TY - JOUR
AU - Golden, Richard L.
AB - Abstract Sir William Osler is one of the most admired and honored physicians in the history of medicine. He influenced the development of medicine in Canada, the United States, and Great Britain, where he held professorships at McGill University, the University of Pennsylvania, Johns Hopkins University, and Oxford University. Through his textbook, The Principles and Practice of Medicine, and other clinical and philosophical writings, he exercised a truly global influence. In this sesquicentennial of his birth, William Osler continues to serve as a model of excellence for the medical profession. This examination of the reasons for his enduring impact reveals a legacy of clinical, scientific, literary, educational, and intraprofessional accomplishments linked to a remarkable personality, and bound together by an extraordinary humanism. William Osler is among the most esteemed and distinguished physicians in the history of medicine. His influence—clinical, educational, and literary—was global, and his legacy remains strong. Although Osler did creditable work in research, he was not a great scientist. The superlative may be applied to him as a clinician, but there were others who functioned at his level. Although tempting, it would be a semantic strain to call him a polymath. There are myriad notable achievers throughout history who are remembered only eponymically or as historical footnotes. Why then, in this sesquicentennial of his birth, does the memory of Osler and his accomplishments continue to captivate succeeding generations? Biographical sketch In reflecting on human achievement, the physician-writer and Osler's favorite author Sir Thomas Browne observed: "The greater part [of men] must be content to be as though they had not been, to be found in the Register of God, not in the record of man."1 Such was not to be Osler's fate, beginning with his birth at Bond Head, Ontario, on July 12, 1849, the anniversary of the Battle of the Boyne (1690) in which the forces of William III, Prince of Orange, defeated James II on the banks of the River Boyne, Ireland, in an important victory for the Protestant cause. When the celebrating Orangemen of the Irish Protestant district of Upper Canada marched to the parsonage in Bond Head, Osler's clergyman father appeared with the babe in his arms and the crowd shouted "William" ("the little Prince of Orange"), and he was so christened. As a youth Osler showed considerable athletic and scholastic prowess combined with high spirits and a reputation as a prankster. His escapades resulted in his expulsion from one school at the age of 14 years, and several days in jail 2 years later when he and his cronies barricaded the door of an unpopular school housekeeper and subjected her to the noxious fumes of molasses, pepper, and mustard heated on the schoolroom stove.2 Osler's initial undergraduate studies at Trinity College, Toronto, were directed toward the ministry, following in the footsteps of his father. In Osler's second year, however, his keen interest in natural science, which had been strongly nurtured by his teachers, asserted itself in a decisive switch to medicine. He entered the Toronto Medical School and later transferred to McGill University School of Medicine, which offered a 4-year curriculum and access to better clinical facilities at the Montreal General Hospital.2 After graduating in 1872, the newly minted doctor departed for the traditional European wanderjahre of Canadian graduates, with thoughts of a career in ophthalmology.2 Osler pragmatically abandoned this quest when his friend and mentor, R. Palmer Howard, professor of medicine at McGill, wrote that other physicians in Montreal were planning to pursue this specialty. He then began to build the foundations for his future career with uncommonly broad-based studies including physiology, medicine, pathology, surgery, neurology, and dermatology in the clinics and laboratories of London, England; Berlin, Germany; and Vienna, Austria. Returning to his alma mater in 1874, Osler began an active period of teaching, private practice, performing autopsies, and taking charge of the smallpox wards for his willing colleagues. In addition to formal lectures, he introduced the first course in clinical microscopy in Canada, purchasing the instruments at his own expense, and later established McGill's first physiology laboratory.2,3 These unusually varied activities culminated in his appointment as professor of the Institutes of Medicine at McGill the following year. In 1878, he was elected to the post of attending physician at the Montreal General Hospital and at once began the practice of bedside teaching on his ward, a McGill tradition4 that contrasted with the predominantly didactic instruction at most medical schools of the time.5 In 1884, after tossing a coin to decide, Osler, with a firmly established and growing reputation, came to the United States as professor of clinical medicine at the University of Pennsylvania. He flourished in Philadelphia as teacher, clinician, and