The Myth of William Osler: A Re-Examination of the Legacies of a Medical Legend

By Patrick Fiddes

The Myth of William Osler presents a radical re-examination of the philosophies and practices of a renowned American medical hero.
It challenges widely-accepted beliefs about Osler which, while unsettling to many readers, brings to light interpretations and approaches which have disrespected Osler’s expressed wishes, exaggerated his achievements and dishonoured his memory.
The Myth questions the originality of both Osler’s teaching philosophies and his educational legacies, and the credit he received for educational innovations that were not his. It examines Osler’s disregard of contemporary advances occurring in moral philosophy and medical ethics, his uncertain values and his documented unethical practices.
The Myth argues that Osler’s immutable habit, his proclaimed Way, reflected a lifelong application to each task that, in the end, became his defining flaw.
While William Osler’s reputation as a learned medical historian is not contested, The Myth attests that even here, his interpretations of medicine’s history were highly selective, often constructed to support a view predicated on Ancient Greek, Renaissance European and English medical philosophies and practices. Osler’s teaching—as revered as it was—centred on the ancient tradition of the Hippocratic art of observation while remaining largely untouched by the emerging importance of the patient’s history that was being pursued by more unbiased and innovative others.
William Osler’s legacy will stand but with a greater complexity than has been previously appreciated.

• Language: English
• Publisher: Austin Macauley Publishers
• Release date: Jul 30, 2021
• ISBN: 9781398456167

Patrick Fiddes

Patrick Fiddes is a retired consultant physician in internal medicine and an associate professor of medicine at Monash University in Melbourne, Australia. His long interest in medicine’s history, its teaching and its ethics gave him cause to reappraise the novelty of William Osler’s contributions to medical education.

Book preview

The Myth of William Osler

A Re-Examination of the

Legacies of a Medical Legend

Patrick Fiddes

Austin Macauley Publishers

The Myth of William Osler

The Myth of William Osler

Copyright Information ©

Acknowledgements

Preface

Introduction

Chapter 1: The Warrant for an Eternal William Osler

Chapter 2: The Genesis of a Teacher

Chapter 3: The Essence of Osler’s Person

Chapter 4: Osler’s Way

Chapter 5: The Nexus Between Osler’s Philosophy and His Teaching

Chapter 6: Osler’s Applications of Philosophy

Chapter 7: William Osler’s Conduct of Life

Chapter 8: Osler’s Pageant of History: His Quest for Knowledge

Chapter 9: Prejudices, Preferences, Truths and Ideological Fallacies

Chapter 10: An Oslerian View of the Renaissance of Medical Learning

Chapter 11: The Standards of Osler’s Teaching

Chapter 12: Osler’s Idée Fixe

Chapter 13: Osler and Osleriana: Fidelity and Apocrypha

Chapter 14: The Merit of Osler’s Educational Practices

Chapter 15: William Osler’s Legacy

Bibliography

Endnotes

About The Author

The Myth of William Osler

Copyright Information ©

Patrick Fiddes 2021

The right of Patrick Fiddes to be identified as author of this work has been asserted by the author in accordance with section 77 and 78 of the Copyright, Designs and Patents Act 1988.

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Acknowledgements

Among the many who have contributed to the genesis of this book is one without whose direction and assistance both the doctorate thesis on which this work is based, and the book itself, could not have reached fruition. Professor Paul Komesaroff has provided me with his unstinting expertise and guidance throughout the period of the research and writing of both, and any success this work may have is due as much to him as to the author.

I am as deeply indebted to the counsel and abundant support provided by Emeritus Professor David Dunt for his thesis supervision and his considerable assistance and advice in the subsequent preparation of the book.

To my daughter, Alisa Fiddes, I express my deepest gratitude for her invaluable editorial advice during the finalisation of my thesis and for her counsel concerning the essence of the subsequent book.

I also express my gratitude to the librarians at Peninsula Health, to Stephen Herring at Monash University’s Rare Books Library, to Chris Lyons and Bozena Latincic at the McGill University Osler Library of the History of Medicine, and to David Russel, Librarian at the Royal Australasian College of Physicians, Sydney. I thank Janty Taylor, site administrator, Peninsula Clinical School for her unfailing assistance and support in the preparation of the thesis.

More than any, I thank my wife Linda, and my family, for their unfailing support and patience throughout these two works.

William Osler, Bart. MD. CM. DCL. LLD. DSc. FRCP. FRS.

Born: July 12th 1849.

Died: December 29th 1919.

To have striven, to have made an effort, to have been true to certain ideals—alone is worth the struggle.i

Tables

William Osler’s journal publications in his four academic appointments.

