An Autopsy of Dr. Osler

1.

In the early summer of 1885, a thirty-six-year-old professor of medicine at the University of Pennsylvania crossed the Delaware River to visit an elderly man with a “transient indisposition.” When William Osler walked into a front room on the ground floor of 328 Mickle Street, Camden, New Jersey, Walt Whitman—his new patient—was sitting in a corner. Over thirty years later, Osler, who was by then an immensely influential professor of medicine, recalled the moment:

With a large frame, and well shaped, well poised head, covered with a profusion of snow-white hair, which mingled on the cheeks with a heavy long beard and moustache, Walt Whitman in his 65th year was a fine figure of a man who had aged beautifully, or more properly speaking majestically. The eyebrows were thick and shaggy and the man seemed lost in a hirsute canopy….

The scene astonished Osler. “The magazines and newspapers, piled higher than the desk, covered the floor so completely that I had to pick my way by the side of the wall of the room to get to the desk.” After his house call, Osler began to read Leaves of Grass for the first time. The result was not pleasing to him: “Whether the meat was too strong, or whether it was the style of cooking—’twas not for my pampered palate, accustomed to Plato and Shakespeare and Shelley and Keats.”

Whitman’s view of Osler was similarly ambivalent. A man who was frequently pessimistic and bad-tempered about his own physical state, Whitman wrote, in 1888, that “Osler made light of my condition. I don’t like his pooh-poohs: the professional air of a doctor grates on me.” When, for example, Osler recommended that he “never let his bowels be closed more than two days,” Whitman replied, “I will ‘let’: it’s not a question of ‘letting’: if that was all there was about it, the matter could easily be settled.” And Osler’s incessant cheerfulness sometimes produced the opposite result of that intended: “I confess I do not wholly like or credit what he says—I do not fancy the jaunty way in which he seems inclined to dismiss the troubles.”

Despite these complaints, Whitman concluded that Osler was “very ‘cute, a natural physician, rather optimistic, but best so”; that “he is relieving me: no doctor could do more”; that “he is a great man—one of the rare men: I should be much surprised if he didn’t soar way way up—get very famous at his trade—some day: he has the air of the thing about him—of achievement.” Osler, he wrote, “is fine looking: examined, he gains on you: you realize him: his forehead is beautiful.”

Whitman had good reason to be an accurate judge of his doctor. In Specimen Days he had chronicled a period during the American Civil War when he assisted wounded soldiers in a Washington hospital by tending their injuries, arranging for food and reading matter to be delivered to them, giving out small sums of money, writing their letters home, or simply keeping them company. Whitman testified to the “professional spirit and capacity generally prevailing among the surgeons, many of them young men, in the hospitals and the army.” If Osler was aware of his new patient’s war work among the sick, there is no record of it.

Osler’s initial distaste for Whitman’s writing was to soften later in life. Osler was invited to give “An Anniversary Address with Personal Reminiscences” about Whitman to Walter Raleigh’s Oxford English literature class in 1919. Seven and a half pages of only partly published notes survive.¹ In his extensive research for the lecture, Osler described Whitman as a “patient and friend.” And in a letter to The Times on May 31, 1919, he noted that Whitman was “possessed in rare degree of the Greek combination of the love of humanity with the love of a craft.” Osler died on December 29, 1919, with his lecture unfinished.

There is a strange parallel between the lives of the poet and the doctor. Osler had been introduced to Whitman by their mutual friend and colleague Dr. Maurice Burke. Osler described Burke as a “hero-worshipper,” a man who displayed “absolute idolatry” of Whitman. Where Osler “saw only a fine old man, full of common sense and kindly feelings,” Burke claimed that Whitman was “one of the world’s great prophets.” Osler was intrigued by the influence that Whitman cast over other men; he described “a cult of a type such as no other literary man of our generation has been the object.” Toward the end of his lecture notes, Osler underlines this view: “Whitman’s greatness is in no way more clearly demonstrated than in his ability to survive the megalomaniac exaggerations of a cult.”

Michael Bliss draws on the Whitman connection to assist his own dissection of the present-day Osler cult. Bliss gives a well-paced and intellectually fascinating account of Osler’s life. He pins down the significant moments in a spectacularly diverse career as a physician and teacher of medicine who did original research on, among other subjects, the components of blood, and wrote in 1892 The Principles and Practice of Medicine, perhaps the most widely read and admired medical textbook of its time. He sets Osler’s scholarly achievements against the background of the usually neglected hinterland of his family affairs. Bliss quotes Whitman approvingly on the work of a poet who “drags the dead out of their coffins and stands them again on their feet.” But even for Bliss, an experienced biographer, the exaggerations that have grown around Osler’s life prove hard to strip away.

