“The World’s Best Doctor”
William Osler discovered no miraculous cure of wonder drug. Yet at his death in 1919 he was the most beloved physician since Luke. And 30 years later an article in the Journal of the American Medical Association said: “The years have added to his glory. No one has in any way taken his place as the world’s best doctor.”
Diagnostic wizardry, brilliant research, writing and teaching—these constituted Olser’s tangible achievements. The revolutionary methods he brought to medical schools have probably saved as many lives as the conquest of typhoid. He was great not alone for what he did, however, but for what he was he was master of the art of ministering to a patient’s troubled mind as well as to his sick body.
William Osler (the first syllable rhymes with dose) was born in and Ontario (Canada) parsonage in 1849, the last of eight children of the Reverend Featherstone Osler. At 15 he was expelled from the village school for unscrewing the desks from the floor one night and piling them into an attic. Transferred to a private boarding school, he came under the influence of two remarkable men: the school warder, W.A.Johnson, and Anglican clergyman who studied natural science as a hobby; and the school physician, Dr. James Bovell, a medical man who late in life entered the ministry. The examples of these men provided the two main streams of influence in Osler’s life: unswerving devotion to science and profound religious faith.
Few medical schools of the time owned a microscope, but Dr.Bovell did. He and Dr. Johnson trained the eager young Osler in its use. Shortly after he entered divinity school to study articles on microscopic fresh-water animals. A year later he told his disappointed father that he had decided to become a doctor.
Graduating from McGill Medical School, in Montreal, Osler went to Germany, Austria and England for further study of regular clumps, which form in blood after it is drawn from the body. Others had noticed the clumping, but Osler was the first to observe that in circulating blood there were colorless globes clumped after exposure to air, he concluded accurately that the bodies (now known as blood platelets) played an important role in clotting. Announcement of this significant scientific discovery brought him so much acclaim that McGill called him home to become, at 24, professor of physiology.
The “boy professor” immediately converted a cloakroom into a laboratory, McGill’s first. Then he spent $600, half of his annual income, to buy a dozen microscopes for his students. Without appearing in the least rushed, he took on innumerable extra jobs, including those of librarian and registrar of the medical school. New medical journals and societies seemed to sprout in his path; he probably founded more of both, and attended more meetings, than any other doctor in history.
Trichinosis was considered a rare disease in Canada—there were then only four cases on record. But from his boyhood examination of farm animals’ viscera under the microscope Osler knew that the trichina worm turned up more often than his elders suspected and was probably sapping the strength of countless Canadians. Now, with his own laboratory, the young professor decided to attack trichinosis; he volunteered to perform autopsies for any doctor who would let him. Soon he was averaging 100 post-mortems a year.
Infected pork had been found to be the source of trichinosis in Europe, so for eight months Osler and a student veterinarian, A.W.Clements, haunted Montreal’s slaughterhouses, performed more than a thousand autopsies on hogs. Finding dozens infected, they demanded that municipal meat inspection be instituted and that the public be educated to cook pork thoroughly. This was the first of many campaigns, which were to make Osler the m most effective public-health crusader of his time.
Though his autopsies young Osler was acquiring a training in pathology that few practicing physicians could match. He reasoned, however, that he could accomplish more if, in addition to studying the organs of those who died, he could study living patients and link their outward symptoms with an abnormal condition of some one internal organ. But living patients were hard to come by; McGill considered young Dr. Osler purely a laboratory man and would hot permit him to examine patients in the wards of the affiliated hospital.
Several all-too reluctant physicians were then supervising the smallpox ward of the hospital on a rotating basis. Osler volunteered to take charge of it—and thus got his first opportunity to work with sick people. (He also got smallpox—a mild case, fortunately.) Soon he talked his superiors into giving him a charge of a noncontiguous ward as well.
Hospitals were expected to be gloomy buildings in those days. Osler changed all that. He began by ordering flowers and a coat of pastel paint for the wards. Then he went to work on his patients. He gave them little medicine but “lavish doses of optimism,” practicing psychosomatic medicine long before the term was invented. “The miracles at Lourdes and Ste.Anne de Beaupre,” he once wrote, “are often genuine. We physicians use the same power every day. It will not raise the dead; it will not put in a new eye or knit a bone; but the healing power of belief has great value when carefully applied in suitable cases.”
