Patrick Fiddes
Melbourne, Australia

To have striven, to have made an effort, to have been true to certain
Ideals—this alone is worth the struggle.¹

On February 22, 1905, Sir William Osler delivered his final address at Johns Hopkins University, in which he said, “I desire no other epitaph…than the statement that I taught medical students in the wards, teaching of medical students in the wards, as I regard this as the most useful and important work I have been called upon to do.”² As well, he had wished to be remembered for instilling into his students an absorbing desire to know the truth, that the library he bequeathed to McGill University would have an educational value,³ that his books would become a source of his remembrance, and that medical schools retain the humanities as essential parts of a liberal medical education.

In each lies an educational commitment that provides a perpetual remembrance of the life and work of an outstanding physician and teacher whose achievements and contributions in medicine and medical education are recorded in books that include: Sir William Osler, An Annotated Bibliography with Illustrations,⁴ a catalogue of 1267 Osler publications; Bibliotheca Osleriana, A Catalogue of Books illustrating the History of Medicine And Science^5,6; Contributions to Medical and Biological Research Dedicated to Sir William Osler⁷; William Osler Memorial Volume: Appreciations and Reminiscences⁸; The Life of Sir William Osler⁹; William Osler, A Life in Medicine¹⁰; Sir William Osler, An Encyclopedia,¹¹ and the intellectual biography, The Myth of William Osler.¹²

While William Osler would have been pleased in the way his life and works were remembered, he had made clear that the errors he had made were of the head and not the heart.¹³ However, Osler would have been disappointed by the development of a substantial literature that included a subset of laudations and misquotations that attribute to him the introduction of the practices that changed American clinical teaching. Such gratuitous claims illustrate their authors’ errors of heart rather than head.

Such hagiolatry caused Harry Bloch to address Oslerian myths, images, and realities in 1986, from which he concluded:

Osler’s historic venture into medical education, the invaluable library, and his pleasant essays will always assure him of a place in the history of medicine. This is all Osler would have wanted—the realities, and not the myths or images that have accreted around him, which Sigerist¹⁴ was the earliest to detect….and only tend to distort the real Osler.¹⁵

Examples of such epithetic hagiography include the appellations “Father of Modern Medicine,”¹⁶ “the Canadian Hippocrates,”¹⁷ “the greatest physician since Hippocrates,”¹⁸ “the ‘inventor’ of both the medical residency and the clinical clerkship,”¹⁹ “the Saint of Baltimore,”²⁰ and most recently, “the Founding Father of Modern Medicine and Medical Education.”²¹

In 1997, Bryan commented about such claims: “Osler often receives credit for introducing bedside teaching for medical students, but he never made that claim.”²² Then, in 2007, he and Golding asked if such literature represented insightful history or insipid hagiolatry.²³

Such Oslerian hagiolatry was also the subject of a trenchant criticism by Michael Bliss in “William Osler at 150,”an article he wrote soon after the publication of his 1999 biography William Osler: A Life in Medicine. In his essay, Bliss wrote, “Trying to commit ‘pathography’ on Osler, I was unable to find anything that would justify the death of his reputation.”²⁴ But, inadvertently, Bliss contributed to the Oslerian mythology by writing, “Pedagogically, Osler brought to Johns Hopkins the institution of the clinical clerkship, which McGill had copied from Edinburgh.”²⁵

Osler had neither “brought to Hopkins the clinical clerkship” nor had McGill copied it from Edinburgh. As Osler recalled in a 1913 address:

The talk of the teachers [at McGill] was of the Royal Infirmary of Edinburgh, or of Glasgow, of the Meath Hospital, of the Rotunda and of Bart’s, of Guy’s, of St. Thomas’ … Scottish and English methods prevailed and we had to serve our time as dressers and clerks. There were four first-rate teachers on the staff, Howard, Wright, MacCallum and Drake…three of whom had learned at first hand the great language of Graves and Stokes.²⁶ The bedside instruction was excellent and the clerking was a serious business.²⁷

The “great language” method was introduced to the Dublin Meath Hospital Medical School early in the nineteenth century by Graves, who “introduced two elements of radical change in medical education: the distribution of the care of patients to senior medical students and the changing of teaching from the lecture room to the bedside of the patient…Graves constantly exhorted students to spend time on the wards gaining practical experience.”²⁸

Howard graduated from Dublin in 1848 and studied in Europe for a few years thereafter.²⁹ He supervised Osler’s clinical instruction as a ward-based clinical clerk and surgical dresser, and in signing Osler’s certificate of attendance wrote, “Mr. William Osler has acted as my dresser and clinical clerk.”³⁰ Howard emulated Graves by encouraging Osler’s pursuit of pathology specimens that were to become the basis of Osler’s final year thesis.^31,32 Howard also encouraged Osler to frequent his home and library.³³ They became lifelong friends.³⁴

What Osler brought to Johns Hopkins was the knowledge he derived from his student learning at McGill, the influence of his close association with Palmer Howard, his postgraduate studies with Burton-Sanderson, and attendance at Virchow’s clinico-pathological teaching at his autopsies.³⁵ Osler also experienced the diversity of clinical teaching methods that were well established in the teaching hospitals of London,³⁶ Germany, Vienna, Pavia, and other European centres.³⁷

These, with his personal attributes, his classical education, and the knowledge he gained through his considerable clinical, pathological, and research experiences as a professor and clinical teacher at both McGill and Philadelphia University Medical Schools, facilitated his success at Johns Hopkins.

