On a brilliantly clear day in early May 1889, six young physicians and scientists looked on in eager but apprehensive anticipation as the opening ceremonies were held in Baltimore for a new kind of hospital, on which they had staked their careers. Ranging in age from 31 to 39, each of the men was riding the upward arc of a brilliant academic trajectory; each of them had been recruited away from a university position that would have assured him the facilities and the support for a productive career. But each of them wanted more than mere professional success. These rising medical stars were risking a great deal in order to take part in an incompletely formed project that would succeed or fail on the basis of their individual and collective abilities to create a novel and quite independent atmosphere of research, teaching, and patient care. On that spring day, however, the entire enterprise was still only a dream in the minds of its planners.
The Johns Hopkins Hospital and the associated medical school that was to be founded four years later held the promise of launching American medicine on excitingly novel adventures, in which each of the new professors would essentially create from scratch the conditions that he considered ideal for his work and for the development of his specialty. But it also held the threat of failing in a welter of poor planning, pedagogical squabbles, and inadequate financing. Franklin P. Mall in anatomy, John Jacob Abel in pharmacology, Ira Remsen in chemistry, William Welch in pathology, Howard Kelly in gynecology, and William Osler in medicine formed the vanguard of a potential revolution in medical science and education, and they knew it.
They also knew that the entire bubble of fantasy might explode in their faces. Even four years later, when the 33-year-old William Howell joined them to be professor of physiology at the opening of the medical school, a great deal was still uncertain. The only sure thing was the conviction of those who observed them that they were all caught up in what one commentator called "the contagion of excellence."
In spite of a bundle of obstacles--not excluding their own philosophical differences and the inevitable personality clashes that might have undone lesser men--the seven thirty-somethings did succeed. With the judicious assistance of the university president, Daniel Coit Gilman, and the hospital's medical advisor, John Shaw Billings, they created an institution by whose example not only education was radically altered, but also an entire philosophy of patient care and research. Within twenty-five years of that auspicious day, American medicine was undergoing such widespread changes that it would soon become virtually unrecognizable from its backward past. It was not long before the initiatives radiating from the Johns Hopkins Medical School and its hospital were being emulated by every program for the training of young physicians and medical scientists in the country. Soon they would be the envy of the world.
One of the seven would become, as Michael Bliss calls him in his eminently readable new biography, "the high priest of his emerging profession." William Osler is remembered as the greatest clinical teacher of his day, a judgment so universal that it needs no modifying by such trendy adverbs as "arguably." In fact, he may have been the greatest clinical teacher of any day, and any country too.
Gifted with a charismatic personality and an infectious cheerfulness, Osler was possessed of the most important attribute of the mentor of the young: an inherent sense of just what is needed to make each acolyte comprehend how much he is appreciated and how well he is understood by his teacher. On Osler was bestowed also a corollary gift that so many thousands of students and patients long remembered, which is the ability to transmit his sense of the singular significance to him of each individual. As Bliss writes, he had the knack for "giving you all his attention and interest, perhaps taking you by the arm, listening intently, remarking on an encounter years earlier or on some other bond you had in common, convincing you that for William Osler at this moment you are the most important person in the world."
Primarily by means of Osler's great textbook, The Principles and Practice of Medicine (which went through sixteen editions, the last being published in 1947, twenty-six years after his death), but also by means of Osler's widely circulated lectures and many published articles, English displaced German as the language of medical discourse, the language that one had to know in order to comprehend the new advances beginning to appear so rapidly near the end of the nineteenth century. An immensely well-liked man and a catalyst to the accomplishments of others, he became the most sought-after medical speaker in America. He served as president, and often founder, of so many cultural and scientific organizations that even an Osler addict like myself is constantly surprised to come across yet another one not previously known to him.
In a widely acclaimed biography of the Canadian surgeon Frederick Banting, one of the discoverers of insulin, Michael Bliss showed that he is no idolater, but an objective seeker after the truth of his subject's life and character. In his new book, he has sought what he calls "the real Osler," and he has done it with the fervor of one who in the past showed that he could write "frankly about a Canadian icon who was a mediocre scientist, a boor, and a chauvinist."