“To the astonishment of everyone,” recalls a Montreal doctor, “the chronic beds at McGill, instead of being emptied by disaster, were emptied rapidly through recovery, and new cases stayed but short time. It was one of the most forceful lessons in treatment ever demonstrated.
Innovations like these spread Osler’s reputation beyond Canada and he was offered a medical professorship at the University of Pennsylvania. Undecided, he flipped a coin; it fell “heads” for Philadelphia. Thus, casually, American medicine was set on the road to its present excellence.
Osler’s students at Pennsylvania hardly knew what to bake of this medium-sized, athlete-looking Canadian with receding black hair, a big drooping mustache and a taste for brilliant neckties. Instead of mounting a lecture platform, as was the professorial practice, he hitched himself up on a handy table, confessed that he hated to prepare lectures and announced that he couldn’t teach without a patient for a text anyway. “To study the phenomena of disease without books is to sail an uncharted sea,” he stated; “but to study books without patients is not to go to sea at all.”
Accordingly, he introduced a thin young man and told the class to see for themselves what a real live case of anemia looked like. Patients illustrating other diseases followed, all lucidly analyzed by Osler. The medical students were electrified; it was the first time most of them had ever tapped a patient’s chest, listened to a heartbeat of examined blood under a microscope. For at that time [18840 no medical school in the United States offered effective “on-the-job” beside teaching. ‘It makes one’s blood boil,” Osler fumed, ‘to think that there are sent out year by year scores of men called doctors who have never attended a case of labor or seen the inside of a hospital ward.”
Not content with bringing patients to his students, Osler now brought students to patients. For the first time anywhere, medical students entered hospital wards freely, as much a part of the team as interns, nurses or attending physicians. They took case histories, examined patients [under close supervision, of course] and made tentative diagnoses that were confirmed or corrected by the experienced doctor in charge.
As Osler hade predicated, the patients received better, more alert care than ever before, with fewer mistakes, thanks to the constant stimulus of inquiring young minds for who diagnoses had to be checked and counterchecked. The cornerstone of all medical education today, William Osler’s bedside teaching pays dividends in better medical care to every human being now alive.
In Baltimore the trustees of the will of a merchant prince named Johns Hopkins were now building the finest hospital and medical school in the continent. Searching Europe and America for physician-teachers, they chose William H Welch to head their pathology department; Howard Kelly, gynecology; William Stewart Halsted, surgery; and William Osler, internal medicine. Of Johns Hopkins’ famed “Big Four,” the oldest, Osler, had not yet reached his 40th birthday.
From the day it opened in 1889, brilliant youngsters flocked to the new Baltimore center, and within a few years Osler’s trainees in particular were eagerly sought from New York to San Francisco.
Dr. Osler’s ward rounds, starting promptly at 9 a.m., were the high spot of the hospital day. Nurses, interns and visiting doctors made an admiring procession in his wake. Patients knew (they were supposed to know) a great man was coming to help them, and they smiled. For his children, to whom he was particularly devoted, he had a “secret” whistle, a prearranged signal to warn them of his approach.
Osler was an uncanny diagnostician, a bedside sleuth with few equals. He knew what to look for, and he took the time to find it. In one patient, for example, he suspected the presence of an arterial aneurysm—a dangerously dilated blood-vessel sac that, if it could be located, might be removed surgically. If not, it might hemorrhage fatally. Repeated physical examinations had failed to turn up the elusive sac when Osler appeared at the bedside.
For an hour, while interns grew restless, the Chief just sat there watching the sick man’s chest and abdomen. Finally he said, “let’s try swinging the bed around to the far wall.” Puzzled, the interns complied.
Lifting the window shaded high, Osler studied his patient only a moment in the new light, and then pointed on the chest wall. There, faintly but unmistakably shadowed by the slanting afternoon sunshine, was the telltale pulsation of the aneurysm none else had been able to find.