consultant, establishing a clinical laboratory at the University and imparting a contagious enthusiasm to his students on the wards where he expanded bedside instruction and in the autopsy room where he demonstrated morbid anatomy.2,6 Osler also entered into the genteel social life of the city, participated in its clubs and societies, and established new friendships. When John Shaw Billings offered Osler the chair of the department of Medicine at the newly formed Johns Hopkins Hospital and Medical School in 1889, Osler did not hesitate to accept. This was the opportunity to fulfill his aspiration to establish a great clinic in the German model, with a well-organized house staff, proper laboratories and research, and an English system of clinical clerks.7,8 At Hopkins, a new era of American medicine was born, with rigorous admission requirements and quality of training that set new standards in the United States and compared favorably with the venerable European institutions. Candidates for admission were required to have a 4-year college degree including 2 years of premedical training in biology, chemistry, and physics, and a reading knowledge of French and German.2 The "Big Four" of Hopkins, William Welch in pathology and the future dean, Osler in medicine, William S. Halsted in surgery, and Howard A. Kelly in gynecology, all younger than 40 years, organized the hospital departments. Osler, in a jocular vein, commented to Welch: "Well, we are lucky to get in as professors, for I am sure that neither you nor I could ever get in as students."9 It was at Hopkins that Osler wrote his magnum opus in 1891, The Principles and Practice of Medicine.10 The following year he married Grace Revere Gross, the widow of a Philadelphia friend and colleague, and a direct descendant of the Revolutionary War patriot Paul Revere. Physically, Osler was of short stature by today's standards, lithe and brisk in movement, with a wiry athletic figure. Coal black hair over a high forehead, and penetrating dark brown eyes with a humorous twinkle were engagingly set in a face of distinctive mobility that took on a serious, almost stern, aspect at rest. A large, black, flowing mustache and a peculiar, dark, almost olive complexion, reflective of his Celtic ancestry, added to his unique appearance. Dressed immaculately with a flower adorning the buttonhole of his dapper Prince Albert coat, he briskly arrived for rounds each morning leading his entourage with invariable good humor .11-14 In 1905, at the peak of his fame and under considerable stress from the burdens of teaching and practice, Osler was offered the Regius professorship of medicine at Oxford. Although the chair at Oxford carried far fewer responsibilities, he hesitated in accepting this late career move. No doubt his positive decision was influenced by Mrs Osler who cabled him in England: "Do not procrastinate, accept at once. Better go in a steamer than go in a pine box."15 With characteristic energy and verve, his tenure at Oxford, rather than being a sinecure, blossomed into a garland that capped an illustrious career. He organized clinics at the Radcliffe infirmary, founded journals and medical societies,16 and entered into the intellectual life of England with ultimate election to the presidencies of the Section of the History of Medicine of the Royal Society of Medicine (1912), the British Hospital Association (1913), the Fellowship of Medicine (1919), and the Ashmolean Natural History Society (1919). His home at 13 Norham Gardens, with its continuous stream of visitors, became known as the Open Arms. Osler was created a baronet in 1911 as part of the coronation honors of George V. In 1917, his only surviving son, Revere, was killed while serving in the British army, a blow that Osler struggled with for the remainder of his life. He wrote: "The fates do not allow the good fortune that has followed me to go with me to the grave—call no man happy until he dies."16 Sir William Osler died at Oxford in December 1919 of bronchopneumonia and empyema.17 In a biographical profile, the physician-historian Fielding H. Garrison said of him: When he came to die, Osler was, in a very real sense, the greatest physician of our time. He was one of Nature's chosen. Good looks, distinction, blithe, benignant manners, a sunbright personality, radiant with kind feeling and good will towards his fellow men, an Apollonian poise, swiftness and surety of thought and speech, every gift of the gods was his; and to these were added careful training, unsurpassed clinical ability, the widest knowledge of his subject, the deepest interest in everything human, and a serene hold on his fellows that was as a seal set upon them. His enthusiasm for his calling was boundless.18 He had served 3 nations, all of which took him for their own. The ethos The distinguishing ethos of a man cannot be easily explained or divided into neat subdivisions, for there are nuances, interactions, and subtleties that defy precise analysis. Osler left a body of work encompassing writings in medical science and his philosophy of life, both personal