Illustrations

William Osler’s Permission to Camac

Palmer Howard’s Certificate

Attachments

1. Sir William Osler’s Monographs

2. The Hippocratic Oath

3. The Hippocratic Law

4. The Ideal Physician

5. North American Medical Schools Established Before 1830

6. A Definition of a Gentleman: John Henry Newman

Preface

In The Myth of William Osler Patrick Fiddes undertakes a complex and courageous task. Despite an obvious deep respect and admiration for the man who was once called the greatest physician of history, he sets out to scrutinise, carefully and methodically, the evidence on which an entire legend has been built. The result is this deeply challenging and iconoclastic book that concludes by proposing a fundamental reappraisal of beliefs and assumptions that have been taken for granted by generations of health professionals.

It is not contested that William Osler was an important figure in the development of modern medicine. No doubt is cast on his erudition, his commitment to teaching, his respect for careful observation and the emerging clinical sciences, or his charismatic ability to communicate with, and gain the respect of, his students and peers. It is recognised that Osler authored many monographs and journal articles and an important textbook, and made many acclaimed speeches. It is accepted that he was an important protagonist in the process of the transition of medicine from the ancient Hippocratic tradition of paternalistic clinical observation to the modern paradigm of a dynamic partnership in which the voice and the experience of the patient provides crucial knowledge and insight. What is at stake is William Osler’s personal contribution to this process and whether the pre-eminent place attributed to him by many of his successors is justified by the evidence.

Fiddes’ scepticism presumably arises in part from the sheer volume of adulatory texts and encomia that have accumulated over the years and the near complete absence of a critical literature devoted to testing their claims. It may also derive from the observation that, despite Osler’s deep erudition and devotion

to medical education and the application of scientific evidence, there is no major discovery with which he is associated, and there were many other figures whose innovativeness in education far exceeded his. The developing contemporary appreciation of the specificity of modern medicine and the philosophical insights that allowed it to move beyond the empirical formations pioneered in the eighteenth century may also have contributed.

Fiddes’ critical appraisal of the voluminous literature, comprising both Osler’s fifteen hundred personal publications and the nearly two thousand publications about him, is rigorous and painstaking. He has also included in his analysis hitherto largely neglected material from posthumous eulogies and memorial articles by those who had known Osler personally. On the basis of this material, he poses some uncomfortable questions and comes up with some troubling answers. In essence, he concludes that the Osler literature contains a great deal of hyperbole and that it is necessary for scholars to distinguish between provable claims and the exaggerated, often factually inaccurate, assertions which have to a significant extent contaminated the historical record.

It has been claimed that the qualities which contributed to the view of some that Osler was the greatest physician of history included his humanism, his teaching and his character. However, as Fiddes has shown, when the evidence is examined dispassionately, major deficiencies become apparent in all three domains. As a humanist and philosopher Osler was at best a minor figure, largely repeating the lessons he had learnt by rote in his early years studying ancient Greek philosophy. He was highly selective in his renditions of medical history and its heroes. He remained unaware of many major contemporary developments in moral philosophy. Surprisingly, he took little interest in the emerging importance of the patient’s experience in the diagnostic process.

In its analysis of Osler’s ward-based teaching, and the history of medical education, The Myth of William Osler shows that claims that the introduction into medical schools of crucial innovations in educational philosophy that laid the basis for a transformation in clinical teaching was an achievement of William

Osler himself, were largely untrue. While Osler was undoubtedly committed to teaching, his educational philosophies and practices were in fact highly derivative, having been adapted from those of more original thinkers.

While the reverence in which Osler continues to be held was already firmly established in his lifetime, his character also left a lot to be desired. His contemporaries testified to his humility, his strong work ethic and his commitment to science and knowledge. However, he also displayed inflexibility, an inability to accept change, along with personal traits that in contemporary terms would be regarded as paternalistic and sexist, based as they were on an assumption of the superiority and entitlement of the wealthier classes. As Fiddes shows, the easy defence here that Osler was merely a man of his times is unconvincing, because many of the attitudes and behaviours he exhibited had already in his lifetime attracted vigorous critical comment and opposition.

Fiddes concludes that despite the massive, uncritical literature, the construction of William Osler as the father of modern medicine simply does not accord with the evidence. When Osler’s thought and life are examined with forensic precision he falls more on the side of a declining, already largely effete, medical culture than of that of the exuberant, innovative, emerging modernity. While he certainly supported extending the application of empirical science to clinical practice that had been initiated more than a hundred years earlier, he was never able to appreciate the key epistemological and ethical innovations that were to become the foundation for the newly emerging paradigm of medicine. The critical breakthrough to modernity had to be taken by others less constrained by the declining and outdated traditions of Hellenic Hippocratism.