It must have been tempting to seek smears on Osler's revered image too, and a historian as respected by his professional colleagues as Bliss can be depended upon to have tried his utmost to do just that. "[I]t did not particularly matter to me how he turned out as a human being," he writes in his preface, and we know that he can be taken at his word, especially in this day when debunking is almost the vocation of biographers. But turn Osler's pockets inside out though Bliss would, only gold coins came forth, as they always have when others tried. Portraits, pockets, mix what you will. In every metaphor, Osler comes up clean:
These chapters are as fair-minded and objective a portrait of Osler as I can produce, using every tool of my trade. Immersing myself in the sources, expecting them to make possible a reasonable amount of icon-bashing, I gradually found myself becoming struck by the power of the Osler image. Osler worship was more widespread than I had realized and was more heartfelt, less selfinterested or promotional than I had anticipated. Osler shone partly by comparison with many of his colleagues, but it became clear to me that he was a man who would have stood out, did stand out, in any crowd--except that he had a habit of disappearing from crowds to find some children to play with. Nothing struck me more forcibly about the beauty of Osler's personality than the magic he could generate with little children. It shines in scores of his wonderfully whimsical, loving notes and in dozens of anecdotes and memoirs, many more than are recounted here...
His was a life that stands up almost too well to critical dissection, even microscopic scrutiny. In an age when biographers make their reputation by claiming to have discovered hidden internal derangements in their subjects, this project has been an unusual intellectual autopsy, at times something of a modern biographer's nightmare. Try as I might, I could not find a cause to justify the death of Osler's reputation. He lived a magnificent, epic, important, and more than slightly saintly life.
There is that word: saintly. Does it mean that Bliss has written a hagiography, whether in the classical sense of its being the life of a saint or in its current usage, carrying the implication of memorializing an exemplary subject whose flaws are minor? The answer to both questions is yes, for William Osler really was a kind of medical saint; and it is reassuring to those of us who have long worshiped at his figurative shrine that no amount of scratching at his holiness has marred the sheen of the halo under which he stands. In fact, thanks to Bliss's uncompromising search, it shines more brightly than ever. Sometimes hagiography is only truth.
Is the biography of a saint filled with sameness, and tedium, and the monotony of one good work after another? Is the life of a saint so removed from common experience that nothing can be learned from it except the impossibility of any effort at emulation? In this case, the answer to both questions is a resounding no, at least in the hands of Bliss. Like all saints, Osler was a living, breathing human being before being canonized, and a colorful one at that. He played outrageous practical jokes, invented an alter ego with a bawdy sense of humor, charged enormous fees (but only to the very wealthy among his patients, of whom there were many), was rumored to have fathered an illegitimate child by his cousin, and offended an entire generation by advising, in a widely reported address, that men beyond the age of sixty should be chloroformed until dead.
Bliss tells a good story, and there are plenty of good stories to be recounted, as he follows his peripatetic subject from the backwoods Canadian parsonage where he was born until his death as Sir William Osler, the Regius Professor of Medicine at Oxford and the most famous doctor in the world. In fact, the stories go well beyond Osler's physical death, to the memorializations of his life that have taken various forms over the past eight decades, not neglecting such vignettes as the author's personal experience of the ultimate shrine, in the Osler Library at McGill: "I was working on this biography in the Osler Library, sitting at Osler's desk, one day in September 1997 when a freshman student at McGill quietly slipped into the inner sanctum and, in an act of secular worship, placed at the foot of the Osler plaque a bouquet of flowers and a card asking for Osler's blessing."
William osler was born in 1849, the eighth of nine children, to English immigrants to Ontario. (The youngest died when Willie, as he was called, was four, so he was raised as the youngest.) His father, Featherstone Lake Osler, had abandoned a promising career as a British naval officer at the age of 28 to become a minister of the Church of England, and settled with his wife in the area north of Toronto, then little better than a wilderness. In time, he became Canon in charge of the parishes of Dundas and Ancaster, and a prominent figure in the religious life of the area.
