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HISTORY OF MEDICINE : GREAT MEDICAL MEN AND THEIR TIMES

* Emeritus Physician & Trustee,

Tirath Ram Shah Hospital, Delhi

** Sr. Consultant Physician & Pulmonologist,

Department of Medicine, Jessa Ram Hospital,New Delhi

THE VERNON PLAQUE

Paris, 1903

Sir William Osler

GB Jain*, DG Jain**

Osler remains one

of the finest and

greatest figures in

modern medicine.

He was a great

scholar, physician

and bibliophile,

beloved and revered

by his colleagues at

McGill, Philadelphia,

Johns Hopkins, and

later at Oxford

University.

William Osler was

born July 12, 1849,

in a parsonage at

Bond Head, Upper

Canada, and was

the youngest son in

a family of nine.

After his schooling at Weston School, he joined Trinity College

and the Toronto Medical School and then went to the McGill

Medical School. In medical school he was much influencedby his teacher Dr. James Bovell, MRCP, and would spend

countless hours at Dr. Bovell's residence, studying the various

Entozoa under the microscope. So great and sincere was the

influence of Dr. Bovell on the young Osler, that he never

forgot his teacher till his death. In an address nearly 33 years

later in 1903, Osler paid a tribute of filial affection to his

teacher where he said: There are men here today who feel

as I do about Dr. James Bovell that he was of those finer

spirits, not uncommon in life, touched to finer issues only in

a suitable environment. Yet, withal his main business in life

was as a physician, much sought after for his skill in diagnosis,

and much beloved for his loving heart. When in September,

1870 he wrote to me that he did not intend to return fromthe West Indies, I felt that I had lost a father and a friend; but

in Robert Palmer Howard of Montreal, I found a step-father,

and to these two men, and to my first teacher, the Rev. W.A.

Johnson of Weston, I owe my success in life if success means

getting what you want and being satisfied with it.

In his last year at the Toronto Medical School, Osler laid the

foundations of what were to be his subsequent habits of life.

The most important habit was work and the finding of it a

pleasure. To this he added three qualities, of which he spoke

in a later address to the medical students:

1. The ART OF DETATCHMENT,

2. The VIRTUE OF METHOD, and

3. The QUALITY OF THOROUGHNESS.

To these, he added a fourth quality as being essential to

performance i.e., the GRACE OF HUMILITY. About himself,

Osler is known to have said, I started in life I may as well

own up and admit with just an ordinary, everyday stock ofbrains. In my school days, I was much more bent upon

mischief than upon books I say it with regret now but as

soon as I got interested in medicine I had only a single idea,

and I do believe that if I have had any measure of success at

all, it has been solely because of doing the days work that

was before me just as faithfully and honestly and energetically

as was in my power. My message is but a word, a way, an

easy expression of a plain man whose life has never been

worried by any higher philosophy. I wish to point a path in

which the wayfaring man, though a fool, cannot err; not a

system to be worked out painfully only to be discarded, not a

formal scheme, simply a habit, as easy or as hard to

adopt as any other habit, good or bad. Life is a habit, asuccession of actions that become more or less automatic.

In a word, habits of any kind are the result of actions of the

same kind; and so what we have to do is to give a certain

character to these particular actions.

What each day needs that shalt thou ask,

Each day will set its proper task.

Osler further remarks : Our main business is not to see

what lies dimly at a distance, but to do what lies clearly at

hand. The chief worries of life arise from the foolish habit of

looking before and after. Just as a patient with double vision

from some transient unequal action of the muscles of the

eye finds magical relief from well-adjusted glasses, so

returning to the clear binocular vision of today, the over-

anxious finds peace when he looks neither backward to the

past nor forward to the future.

Happy the man and Happy he alone,

He who can call today his own,

He who is secure within can say,

Tomorrow, do thy worst for I have lived today.

At another occasion Osler has said : It may be well of a

physician to have pursuits outside his profession, but it is

dangerous to let them become too absorbing. This remark

assumes a greater significance today in a society where

distractions, attractions, materialism and consumerism have

corroded the steel frame-work of humanity and humanism.

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On the study of literature, Osler used to say : As the soul is

dyed by the thoughts, let no day pass without contact with

the best literature in the world. Mankind, it has been said, is

always advancing, man is always the same. The love, hope,

fear, and faith that make humanity, and the elemental

passions of the human heart, remain unchanged, and the

secret of inspiration in any literature is the capacity to touch

the chord that vibrates in a sympathy that knows not time

nor place.

At the young age of seventeen, Osler read the great book

Religio Medici by Sir Thomas Browne for which he developed

a deep love and respect. This book turned out to be an

important thread which, from this point onwards, wove its way

through Oslers story to the end. So much so, that the 1862

edition of the Religio his second book purchase, was the

very volume which lay on his coffin fifty-two years later.