This conclusion lays the basis for Fiddes’ radical—and potentially inflammatory—claim: that much of the contemporary view of Osler is in fact an historical invention that stands in direct contradiction to the facts. William Osler was but one of many outstanding physician-educators—admirable perhaps, but

not the sole or even the main founder of a new practical discipline and social practice.

The unmasking of the grandiloquent exaggerations underlying the construction of the Osler legend raises deep and troubling questions. How is it that the historical record has come to be so distorted? Why have generations of physicians and historians of medicine failed to question key assumptions and beliefs of significant consequence for the understanding of contemporary practice? How is it that an entire academic industry has arisen and flourished on the basis of claims that are directly contrary to the evidence? What does this tell us about the discipline of medicine itself, that claims to be based quintessentially on a disinterested appraisal of evidence and scientifically-validated data?

In taking on assumptions and beliefs deeply embedded within contemporary medicine Patrick Fiddes has written a brave and challenging book, but it was a book that had to be written. His exposure of the adulatory magnifications of Osler’s work brings medical history more closely into line with factual reality. It also leaves us with the lingering questions about how such collective blindness is able to develop in the first place, and how—or whether—we can protect ourselves from it in the future.

Paul A. Komesaroff

Introduction

The immediate problem that confronts any contemporary examination of William Osler’s philosophies and his teaching practices is that the existing body of Oslerphilic literature is accepted as having sufficiently portrayed both his nature and his highly commended intellectual works. The further problem is that he has become such a popular legend that any questioning of his person, or doubt about his work, may be dismissed as heterodoxy.

William Osler has been immortalised by successive generations of dedicated Oslerphiles who have collectively established a voluminous literature that attests to both his standing and his high personal and professional regard. Such literature embodies the work of many scholarly Oslerphiles, among which are some that have genuinely advanced the body of Oslerian knowledge, others that have portrayed Osler’s general and professional philosophies while avoiding deeper interrogations of their foundations, and much that represents an assiduous reworking of existing and well-known Oslerian data, yet, has contributed little to his further understanding. Together, these accounts have illustrated the life and legacy of this most complex man.

However, among this literature are accounts that were written by his admirers and those who were captivated by his charisma and enthralled by his legend. Much of this literature has since been deemed to have been hagiographic, among which are claims that amount to apocrypha and a small number that have empathetically canonised him or portrayed Osler as being God-like or saintly.

Such inaccuracies reflect a concerning disrespect for Osler’s expressed wishes and give sufficient reason to question the reliability of the existing accounts of William Osler’s personal and educational philosophies, of his legacies to medicine’s teaching and the judgement of those authors who magnified his person or his contributions.

It is without question that William Osler was the most famous physician in America during a critical period of change in its medical schools, changes that were both necessary in the teaching of its undergraduates and in the training of her postgraduates. Osler became the enduring symbol of the improvements that had been brought into America’s undergraduate clinical teaching and was immortalised by the accolades of those who had known him, by those who admired him, and by those who were to follow and hold him in like high regard.

Osler’s personal celebrity was to facilitate the legend that surrounds his name and continues to be deserved for reasons that include: the number of his academic appointments; the many honours he received; his ardent commitment to teaching; his advocacy for the inclusion of the sciences and the humanities in medical education; for his books and monographs, and, for the considerable volume of his clinico-pathologic research publications. Osler’s work and passions were to compliment a bibliographic avocation that enabled him to leave a material legacy of a memorable book collection, a publication list that encompassed two textbooks, several medical monographs, many journal articles and ninety-nine speeches that he had published as essays. These achievements were coupled with his passion for the history of medicine and a commitment to the practices and theories that had been held by successive generations of physicians whose principles he was to apply in his teaching of his students.

In July 1919, at the time of his seventieth birthday, Osler’s standing was recognised by his past colleagues and students who published a comprehensive two-volume book, Contributions to Medical and Biological Research dedicated to Sir William Osler. Also in July 1919, his previous Johns Hopkins’ colleagues published a series of articles in the Johns Hopkins Bulletin, which was then published as a book in 1920, Sir William Osler, Bart.

In December 1919, five months after his birthday, William Osler died and his life and work were honoured in a further series of publications. Of these, the first was an obituary published in The Times four days after his death, which empathetically described Osler as the greatest physician of history. Fremantle’s letter was followed by Osler’s funeral eulogies and many obituaries. In July 1920, the Canadian Medical Association Journal devoted an entire edition to 16 articles by his close friends and colleagues that became the Sir William Osler memorial number. Next, Lady Osler asked her husband’s close friend, Harvey Cushing, to write Osler’s definitive biography which was published in 1925 as a two-volume book, The Life of Sir William Osler, and then, in 1926, Osler’s friends, colleagues and past students published the Sir William Osler Memorial Volume. Together, these legacies give a sufficient reason for his continuing high regard and his standing in contemporary medicine.