At school, Willie was a fine athlete and a bit of a gymnast, given to more pranks than he could get away with. But for an accident, he might have followed his father into the ministry. During a prolonged recovery from a football injury shortly before becoming a student at the Trinity College School, the 17-year-old Osler saw a great deal of the institution's warden, the Reverend William Johnson, a man intrigued by the study of nature and adept with the microscope, a tool of research beyond the comprehension of all but a very few advanced thinkers of the time. Johnson shared his interests with Willie, who soon caught his teacher's infectious fascination with the wonders that could be revealed once the instrument had been mastered.
Shortly after entering the school, the boy's growing obsession with natural history came into full flower, as it were, under the tutelage of one of the instructors, Dr. James Bovell. From his earlier tendency toward the ministry, Willie soon found his interests diverted toward a medical career, and he entered the Toronto School of Medicine in 1868, where Bovell also taught in addition to his position at the Trinity College School. Bovell's influence on his young follower was profound: "By far the dominant personality in Osler's life during his medical studies in Toronto was James Bovell," Bliss writes. "Osler worked with Bovell constantly during the first year and lived in his house the second. In fact, his Toronto medical training was virtually an apprenticeship to a medical father figure."
The Toronto School of Medicine was hardly the place to acquire what passed for a first-rate medical education, and had it not been for Bovell, the two years spent there would have been of very little value as anything but preparation for the routine and largely ineffective medical practice of the time. When the underpaid and underappreciated Bovell emigrated to the West Indies, Osler transferred to Canada's best medical school, the McGill Faculty of Medicine. Here he came under the tutelage of the scholarly Dr. Palmer Howard, who became the third of the men he would call his great mentors.
With howard's encouragement, young Osler began what would be his lifelong dedication to studying disease by means of post-mortem examination. He became extremely adept not only in the technique of autopsy, but in the direct and microscopic study of pathological tissues. Osler's doctoral thesis survives only in fragments, but a brief quote from its introduction appears to encompass the philosophy that would become the guiding principle of his approach to the understanding of the processes of disease; and it proved also to be the basis of his ability to teach others what he had learned, in a form so indelible and even dramatic that sickness and organ pathology took form before students' eyes as he spoke at the bedside and demonstrated his findings while examining patients: "To investigate the causes of death, to examine carefully the condition of organs, after such changes have gone on in them as to render existence impossible and to apply such Knowledge to the prevention and treatment of disease, is one of the highest objects of the Physician." The year was 1872. Osler was 22. Had he been asked about this statement half a century later, near the end of his long and illustrious career, he would doubtless have agreed with his younger self.
Having obtained his degree, Osler spent more than a year studying and working in England before going off to the medical meccas of the time, the great hospitals and schools in the German-speaking countries. Only there were the beginnings of truly scientific medicine to be found. Research was the focus of the German universities, and postgraduate education was a major priority, so much so that physicians from the entire world made their way there in order to partake of the most advanced techniques and the instruction of the greatest authorities. In Vienna alone, some 10,000 American doctors undertook various kinds of formal postgraduate studies between 1870 and 1914. A high percentage of America's next generation of medical researchers and teachers came from that group.
When William Osler returned to McGill to become a lecturer in medicine in the fall of 1874, he had absorbed the best of German methods. He knew how medicine should be taught, and he was ready to start his career in the academic arena. The beginning was difficult. The sparkling style that could hold the attention of a lecture hall full of entranced students or captivate a small group on bedside rounds did not spring fully formed, and took some months for the inexperienced young teacher to display. Still, he did not lack confidence, and once some initial awkwardness passed, Osler was well on his way.
He dealt with problems expeditiously and on the spot. Bliss illustrates this with a story. Some of the senior men resented their former fellow student's having been given such an elevated appointment, and they made their displeasure known by congregating outside his classroom and making as much noise as they could. Osler put up with the clamor for a few days and then posted a note on the bulletin board, asking that the seniors desist. The noise was even louder the next morning. The wiry little lecturer, whose full height was less than 5'6", took matters into his own hands. "After standing it for a while Osler opened the door, stepped into the corridor, pulled off his frock coat, and challenged the best man to step forward and fight it out with him. No one came forward, and peace and quiet reigned thereafter." This was the same Willie Osler who as a teenager had noted a smallish friend being manhandled during a football game by a boy described by onlookers as "one huge bully," and leaped up to punch the lout in the jaw, which "sent him to the ground and thence to bed for a week." Willie was no shy scholar.
