Sir William Osler, Baronet
- Osler's sign
- Libman-Sacks syndrome
- Osler's filaria
- Osler's manoeuvre
- Osler's nodules
- Osler's syndrome
- Osler's triad
- Rendu-Osler-Weber disease
- Sphryanura osleri
- Vaquez' disease
Biography of Sir William Osler, Baronet
William Osler played a key role in transforming the organization and curriculum of medical education, emphasizing the importance of clinical experience.
William Osler was born in the backwoods of Canada, the youngest of the nine children of the Reverend Featherstone Osler, who had gone to Canada as an Anglican missionary, and his wife, Ellen. All of the children achieved success. As a schoolboy he was a small, wiry boy with a vivid manner who excelled both in sports and studies.
William, like his father, was intended for the church. But while at school he read Sir Thomas Browne's (1606-1682) Religio Medici (1643) and became fascinated by natural history. He began to study arts at Trinity College, Toronto, but decided that the church was not for him and entered the Toronto Medical School in 1868. He subsequently transferred to McGill University in Montreal, Quebec, where he took his medical degree in 1872. During the following two years he visited medical centres in London, Berlin, Leipzig, and Vienna, spending the longest period at University College, London, in the physiology laboratory of John Burdon-Sanderson (1828-1906), who was making experimental physiology pre-eminent in medical education.
Osler returned to Canada and began general practice in Dundas, Ontario, but was soon appointed lecturer in the institutes of medicine at McGill University, Montreal. He became professor there in 1875. A year later he became pathologist to the Montreal General Hospital and in 1878 physician to that hospital. At McGill he taught physiology, pathology, and medicine. His research was conducted largely in the postmortem room. In 1884, while in Leipzig, he was invited to occupy the chair of clinical medicine at the University of Pennsylvania in Philadelphia. He decided to do so on the toss of a coin. While in Philadelphia he became a founding member of the Association of American Physicians.
In 1888 Osler accepted an invitation to be the first professor of medicine in the new Johns Hopkins University Medical School in Baltimore. It was here that he established himself as the most outstanding medical educator of his time, and commenced the modern era as we know it today. There he joined William Henry Welch (1850-1934), chief of pathology, Howard Atwood Kelly (1858-1943), chief of gynaecology and obstetrics, and William Steward Halsted (1852-1922), chief of surgery. Together, the four transformed the organization and curriculum of clinical teaching and made Johns Hopkins the most famous medical school in the world.
For the first four years there were no students at Johns Hopkins, and Osler used the time to write The Principles and Practice of Medicine, first published in 1892. In the same year, he married Grace Gross, widow of a surgical colleague at Philadelphia and great-granddaughter of Paul Revere, a folk hero of the American Revolution whose dramatic horseback ride on the night of April 18, 1775, warning Boston-area residents that the British were coming, was immortalized in a ballad by Henry Wadsworth Longfellow.
Osler's textbook spread his fame throughout the English-speaking world. It was lucid, comprehensive, interesting, and scholarly. It quickly became the most popular medical textbook of its day and has continued to be published since under a succession of editors, though never regaining the quality with which Osler endowed it. The textbook had an unexpected sequel. In the summer of 1897 it was read in its entirety by the philanthropist and businessman Frederick T. Gates (1853-1929), who had been engaged by John D. Rockefeller to advise him in his philanthropic endeavours. As a result of his reading, Gates inspired Rockefeller to direct his foundation toward medical research and to establish the Rockefeller Institute of Medical Research in New York.
Students studied their patients in the wards and presented the results to the "Chief." They were also encouraged to take their problems to the laboratory. Finally, the experts pooled their knowledge for the benefit of the patient and the student in public teaching sessions. Thus was born the pattern of clinical teaching that spread throughout the United States. Osler was not only professor of medicine but physician in chief to the hospital, an office first devised by the president of the university on the basis of his experience of running a large department store and later to spread to most of the medical centres of the United States.
In 1904, while visiting in England, Osler was invited to succeed Sir John Burdon-Sanderson (1828-1906) in the Regius Chair of Medicine at the University of Oxford. Osler's practice and teaching had for many years imposed enormous demands on his time and energy. His forceful wife telegraphed him from America: "Do not procrastinate. Accept at once." Osler did. The Regius Chair at Oxford is a crown appointment for which only citizens of the crown are eligible, but Osler had kept his Canadian nationality.
Upon leaving the Johns Hopkins University in 1905, Osler gave a goodbye lecture in which he referred to the “relative uselessness of men over forty years of age” – remarks that were freely and frequently misquoted and occasioned a great del of public controversy.
He took up his chair in the autumn of 1905, becoming a student, roughly a lifetime fellow, of Christ Church, one of the Oxford colleges, a member of its Hebdomadal (weekly) Council, and curator of the Bodleian Library. In Oxford he taught only once a week, did a small amount of practice, and spent most of his time on his books. His library became one of the best of its kind, and after his death it passed intact to McGill, where it is specially housed. His scholarship was recognized by his election as president of the Classical Association. He was elected a fellow of the Royal College of Physicians of London in 1884 and a fellow of the Royal Society of London in 1898.
