William Osler: the Legacy of a Great Canadian

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“The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.”

    

– William Osler

 

When a young William Osler was attending medical school at McGill University in the early 1870s, the existing body of medical knowledge was increasingly being called into question. The discoveries of bacteria and insulin were revolutionizing medical treatments, effectively putting ancient practices such as bloodletting and homeopathy to an end. Until his death in 1919, Osler was at the forefront of this reformation, helping to transform medical schools into what they are today.

“Osler was not single-handedly responsible, but was certainly the flag bearer of a reform movement in medical education that was to make medical education scientific,” said McGill history of medicine and science professor Faith Wallis. “[This reform movement] was going to change this antiquated and inadequate medical system, and was going to bring it up to speed with new scientific discoveries.”

The changes Osler proposed were not easily implemented, however. Wallis explained that because medicine is not limited to a scientific paradigm, changing the system is a complex process.

“Medicine is indeed a science, but because medicine is also an art and a practice that happens between doctor and patient, change is very complicated in the medical world,” she said.

When Osler died in 1919, he left approximately 8,000 books to McGill, a collection that he had been avidly building up since his early years in Montreal. The Bibliotheca Osleriana, located on the third floor of the McIntyre Medical Building, now holds this collection and is a symbol of his legacy.

 

The Professor

 

By the age of 25, Osler was a medical professor at McGill. He then went on to be the chair of clinical medicine at the University of Pennsylvania, and shortly thereafter went to John Hopkins to work at both the university and the hospital. He ended his career at Oxford as Regius chair of medicine.

What made Osler unique were, among other things, his teaching methods and his beliefs about how a physician should be educated. Osler believed that lectures could only cover a fraction of what medical students should be learning. According to Wallis, prior to Osler’s advances it was conventional that “many students never saw the inside of a hospital.”

Richard Fraser, McGill Professor of Pathology and a pathologist at the Royal Victoria Hospital, elaborated on another of Osler’s beliefs, the union of university and hospital.

“Shortly before he died, he wrote letters to McGill saying that they needed to modernize and build a closer association between the university and the hospital to develop teaching methods,” Fraser said.

Although this was something Osler had been developing during his time in Montreal, there was still a long way to go until a mandatory medical residency would be fully implemented at McGill.

Osler’s dedication to teaching is evident from a story Wallis recounted of his time at the University of Pennsylvania. While conducting an autopsy on a patient, Osler told his students to gather around and observe. He told them that he had diagnosed the patient as having died of disease X, but that if they looked carefully at certain anatomical characteristics that could be observed post-mortem, he had been incorrect. Instead the patient had died of disease Y. Wallis paraphrased Osler telling his students, “I really blew it, now you take note of this and don’t you ever make the same mistake.”

The student who recorded this event was shocked that a professor would so openly admit his mistakes. With this act, he brought himself to the students’ level, demonstrating that learning was not only for the student but for the professor as well.  

“He believed in teaching by example, and by his own example what he wanted to model for them was intellectual honesty,” Wallis said. “If you don’t learn from your mistakes, how can you learn from your successes?”

 

The Individual

 

Osler’s accomplishments extended beyond his professional and academic careers; his sincerity and earnestness did not end when he left the classroom. Letters and testimonials compiled after his death show that very few people who knew Osler did not like him. However, with the passing of time, history is romanticized and the dead are often glorified. Did Osler have any vices? Award-winning author and renowned historian Michael Bliss wrote the second biography on Osler.

“Virtually everybody who knew Osler idolized him, and you say to yourself, ‘Oh well surely that’s an exaggeration.’ The trouble that I found as a biographer was that going through private correspondence that was never meant to be seen by anyone you still found this adulation of Osler, which is really, truly remarkable,” Bliss said.

According to Bliss, Osler thought of medicine as his vocation. Osler believed that “once you had become a doctor, you lived, breathed, ate, slept, and drank medicine, it was your full-time profession.”

This brings us to Osler’s bedside manner. He was able to remain calm and emotionless as a doctor, no matter how deep his personal or emotional involvement in a case. Wallis told one story involving a young girl who was on her deathbed. Osler sat by her side and comforted her, but as he left and was walking down the hall, he started whistling. When asked by his colleagues how he could emit such a merry tune, Osler apparently responded “I whistle so that I do not weep.”

 

A Lasting Legacy?

 

Differences from original Oslerian practice have developed since the beginning of the 20th century.

Osler and some of his contemporaries openly admitted to their mistakes, noting them down transparently in reports. Current physicians do not openly admit to mistakes at the risk of having malpractice suits filed against them. Instead, medical students are taught to present options to their patients. In this way, the relationship between doctor and patient has evolved since Osler’s day. Patients have become more educated, and there is no longer a sense that the doctor knows best.

Additionally, the doctor’s priority seems to have shifted from his patient to his family.

“Osler’s generation of physicians thought that your obligation to your patient was that you’re with them every hour of the day and night that you’re needed,” Bliss said.

Yet despite an obvious and inevitable evolution of the medical system over the course of almost a century, Osler’s ideals are still very relevant today. Osler Fellows, positions created four years ago in the Faculty of Medicine at McGill, are a concrete example of how his impact is still felt.

“Osler Fellows are meant to help the students make the transition from being a student who doesn’t know anything about medicine to a physician who deals with patients,” Fraser said.

 

The Library

 

According to Pamela Miller, the history of medicine librarian at McGill’s Osler Library, Osler chose to leave his collection to the school because this is where he built his reputation.

“He said in his will that he was giving it to the Faculty of Medicine in gratitude for their support of him as a student and as a professor,” Miller said. “Their support of him gave him faith in himself which he thought was the best form of education.”

Canadian architect Percy Nobbs and Osler’s wife Grace Revere worked diligently for the decade after Osler’s death to build a place that would hold his books, and in some ways his legacy. The library was originally housed in the Strathcona building, but was moved to the McIntyre Medical Building in the 1960s.

Thanks to donors, the library’s collection now boast
s about 100,000 rare books. The library is also home to both Mr. and Mrs. Osler’s ashes.

Some of the pieces the library has come by are priceless and irreplaceable. These include a collection of Thomas Browne’s multi-volume the Religio Medici, a facsimile of McGill’s oldest diploma, and literary works that date as far back as the eighth century. Osler’s goal for the library was to collect the great works of medicine, and to potentially create a curriculum for medical students.

Osler’s influence ranges far and wide; people come from all over the world to visit his library, a sort of Mecca for Oslerians. Christopher Lyons has been the liaison librarian for the Osler Library for the past six years and has seen many different people come to visit.

“When I started working here, I started to appreciate the extent to which Osler was influential in medicine in the space of about one week,” Lyons said.

The first three people that came to the library when Lyons started working there came from opposite ends of the world, from Australia, Brazil, and Japan.

In one way or another, Osler had inspired these people and had brought them all to the Bibliotheca Osleriana.

“They all came from thousands of miles away. What’s driven them to this place?” asked Lyons.

The Bibliotheca Osleriana is locked at all times, but the librarians are wonderfully welcoming and will gladly give curious students a guided tour. They are also hoping to open this part of the library as a study space for students sometime after Christmas.

 

 

Even if Osler graduated over a century ago, McGill is be proud to call one of the greatest Canadian physicians, and perhaps even one of the greatest Canadians, one of their own. In Bliss’s words, Osler was the doctor’s doctor, but his message that learning is a continuous process can be extended beyond the medical profession.

“As people said after his death,” Bliss concluded “This truly was an unusual and remarkable life.”