During his second year as a lecturer, Osler ordered fifteen microscopes for his students, paying for them with money that he had earned caring for smallpox patients (and in the process contracting a light case of the disease). The purpose of the instruments was to enable him to begin what would be the first of his many pedagogical innovations--the teaching of a practical course on microscopy that was meant to help the young men study not only pathological tissues but also to examine the blood and the bodily secretions of patients. The magnitude of this step was enormous. There was no such course in any American or Canadian school at the time.
Throughout the McGill years, the young instructor continued his assiduous autopsy work, carried out clinical research, treated the sick, and taught. And he did it all with a cheerfulness that sometimes bordered on gaiety. He seemed always in a good mood, and always to have time for a student or a colleague who might need a few minutes with him. His way was a smile, words of warm encouragement, and an arm draped over a young shoulder, or perhaps a gentle touch on the arm. He was immensely popular with the young people and rapidly gained the respect and even the affection of his colleagues on the faculty. And he apparently--no, genuinely--liked everyone.
The school seemed to expand, to become ever greater, as though in response to his bursting energy. Bliss entitles this chapter in Osler's life "The Baby Doctor," and so it must have seemed to those who watched and admired the precocity with which such a young man took on the role of a teacher much older than his years. Honoring itself as well as him, the history of the McGill Faculty of Medicine refers to this period as "The Osler Years."
The decade of the 1880s was perhaps the most exciting brief period that had ever occurred in the 2,300-year history of Western medicine. The germ theory of Louis Pasteur, Robert Koch, and Joseph Lister gained acceptance during that time, and one disease after another was shown to be caused by some specific organism. Medical thinking was transformed. William Osler was one of very few men on this continent equipped fully to comprehend the magnitude of the changes about to take place in research and later in practice. His unique expertness with the microscope, his studies with leading scientists in Vienna and Berlin, his focus on the study of pathological tissues as guides to the understanding of disease processes, his youthful energies and enthusiasms: all of these combined to guarantee that the new discoveries so rapidly emerging from European laboratories would find practical use in his hands, not only in the study of sickness but also in the teaching of students.
In 1884 the medical school of the University of Pennsylvania, America's oldest and one of its best, called Osler to the chair of medicine. Osler's departure was a devastating blow to McGill. Their finest teacher and the man called by Palmer Howard "the one single disciple of science" in the school was escorted to the train station by the entire student body. He was on his way to the next phase of the journey that would lead inevitably to Baltimore. The geographic progression southward was partnered with the academic progression upward.
In Philadelphia, Osler gave free rein to his determination that autopsy and microscopic study were the keys to understanding the evolution of disease. He conducted so many postmortem examinations that complaints inevitably arose about what must have been his sometimes cavalier attitude about permissions and the formal protocols required by the hospital authorities. Even in the flood of new scientific information he was discovering, however, Osler never neglected the humanity of his patients. The medical statistics and massing of cases into groups that were necessary to elucidate clinical conditions did not mislead him into forgetting the distinctiveness of each person who came under his care.
In 1886, Osler wrote of the necessity that a doctor have a profound knowledge of human nature, and stressed "the careful consideration which is given to every circumstance in the life and condition of the individual." Two years later, thinking about a visit he had just made to his famous patient Walt Whitman, he penned a note in his commonplace book: "A doctor does not treat typhoid fever, but he treats the man with typhoid, and it is the man with his peculiarities--his bodily idiosyncracies we have to consider." These were themes that Osler would reiterate for the rest of his life.