At Oxford Osler was largely responsible for the foundation of the Association of Physicians of Great Britain and Ireland, and the Quarterly Journal of Medicine. He presented evidence before the Haldane Commission which virtually assured the establishment of full time chairs of medicine at the university of London. He became a fellow of Christ Church College which attracted him because of its association with Robert Burton, whose “Anatomy of Melancholy” he admired so much.
Osler had a puckish wit and wrote some admirable medical nonsense under the pseudonym of Egerton Yorrick Davis, whom he presented as a retired surgeon captain of the U.S. army.
Osler was a man of immense personal charm, he epitomized Peabody’s saying that “the secret of patient care is caring for patients.” Osler himself was famous for many aphorisms which are still as cogent today as when he first introduced them: “To study medicine without reading textbooks is like going to sea without charts, but to study medicine without dealing with patients is not going to sea at all.”
For a man who is held in such reverence by all the English-speaking medical profession, Osler’s scientific accomplishments were perhaps not great. However, his description of disease bordered on that of Hippocrates, and as he matured his writing became more and more succinct and easy to follow. He wrote some of the early descriptions of the platelets in morphology and wrote classical papers on hereditary telangiectasia, lupus erythematosus and polycythaemia vera. His textbook was a goldmine of information and is still worth reading.
In 1873 Osler demonstrated that hitherto unidentified bodies in the blood were in fact the third kind of blood corpuscles, which were later named the blood platelets. These corpuscles had been observed before, but no one before Osler had studied them so thoroughly. Thus began what he called his periods of "brain dusting" - travel and studies that made him almost as much a part of Europe as of America.
Many of his essays are classics which should be read by the modern medical undergraduate and graduate. Perhaps the two most famous are “A way of life” and “Aequanimitas” - the latter title also what he considered the most desirable quality in physicians.
Osler’s real strength, however, lay in his ability to inspire and influence his students and postgraduate fellows. Through these men and women, he exerted an influence which had never been seen before and has never been equalled since. He was the example par excellence of his own saying that the future of a university or hospital “lies in the men who work in its halls and in the ideals which they cherish and teach.”
It is said that if he had a blind spot it was his inability to tell patients the reality of their disease and in consultation he sometimes caused the referring doctor problems since he would always leave the patient and relatives with the feeling that they could recover. However, perhaps this was one of the secrets of his success in a day when treatment was relatively inefficient.
Osler was a superb diagnostician who insisted on hospital patients being treated as human beings not as “interesting cases”. He had many personal ideals which he spelt out in his essays, but perhaps 3 recurring themes were:
1. Doing the day’s work well and not bothering about tomorrow,
2. always being courteous and considerate to professional colleagues and to patients, and
3. cultivating a feeling of equanimity.
In many ways Osler was responsible for combining the best of German and English medicine, and thus for the ultimate shift of the centre of progress in medical science to the United States. He had a curiously impish side to his character which led him to use a pseudonym when involved in practical jokes – Egerton Yorrick Davis. Osler considered an editorial by Dr. Theophilus Parvin, a professor of obstetrics in Philadelphia, to be ridiculous. He wrote a fictitious tongue in cheek article about vaginismus and this was published in “The Medical News” and was reproduced in two books on sexual disorders.
He and his wife were immensely hospitable, especially to visiting Americans, among whom their house was known as the "Open Arms." They had a son, named Revere for his great grandfather, Paul Revere, of “ride” fame. It is said that Osler’s personality changed when the son, his only child, died in an artillery barrage at the Ypres salient towards the end of the Ist World War.
William Osler died following bronchopneumonia and empyema on December 29th, 1919. He was buried in the chapel at Christ Church, Oxford, on January 1, 1920. In his will he had bequeathed his library of about 8000 books to his alma mater and after Lady Osler died in 1928 both her and her husband's ashes were moved to the Osler Library of the History of Medicine at McGill University. A printed catalogue of the material that Osler donated to McGill, which forms the foundation of the Osler Library, was published as Bibliotheca Osleriana.
A long-time admirer of Osler was Dr. Robert N. Larimer, a physician of Sioux City, Iowa. For many years before his death in 1978 Dr. Larimer engaged in the pleasant and rewarding hobby of collecting as much as he could of Osler's enormous output of published materials and selected items of Osleriana. Although Osler wrote a number of books, the largest proportion of his publications was in medical journals. He had most of these journal articles reprinted in a limited number of copies for presentations to friends and colleagues. An idea of the immensity of his published work may be gained from the list of collected reprints appearing as item No. 3576 in Bibliotheca Osleriana, which identifies 324 separate reprints of articles, in addition to which are scrapbooks containing an additional 161 shorter articles, letters, notices, obituaries, and pamphlets. Most of these items are elusive and many are quite rare.
Besides his own works, Osler contributed profusely to various textbooks and encyclopaedias by other authors.
We thank David S. Crawford for information submitted.