The educational paradigm introduced at the Johns Hopkins University Medical School and Hospital was that proposed by the school’s dean, William Welch. Students needed to meet set pre-admission standards and undertake a four-year course, of which the first two years were to be a chemical-biological course and the last two “very largely clinical, that is, bedside and dispensary instruction.”³⁸

Though “Welch was the foundation upon which the medical school was built…it is Willliam Osler who was the most famous representative of the institution.”³⁹ However, Osler neither invented the medical residency nor introduced clinical clerkships to the United States.

Clinical teaching was first introduced in North America at the Philadelphia Hospital in 1752 by Thomas Bond, who wrote, “There the Clinical Professor…meets his students at stated times in the Hospital and when a case presents adapted to his purpose, he asks all those Questions which lead to a certain knowledge of the Disease and parts Affected.”⁴⁰ Such clinical teaching was introduced soon after to New Orleans in 1857.⁴¹

Osler was neither the Father of Modern Medicine, nor Father of Medical Education, nor the Saint of Baltimore, other than as a cherub depicted in Max Brödel’s 1896 cartoon, “The Saint-Johns Hopkins Hospital.”⁴² Nor did he introduce bedside clinical teaching, despite Harvey Cushing’s dedication in his 1925 biography, The Life of Sir William Osler:

To Medical Students. In the hope that something of Osler’s spirit may be conveyed to those of a generation that has not known him; and particularly to those in America, lest it be forgotten who it was that made it possible for them to work at the bedside in the wards.⁴³

Cushing also wrote that Osler “expressed the desire that his epitaph should read, ‘Here lies the man who admitted students to the wards,’”⁴⁴ which resembles closely the Johns Hopkins Medicine website averment: “He once said he hoped his tombstone would say, ‘He brought medical students into the wards for bedside teaching.’”⁴⁵

Each was incorrect, for in 1905 Osler expressed the wish that his epitaph should state that he “taught medical students in the wards, as…the most useful and important work [he had] been called upon to do.”⁴⁶

A further example illustrates the propensity to comment by those who may not have studied Osler’s life and works:

Osler, who had observed bedside teaching in his post-graduate studies, recognised that this method had much to offer in the instruction of medical students. Opportunity to introduce this method of teaching into the medical curriculum came in 1888 when he was called to serve as Professor of Medicine and Physician-in-Chief at the newly established Johns Hopkins Medical School and Hospital.⁴⁷

Harvey overlooked Osler’s student experience of bedside clinical teaching and clinical clerking at McGill and may have been unaware that bedside teaching had been introduced previously at Philadelphia, New Orleans, and many other American medical schools.⁴⁸ He also mistook Osler’s “call to” Hopkins that occurred in 1889.⁴⁹

The last example is purported to be an Osler aphorism: “Listen to the patient, he is telling you the diagnosis.”⁵⁰ However, Silverman et al. noted its uncertain source and its common usage.

In each of these epithets and solecisms, the authors’ desire to express their admiration for Osler and enhance the body of his achievements overcame their responsibility to authenticate data and to verify the same truths that Osler tried to inculcate in his students.

Despite their intentions, the authors of these epithets or solecisms failed to add to the just reputation that was established in Osler’s lifetime and maintained in the responsible literature, which attests to the standing and remembrance of an outstanding physician, teacher, and educator.