Osler was doing clinical research, writing journal articles, taking on a huge load of teaching, and lecturing to his medical colleagues in Philadelphia and elsewhere. In 1884, he was invited to London to follow centuries of distinguished British physicians by giving the Goulstonian Lectures, choosing to describe the pathological and clinical findings in two hundred cases of endocarditis and the role of bacteria in the disease. He described the inflammation that occurs in the inner lining membrane and valves of the heart and the streptococcal, staphylococcal, or other bacterial invaders that cause it. The three lectures were characteristic of Osler's approach in all his research writings: detailed clinical and pathological descriptions of distinct disease processes so accurate and so lucid that even in later years they could barely be improved upon. Osler would never become known for presenting grand conceptual notions or overriding theories of disease. His great gift was the presentation of material so finely and comprehensively observed that it was of enormous value to bedside physicians, pathologists, and even students.
But even all of those obligations did not consume his vast energies. Osler was the original "clubbable man" on whose "social instinct" Palmer Howard had remarked during the testimonial dinner in his honor when he left Montreal. Handsome and witty, the young bachelor became a favorite at Philadelphia social evenings. And he never could resist an opportunity to tease anyone in his vicinity. As the usually stern Hopkins nurse, Miss Nutting, put it after he grabbed a grapefruit off a basket one day and bowled it down a hospital hallway, "It was Dr. Osler, you know, and his behavior cannot be predicted."
Another of Osler's favored pastimes was the whimsical leading astray of his colleagues by inserting a bit of pseudo-medicine into a weighty academic journal. While in Montreal, he had invented a mythical character called Dr. Egerton Y. Davis, a former U.S. Army surgeon who from time to time reported on his clinical activities, some of which had distinctly prurient overtones. In the December 13, 1884 issue of the Medical News, an editorial by Davis appeared, much of which Bliss records in his book, to give his readers the flavor of the Osler that was sometimes the despair of his friends, not to say the gracious Boston Brahmin he would marry a few years later. The editorial describes Egerton's experience attempting to treat a case of vaginismus, or spasm of the vagina occurring during intercourse. "A big burly coachman had been caught in bed with a wee maid, Davis wrote, and they could not be separated:"
When I arrived I found the man standing up and supporting the woman in his arms, and it was quite evident that his penis was locked in her vagina, and any attempt to dislodge it was accompanied by much pain on the part of both. It was, indeed a case of `De cohesione in coitu.' I applied water, and then ice, but ineffectually, and at last sent for chloroform, a few whiffs of which sent the woman to sleep, relaxed the spasm, and released the captive penis, which was swollen, livid, and in a state of semi-erection, which did not go down for several hours, and for days the organ was extremely sore. The woman recovered rapidly, and seemed none the worse.
Osler traveled frequently during the Philadelphia years, either to visit other hospitals and schools, to lecture or to see patients in his rapidly expanding consultation practice; he was setting a pattern that would never be abandoned, though it did lessen considerably during his last years at Oxford. In 1886, he went to Baltimore to visit the campus of the new Johns Hopkins University, founded by the will of a wealthy Quaker merchant whose $7 million bequest (according to Bliss's calculation, it would be a bequest of $210 million today) was also directed toward building a hospital and a medical school. "It is the university of the future," Osler wrote to an Ontario friend, "& when the Medical school is organized all others will be distanced in the country." At that time, rumors were already flying around Philadelphia that their best medical teacher was soon to be offered the chair at Hopkins. The rumors were well founded. Osler traveled to Baltimore in September 1888 to accept the appointment.
And so the heady days began. The next sixteen years would be a period of immense productivity, during which the Hopkins experiment was successful beyond even Osler's predictions. And so was he. His international fame grew, his clinical research flourished, and he was more popular a teacher than ever, if it is possible to imagine such a thing. The atmosphere of joy that he brought to everything he did, and the sense of high purpose that he conveyed, infected students with a love of medicine and an appreciation for the nobility of the calling they had chosen.