and professional. In addition to his literary accomplishments, he built a magnificent library. He advanced the frontiers of medical education and was a unifying force in the medical profession. Osler had presence and a catalytic personality that brought him friendship, devotion, and disciples. But what was the binding force of this paradigm, the cement of the structure of his greatness? It was humanism. William Osler was a humanist, not merely in the narrow sense of educational or literary culture which he certainly had, but in the broader sense of compassion, understanding, and the love of one's fellow man.19,20 Writings Osler left a written record, a vast body of more than 1600 items encompassing medical, philosophical, educational, and historical papers, essays, and books.21 As a young man of 19, fascinated with natural history and already a skilled microscopist, he published Christmas and the Microscope,22 a description of the microcosm of a winter stream near Dundas (Ontario) and the beginning of his "inkpot career."23 While doing research in the London laboratory of Sir John Burdon-Sanderson, during his European postgraduate studies, Osler made important, original observations on the nature of the blood platelet.24 On the wards, before the growth of specialization, his clinical perspicacity was legendary and he was among the last of those giants who took all of medicine for their own. Among the disorders that now bear or have borne his name are Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia), Osler disease or Osler-Vaquez disease (polycythemia vera), maladie d'Osler or Osler-Libman disease (subacute bacterial endocarditis), and Osler-Libman-Sacks syndrome to describe systemic lupus erythematosus with verrucous endocarditis. Other terms with Osler's name include Osler maneuver (pseudohypertension), Osler phenomenon (platelet agglutination), and Osler nodes (subacute bacterial endocarditis). Cushing suggested the nomenclature Osler's syndrome for ball-valve gallstone with intermittent jaundice, chills, and fever. It is demonstrative of the catholicity of his interests that there is also a trematode worm, found in the gills of a newt, that carries the name Sphryanura osleri; and a nematode causing canine bronchitis, once called Oslerus osleri.12 Osler's single-authored textbook, The Principles and Practice of Medicine, went through 16 editions and influenced generations of medical students and practitioners for more than a half century, during which an estimated 500,000 copies were printed.25 Written in a clear, precise, literary style with frequent classical and historical references, it provided the latest information on internal medicine enhanced by Osler's extensive knowledge of pathology. Unlike other textbooks, therapeutic information was limited and the absence of adequate treatment for most diseases freely admitted. The book's impact was not limited to the English-speaking world which saw American, British, and Indian editions, but had a truly global effect through its translations into Russian, French, German, Chinese, Spanish, and Portuguese. In the summer of 1897, Frederick T. Gates, a Baptist minister and philanthropic assistant to John D. Rockefeller, read the entire book to acquaint himself with the current state of medical knowledge. Impressed with the literary quality of the book and Osler's scientific candor on medicine's inability to cure most diseases, he recommended the support of medical research to Rockefeller. From this came the establishment of the Rockefeller Institute of Medical Research.25 Many a physician and scientist has left a distinguished and respected professional corpus but is little remembered by future generations. It was on the foundation of his nonscientific writings, however, that the conditions of Osler's special distinction began to take form. The best known of his philosophical essays, A Way of Life26 and Aequanimitas With Other Addresses to Medical Students, Nurses and Practitioners of Medicine,27 have been reprinted numerous times, the latter having been traditionally presented to some 150,000 graduating physicians between 1932 and 1953.28 Here Osler tells us: I have had three personal ideals. One to do the day's work well and not to bother about to-morrow. . . . The second ideal has been to act the Golden Rule, as far as in me lay, towards my professional brethren and towards the patients committed to my care. And the third has been to cultivate such a measure of equanimity as would enable me to bear success with humility, the affections of my friends without pride and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man.7 With the Titanic in mind he advises us to live with "day-tight compartments"26 and to follow the credo of Carlyle who said: "Your business is ‘not to see what lies dimly at a distance, but to do what lies clearly at hand.'"29 He sets no lofty goals, suggests no pretentious achievements, but rather counsels us that, "To have striven, to have made an effort, to have been true to certain ideals—this alone is worth the struggle."30 Books