2.

Osler’s upbringing gave little hint that he would eventually dominate Anglo-American medicine for thirty years. His family emigrated from England to Canada in 1837 and his father—Featherstone, a well-read clergyman—hoped that his eighth child would follow him into the Anglican ministry. William was a bright student at a Toronto private school, prone to pranks that led not only to expulsion (for shouting abuse at a teacher) but also, Bliss hints, to a few days in prison for cruelly persecuting an unpopular matron. The turning point in his school life came during a spell of illness, when he developed a passion for natural history and learned microscopy from his inspiring school warden, the Reverend William Arthur Johnson.

Still destined for clerical studies, Osler’s mind was finally diverted to medicine by James Bovell, an eccentric Toronto physician infamous for transfusing milk into the arteries of patients with cholera. While studying medicine at McGill University, Osler was taken under the wing of another appreciative mentor, Palmer Howard, a physician with an interest in the new European sciences who helped Os-ler gain a precocious reputation for research.

Medicine was not a safe career in the 1870s, even for such a talented student as Osler. In 1872, he moved to London for what was the equivalent of medical finishing school. After declining an offer to become professor of botany at McGill, he traveled to Berlin and Vienna to study pathology in the great institutions led by Rudolf Virchow and Karl Rokitansky. Two years later he returned to a lectureship in McGill’s medical faculty. Bliss describes Osler’s difficult early career by charting his meager income as a Canadian tutor. In 1874, for example, he earned $1,129, and his salary had risen only a few hundred dollars by the end of the decade. This precarious situation forced Osler to develop a flourishing clinical practice to secure his finances. He also began to treat smallpox among the down and outs of Montreal, a gruesome task he carried out successfully. He threw himself into autopsy work, completing a thousand post-mortems in the style of Virchow² ; and he gave a hundred lectures in an exhausting first year at McGill. He was also beginning a successful research career, being one of the first scientists to describe a new type of blood cell that later came to be called the platelet.

Osler’s time at McGill was not wholly orthodox. He took an unexpected excursion into criminology. In 1879, Moritz Benedikt claimed that “the brains of criminals exhibit a deviation from the normal type.” Osler sought out the brains of two Canadian murderers and refuted Benedikt’s anatomical findings.³ Harvey Cushing, Osler’s previous biographer, concluded that this odd “episode is important only in showing Osler’s eagerness in the pursuit of knowledge and his outspokenness of opinion.” Bliss goes beyond this bare interpretation by placing Osler’s investigation in a new philosophical setting. He cites this 1882 paper as the first in which “Osler wrote on an issue involving the divide between science and liberal thought.” This subject became a persistent and important theme in Osler’s later writing.

His reputation was growing and his ambitions too. In 1885, he was invited to deliver the prestigious Gulstonian lectures at the Royal College of Physicians in London. This international honor made him an ideal candidate for a vacancy that had just arisen at the University of Pennsylvania, America’s oldest medical school. In Philadelphia he quickly expanded his research interests across a vast range of subjects—he wrote about pneumonia, endocarditis, typhoid fever, duodenal ulcers, cerebral aneurysms, cholera, blood cells, and epilepsy, although his “deep conservatism,” as Bliss calls the Osler family nature, led him to cling to vestigial techniques such as blood-letting and leeches.

Philadelphia could not contain Osler for long. The establishment of Johns Hopkins Hospital in Baltimore on May 7, 1889, marked an irreversible shift in academic leadership from the old European medical centers to the modern schools of America. Osler became chief physician at Johns Hopkins and in 1890 wrote: “I have everything I could desire and more than I could deserve.” His research continued to extend even further across the human corpus—heart, aorta, gut, blood, liver, brain, and thyroid. But he also had the task of creating a new medical school. Osler was now able to import the principles he had first observed in Europe—namely, clinical apprenticeships on the hospital wards rather than dry instruction confined to the lecture theater. “The student begins,” he wrote, “with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end.”

But Osler’s greatest achievement in Baltimore was his textbook, The Principles and Practice of Medicine, published in 1892. The book was dedicated to his three mentors—Johnson, Bovell, and Howard. Bliss calls Osler’s Principles “one of the great books in the history of medical education and publishing.” Indeed, it solidified America’s new place in world medicine. Bliss describes the conditions in which Osler produced the 1,079-page text—“in his shirtsleeves, surrounded by books in time-honored and Whitmanesque authorial style, dictating to his stenographer”—and its success (14,000 copies sold in its first two years).