However, such objective tributes by those who had known Osler personally were followed by a succession of more subjective and popular assessments in which William Osler was presented as an archetypal physician and acclaimed a hero of American medical education. He received further praise for his charismatic and exceptional character, was admired for the wisdom he had expressed in his philosophical speeches and his advocacy for medical and Renaissance humanistic values. Osler also gained respect for the extent and detail of his historicism, and for his determined panhellenism. However, he received the highest praise for his introduction of innovative teaching practices, his enthusiastic mentoring of his students and fellows, and for his determined Hippocratism.

Such praiseful literature continued through much of the twentieth century, which, in 1986, was referred to as an Osler industry and, one decade later, was described as hagiolatry. Despite such cautionary comments, the praiseful literature continued; in 1997, William Osler was proclaimed a virtue ethicist and in 1999, his most recent biographer concluded that Osler had lived an important and heroic life that had approached saintliness.

Such exceptional acclaim positioned William Osler apart from other modern era medical educators and placed him among the heroes of the two- and one-half millennia of Western medicine’s history. However, given the many and wide-ranging advances that had occurred in medicine, and in its teaching during Osler’s life, it appeared remarkable that he, among the many other well-educated and notable academic physician educators of his time, should have received such broad and universal acclaim. William Osler had neither made major-medical discoveries, nor had he introduced new therapies that had improved patient care.

The unparalleled and persisting praise that Osler received seemed immoderate, and perhaps overdone, and had relied on data that had been extrapolated from the posthumous memorial publications, from the writings of others who had known him, and from Osler’s own writings. Such accounts progressively became more laudatory and his attributes, his example and his influence seemed to grow as the period of his life receded. Given that such literature had been called an Osler industry and hagiolatrous, it invited a more considered reading of the Oslerian literature.

From the resultant questioning emerged a William Osler who was indeed a remarkable and most complex physician-educator. Notably, he was a polymath, one who had written an outstanding textbook of medicine and had been a distinguished bibliographer, a determined bibliophile and an outstanding and charismatic educator with an extraordinary knowledge of medicine. He was also a notable Renaissance humanist and a capable educator who had been given the credit for introducing novel teaching practices into America’s medical schools. It was equally evident that Osler had inadvertently become the subject of an immoderate and persisting praise, which more concerningly had amplified his contributions through some unseemly and erroneous apocrypha.

That realisation was sufficient to question the reliability of some of the narratives that surrounded William Osler’s work. Such doubt as to which of the literature about him was sound was matched by an unease about the nature of the man behind the popularised persona. Together, these reservations were sufficient to warrant a more vital appraisal of Osler’s contributions to medical education.

The inherent objectives of such a critical reappraisal of Osler’s philosophical contributions to medical teaching, and of the Oslerian literature, centred on gaining a deeper insight into William Osler’s life, on establishing the formative influences that had facilitated his academic medical career and on the realisation of the relationships between his life and his professional calling. As important was the consideration of both the novelty and the significance of his intellectual and creative works, and the instrumental value that his works will have in medicine’s ongoing history.

Such a broad endeavour reflects the inherent principles of an intellectual biographic inquiry, one that would enable the determination of the rightness of the legend of William Osler. Such a recension has examined the considerable data that was left by William Osler and an even more voluminous Oslerian literature in which there was little that had not previously been examined.

The reappraisal of Osler and the Oslerian literature has achieved a novel and more objective appreciation of an exceptional and gifted physician, whose character, personal development, moral compass and educational philosophies have been subjected to deeper scrutiny. As well, the ways in which he gained his scientific and medical knowledge, and a deep familiarity with the history of medicine and science, have been realised. Each attribute was integral to the distinctive practices he adopted in his direct teaching and in his broader communications with others through the vehicle of his speeches and his publications. Each was essential to the framing of his educational philosophies, of his epistemologies and of his pedagogic practices. Such data has confirmed that William Osler was a determined and lifelong proponent of the philosophy of Hippocratism, and has shown that the hagiolatry he had applied in his renditions of his heroes in medicine’s history was, in turn, applied to Osler by those for whom he had become a like, but modern hero.

Such purposeful overpraising of Osler’s life, his persona and his work has coupled his considerable attributes with an enthusiastic, yet error-laden, commendation of some uncertain values and teaching innovations that were not his. Such purposeful errors have demeaned both the reputation and the memory of one who had made no claim to the conception of the teaching and training methods for which he was to receive inappropriate and unwarranted recognition.