As in Montreal and Philadelphia, Osler introduced a number of pedagogical innovations, the most important and enduring of which was to bring students out of the lecture halls and onto the wards, as so-called clinical clerks, partners in the care of the sick. He called this "the natural method" of teaching. It had never been attempted in an American hospital, and it became the precedent upon which every teaching service would thereafter be based. Its purpose was clearly stated by Osler: "The student begins with the patient, continues with the patient, and ends with the patient.... [T]each him how to observe, give him plenty of facts to observe, and the lessons will come out of the facts themselves.... [T]he best teaching is that taught by the patient himself."
In 1890, the work on the monumenal textbook began, upon whose publication not only Osler but all of American medicine stepped forward into a position to rival the Germans and eventually to exceed their greatest clinical stature. Subsequent editions benefitted from their author's relentless pursuit of new medical knowledge, not only in his own work at the medical school but also on the frequent trips he was making to European centers. As John Jacob Abel wrote to his wife in June 1892, in a sort of mini-biography of the man he had come to admire so much, Osler was "the only medical man I have ever met in America who burns to know. He began at 18. It makes me wild with envy, has been across 8 times to study. Says whenever he gets 1000 or 12000 dollars he skipped off to Europe... My talks with him have moved me afresh."
In 1890 osler also married the 37-year-old Grace Revere Gross, the widow of a prominent Philadelphia surgeon and a direct descendant of the famous Revolutionary War courier. A son born nine months almost to the day after their wedding died shortly after birth, but within two years Mrs. Osler had given birth to a boy they named Revere, who would become the adored only child of his parents as they aged.
By the turn of the century, Osler's various sources of income--salary, book royalties, and consultation fees--were bringing him a huge income, in 1903 amounting to $47,000, or $1.4 million in today's money, some $9,000 of which he gave away. But the huge prosperity was coming at a huge price. His patients included the president, members of the cabinet, and many public officials and wealthy men and women, and such consultations often demanded travel over considerable distances. Between these and his visits to various medical facilities and universities he was out of town thirty-three times in 1901.
He was writing essays, and continuing his clinical research; and he had begun seriously to collect books. His home was the site of a constant whirlwind of social activities, what with students, colleagues, and all manner of visiting firemen being entertained, and often having the free run of the house. He began to complain about the pressures of it all. This was the busiest period of his life, and even his seemingly limitless energies were being severely tested: "The racket of my present life is too much for me. I am going downhill physically and mentally."
When a letter arrived in June, 1904 inviting Osler to become the Regius Professor of Medicine at Oxford, a position whose responsibilities were largely honorary, he gave it serious consideration. But Grace, who had become increasingly concerned about her husband's overwork, did more than that. She was determined that he should accept, and right away. Of the invitation, she wrote: "As I read the letter I felt a tremendous weight lifted from my shoulders as I had become very anxious about the danger of his keeping on at a pace he had been going for several years in Baltimore." She prevailed, but she met with virtually no resistance. On May 19, 1905, the Oslers sailed for England, and what was meant to serve as semi-retirement for the 56 year old Chief.
Oxford proved to be all that was hoped for, though there was still plenty of demand for consultations, and the writing and the speechmaking continued unabated; and there were too many meetings to attend. But the Regius professorship proved a welcome relief from the unsustainable burdens of Baltimore. There was much more time for the beloved books and for the history of medicine, which Osler now began to study avidly after many years of intermittent attention.
His avenue of approach was in general biographical, and considerably more triumphalist than a modern historian might like. In Osler's view, the great personalities of earlier times "remind us continually that in the records of no other profession is there to be found so large a number of men who have combined intellectual pre-eminence with nobility of character." He never failed to stress the moral aspects of historical studies. It was for what he called "the silent influence of character on character" that he valued the study of the past, as well as for the events themselves.
As in all his other non-clinical writings, Osler's essays and the text published from the Silliman Lectures he gave at Yale in 1913, under the title The Evolution of Modern Medicine, are characterized by a style so conversational and so appealing that the writer seems to be standing at the reader's elbow. He has a way of capturing in one or two sentences the essence of a personality. Of the unpredictable and constantly angry Paracelsus, for example, the stormy petrel who convulsed the staid medical establishment of the sixteenth century by demanding radical reforms in clinical thinking, he wrote: "This first great revolt against the slavish authority of the schools had little immediate effect, largely on account of the personal vagaries of the reformer--but it made men think. Paracelsus stirred the pool as had not been done for fifteen centuries."