Unfortunately, Bliss is rather less interested in the book’s radical ideas. Although the Principles is “a book of diseases and how to treat them,” it was far more than that. It combined an account of the natural history and science of disease with observations on the impact of those diseases on society. Bliss traces Osler’s widening interest in public health to the late 1890s. But the Principles offered Osler an earlier forum to develop his ideas on the social aspects of disease. For typhoid, Osler reports results from Munich which showed how the prevalence of the disease “is directly proportionate to the inefficiency of the drainage and the water supply.” “There is,” he concludes, “no truer indication of the sanitary condition of a town than the returns of the number of cases of this disease.” He emphasized the importance of disinfecting ports to drive out yellow fever and he insisted, as Bliss acknowledges, that accessible sanitariums be provided for patients with tuberculosis.

But Osler’s most original comments were reserved for syphilis. He begins his discussion of preventing the disease by admitting that “irregular intercourse has existed from the beginning of recorded history, and unless man’s nature wholly changes—and of this we can have no hope—will continue.”⁴ Osler identifies two preventive measures. First, that of “personal purity,” which can be achieved only through “hard work of body and hard work of mind,” since “idleness is the mother of lechery.” Second, and here one must recall that Osler is writing in the conservative climate of the late nineteenth century, “a rigid and systematic regulation of prostitution.” Although he agrees that public sentiment of the time opposed such a policy, “the choice lies between two evils—licensing, even imperfectly carried out, or wide-spread disease and misery.” Even today, a century later, licensing prostitutes to curb sexually transmissible disease remains an impossibly controversial matter in many countries.

Research, teaching, autopsies, university administration, publishing academic papers, and writing a textbook—there could hardly be time for much else in Osler’s life. Yet during his period at Hopkins he also became an influential essayist. His first volume, Aequanimitas, collects his most important speeches from 1889 to 1905. The title, and most famous, essay discussed two virtues of the successful doctor. The first was imperturbability—“coolness and presence of mind under all circumstances”—a “quality which is most appreciated by the laity though often misunderstood [as] hardness.” In a paternalistic style at odds with today’s attitudes, Osler advocates not only coolness but “a callousness which thinks only of the good to be effected, and goes ahead regardless of smaller considerations.” Other virtues were equanimity, “an infinite patience,” and “an ever-tender charity.”

Essays such as these turned Osler into America’s foremost physician. Bliss attributes a not altogether complimentary self-awareness to Osler’s writing: “He begins to see himself as an elder statesman, or a high priest or bishop of a profession he constantly compares to the clergy.” In effect, Bliss concludes, he is preaching, but often entertainingly so. In one of his final addresses to Johns Hopkins in 1905, Osler spoke about “the fixed period.” He began by wondering if professors outstayed their welcome through long uninterrupted periods of rule at one institution. He thinks they often do, thereby suffering from the twin diseases of “intellectual infantilism” (“the mind too long fed on the same diet in one place”) and “progeria” (in which the mind “is sterile, with the mental horizon narrowed, and quite incapable of assimilating the new thoughts of his day and generation”). Osler went on to disclose two of his “harmless obsessions.” First, the “comparative uselessness” of men when they reach about forty years of age. Second, the unqualified “uselessness” of men over sixty. The logic of his argument was that

The teachers’ life should have three periods, study until twenty-five, investigation until forty, profession until sixty, at which age I would have him retired on a double allowance.

To promote his vision, Osler suggested euthanasia with chloroform for his older colleagues. Of that idea, he said he had “become a little dubious, as my own time is getting so short.” The American press took up Osler’s “useless at forty…” claim. Studious news reports, humorous columns, and sarcastic editorials and cartoons filled the newspapers. Osler was stung and he had to give a series of interviews to clarify his remarks. His serious attempt to launch a debate about the need for older professors to give way to their younger, more creative colleagues was lost amid the hullabaloo.⁵ The controversy dogged him for the rest of his life.

