr.
Osier's own personality of influence upon men and the com-



Tuberculosis Crusade in Maryland 79

munity; so strikingly straightforward, so genial even con-
vivial, so playful in youthful spirit, so enthusiastic in help-
fulness and sympathy, so painstaking and so wise, he soon
had both patients and acquaintances alike in an attitude of
devotion, almost, I might say, of adoration. And although
he took no official part in the civic affairs of the city, he
gained through his association in the medical profession, by
reason of his acknowledged eminence in that profession, and
through his friends and acquaintances, a leadership in the
affairs of the city and state which was most powerful and
beneficent even though it was exercised in an indirect way.

From the moment when Koch discovered the germ of
tuberculosis in 1882, Dr. Osier has never lost interest in this
disease. He dwelt upon it in his teaching and he insisted that
his students should be familiar with it. When in 1892 the
use of tuberculin was thought to be specific, he was among
the first in this country in giving it a thorough trial in
the wards of the hospital. For greater encouragement to
the study of the disease, which so long has been such a fatal
enemy of mankind, he suggested and carried out the establish-
ment of a society whose single purpose should be the con-
sideration of the history and the various phases, clinical and
pathological, of tuberculosis, and this society he named, after
the great French student of tuberculosis and discoverer of the
stethoscope — The Laennec.

On November 14, 1899, Dr. Osier read an important paper
on the " Home Treatment of Pulmonary Tuberculosis," at
the semi-annual meeting of the faculty at Westminster, and
on the same day and in the same place Tk. Charles S. Millet of
E. Bridgewater, Mass., described his outdoor sleeping porches
for tuberculous patients. This was the first public discussion
of the value of unlimited night air in the cure of consumption
and marks a new epoch in the method of treatment. Inci-
dentally I may remark that at this same meeting mention was
first made by Dr. Joseph E. Oichner of the need and desira-
bility of a State Sanatorium in Maryland.



80 Sir William Osler, Bart.

On April 19, 1901, at the invitation of Dr. Osier, Dr.
Lawrence F. Flick of Philadelphia came to Baltimore and
before the Clinical Society delivered an address on the " Regis-
tration of Tuberculosis/^ saying that Philadelphia and New
York had already inaugurated such a provision. Dr. Osier
urged that Maryland should do likewise, as in this way the
location of cases could be known to the health authorities
and such steps be taken as would be of advantage to the patient
and to the community.

By the end of the year 1901 there had arisen great interest
in the tuberculosis movement, and it was proposed that the
Legislature of January, 1902, should pass new and vital laws
which should be of benefit to the whole people. To this end
a big meeting in McCoy Hall was proposed under the auspices
of the Maryland Public Health Association, the Medical and
Chirurgical Faculty of Maryland and the Laennec Society.
Dr. Osier's " fiery " speech thrilled the audience :

Mr. Chairman and my long suffering, patient, inert fellow-
citizens: .... now what is our condition in this city, and what
are we doing for the 10,000 consumptives who are living today
in our midst? We are doing, Mr. Mayor and fellow-citizens, not
one solitary thing that a modern civilized community should do.
Through the kindness of a couple of ladies — God bless them! —
I have been enabled in the past three or four years to have two of
the medical students of The Johns Hopkins University visit every
case of pulmonary consumption that has applied for admission to
the dispensary of our hospital, and I tell you now that the story
those students brought back is a disgrace to us as a city of
500,000 inhabitants. It is a story of dire desolation, want and
helplessness, and of hopeless imbecility in everything that should
be in our civic relation to the care of this disease.

He then argues for registration, disinfection after death or
removal, a State Sanatorium for curable cases and a hospital
for advanced cases, a sewerage system and a hospital for con-
tagious diseases. This address and others made the same even-
ing had an effect, to wit: The Legislature of 1902 created a
Tuberculosis Commission, the Governor naming Dt. Thayer
as its chairman.



Tuberculosis Crusade in Maryland 81

All that is progressive or worth while in the Tuberculosis
Crusade in Maryland followed thereafter; the commission
with its advisors taking the initiative in beneficial measures,
At Dr. John S. Fulton's suggestion the commission decided
upon a tuberculosis exposition in January, 1904, which
should show graphically and practically the general incidence
of tuberculosis, its methods of prevention and cure, its
aetiology and pathology, its relations to social and economic
problems, and a history of its study from the time of Hippoc-
rates. Such an exposition for any single disease had never
before been attempted. Lectures and demonstrations were
given and the attendance not only from Baltimore but from
the counties and from outside the state was remarkable. The
public was intensely interested and the exposition " demon-
strated that it is both expedient and practicable to admit the
general public to free participation in the scientific knowledge
of tuberculosis." (Editorial, Md. Med. Jour.)

Dr. Osier was the moving spirit in this most successful
undertaking and it was he who invited the distinguished
speakers who were heard. As a result of this exposition, the
Legislature of 1904 passed laws requiring:

(1) Eegistration of tuberculosis in Maryland, and

(2) Providing means and measures to be administered by
the State Board of Health for the domestic prophylaxis of
consumptives.

Growing out of this exposition, too, was the formation, fol-
lowing the suggestion of Dr. S. A. Knopf, of the National
Association for the Study and Prevention of Tuberculosis. In
this enterprise Dr. Osier had a leading part. In its organiza-
tion he was made vice-president, and since his residence in
England has been continued one of the two honorary vice-
presidents, Mr. Roosevelt being the second.

In December, 1904, the Maryland Association for the Pre-
vention and Cure of Tuberculosis was formed and again to
this local movement Dr. Osier lent his interest and enthusi-
asm. His last effort for the tuberculosis cause in Baltimore
was to induce Mr. Phipps to give the sum of $10,000 for a

6



82 Sir William Osler, Bart.

Tuberculosis Dispensary at The Johns Hopkins Hospital.
This was opened with addresses on February 21, 1905, Mr.
Phipps being present.

In reviewing thus briefly the activities of Sir William
Osier during his sixteen years in Baltimore, I realize how
inadequately I have been able to convey any idea of his great
work and influence, or the universal esteem, love and honor
in which he was held not only by the people of Maryland, but
by the country at large. I cannot believe that any man ever
left our shores for a new work elsewhere more deeply and
sincerely missed by a larger army of friends. His address of
farewell delivered before the Medical and Chirurgical Faculty
of Maryland April 27, 1905, on " Unity, Peace and Concord "
typifies his attitude to all his fellows both professional and lay.
In closing he sums up this relationship in the one word which
he leaves as his benediction — Charity.



OSLER^S INFLUENCE ON OTHEE MEDICAL
SCHOOLS IN BALTIMORE

HIS RELATION TO THE MEDICAL PROFESSION

By Edward N. Brush

To estimate correctly Osier's influence upon other medical


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Online LibraryMinnie Wright BloggSir William Osler, bart. Brief tributes to his personality, influence and public service → online text (page 6 of 14)