William Osler life was portrayed in six biographies. Cushing’s Life was followed by four lesser biographies and one major biography, in which each author approached Osler’s life differently. Harvey Cushing wrote that an appraisal of Osler’s professional accomplishments was not then required, and that the comprehensive story of his life would speak sufficiently for him. He undertook a detailed and near daily account of Osler’s life, his meetings, his writing, his friendships and his achievements that earned Cushing a Pulitzer Prize for biography. Of the four lesser biographies, three were more personal and interpretative, and admiring. One, however, was more questioning, and in 1951, Bett identified the Osler-idolatry that had by then become apocryphal, and, he also commented that Cushing’s biography had failed to convey the spirit of Osler.

Seven decades after Cushing’s Life, Emeritus Professor Michael Bliss asked if Osler had been the greatest doctor in the world and set out to examine his life in the context of his times and contributions. Bliss had the benefit of substantial new material that had become available in the seventy-four-year interval between him and Cushing, and in his book’s preface, ‘On Doing an Osler Autopsy,’ he stated his intention to undertake a revisionist Oslerian examination, to examine the way in which those who had idolised Osler had established his seeming immortality, and, to confirm their conclusions. Bliss referred to Cushing’s biography as a detailed, difficult to read and reverential hagiographic biography, but made no reference to the concerns Bett had expressed.

Bliss acknowledged that his approach had been extremely cautious, that he had been highly careful not to make inferences, and, that he had confined himself very much to the evidence available to him, and accordingly, had not taken liberties. He wrote that he had been struck by the power of the Osler image and praised Osler’s persona, his life and his work; he concluded that William Osler had been an inspiring medical humanist and scientist, who had lived an important and heroic life that had approached saintliness.

While Bliss accepted that he had been unable to find sufficient cause to lessen Osler’s standing, he had, as had Cushing, reported instances in which Osler’s demeanour, his attitudes and his actions were less than admirable. In some, his humanism was in doubt and in others, his professional work was far from commendable; indeed, in some, his actions were reprehensible and clearly illicit. Osler, however, reasoned that such behaviour was both acceptable and commonplace, and had been undertaken with the greater interests of mankind in mind. In doing so, William Osler disregarded the philosophical thinking and firm beliefs of then informed and opposing opinions of the public, of lawmakers, churchmen and those physicians, and philosophers, who had maintained a dialogue with contemporary thinking in moral philosophy and both societal and medical ethics.

Despite these then opposing societal opinions, Bliss did not deliberate on the ethical implications of Osler’s actions and attitudes; rather, he, like Cushing and others, applied a relativist viewpoint and by refraining from drawing conclusions, facilitated Osler’s venerable image.

Both Michael Bliss and Harvey Cushing left an opportunity for a further innovative intellectual biographic analysis of Osler’s life and work in theories and practices of medical education; one that will give a greater understanding to the nature of his character and of the influences that shaped his thinking in medicine and of the development and faithfulness of his teaching philosophies and practices.

In the ninety-nine years since Osler’s death, many writers have discussed his person, his character and his works, and by 2000, such articles have numbered 1,871. Within them are many scholarly appraisals and even more that have varied in their detail and accuracy. Such secondary literature has had three sources: those who were his family and very close friends; those who had known William Osler as his students, his fellows, his colleagues and his many peers who had written insightful personal accounts; and those who had not known him but had relied on the works of other’s and on Osler’s own publications to formulate their accounts. Collectively, a praiseful literature was established that has centred about three peer-identified attributes that had distinguished William Osler’s life and his work, his character, his humanism, and his teaching.

Osler’s character reflected his faith, his Britishness, his Hellenism and a life lived in accordance with Saint Mathew’s Golden Rule, and his capacity for sustained application, his Way. His humanism incorporated both his renaissance and medical humanisms, his moral philosophies and his wisdom, and his more general philosophies.

However, it was through Osler’s diverse teaching that he achieved his greatest renown, a skill that was inextricably related to both his character and his humanisms. His teaching encompassed the contributions he had made to medical education that cross many domains beyond his direct student teaching. They include his textbooks, his monographs, his scientific and journal publications, his manifold speeches, which, as essays, were invariably published, and his wide academic responsibilities.

Osler’s person, his contributions and educational principles, and his reputation were amplified by an abundant 20th-century secondary literature that facilitated the development of the Osler legend. Included in that literature were misleading and unproven assertions that magnified Osler’s attributes and contributions, and wrongly framed the Johns Hopkins University Medical School educational initiatives as instances of Osler’s personal innovation. In doing so, Osler’s imperfections were forgiven, or overlooked, and any appraisals that may have impugned his heroic image were avoided. Some such accounts were clearly apocryphal and unintentionally, yet remissly, have taken little regard of Osler’s expressed wishes.