From the perspective of distance, Osler watched as the fruits of his labors at Hopkins were being eagerly consumed in medical schools all over North America. Bliss is very good about presenting the professional background in which Osler lived and worked, so that a reader obtains a clear view of the importance and magnitude of the changes wrought by the existence of the Johns Hopkins Medical School and the critical role played by its Professor of Medicine.
By 1909 the spirit of what everyone called `modern' medical education was sweeping the United States and Canada as universities and medical schools made plans to join forces, lengthen courses, raise admission standards, pour millions into laboratories and hospitals, introduce clinical clerkships, and hire the best scientists and clinicians they could find.... Philanthropists and their foundations were about to pour resources into medicine, betting with their money that it offered more hope for the future than theology.
As Osler himself put it, "What an age of growth everywhere!" And well he might exult: much of this growth was the result of the recommendations that he had been advocating throughout his career.
The rewards for all the years of dedication began to pour in. The baronetcy conferred in 1911 was the highest of the honors, but offers of memberships, degrees, and presidencies aplenty came Osler's way. The applause never seemed to die down. The Oslers' home in Oxford was the center, as it had been in Baltimore, of a constant celebration of life. They watched in awe as Revere, at first a callow and unambitious youth, began to develop into a serious young man dedicated to books and devoted to his father. Willie and Grace loved England, and the years seemed charmed.
And then the lamps went out all over Europe. On August 14, 1914, Great Britain went to war. Less than six months later, Revere joined the army as orderly to Dean F.S. Birkett, commanding officer of the McGill medical unit. He chafed under the inactivity and transferred to the artillery. Before long he was on a troop train to France, and his parents commenced the long vigil. On a brief leave he took from the front, they were proud of the change in him, of the thoughtful man he was becoming. Father and son fished together, and they spent many hours discussing books.
The carnage of the war was beyond anyone's imagination. Scarcely a family among the Oslers' acquaintance had not lost a son or sons, and the house was always full of Oxford men recovering from wounds. After Revere returned to the front, Grace wrote to a friend: "It broke my heart to look at him & to think I may never see him again--One stroke and all may be over." The stroke came on August 29, 1917. Revere was hit by shrapnel and died a few hours later, after surgery in an attempt to stop internal bleeding.
The enchanted life of the Oslers was over. "We have been preparing for the blow," Osler wrote to the surgeon Harvey Cushing, who had been with Revere at the end. "I felt sure the fates would hit me through him. I have escaped all these years without a great sorrow, and have had so much in life, so much more, really, than I have deserved that I have all along felt we could not escape.... Poor Grace! It hit her hard; but we are both going to be brave, and take up what is left of life as though he were with us." They faced their loss with courage, at least externally, but Osler was a broken man. The following spring, Grace wrote to a nephew that he was "wrecked and heart-broken." She would "hear him sighing and sobbing his heart out at night." Another year passed before a semblance of normality returned to their lives, and even then they lived with the awareness that everything had changed, and their happiness would never return.
Seasonal upper-respiratory infections that had plagued Osler over the course of many years now began to be more common, and harder to shake off. He returned from a visit to Edinburgh in late September, 1920 with the beginnings of what appeared to be influenza, and his condition gradually worsened during the next few weeks. He developed pneumonia and then pleurisy, and after a time it became obvious that there was pus in his chest cavity. He suffered through several weeks of pain, needling of his chest and finally a small operation done in his bed, in an attempt to remove the pus. But nothing helped. On the afternoon of December 29, he died following an intestinal hemorrhage. True to form, he had requested an autopsy, which was done in his own home on the following day. Bliss tells us that "Osler had said that he wished he could be present, having taken such a lifelong interest in the case."
