William Osler: A Life in MedicineBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7268.1087/a (Published 28 October 2000) Cite this as: BMJ 2000;321:1087
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He lived to the age of seventy and in the evenings of the summer would be chaired in his study, the window behind him, reading about the history of his profession and the people who had preceded him. In the furtherance of his profession he is incontestably the most citable figure to have emerged in the last two centuries. Clinical signs from across the panorama of medicine bear his stamp though rare is the student who knows from whom “Osler’s nodes” borrow that name. Rarer still is the student who whistles knowledgeably to Chopin and peruses the rhapsodic writings of Sir Thomas Browne. Yet students cannot be called ignoramuses for the mentioning of a doctor who is known as “the father of modern medicine” elicits expressions of almost equal blankness from the qualified battalions on the Healthcare Front.
Regrettably, a spearhead figure of medicine has now become extinct in the consciousness of present-day doctors. Yet only fifty years ago, William Osler (“Oers-ler” rather than “Ohz-ler”) was readily remembered by all in the fold as a totem of the profession. Such was his influence when his veins were tepid with blood, and after his bones had sunk to the earth, that there existed for decades a well-membered swarm of aficionados called the Oslerians. After his demise in 1919 in Oxford, his brain was extracted for study because pathologists wanted to see if fine intellects had anatomies that were dissociable from the brain structure of the multitudes. Keen to further the frontiers of medicine after his exit, Osler had willingly assented to the taxidermy and scrutiny of his high-performance brain. His galactic and single-authored “Principles and Practice of Medicine” had a print run from 1892 to 2001 and was updated by him on eight thorough occasions. In his own expeditions through the rainforest of medicine, he was one of the first to identify platelets as a new type of blood cell, and from a writing table strewn with arrangements of open books and encyclopaedias he haemorrhaged monographs on tumours of the abdomen and inflammatory lesions of the heart. With the balance of the wise physician, he was always aware of the fallibility of medicine and its practitioners and himself made misdiagnoses in his career.
The appeal of William Osler was maximal in North America and Great Britain since these are the two places where he spent a life hallmarked by generosity and truly legendary humour. He belongs to the axis of unity between these two English-speaking geographies, but his modifications to the medical profession were palpable in other linguistically comparable areas of the world.
Originating from Cornwall, Osler’s parents migrated a long way from this outpouching of southern Britain to the redwood forests of a region that was once called Upper Canada. Qualifying MDCM, doctor of medicine, master of surgery, William Osler became a lecturer at the age of twenty-six in 1874 when clinical medicine was in a state of embryogenesis. He was to remain attached to a professorship throughout his life and in this guise worked in four institutions from among which the John Hopkins Hospital in Baltimore is recognised as a founding stone of modern medicine. Tending away from charlatans and quacks, the arena of clinical medicine was acquiring a uniformity of method, and over the years and decades of the late 1800s was turning recognisably modern. Osler, professor of medicine, was one of the inaugural “Big Four” at Baltimore alongside the leading lights of surgery, obstetrics and pathology. But Professor Osler would make the most far-ranging improvements to his profession.
Osler fundamentally altered the process of medical education by displacing students from the lecture theatre onto the wards. It was a radical move since the firmly entrenched belief was that incubatory physicians should nest in libraries and learn medicine through long hours of book-work. With the radiance of the natural teacher, Osler’s mellifluous voice could be heard at a clinical bedside where he would never admonish but would always entertainingly educate. Even the student who had turned cheerless from aggravations at the hands of another teacher would respond to the style of Professor Osler who with a friendliness would whisper over a shoulder, “Just listen to your patient, he is telling you the diagnosis.” By emphasising the centrality of history-taking and the examination of patients, Osler compressed the course of undergraduate and postgraduate development. Physicians would no longer embark on a haphazard journey of discovery but would acquire clinical method at the beginning of their vocation. Outside of the junior ranks, he was knowingly and selectively appreciative of contemporaries such as William Gowers whom he called “that brilliant ornament of British medicine,” a physician assessed as the most piercingly talented neurologist of all time.
Though solicitious in manner when it came to the teaching of medicine the humanism of Osler was apparent in his unquenchable thirst for humour. As a child he had met a visitor at the door and told him that his father, waiting inside the house, was extremely hard of hearing. Before ushering the gentleman into the study, Osler the boy had warned his father that the new visitor had eardrums of cloth. As the two men shouted at each other in a tiring conversation the boy Osler was hiding round the corner with a hand on his mouth and tears in his laughing eyes.
Returning to the country from which his parents had left for Canada, Osler became Regius Professor of Medicine at the University of Oxford in his middle fifties, a post he would occupy for the last fifteen years of his life. In the June of 1915, with the Great War now unravelled, Professor Osler climbed into a horseless carriage on a wet English day in Oxford and began snailing and bouncing along in a northwesterly tangent. Made happier by a couple of friends, he stopped first in the Regency City of Cheltenham before chuntering on to the town of Malvern in the county of Worcestershire. Having viewed the famous Malvern Hills the famous physician bounced into the city of Worcester to visit the cathedral and was moved by the stock and tranquillity of its library. Two years later he lost his only child, his son, in the trenches of the Great War and a chain of the more reflective historians have attributed his own end another two years later to the effects of this personal calamity. When asked how he wished to be remembered the eulogised Osler was as steady as the Rock of Gibraltar in his response : “I wanted to be remembered for bringing the students out of the lecture hall and onto the wards.”
Competing interests: No competing interests