and Libraries With eloquence and wit, Osler acknowledged the extent of his bibliomania when addressing an international antiquarian booksellers congress: You see before you a mental, moral, almost, I may say, a physical wreck—and all of your making. Until I became mixed up with you I was really a respectable, God-fearing, industrious, ardent, enthusiastic, energetic student. Now what am I? A mental wreck, devoted to nothing but your literature. Instead of attending to my duties and attending to my work, in come every day by the post, and by every post, all this seductive literature, with which you have, as you know perfectly well, gradually undermined the mental virility of many a better man than I.31 His lifelong devotion to books and libraries led to his election to the presidencies of the Medical Library Association [America] (1901), [England] (1910); the Bibliographical Society (1913); and the Classical Association (1919), uncommon achievements for a medical man. Osler's gifts to libraries were munificent and occasionally embarrassing, as when he absentmindedly presented a copy of Vesalius's Fabrica to McGill for the second time.16 In the United States, his influence and untiring support were well-known at the libraries of the surgeon general in Washington, The College of Physicians in Philadelphia, and at the Johns Hopkins Medical School and the Medical and Chirurgical Faculty in Baltimore. At Oxford, Osler served as ex-officio Curator of the Bodleian Library where he soon became a familiar face both as a dignitary and a reader.2,16 When Osler spoke at the Boston Medical Library he confessed: "It is hard for me to speak of the value of libraries in terms which would not seem exaggerated. Books have been my delight these 30 years, and from them I have received incalculable benefits."32 In the introduction to the Bibliotheca Osleriana, the descriptive catalog of his great collection, Osler philosophizes: "a library represents the mind of its collector, his fancies and foibles, his strength and weaknesses and preferences . . . The friendships of his life, the phases of his growth, the vagaries of his mind, all are represented."23 In the catalog Osler divides his library into 8 divisions: I. Prima, which gives in chronological order, a bio-biographical account of the evolution of science, including medicine; II. Secunda, the works of men who have made notable contributions, or whose works have some special interest, but scarcely up to the mark of those in Prima; III. Litteraria, the literary works written by medical men, and books dealing in a general way with doctors and the profession; IV. Historica, with the story of institutions, etc.; V. Biographica; VI. Bibliographica; VII. Incunabula; and VIII. Manuscripts.23 The collection of almost 8000 volumes was bequeathed to McGill University where it became the Osler Library of the History of Medicine in 1929. The nucleus of the library is the Osler Niche, dominated by a bronze bas-relief of Osler, the Vernon Plaque, surrounded by his favorite books including the works of Sir Thomas Browne, Robert Burton, and François Rabelais. Here, his ashes and those of Lady Osler lie concealed behind a panel in fulfillment of the bibliophilic desire of which he wrote: I like to think of my few books in an alcove of a fire-proof library in some institution that I love; at the end of the alcove an open fire place and a few easy chairs, and over the mantle piece an urn with my ashes and my bust or my portrait through which my astral self, like the bishop of St. Praxed could peek at the books I have loved, and enjoy the delight in which kindred souls still in the flesh would handle them.33 Education In the field of education, Osler considered his advocacy of the bedside training of students as his major achievement and indeed, suggested that his epitaph be: "He taught medicine in the wards."34 The dedication in Harvey Cushing's The Life of Sir William Osler is: "To Medical Students . . . lest it be forgotten who it was that made it possible for them to work at the bedside in the wards."2 At the Johns Hopkins Hospital, Osler introduced and used the clerkship as the means of clinical instruction and advocated that " . . . the natural method of teaching the student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end."8 In dealing with students, Osler not only correlated his teaching with ward work, but opened his home and personal library, and inculcated in them an interest in books and the history of medicine. Known as "the young man's friend,"35 he considered himself a life-long student and warned his pupils: The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.36 To this end Osler revealed to his students the "secret of life" promulgated in a single "master-word"—work. "To the youth it brings hope, to the middle-aged confidence, to the aged repose." He further elaborated: "The stupid man among you it will make bright, the bright man brilliant, and the brilliant student steady."37 Osler was well aware of the problems of medical education in his time and the major imperfections