In 1898 he reached the official peak of his career, becoming a Fellow of Britain’s Royal Society and dean of Johns Hopkins. His salary continued to rise, reaching $23,440 in 1897 (about $700,000 today, according to Bliss), and $47,280 in 1903. Osler was rapidly heading for burnout. In the fall of 1898 he developed pneumonia and after weeks of illness resigned his deanship. By 1902, as other work crowded into his schedule, he cut back ward rounds and classes, and canceled holidays to catch up on his writing. The astonishing pace of this period seemed to foster recurrent chest infections and “sub-sternal tension, a warning,” he thought, “of too high pressure.” He simply could not continue to work at such a rate.

3.

Osler was only second choice for the Regius Professor of Medicine at Oxford—a largely honorific position founded in 1546 by King Henry VIII—but that did not make him less keen to escape Johns Hopkins. He considered that the move to Oxford in 1905 was tantamount to a “retirement.”⁶ Bliss quotes Harvey Cushing: Oxford would be “a synecure—no work big salary—nothing to do but give one lecture a year and drink port.” True enough. Oxford life provided a butler and maids for his young family. (He had married Grace Linzee Revere, a descendant of Paul Revere, in 1892, and their son, Revere, was aged nine when they emigrated.) Bliss assembles a list of Osler’s duties and preferments in England: college dinners, aristocratic receptions, membership of the Athenaeum, and a baronetcy in 1911. Little has changed.

Osler immersed himself in family life, and Bliss shares the general view that Osler used Oxford as a means to indulge his love of old medical books (his library of eight thousand titles is now at McGill), periodicals (he founded the Quarterly Journal of Medicine in 1907), classical literature (he was president of the Classical Association in 1918), and the brotherhood of his fellow doctors (he co-founded the Association of Physicians of Great Britain and Ireland). This standard presentation of Osler’s final fourteen years is, I think, a serious, although common, misinterpretation. For Osler’s lighter clinical workload allowed him to pursue two interests—philosophy and public health—that had emerged earlier in his life, but had remained peripheral to his inescapable university obligations.

Bliss duly records some of the lectures and essays that set out Osler’s views on these matters, but he underplays their importance. Emphasizing the historical aspects of Osler’s interests rather than their philosophical implications, he fails to stress the coherence of Osler’s last intellectual efforts, and he does not explore the depth and originality of the arguments Osler develops.

First, Osler was concerned with the epistemology of medicine. His interest in philosophical matters began early in his research career when he wrote about the link between the minds and brains of criminals, challenging claims of inherited criminal tendencies. In that 1882 paper he had posed the question of how the child of a philosopher might fare among bushmen, and his essay raises important issues concerning free will and determinism. He returned to philosophy in a later study of John Locke, a work passed over by Bliss. After a diligent review of all available primary manuscripts, Osler showed how Locke worked closely with the physician Thomas Sydenham to refine the basis of seventeenth-century medical thought—namely, “to return to Hippocratic methods of careful observation and study.” Locke criticized doctors of his time for trying to fit observations to “their own fancies.” He argued that “this is beginning at the wrong end,” and commented, “I see it is more easy and more natural for men to build castles in the air of their own than to survey well those that are on the ground.” Locke wrote an introduction to a treatise on the philosophy of medicine (Ars Medica), and Osler reports that “one cannot read the fragment without feelings of deep regret that the design was not carried out.”

Philosophical issues became a central concern again in 1906, when Osler delivered the Harveian Oration at the Royal College of Physicians of London. His subject was “The growth of truth, as illustrated in the discovery of the circulation of the blood.” In this essay, Osler argues, contrary to his times, a strong relativist position on knowledge: “All scientific truth,” he said, “is conditioned by the state of knowledge at the time of its announcement.” Although Osler roots his belief in Plato’s Theaetetus, describing “the states of knowledge” as “acquisition, latent possession, and conscious possession,” his point of departure is not Plato but, once again, Locke, who wrote that “Truth scarce ever yet carried it by vote anywhere at its first appearance.” The “final struggle for acceptance” was the real challenge in achieving knowledge, and Osler doubted whether doctors of his time were more receptive than their predecessors centuries ago.⁷

The example he chooses to prove the “iron yoke of conformity” is William Harvey, who waited in fear for twelve years before publishing his 1616 lecture outlining a new theory on the general circulation of the blood. When Harvey challenged the still prevailing doctrines of the second-century physician Galen, his views were received with disdain by most of his contemporaries—Osler calls Harvey’s opponents “intellectual Philistines,” who were guilty of “mental blindness.” In France, official recognition of Harvey’s discovery came only in 1673. The reason, Osler suggests, was neither the prejudice of physicians wishing to defend Galenic doctrines nor the narrow-mindedness of scientists who could not follow Harvey’s experimental logic. Although Harvey’s discovery certainly did mark the beginning of experimental medicine, Osler wrote,

Even when full grown in the conscious stage truth may re-main sterile without influence or progress upon any aspects of human activity…. The special distinction which divides modern from ancient science is its fruitful application to human needs…. In making knowledge effective we have succeeded where our masters failed. But this last and final stage, always of slow and painful consummation, is evolved directly from truths which cannot be translated into terms intelligible to ordinary minds…. [Despite] Harvey’s triumph…there was nothing in it which could be converted immediately into practical benefit.