Sir William Osler was known for his kindness. A well known

example of his kindness of heart and also of how strangely

peoples paths sometimes cross in this world, is the story of

his Montreal days. In the autumn of 1875, Osler had joined

the Metropolitan Club, where he was accustomed to dine.

Since he was usually alone, he occasionally sat with an

attractive young Englishman who happened to be in Montreal

on business, and was putting up at the club. One evening,

observing that he appeared ill, Osler questioned him, and

suspicious of the symptoms, got him to his room and to bed,

where it was soon evident that he had malignant smallpox.

The disease proved fatal after an illness of three days, and

having learned the youngmans name, and address of his

father in England, he wrote a letter telling all about the illness,

the medical aid given, and the last rites performed. Thirty

years later almost to the day since Osler wrote this letter,he was the newly appointed Regius Professor of Medicine in

Oxford, when he chanced to meet at dinner a Lady S , who,

attracted by his name, said that she once had a brother who

had gone out to Montreal and been cared for during a fatal

illness by a doctor named Osler, who had sent a sympathetic

letter that had been the greatest possible solace to her parents

: that her mother, who was still living in the south of England,

had always hoped she might see and talk with the man who

had written it. Later, on his way to Cornwall, Osler paid a

visit to this bereaved mother, taking with him a photograph

of her boys grave, which he had sent for and obtained from

Montreal.

On the question of medical teachers and professors, Osler

was of the opinion that these men should be placed above the

worries and problems of practice, whose time will be devoted

solely to investigating the subjects they profess. On the general

medical practice Osler remarked: There are two main types

of practitioners the routinist and the rationalist neither

common in the pure form. Into the clutches of the demon

routine, the majority of us ultimately come.

At the age of thirty-five, Osler left McGill University for

Philadelphia and so McGill lost what Howard called its potent

ferment. Thus closed Oslers Canadian period. Years later,

in an address given at McGill, while admitting that the dust

of passing time had blurred the details, even in part the

general outlines, of the picture, Osler spoke of this formative

period of his medical career as on during which he had

become a pluralist of the most abandoned sort, and

concluded his interesting and amusing recollections by saying:

After ten years of hard work I left this city a rich man, not in

this worlds goods, for such I have the misfortune or the

good fortune lightly to esteem; but rich in the goods which

neither rust nor moth have been able to corrupt, in treasures

of friendship and good fellowship, and in those treasures of

widened experience and a fuller knowledge of men and

manners which contact with the bright minds in the profession

ensures. My heart has stayed with those who bestowed on

me these treasures. Many a day I have felt it turn towards

this city to the dear friends I left there, my college companions,

my teachers, my old chums, the men with whom I lived in

closest intimacy, and in parting from whom I felt the chordae

tendinae grow tense.

At the Philadelphia University School, Oslers disinclination

for a general practice, for which a university position was

coveted as a portal of entry, and his determination to limit

himself largely to consultations, was mystifying to his medical

colleagues, most of whom were accustomed to hold

afternoon office hours and to engage actively in house-to-

house practice. On the contrary, he would spend his

afternoons with a group of students, making post-mortem

examinations instead of sitting in his office awaiting patients.

In 1888, Osler accepted the invitation to join the now

renowned Johns Hopkins Hospital, and was amongst a select

few present at the birth of this great institution in 1889. Infact, he is one of The Four Physicians who have been

immortalised in the famous painting by Sir John Singer

Sargent, which now reposes in the great hall of the Welch

Memorial Library Building at Hopkins. The opening of Johns

Hopkins in 1889 marked the begining of a new era in medical

education in the United States. In a letter, Osler writes : It

was not the hospital itself, as there were many larger and

just as good; it was not the men appointed, as there were

others quite as well qualified; it was the organisation.

On the medical training of those days in the United States,

Osler once remarked : It makes ones blood boil to think

that there are sent out year by year scores of men, calleddoctors, who have never attended a case of labour, and who

are utterly ignorant of the ordinary everyday diseases; men

who may have never seen the inside of a hospital ward and

who would not know Scarpas space from the sole of the

foot...... Is it to be wondered, considering this shocking laxity,

that quacks, charlatans and imposters possess the land?

Dr. Bernheim has given a graphic description of Osler s ward

rounds and clinics at Johns Hopkins : I wish you could have

seen Osler come into the Hospital of a morning. It was the

grand entrance of a grand showman and it became a ritual.

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With Old Ben, Negro factotum, bowing and scraping as he

opened the doors of the main building on Broadway, and

residents, interns, even the superintendent of nurses milling

around to take his coat, hat, and books, and get the cheery

greeting and wave of the hand, it was a sight fit for Hollywood.