of many of the pre-Flexnerian medical schools where ill-prepared students received didactic instruction, often from poorly trained lecturers in the context of an abbreviated curriculum.38 To this he counseled: "To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all."32 In a day when students could graduate from medical school without having seen a delivery or the abdomen surgically opened, he urged his students to: Live in the ward. Do not waste the hours of daylight in listening to that which you may read at night. But when you have seen, read. And when you can, read the original descriptions of the masters who, with crude methods of study, saw so clearly.39 Henry A. Christian, later professor of medicine at Harvard, recalled his student impressions of Osler at the bedside: He would enter a ward . . . go to a patient's bed, . . . give him a cheery greeting and, if he were a new patient, ask for his history which was then given by the student clinical clerk. After it had been commented on, possibly criticized and often added to and illuminated by Dr Osler . . . the report of the physical examination was called for from the clinical clerk. Often he was asked to demonstrate the features of the clinical examination. Usually Dr Osler made some examination himself and demonstrated and discussed salient features, all the time mingling his discussion with remarks and explanations to the patient so that he would not be mystified or frightened. . . . Ward visits were an unusual combination of informality and dignity. Students and patients were quickly put at ease by Dr Osler. His criticisms of students and their work were incisive and unforgettable, but never harsh or unkindly; they inspired respect and affection, never fear.40 Women were admitted to the new Johns Hopkins Medical School on the same basis as men as a result of the provisions of an endowment given by Mary Garrett, an ardent feminist.2 Osler, who was sympathetic to the medical education of women, although with some reservations characteristic of the time, later wrote: For years I have been waiting the advent of the modern Trotula [an 11th century female medical author of Salerno], a woman in the profession with an intellect so commanding that she will rank with the Harveys, the Hunters, and Pasteurs; the Virchows, and the Listers. That she has not yet arisen is no reflection on the small band of women physicians who have joined our ranks in the last fifty years. Stars of the first magnitude are rare, but that such a one will arise among women physicians I have not the slightest doubt. And let us be thankful that when she comes she will not have to waste her precious energies in the worry of a struggle for recognition.41,42 Osler's approach to education was not only to produce technically competent physicians, but also to make reliable, caring physicians of high character and standards. He counseled medical students on "a way of life,"26 devised criteria and methods for their education,5 provided a textbook with both literary and scientific merit,10 and supported new schools and institutions. Wilder Penfield, the eminent Canadian neurosurgeon, said of him: He belongs to medical students of all time, as Lincoln belongs to the common man everywhere, a man who grew to be what he wanted by dint of hard work, and in whose footsteps any undergraduate may dare to ‘hope and dream' that he may follow.43 The Profession Medicine was thought of in the divine sense by Osler when he told his students: You are in this profession as a calling, not as a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.44 When he addressed the graduating class at McGill in 1875 he cited this lesson from Sir Thomas Browne, cautioning that, "No one should approach the temple of science with the soul of a money changer."45,46 Osler was a peacemaker in the profession. He spread the doctrines of "unity, peace and concord"47 among his colleagues by means of a personality that brooked no prejudice or intolerance, brought together clannish schools, societies and factions, and eliminated hostility through his special charm, friendship, and the appeal of a magnetic leadership. Just as early in his career he brought together the discordant French and English physicians of Montreal, so he later unified the medical community of Baltimore represented by 5 hostile medical schools that faced the conceived threat of the new Johns Hopkins Medical School.2 On a national scale he called for a more cohesive profession by advocating interstate licensing reciprocity, medical school consolidation, and a reconciliation with homeopathists (in spite of "the anomaly of their position").47 In Oxford, bolstered by experiences in 3 nations, he helped draw together British and North American medicine. Osler strongly and repeatedly rejected contemporary medical chauvinism proclaiming: The great republic of medicine knows and has known no national boundaries.37,48 . . . The profession in truth is a sort of guild or brotherhood, any member of which can take up his calling in any part of the world and find brethren whose