The technical complexity of Harvey’s new discovery, together with its apparently limited practical application, buried his findings for much of the seventeenth century. The new scientific methods that Harvey developed seemed to render science obscure and practical knowledge elusive; this had troubling implications that remain with us today. The impenetrability that affects so much of modern science—from particle physics to post-genomic biology—has diminished its public understanding and therefore has often produced confusion about its implications for public policy. The difficulties faced by science reporters trying to cover the subject of genetically modified food is a modern case in point.

Osler’s second preoccupation was public health. His early interest in syphilis continued in Oxford. In addition to a campaign of education and treatment, Osler advocated confidential notification of cases and compulsory drug therapy. He drew attention to the deep stigma associated with the disease, the “ghastly failure” of “the preaching of chastity,” and the fact that “for the aggressive harlotage that still disgraces our streets man is primarily responsible.” Osler also developed a new concern with tropical diseases. The acquisition of an empire brought with it responsibilities, he wrote, “to give to the inhabitants of the dependencies, Europeans or natives, good health—a freedom from plague, pestilence, and famine.”

However, it was World War I that did most to shape Osler’s later contributions to public health. When conflict broke out, he was almost complacent in his view about the likely course of war. In a letter to The New York Times on October 21, 1914, he wrote, “I think this war will set a new record for low mortality among the wounded.” But he soon began to report in the Journal of the American Medical Association how frostbite, cerebrospinal fever, poison gas, and shell shock were affecting soldiers in France and Belgium. His interest at first was wholly scientific: “It is intensely interesting to see a set of severe cases some weeks after their admission.” In September 1915, Osler visited a Canadian General Hospital Unit at Camiers, where he saw “everywhere great squares of graves—marked with the names of the men of the Regiments.”

On his return, he traveled to Leeds to give an address at the opening of the medical school. He could no longer remain a detached observer. In his essay “Science and War,”⁸ Osler displays to the full his skill as a writer, but it remains his least convincing performance as an orator. He begins by calling attention to the fact that “the pride, pomp, and circumstance of war have so captivated the human mind that its horrors are deliberately minimised.” He goes on to discuss the impact of science on methods of warfare:

In three directions science has scored in a mission of destruction. What a marvellous adaptation of physics, pneumatics, and mechanics is displayed in a submarine, with which the highest standard of wholescale destruction is reached. …And the new guns and modern explosives! Chemistry, electricity, physics, optics, mathematics, every aspect of the subtlest human study has contributed to their perfection…. Every device of science has been pressed into use….

Osler tries to balance his argument by emphasizing that science can also be a “beneficent force.” But in reading his essay today, one cannot help feeling, with Bliss, that his effort to cast science for, and not against, humanity is “flat” and “forced.”

Worse was to come for Osler personally. Revere Osler was sent to the front in October 1916. Meanwhile, his father had launched himself into war work, helping to organize military care in Oxford and attending wounded soldiers returning from the battlefield. In Belgium, Revere survived poison gas, but near Ypres he was hit by shrapnel. He died the following morning—August 30, 1917—with Harvey Cushing at his side. When the news reached Oxford, the usually imperturbable Osler collapsed, and Grace wrote to a friend of her husband “sobbing hour after hour.”

4.

Bliss asks: “Was William Osler the greatest doctor in the history of the world?” Two recently published reviews of his biography reflect the long-established divided opinion on this question. Sherwin Nuland, a surgeon and medical historian, claims that Osler “really was a kind of medical saint.”⁹ He argues that

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 rancour, conflict, and special interests….

By contrast, the historian Bill Bynum writes,

The wonder is that, during Osler’s life and after, so much fuss was made about a man who did not discover anything of much im-portance…Bliss succumbs to the Osler magic…[he] reinforces rather than displaces the received image of Saint William.¹⁰

Bliss seems caught between these two extreme views. One can sense his uncertainty about which interpretation to follow. He acknowledges that Osler’s essays are “dated” and that “he charged high fees, came to be chauffeured around in a flashy car, and regretted that champagne did not agree with him.” The mystique of Osler does indeed look a rather shabby affair today. But Bliss also concludes that Osler “may never be surpassed as English-speaking medicine’s most inspirational father-figure, mentor, and role model.” Bliss does not hide his difficulties as Osler’s biographer:

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.