References

1. Osler, W. (1908). An Alabama Student. (Toronto; Oxford University Press), 18.
2. Osler, W. (1905). “The Fixed Period.” In Aequanimitas (London, H.K. Lewis. 2nd Edition), 407. 
3. The Osler Library of the History of Medicine.
4. Golden, R.L & Roland, C.G. 1988. Sir William Osler, An Annotated Bibliography with Illustrations. (San Francisco, Norman Publishing.)
5. Francis, W., Hill, R. & Malloch, AH. (eds.) 1929. Bibliotheca Osleriana (Oxford; Clarendon Press)
6. The Bibliotheca Osleriana editors detailed other books Osler had donated to a number of other libraries.
7. Dana, C.L. & et al. (1919). Contributions to Medical and Biological Research, Vols. l & ll(New York, Hoeber).
8. Abbott, M. (ed.). (1926). William Osler Memorial Volume: Appreciations and Reminiscences (privately printed). Montreal: Bulletin 9. International Associations of Medical Museums.
9. Cushing, H. (1925). The Life of Sir William Osler, Vols. l & ll. (Oxford; The Clarendon Press).
10. Bliss, M. (1999). William Osler. A Life in Medicine. (Toronto; University of Toronto Press).
11. Bryan, C.S. (ed.) (2020). Sir William Osler, An Encyclopedia. (Novato, Norman Publishing).
12. Fiddes, P. (2021) The Myth of William Osler. A Re-Examination of the Legacies of a Medical Legend, (London; Austin Macaulay). A book based on a 2018 PhD thesis, Sir William Osler’s life in Medical Education. https://doi.org/10.4225/03/5a5c1fafcf662. 
13. Osler, W. “L’Envoi.” His farewell address, New York, May 2,1905.
14. Sigerist, H. (1934). American Medicine. Trans., H. Nagel (London; Oxford University Press),124-7.
15. Bloch, H. “William Osler, MD (1849-1919): Myths, Images, Realities.” Medical History, 1986, 78(2),155.
16. The Canadian Medical Hall of Fame online video. https://www.cdnmedhall.ca/laureates/williamosler.
17. Romanell, P. “A philosophic preface to morals in medicine.” Bull N Y Acad Med 1974 Jan; 50(1),4.
18. Buchanan, W.W. “Sir William Osler (1849–1919): The early years, with special reference to his boyhood days in Dundas, Canada.” Proc R Coll Physicians Edinburgh 2001; 31:154.
19. Norman, G. “Medical education: past, present and future.” Perspect Med Educ (2012) 1: 7.
20. Nuland SB. Med Econ. 2000 Apr 24;77(8):137-42.
21. Cao, W & Yang, X. (2024).”Re-exploration of Oslerian legacy of Osler’s address ‘Old Humanities and New Science.’” https://www.degruyter.com/journal/key/ajmedh/html
22. Bryan, C.S. Osler: Inspirations from a Great Physician. (New York, Oxford University Press, (1997), 127.
23. Bryan, C., & Golden, R. “The Osler Industry: Insightful History or Insipid Hagiography. Journal of Medical Biography, 2007:15, supplement 1: 2-5.      
24. Bliss, M. “William Osler at 150.” Canadian Medical Association Journal 1999. 161 (7): 831-832.                 
25. Bliss, (n. 10), 834.
26. Graves and Stokes were famous Dublin physicians; Graves graduated from Dublin Medical School, then Trinity College, and Stokes graduated from Edinburgh.
27. Osler, W. “The Medical Clinic.” The British Medical Journal Jan. 3, `1914: 10.
28. Bergin, C & Horgan, M. “Past, present and future of medical education in Ireland.” The Asia Pacific Scholar. 2020, 5, (2), 2.
29. Howard, R. Palmer. 1983. “The Chief: Doctor William Osler.” (Canton. USA. Science History Publications), 3.
30. The certificate is held in the William Osler Letter Index, McGill University Library.
31. Cushing, (n. 9), Vol 1, 83-85.
32. Fiddes, (n. 12), 51.
33. Howard, (n. 29)ix. The Prefatory Note
34. Osler, W. (1906). “The Student Life.” In Aequanimitas (London, H.K. Lewis. 2nd Ed, 1906), 407.
35. Cushing, (n. 9), Vol 1, 110.
36.  Poynter, F. “Medical Education in London since 1600.” O’Malley, (1970) (Ed) The History of Medical Education. (Berkley, University of California Press) 235-249.
37. Risse, G. 1989. Clinical Teaching, Past and Present. (Amsterdam, Rodolpi).
38. French, J.C. A History of the Hospital Founded by Johns Hopkins. 1946. (Baltimore, Johns Hopkins Press): 113.
39. Silverman, B.D. “William Welch (1850-1934): the road to Johns Hopkins.” Proc Bayl Univ Med. Cent 2011 Jul; 24 (3):23;11.
40. Flexner, A. (1990). Medical Education in the United States and Canada. (The Classics of Medicine Library. 1990), 4.
41. Norwood, W. (1971). “Medical Education in the United States before the Civil War.”(New York, Arno Press and the New York Times).
42. “The Saint-Johns Hospital” [Caricature of Sir William Osler above Johns Hopkins Hospital as an angel]. Photomechanical reproduction. 1896. National Library of Medicine. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101433793-img
43. Cushing, (n. 9), Vol.1, vii.
44. Cushing, (n. 9), Vol l, 596.
45. “The Founding Physicians: William Osler (1849 – 1919).” About Johns Hopkins Medicine: History. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/about/history/history-of-jhh/founding-physicians
46. Osler, (n. 2), 407.
47. Harvey, J. (1966). “The Foundation of Ethical Theory in the Clinic.” Kennedy Institute of Ethics Journal, 6, 343.
48. Norwood, (n. 41)
49. Cushing, (n. 9). vol. l. 296
50. Silverman, M.E., Murray, T.J. & Bryan, C.S. (2007) The Quotable Osler (Philadelphia, The American College of Physicians) Part 4, Item 287, 98.