language and methods and whose aims and ways are identical with his own.49 Personality An attempt to describe a personality is often an exercise in vacuous semantics, particularly in regard to the past. Osler lived in an early era of technology and probably left no vocal or cinematic clues, and indeed, seemed ill at ease with the portraiture of canvas and camera. Nevertheless, it is from the narrations of his contemporaries and disciples, as well as his own words, that we garner some insights into this remarkable man. He had warm presence, a lodestone personality combined with charm and mirth, and the ability to effortlessly spread the mantle of his wisdom and friendship to a vast host. A New York pathologist, D. Bryson Delavan, sums up a more than 40-year acquaintanceship describing Osler as: Generous, gracious, magnetic, responsive, he attracted himself to all who were worth knowing, ever seeking merit in others and appreciating it when found. At once a discerning companion and a great leader, he more than others, has exemplified to me the beauty of friendship, the glory of work, and the joy of living.50 In reflecting on Osler's image, William B. Bean, the first president of the American Osler Society, opined: Though his warmth was widely diffused, it never became attenuated. Each person in the group—the patient, the nurse, the student—felt that Osler's special interest and favour centred on just one person, himself.11 Egerton Yorrick Davis was not only a nom de plume of Osler, but a veritable alter ego who provided a balance and no doubt an outlet for the staid Victorian-Edwardian period in which Osler lived. It was in his Davis persona that Osler engaged in practical jokes, told tall tales, wrote elaborate hoaxes, and indulged his proclivities for sexual topics. He thus wrote on Peyronie disease, penis captivus, and the fanciful marital and obstetrical customs of the Indian tribes of the Canadian Northwest Territories.33,51 Once, when in the throes of an attack of renal colic, he added some quartz stones from the driveway to his urine specimen.52 He often signed hotel registers as Egerton Y. Davis and playfully did so once while traveling with Mrs Osler—no doubt to her annoyance and chagrin.2 Henry Hurd, the first superintendent of the Johns Hopkins Hospital observed: His boyishness and love of fun continued as long as he remained in Baltimore, and many of his friends learned to know what to expect and to measure the amount of credence to be placed on many of his extravagant statements.53 A special facet of his personality was his delight in children who immediately sensed his empathy and affinity and allowed him uninhibited entry into their world. Wilder Penfield recalled his chilly reception as a student at Oxford University, and his apprehensive arrival at the Open Arms to meet the Regius professor: At the far end of the room we found a young officer stretched out on the floor and Sir William on his knees bandaging an imaginary wound with his pocket handkerchief. The explanation of the strange scene was to be found in the ecstatic applause of two little children. They called the kneeling man William and he was evidently a beloved companion. He got up and came to me laughing.54 There are observers who consider that Osler's light-hearted, merry exterior concealed an inner melancholy; and that his driving force flowed from a deep sorrow within, perhaps like "the wounded healer" of Aesculapian myth.11,12,19,55,56 Sir Robert Hutchinson believed that "a nature so sensitive as his could not escape from the sense of tears in mortal things and that his ears were always open to the ‘sad still music of humanity.'"57 When asked why he whistled after attending a gravely ill patient, Osler replied, "I whistle that I may not weep."58 The theory of his melancholy represents a minority view, provocative but uncorroborated. Osler was remarkably free of prejudice, intolerance, and malevolence, particularly so considering the contemporary mores to which he was exposed. In commenting on Osler's boyhood and the prejudices of the times, his cousin, Norman Gwyn, in a testament to a tolerance remarkable for the time, observed that "the seed of prejudice must have fallen on stony ground in Sir William's case. . . ."59 This was echoed by Osler: What I inveigh against is a cursed spirit of intolerance, conceived in distrust and bred in ignorance, that makes the mental attitude antagonistic, even bitterly antagonistic, to everything foreign, that subordinates everywhere the race to the nation, forgetting the higher claims of human brotherhood.49 Commenting on the progress of the state of medicine in the English-speaking world, in a statement far ahead of his time, he further cautioned: "Distinctions of race, nationality, colour, and creed are unknown within the portals of the temple of Æsculapius."60 Sir Arthur S. MacNalty, who first met Osler as a student at Oxford, remembered him in this memorial tribute: He advanced the science of medicine, he 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 metaphorically as well as physically. 