The acceptance of such common beliefs and assumptions that surround William Osler’s person, and his works, have given sufficient reason to apply the discipline of a revisionist biography in the questioning of the faithfulness of the popular Osler legend,

However, it is as imperative to ensure that both the intent and the methods of this recension reveal the principles that William Osler had expressed, and, make evident his essential wishes and his theories of knowledge. In doing so, it would be inappropriate to believe that he would have accepted either posthumous hagiolatry or the near saintlike life he was accorded by Michael Bliss. Neither would he have accepted the embellishment of his writings, his statements or his work through apocryphal enhancements or the de facto pardoning of his errors. He would have been dismayed by the adulatory accounts that had become an Osler industry, as he would have been by the exaggeration of his educational practices.

Osler had made no claim that would warrant any augmentation of his contributions to medical education and his affirmations give some insight into how he may have regarded such fame: he regarded humility as the most important virtue; he confessed to his errors as being those of the mind rather than of the heart; he made clear his debt to those who had assisted in his success, and, he made clear that his selections of those who had contributed to the history of medicine, and so to medical education, reflected his acknowledged biases.

His educational wishes were similarly quite clear: to instil into his students an absorbing desire to know the truth; to be remembered for having taught medical students in the wards as the most important thing he had done; that his library should have an educational value; that his books should become a source of his remembrance, and, that medical schools retain the humanities as essential parts of a liberal medical education.

In this examination of Osler’s life and his work, and of the literature that surrounds his memory, four of his principles are applied: that the educational value of any science is directly proportionate to the thoroughness of its study; that the history of medical education contains both omissions and errors and its study requires the identification of that which has passed as being true, and its correction; that any inquiry must reflect an absorbing desire to search for the truths in the science of medicine, and, that the study of his works takes into consideration his acknowledged prejudices and biases, his preferences.

By applying Osler’s wishes, and his directives, this critical analysis of William Osler’s intellectual and educational legacy gives a truer understanding to his works, and brings into question the perception that Osler was among the greatest physicians of history, that he was a virtue ethicist, and that he had displayed the highest standards required of a medical humanist. But more importantly, the like perception that he had been responsible for innovative educational advances in medicine’s teaching is challenged and his inflexible medical epistemologies and pedagogies are made evident. Each has facilitated the apocrypha that persist and continue to dishonour the memory of this exceptional physician and medical educator.

Within this recension, neither William Osler’s philosophies nor his practices are criticised through a historical presentist viewpoint, nor are they accepted within the realm of cultural relativism. Rather, they are presented as a faithful account of his work, one that will balance a prevailing hagiography, and one that will inevitably challenge some who may see in this inquiry a heterodoxy rather than its intended veracity.

Osler’s many worthy contributions that lay beyond his teaching remain as testament to a gifted, charismatic and highly popular, and a much-loved physician, whose capacity for purposeful application was such that he had achieved his stated ambitions when only forty-three. By doing so, Osler became the idealised and enduring symbol of American medical education.

Chapter 1

The Warrant for an Eternal

William Osler

Osler’s influence upon the English-speaking medical world was greater than that of any other physician. His personal charm and warm character equalled his skill as a clinical leader at the bedside and as a planner for the modern curriculum in his medical school and house staff training (Talbott, 1970, p. 1139).

Dr John H. Talbott, a researcher, educator and author, wrote this tribute to William Osler in his 1141-page book, A Biographical History of Medicine: excerpts and essays on the men and their work. His biographical synopsis accorded closely with that which was presented by many Oslerphiles who had helped establish an Oslerian literature that was both voluminous, overly praiseful and hagiographic.

A further, and more informed, judgement was given by Emeritus Professor Michael Bliss in the Canadian Medical Association Journal’s celebration of the sesquicentenary of Osler’s birth. His view was expressed shortly after he had published the biographic book, William Osler: A Life in Medicine. Bliss wrote:

William Osler, the world’s most famous physician at the beginning of this century, has become a dim legend at its end… Here, then, is a physician whose writings are no longer widely read, whose views on many of the issues that concern us are seriously dated and who perhaps is most appropriately dealt with when honoured as a great man of a different era. Why suggest that at 150 Osler might still speak to medicine in our time? (Bliss, 1999b, pp. 311–313).

The contrast between these two judgements illustrates the challenge that is presented in seeking to better understand William Osler and to appraise the proper benefit of his various contributions to medical education. The further challenge is to determine which of the many accounts of Osler’s life and work are reliable, and, which may need further consideration. In doing so, a fresh insight will be gained into the standing of a renowned hero of medicine’s more recent history, one whose place in that history should rest primarily on the enduring benefit of his teaching, on the many worthy contributions he made to education and on a better understanding of the philosophies that determined his educational theories and practices. William Osler’s further remembrance should rest neither on hyperbole nor fallacy, but instead, rely on his authentic ideals and on his expressed wishes.