Falling in step with his resident, hed immediately start around

the great marble statue of Christ standing in the rotunda

and make for the long corridor leading to his wards all

others falling in line. A middle-sized man, with swarthy olive-

coloured skin, high forehead, drooping black moustache

hed have made a wonderful-looking pirate, properly

costumed hed set sail, coat-tails flying, talking animatedly

in easily heard tones, greeting men and women he passed

and often taking them by the arm as the cavalcade, pleasantly

noisy and laughing at the Osler quips, went happily on its

way to the grand rounds. We who were students, would be

waiting on our respective wards, charts and everything ready,

while nurses nervously set things to right and orderlies flicked

imaginary specks of dirt off tables and beds. Even the sickest

patients perked-up, knowing well that a great event was about

to take place.

And a great event it was as Osler passed through the doors

smartly held open by the resident, greeted the nurses

incharge, and immediately proceeded to the first patient

the cavalcade in hushed silence now gathering around the

bed. As I recall, hed never burst right into examination but

would indulge in some sort of extraneous talk while patting

the patient on the shoulder or otherwise reassuring him. Then

came the history, given by a student, then the great physician

would make his meticulous examination and talking. Osler

really made bedside teaching of medicine come alive.

Everything about him was interesting, especially his mannerof handling the sick. He could teach and he knew his stuff.

His ward rounds were the pinnacle of perfection and

simplicity, and to this day I have never seen their equal. From

bed to bed he'd go, from ward to ward, from one illness to

another, and never did I see a man or woman leave before

Osler completed his rounds.

He used to say the four Fs give you typhoid fever : fingers,

food, flies, filth. Morphine was G.O.M. Gods own medicine.

If you knew syphilis and T.B., you could come pretty near

practicing medicine successfully. Syphilis was the greatest

simulator and would fool you. And so on and so on. Great

teaching by an inspired teacher who literally oozed personalityand had no truck with anything but truth. They called him

the Chief. They never called anybody else that at the Hopkins

before or afterwards.

Osler never tired of repeating to the medical audience the

following lines :

Knowledge and wisdom, far from being one,

Have oft-times no connection. Knowledge dwells

In heads replete with thoughts of other men;

Wisdom in mind attentive to their own.

Knowledge is proud that he has learned so much;

Wisdom is humble that he knows no more.

One remarkable quality that Osler possessed was that he

always honoured his seniors, praised his colleagues, and

encouraged his juniors. He did this with all sincerity. On

Virchows 70th birthday, Oslers address was one of the few

tributes that have ever been paid a member of the medicalprofession to equal those paid Virchow at this time, when, to

use Oslers words : as the shadows lengthen, and the twilight

deepens, it has seemed right to his many pupils and friends

the world over, to show their love by a gathering in his

honour.

Osler was a therapeutic conservative, a therapeutic sceptic,

though by no means a nihilist. His greatest professional

service was that of a propagandist of public health measures.

His celebrated textbook The principles and practice of

medicine was first published early in 1892. In his book, he

observed that excess eating has a lot to do with an attack of

asthma and, therefore, attributed asthmatic attacks to gastric

distention caused by overeating. Osler was an extremely

hospitable person too! his house was always full of guests,

students and colleagues, so much so that at Oxford his house

was known as Open Arms.

In his lifetime Osler advanced the science of medicine,

enriched literature and the humanities; yet, individually

he had a greater power. He became the friend of all he

met he knew the workings of the human heart physically

as well as sentimentally unlike most modern day

cardiologists! He joyed with the joys and wept with the

sorrows of the humblest of those who were proud to be

his pupils. He stooped to lift them up to the place of his

royal friendship, and helped many of them in the ruggedpaths of life. He achieved many honours and many

dignities but the proudest of all was his unwritten title,

the Young Mans Friend (Sir A.S. McNaulty).

The death of Oslers only son Revere, who had joined the

army and died in 1917 during the war hastened Oslers

physical downfall. He had been accustomed to read it himself

to his son Revere on Christmas Eve : The days of our age

are three score years and ten......so soon passeth it away,

and we are gone. As if prophetically, Oslers end came at

4-30 on the afternoon of December 29, 1919 (at the age of

70) quietly and without pain.

Harvey Cushings description of the night of Oslers death isvivid and unsurpassed : So they the living left him

overnight; alone in the Lady Chapel, lying in the scarlet gown

of Oxford, his bier covered with a plain velvet pall on which

lay a single sheaf of lilies and his favourite copy of the

Religio.

This was just a brief glimpse into the life and teachings of Sir

William Osler a great physician and a great humanist. The

sweep of his mind and interests embraced every phase of

human activity, and his example of how to live should inspire

the lives of all men and women even today.

196 Journal of Indian Academy of Clinical Medicine Vol. 5 No. 2