Efforts to canonize Osler fill the medical literature to this day.¹¹ The embalming process began early with the tremendous success of the Principles. His textbook became standard for at least two generations of doctors. His speeches and essays bestowed a reflective scholarship and sense of identity—“The unity of knowledge, its orderly continuity and its steady progress throughout the ages,” according to one critic—on a profession challenged by the new science of the nineteenth century. And when Osler died, he quickly became a legendary figure. An editorial in the medical press began, “William Osler was the greatest personality in the medical world at the time of his death.” His obituary in The Lancet commented,

The medical profession has lost in Sir William Osler an acknowledged head; the east and west of Anglo-Saxon worlds have been deprived of their firmest common friend; and the individuals who mourn him today stand in every class not only in this country and in America, but throughout our Dependencies and the Continent of Europe.

Public meetings were held and permanent memorials planned. But it was the success of Cushing’s biography that provided the strongest historical foundation for Oslerian legend, which has undergone a spirited revival during the past decade or so. The rebirth of Osler’s reputation parallels another period of turmoil for medicine, although this time not from the creative energies of science but from the exigencies of health economics. Here are the titles of just a few papers invoking Osler’s memory, all published in the 1990s: “Clinical Education: The Legacy of Osler Revisited”; “Osler and His Thoughts for Us in 1991”; “Osler’s Changing Influence”; “What Is the Oslerian Tradition?”; and “William Osler: A Model for the 21st Century?” (to which the answer was yes).

These eulogies are puzzling, since Osler himself cheerfully acknowledged his own personal failings, especially his brusque egotism. (He wanted his brain preserved for study and posterity in the Wistar Institute in Philadelphia.) A further contradiction to his sacred contemporary image is supplied by one of his mentors, W.A. Johnson. In a letter to his son, Johnson wrote, “I am not surprised at your not taking up with Professor Osler. He is an Osler and there is that in him, unless I am much mistaken, which you must never admire.” Johnson recognizes Osler’s application but he cannot discern “any talent…or any high principle of action. Simply great application, and, probably, the motive is money making.”¹²

A more insistent question that emerges from Osler’s life—one that Bliss, Bynum, and Nuland avoid—is why a few doctors have expended so much energy during the past century in creating a cult around this man. I write “a few” because most doctors could not give a hoot about Osler, or any other doctor beyond their immediate experience. Many of us will have had mentors whom we admire, perhaps even revere. But veneration of the medical dead is unusual. So why Osler?

The fact is that original scientists are more likely to be remembered and celebrated than medical doctors. Those engaged in ordinary medical practice and teaching commonly lack not only the elusive spark that leads to significant advances in science or treatment but also the glamour that invites public applause. Here perhaps lies the reason for Osler’s extraordinary reputation. Doctors who are simply doctors, and who are not famous researchers, have had few heroes since the days of Hippocrates. In any professional order of merit the science of experimental medicine has eclipsed the skill of the clinical practitioner. Doctors are less esteemed than they once were. Their authority has been eroded and their traditional influence heavily circumscribed.

A once-prized clinical freedom to practice and prescribe as one wished has now, thankfully for patients, evaporated. Doctors are rightly, but unusually when one looks back across the history of medicine, expected to adhere to evidence, applying the findings of clinical research to their patients in a more ordered way. This approach, by which doctors must follow guidelines, has been exploited by public and private health providers as a perverse means to limit care by imposing spurious restrictions on cost. A consequence of this distorted market is that medicine is becoming dramatically deprofessionalized. To celebrate the life of Osler is, for some, to recall a different and better time for medicine, when an intelligent and devoted physician could expect to become a respected specialist or perhaps even, for those with less self-effacing desires, a public hero.

Here lies an obvious danger. There is much in Osler’s life to study with modern advantage. His achievements are a remarkable testament to professional ideals that deserve discussion and reinterpretation among every new generation of medical practitioners. But to sustain the Osler myth, as doctors and medical historians have done, serves only to promote a version of medicine that is disengaged both from contemporary clinical inquiry and the difficult political discussions that affect the future of health care. Those inquiries and debates need fresh thinking, not curatorial reverence.