Osler was dead, but Osler lived on. Although the numbers are now becoming small, medical students and grizzled physicians still occasionally seek inspiration by reading the many essays that he wrote on the medical life. Some are dated, but others are as fresh as the day he put pen to paper. Among many examples that may be quoted is the following, from an address to students at the University of Toronto in 1903:
To you the silent workers of the ranks, in villages and country districts, in the slums of our large cities, in the mining camps and factory towns, in the homes of the rich, and in the hovels of the poor, to you is given the harder task of illustrating with your lives the Hippocratic standards of Learning, of Sagacity, of Humanity, and of Probity. Of learning, that you may apply in your practice the best that is known in our art, and that with the increase in your knowledge there may be an increase in that priceless endowment of sagacity, so that to all, everywhere, skilled succour may come in the hour of need. Of a humanity, that will show in your daily life tenderness and consideration to the weak, infinite pity to the suffering, and broad charity to all. Of a probity, that will make you under all circumstances true to yourselves, true to your high calling, and true to your fellow man.
There were celebrations on the sesquicentennial of Osler's birth this past year, and speeches of tribute were heard, and reverential articles were published, particularly by the Osler Societies that to this day are composed of some of the leading physicians of Britain and North America. Many of those tributes recalled Osler's emphasis on the physician as humanist--his constantly reiterated counsel that the great books of the past and present hold the truths of our civilization, the truths that should be known by those who would presume to heal their fellows.
He drew up a list of ten books, in fact, that he called the Bedside Library for Medical Students, and recommended that it be used in a particular way: "Before going to sleep, read for half an hour, and in the morning have a book open on your dressing-table. You will be surprised to find how much can be accomplished in the course of a year." His big ten were the Old Testament, the New Testament, Shakespeare, Montaigne, Plutarch's Lives, Marcus Aurelius, Epictetus, Religio Medici, Don Quixote, Emerson, and the Breakfast-Table series of Oliver Wendell Holmes. Osler himself was the very physician that we have idealized--and rightly--in the never-ending but rarely heeded admonition that a healer should be a scholar of the humanities. He was so much the archetype of that scholar that the members of the Classical Society of Oxford elected him their president.
And now he has the biography that he has so long needed. In Michael Bliss, the spirit of William Osler has found a chronicler both scholarly and popular, a rare combination but a necessary one if justice is to be done to this uncommon man. At Lady Osler's request, Harvey Cushing undertook to do the job shortly after his friend's death, and published a two-volume study that won the Pulitzer Prize in 1926. The work quickly became a minor classic in the literature of medicine, and has been reprinted in numerous editions that adorn the libraries of all manner of physician-pretenders to scholarship. I have no fewer than four copies of my own, and never hesitate to show off by pulling out the first edition signed by Cushing and Lady Osler on the day of publication.
But that doesn't mean that I read the books. A few pages at a time is all I have ever managed to digest at a single sitting. The writing is too dense for pleasure, almost as though detail was more important to the writer than his reader's enjoyment. He must have thought Grace or his inspiration's shade would scold him if he left anything out. I have never seen the book's early reviews, but I suspect that the word "meticulous" must have appeared in many of them. Cushing's is a biography more honored than read, and for good reason. It is an archive of its subject's life, more a complete clinical description than a narrative.
Not so for Bliss's warm, engaging, and in places quite humorous book. This is the sort of writing that has the air of coming easily off the pen, in spite its scholarly documentation and the enormous wealth of research and erudition hidden between its lines. Bliss's panoramic biography has been as scrupulously documented as Cushing's, but one would hardly know it by reading it as I believe it is meant to be read: as a fascinating story about a fascinating man.
And William Osler is a fascinating man whom we need nowadays. In this time of cynicism, it is good to know that the earth can be inherited by those who have faith and trust in the improvability if not the perfectibility of humankind; in this time of bioethical conundrums, it is good to know that patience, good will, and personal morality will untie far more intellectual knots than the disarray of rancor, conflict, and special interests; in this time of great medical miracles it is good, and properly humbling too, to know that there have been other periods of miracles, and yet the ancient problems of health and human happiness remain, bringing new challenges to each succeeding generation. William Osler's life and his writings tell us of these things, but they are beginning to fade from the experience of all but a few men and women who seek them out. They need to be revived, and he needs to be heard again.