William Osler was an extraordinary physician whose work built a reputation that was then unmatched across Canada, America and Britain, and had an influence beyond the four universities in which he held professorships. He gave benefit to medicine’s students and to practitioners, and educators, in countries across the world through the medium of medical journals, his published books and his speeches, and in the more personal and direct guidance he gave to colleagues, students and patients. Professor Faith Wallis had supported this view by writing: But in the long view of history, his most important contribution to his profession was without doubt the changes he wrought in medical education (Wallis, 1999, p. 1).

During his highly productive life, Osler held six professorial positions: Physiology at McGill; Veterinary Medicine in Montreal; Clinical Medicine in Philadelphia; the Principles and Practice of Medicine at Johns Hopkins Hospital; Medicine at The John Hopkins University School of Medicine, and Regius Professor at Oxford. His reputation as a teacher, pathologist and researcher was established at Montreal, furthered in Philadelphia and with his wider reputation, was reason for his appointment to Baltimore. His international reputation became sufficient reason for his Oxford appointment.

Osler made many contributions beyond his teaching, works which crossed a wide spectrum across the broad church of medicine for which he was, and justly remains, renowned, and which provide sufficient reason for his remembrance. Those successes resulted from the power of his determined applications, which, he expressed as his Way, and which was evident in his purposeful pursuits of his ambitions, through the exhibition of his personal and professional values, and, ultimately, in the achievement of his expressed wishes.

In four speeches between 1889 and 1913, Osler successively revealed his virtues and his values, his ideals and his ambitions, and his essential work ethic. Together, they show his character, his mode of work and the traits he developed in his early life that became invariable lifetime habits. In 1889, Osler’s Aequanimitas valedictory address to the University of Pennsylvania faculty became his most famous speech, in which he spoke of the virtues of equanimity and imperturbability as ways in which emotion and its display could be controlled, but on this occasion, he went further and conjoined imperturbability with, when required, an indifference or callousness (Osler, 1905b).

In 1892, Osler spoke to the University of Minnesota students and identified the virtues he thought were required for a fruitful life in medicine: detachment as equanimity, the habits of method and thoroughness, and, the need for humility in the face of success (Osler, 1905l). He also advised that humility took place of honour among those virtues (ibid.). Then, in 1905, when leaving America, Osler expressed his ideals in ‘L’Envoi,’ an address to the Profession of American and Canadian doctors:

I have had three personal ideals. One to do the day’s work well and not bother about to-morrow. It has been urged that this is not a satisfactory ideal. It is; and there is not one which the student can carry with him into practice with greater effect. To it, more than anything else, I owe whatever success I have had—to this power of settling down to the day’s work and trying to do it to the best of one’s ability, and letting the future take care of itself. 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 affection 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 (Osler, 1906b, p. 473).

The last in this series was his 1913 address, A Way of Life. It became his second most famous address in which he expressed his essential life philosophy as his Way, a philosophy that centred around one word; habit (Osler, 1937). His Way reflected his determined and assiduous application to each day’s work, and was the essential philosophy that would become the hallmark of his life and be evident in his unchanging educational theories and practices. His invariable habit would limit his capacity for change, and become his Achilles Heel.

Posthumously, William Osler was to achieve each of his wishes. His primary wish was to be remembered for having taught students in the wards (Osler, 1905b), next, in 1913, he referred to Galen who had wished to be remembered for the books he had written (Osler, 1921), and last, between 1917 and 1919, Osler wrote of his wish that the library he bequeathed to McGill would realise its educational purpose (Osler, 1929). His wishes reflect his primary role as an educator, one that is evident in the number of his published works.

Osler’s published works

I do not think I have ever done anything that has not been done by someone previously, often very much better. One picks up a brick or two and carries it to the common edifice, but I have only been a hod carrier and do not come into the class with the great architects of the whole building, or even with the designers and decorators of the halls and walls (Osler 1915c).

William Osler’s schoolboy reading and his interest in books led to his book collecting, to his passion for bibliography, and to an avocation that encompassed the history of both medicine and science. His avocation grew into a significant library that he compiled as the Bibliotheca Osleriana, an index that, when he died, was left unfinished. It was completed over the next decade by three of his protégés who became its editors, William Francis, Reginald Hill and Archibald Malloch, and has become his most enduring published work (Francis, Hill and Malloch, 1929).