Often Osler could diagnose quickly. Leading his students through a ward one morning, he passed the bed of a patient whom he had ever seen before. Grasping the man’s toes for an instant he waved good-bye, and as soon as they were out of earshot he informed his startled retinue that the owner of the tows suffered form leakage of a heart valve. No undergraduate who saw him pull that diagnostic rabbit out of the hat ever forgot that this particular heart condition causes a distinctive jerky pulse, easily observed in the big toe.
Among the visiting doctors who followed Osler through the wards one day was an unknown young country surgeon from Minnesota. Osler’s through study of patients and the constant use of scientific diagnostic aids like the microscope made a deep impression on him, and he came back many times with his brother. The brothers’ name was Mayo.
Another young man used to wander over from the surgical department to watch Osler—a young man so impatiently outspoken about the work of other staff surgeons that rumor said his days at Johns Hopkins were numbered. Sensing his potential greatness, Osler gently suggested self-restraint. The hotheaded young man offered to resign. Next morning he had a note for Osler. “Do nothing of the kind!” it said. “Who is free for faults? Your prospects here are A-1 and we need you.” So it was that Harvey Cushing stayed at John Hopkins to blaze new trials in brain surgery and to become William Osler’s devoted son in all but name.
Duties at Johns Hopkins were just part of Dr. Osler’s activities. He was also president of the American Pediatric Society, author of a neurological study of cerebral palsy, an authority on angina pectoris and certain other circulatory aliments (on is still called Osler’s disease), co-founder of the National Tuberculosis Association, of Christmas Seal fame. He was a crusader against malaria, typhoid and syphilis, and a pioneer advocate of better mental hospitals. Meanwhile, he wrote no less than 1200 books and articles, an amazing average of one every two weeks during his adult life. Some of them remain classic in their field, unexcelled even after a half century of medical advance.
In 1897 a Baptist minister in Montclair, New Jersey, read Osler’s ‘Principles and Practice of Medicine’ and was both enthralled and appalled. In it Osler had summed up all that medical science knew at that time, then bluntly declared there was much more it should know and didn’t. The minister was Frederick Gates, philanthropic adviser to John D. Rockefeller, Sr. He discussed Osler’s book with Rockefeller, and out of that conference grew the Rockefeller Institute for Medical Research and, later, the Rockefeller Foundation.
By 1905 Osler, besieged by sick people, working at a killing pace, concluded that if he were to retain his own health he would have to find a quieter post than John Hopkins. Medical schools all over America sought him; a Canadian millionaire offered McGill $1,000,000 if it could get him back. But his choice was made when King of England appointed him Regis Professor of Medicine at Oxford. A few years later the King conferred on him the baronetcy that made him Sir William.
His first move in England was to make peace between London’s two rival medical societies, which had not spoken to each other for 50 years. His second was to reintroduce bedside teaching to a nation, which had neglected its potentialities. Osler took Britain to his heart, and she took hi to hers. His Oxford home became a sort of New World embassy in the Old, fabulous for its hospitality.
Too old for front-line duty in World War 1, Osler went into uniform as a medical consultant to the Canadian and American Army hospitals in England, and unofficially earned the title of Army Consoler General.” He received hundreds of anxious cables for next token whose wounded soldiers were hospitalized in Britain. In each case he located and examined the wounded man. The Canadian Medical Corps adopted for parents the most reassuring from cable it could think of: “Your son has been seen by Osler and is doing well.”
In August 1917 Sir William’s own son and only child, 21-year-old Revere Osler, was gravely wounded at Ypres. Half a dozen of the American Army’s greatest surgeons—Harvey Cushing and George Crile among them—sped to the scene. An operation was performed, but in vein. With heavy hearts they watched as the Chief’s beloved boy was lowered into the earth of Flanders.
Following the Armistice, Sir William spent a year raising money to save the war-ravaged libraries of Allied Belgium and the starving children of ‘enemy’ Austria. Then, in December 1919, worn oust by his wartime activities and by grief for his son, he was unable to withstand an attack of pheneumonia that followed recurrent attacks of bronchitis. Knowing more about the disease than his attending physicians, he realized how it would end for him, and faced death serenely.
After he died a slip of paper found on his bed. On it he had written: “The Harbor almost reached after a splendid voyage, with such companions all the way, and my boy awaiting me.”