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 the magic touchstone of his generous personality helped many a disponder in the rugged paths of life. He achieved many honors and many dignities, but the proudest of all was his unwritten title, ‘the Young Man's Friend.'16 Humanism Humanism is a complex, sometimes confusing, glibly used term: a catchword that may be loosely used to endorse the goals of various groups and individuals of diverse philosophies. It is used here not in its older and admittedly more precise educational and literary context, but in its more comprehensive sense. As Pellegrino has defined it: Humanism encompasses a spirit of sincere concern for the centrality of human values in every aspect of professional activity. This concern focuses on the respect for freedom, dignity, worth, and belief systems of the individual person, and it implies a sensitive, non-humiliating, and empathetic way of helping with some problem or need.61 Humanism in the care of patients was not part of the contemporary idiom of Osler's era, but the concept was an innate part of his philosophy and professional conduct extending to his relationships with physicians, nurses, and students. He counseled the latter group to: [c]are more particularly for the individual patient than for the special features of the disease.48 . . . Nothing will sustain you more potently in your humdrum routine, as perhaps it may be thought, than the power to recognize the true poetry of life—the poetry of the common place, of the ordinary man, of the plain, toilworn woman, with their loves and their joys, their sorrows and their griefs.36 A cousin, Marian Osborne, Canadian author and poet, recounts how on a cold Montreal day Osler ran after an aged, alcoholic beggar to whom he had earlier given some coins and removing his overcoat placed it on the astonished old man exclaiming: "Here, take this, I have a father of my own. You may drink yourself to death, and undoubtedly will, but I cannot let you freeze to death."58 During his Oxford tenure, Osler was a frequent visitor to the home of his friend and colleague, Ernest Mallam. In a story often told, Patrick Mallam, then a child, recalls the illness of: . . . a younger brother with very severe whooping-cough and bronchitis unable to eat and wholly irresponsive to the blandishments of parents and devoted nurses alike. Clinically it was not an abstruse case, but weapons were few, and recovery seemed unlikely.62 Osler, on the way to graduation ceremonies in his academic robes, stopped and saw the child, and after a brief examination, peeled, cut, and sugared a peach, which he fed bit by bit to the enthralled patient. Although he felt that recovery was unlikely, he returned daily over a 40-day period, each time dressed in his robes, and personally fed the child some nourishment. Within a few days the tide began to turn and recovery became evident. Mallam concluded: If the value of personal approach, the quick turning to effect of an accidental psychological advantage (in this case decor), the consideration and extra trouble required to meet the needs of an individual patient, were ever well illustrated, here it was in fullest flower. It would, I submit, be impossible to find a fairer example of healing as an art. This kind of inspired magic, independent of higher degrees and laboratory gimmicks is given only to a doctor with a real vocation, and the will to employ it.62 Conclusion William Osler is the quintessential physician of our time because of his literary legacy, scientific and clinical accomplishments, educational contributions, and influence on intraprofessional relationships. He had an extraordinary personality, a facile wit, a bibliophilic spirit, and a philosophy of life that permitted him to envision and achieve remarkable goals. Osler's humanism, which permeated all of his activities, was the sine qua non of his particular claim to posterity. His continuing influence on succeeding generations is that of a role model (or hero in an older parlance) that has often been characterized as "the Oslerian tradition," a concept appropriately defined by Bryan as "a virtuous approach to medicine and life as taught and modeled by Osler."63 The life and philosophy of William Osler continue to serve as a standard of excellence and a model for the evolution of the profession and its practitioners. References 1. Browne T. Hydriotaphia or urne buriall. In: Endicott NJ, ed. The Prose of Sir Thomas Browne. Garden City, NJ: Doubleday; 1967:282. 2. Cushing H. The Life of Sir William Osler. Oxford, England: Clarendon Press; 1925:i. 3. Howard RP. The Chief: Dr William Osler. Canton, Mass: Science History Publications; 1983. 4. Reid EG. The Great Physician: A Short Life of Sir William Osler. 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TI - William Osler at 150: An Overview of a Life
JF - JAMA
DO - 10.1001/jama.282.23.2252
DA - 1999-12-15
UR - https://www.deepdyve.com/lp/american-medical-association/william-osler-at-150-an-overview-of-a-life-ZhfBuhkaaQ
SP - 2252
EP - 2258
VL - 282
IS - 23
DP - DeepDyve
ER -