Osler had however completed his book’s Introduction, in which he wrote of his growing interest in English poets while in England, in American authors and his collection of historical texts and literature in Philadelphia, and of his quickening interest in bibliography in Baltimore:

The Historical Club of the Johns Hopkins Hospital awakened no little enthusiasm. In the classroom, more and more attention was paid to the historical side of questions…and at my Saturday evening meetings…we usually had before us the editions of some classic. Altogether, the foundations were laid for a successful avocation, without the addition of which to his vocation, no man should be called successful…. My colleagues…soon found that I was really fonder of books than anything else (Osler, 1929, p. xxii).

Osler was not only fond of books, but he held the conviction that the advancement of knowledge can best be realised through the books and biographies of great men:

Not an expert bibliographer, but a representative of an ever-increasing group of ordinary book-lovers, I have tried in the casual studies of a life devoted to hospital and consulting practice to glean two things, the book biographies of the great men of science and the influence of their books in promoting the progress of knowledge (ibid., p. xi).

The information that Osler gained from these great men was held in the books that he chose for his library, through which he gained knowledge about the evolution of man and of medicine, and of the history and development of the philosophies and practices of medical education. He explained that in his selections, and in his preferences, he was interested in the authors thinking, in the vagaries of his mind, in his theories, his philosophies:

A library represents the mind of the collector, his fancies and foibles, his strength and weaknesses, his prejudices and his preferences. Particularly is this the case if to the character of a collector he adds—or tries to add—the qualities of the student who wishes to know the books and the lives of the men who wrote them. The friendships of his life, the phases of his growth, the vagaries of his mind, all are represented (ibid., p. xxi).

Osler’s examination of the books and lives of his heroes, of other past authors, and of medical historians, gave him the knowledge he was then to apply in his teaching, in his speeches and in his writing. Such knowledge became the data which he acquired through a historical method that Faith Wallis described as: archaeologists, excavating the origins of modern medicine (Wallis, 2010, p. xvii).

In contrast, in some of his biographical essays and in his aesthetic appreciations of literary writers, Osler examined the intellectual and philosophical intents of the subject physicians and writers, and by determining the truths and beliefs that were inherent in their theories and practices, became the historiographer who selected authentic materials to create a narrative that reflected a more critical analytic method (Tucker, 2009).

Osler’s avocational bibliography became his passion and his collection grew to contain books that embraced medicine’s progress from ancient civilisations to the Greco-Roman period and from the Middle Ages through to the end of the nineteenth century, and, included those books that he regarded as being most important in the advancement of science and medicine. However, while his published essays and books encompassed the growth of man’s knowledge, they reflected a propensity to agree with the accepted judgements of medical history.

At Osler’s death, his library comprised a collection of 7,505 books and 163 manuscripts, which, through posthumous donations and purchases by his wife and the editors of the Bibliotheca Osleriana, rose to 8,000 titles when shipped to McGill University in 1929. There it became the Osler Library of the History of Medicine and has continued to grow and live in keeping with Osler’s desire that the library have an educational purpose. By 2011, the Library had risen to over 100,000 books and continues to grow by 1,000 books each year (Lyons, 2011): for this work alone, his name will live forever.

As well, in 1919, William and Grace Osler gifted to the Johns Hopkins University the books their late son Edward Revere Osler had collected, which with many of Osler’s non-medical books, became a memorial to Revere. It became the endowed Tudor and Stuart Collection. Osler’s collection of modern books on the heart, arteries, blood, and tuberculosis was left to the Johns Hopkins Hospital (Francis, et al., 1929).

Beyond Osler’s extensive library are many published works that comprise his journal articles, his published speeches, his monographs (Attachment 1), and the books he wrote. His publications total 1,500, of which 1,267 were journal articles. His first published paper was ‘Christmas and the Microscope’ (Osler, 1869), his next two were published while still a student,ii and his most important undergraduate paper, his thesis, remains unpublished in full. It was found in part and published as ‘Osler’s Lost Thesis’ (Golden, 2007).

His most famous accomplishment was his textbook, The Principles and Practice of Medicine, which was published on February 27 1892 (Osler, 1892a). Its writing reflected Osler’s intense application to his philosophy of achievement through his assiduous habit and the establishment of day-tight compartments (Osler, 1937). The book became a seminal textbook of his sole authorship that sold over 100,000 copies in its first thirteen years and was translated into six languages (Lampert, 1983); the last edition was published in 1947. For its successful correlation of medical history, microbiology, clinical pathology and the clinical features of disease, and its durability and worldwide popularity, Osler’s Principles and Practice of Medicine warrants a place in history.

Together with Thomas McCrea, Osler also edited a seven-volume encyclopaedic *Modern Medicine**: