Author: Michael Bliss
This biography of William Osler is a detailed exploration of the exceptional qualities which transformed him into his era’s ‘most famous, most beloved, and most influential physician’, and a thrilling odyssey into his exceptional career especially at the Johns Hopkins Hospital in Baltimore where he wielded his unrivalled influence on Medicine. Although the book was almost fawning in describing Osler as ‘magnificent, epic, important, and more than slightly saintly‘, it nevertheless argues that his life stands up to ‘critical dissection, even microscopic scrutiny‘. The portrait of Osler that emerges is of a beloved physician who ‘enchanted‘ his patients and colleagues with his unique personality, and as the physician who ‘more than anyone else made Johns Hopkins a very, very good medical school‘. The narrative most helpfully documents the personal habits and professional practices which enabled Osler to attain legendary status as a physician – from his encyclopaedic medical knowledge and astute clinical and pathological skills, to his ‘strikingly new and important teaching methods‘. Equally enlightening is the biography’s chronology of Osler’s later life as he evolved into ‘an elder statesman‘ who reflected on ‘the state of the profession, the advancement of science, the march of history‘, and on ‘death and the meaning of life‘ (pages ix, xiii, 109-111, 196, 208-210 and 218-227).
The most revealing feature of the biography is its characterisation of Osler’s genuinely awe-inspiring and ‘charismatic‘ personality, and why this had an almost magical impact on everyone he encountered. Remarking that ‘almost everyone loved him’, and that ‘a few disciples literally worshipped him’, the author explained that ‘the beauty‘ of his personality’, and his ‘contagious’ or ‘infectious’ enthusiasm, made him ‘a man who would have stood out, did stand out, in any crowd’. The author further described how his ‘good-natured equanimity‘, his ‘air of authority‘, and the ‘knowledge of his great reputation‘ combined to ‘give him enormous influence over his patients’. The biography also attributed some of Osler’s charm to his ‘light-hearted, jaunty, breezy‘ manner; his ‘mastery of the uses of optimism, humor and good cheer‘; his ‘ability to remember names and faces’; and the ‘personal interest‘ he takes in his students. It is undoubtedly his phenomenal personality that made it easy for Osler to make friends across the Atlantic, and to rapidly advance from a young physician at McGill University to the Regius Professorship of Medicine at Oxford. The book also reviewed Osler’s other defining habits, from his avid bibliomania and his prolific essay writing, to his ‘love of children and childhood play and fantasy that would stay with him all his life’ (pages x, xiii, 89-97, 100, 115, 208, 264, 276, 294-300, 363-364).
A major theme of the biography is its exploration of what the author referred to as ‘Osler’s medical art‘ – the cornerstone of his abiding fame. In exploring this, the author pointed out that Osler’s ‘revolutionary impact’ was not established by any discoveries he made, but to his being ‘an observer and scholar of the natural history of disease‘, and to being ‘a teacher of the natural history of illness‘. This explains why the book portrayed him mainly as ‘a working doctor’ and as a teacher who taught medical students how to ‘learn doctoring at the bedside‘. Although he was open-minded to new discoveries and innovations, and even though his practice ‘was informed and controlled by all the assistance science could give’, the author nonetheless asserted that Osler’s success relied on the personal touch he brought to the bedside, and on the comfort and ‘cheerful encouragement‘ he conveyed to his patients. In reviewing Osler’s medical practice, the book also explored his exhaustive clinical examination methods, his ambivalence to laboratory test results, and his almost pathological enthusiasm for postmortems which the author said offered him great insights into the natural history of disease processes. The author was however also critical of aspects of Osler’s practice such as his tendency to spend ‘most of his visits examining bodies for signs of organic disease‘, arguing that ‘as a diagnostician, he probably did not attend as carefully to patient narratives as physicians do today’ (pages x, 157, 112-113, 125, 140-143, 266 and 270).
The biography’s account of Osler’s time at the Johns Hopkins Hospital was narrated on the backdrop of the history of the institution, and of his collaboration with its other founding physicians. In this regard, the book documented such epoch-making episodes as the generous bequest of the eponymous Quaker millionaire with which the university and hospital were established; and the substantial donation made by Mary Garrett, Carey Thomas, Mary Gwinn, and Elizabeth King – the ‘group of women’ who stepped in to ‘rescue the medical school’. The book also reviewed the notable appointments of Daniel Coit Gilman as University president; of John Shaw Billings to lead the building of the hospital; and of William Welch to head the medical school. The book’s profiles of the other founding physicians were similarly enlightening, referring for example to William Halsted as ‘a surgeon who was of immense brilliance and influence‘, and to Howard Kelly as ‘technically the most brilliant of the Hopkins surgeons’. In its assessment of the factors which contributed to the success of the Johns Hopkins, the book particularly highlighted its ‘leaderless diffusion of authority‘, and its collegiate culture which enabled Osler and the other founding fathers to institute the remarkable medical reform movement which distinguished the Johns Hopkins Hospital (pages 168-178 and 199-216).
Whilst Osler’s time at the Johns Hopkins Hospital was the defining phase of his career, his life before then played an influential role in determining his future success. For example, the book described how he acquired his legacy of ‘bridge-building‘ and a ‘common-sense mindset’ from his father, and the ‘capacity for sustained hard work‘ from his mother. Similarly, the biography credited his ‘professional, personal, and cultural‘ refinement, and his broad ‘range of experience‘, to a two-year stint of medical studies he undertook in Europe. Osler’s time at McGill University – ‘the best Canada had to offer’ – was also critical as this was where he ‘impressed practically everyone with the range of his achievement and his idealism‘, and with his ‘complete self-discipline, application…and good humor‘. It was also at McGill that the author said Osler acquired his ‘passion for postmortems‘; introduced key teaching innovations; expanded the range of the curriculum; and raised the profile of pathology in the Medico-Chirurgical Society meetings. Becoming one of the ‘most popular professors’ and ‘a rising star in a rising profession’, it was perhaps inevitable that Osler was poached by an American university, the book recounting his career move first to Philadelphia, ‘the oldest medical school in the United States’ where the administrators were ‘debating the limits of professional inbreeding‘ and had set their sights on Osler to fill their vacant chair of clinical medicine (pages 3-31, 39-66, 78-81, 86-88, 119-120 and 126-131).
The biography’s discussion of Osler’s sterling contributions to medical practice revealed the extraordinary range and scope of his medical skills. This was evident even in Philadelphia where the author said Osler ‘transformed himself into a medical statesman‘ giving frequent lectures around the world on medicine, medical education, medical reform, women in medicine, nursing, and professional organisations. It was also in Philadelphia that the author said Osler began to ‘rechannel his energies in directions more clinical than pathological, more oriented to neurology and problems of therapeutics‘ such as rheumatic chorea. But perhaps what best conceptualised Osler’s academic contributions was The Principles and Practice of Medicine‘, his seminal textbook which the author depicted as ‘a monument to the achievements of nineteenth-century scientific medicine and a gateway to the twentieth century’. Referring to it as ‘the last text in which a single author dared to write on the whole range of the body’s internal ills’, the author praised it for its ‘up-to-date content’, its ‘extreme clarity‘, its ‘straightforward style‘, and its ‘short, uncluttered sentences‘. It was therefore not surprising that ‘the book was an immediate success‘ and ‘was a major source of Osler’s income‘ for life. Other academic landmarks established by Osler, reflections of his astute clinical observation, are the number of signs and diseases that are eponymously named after him, from Osler nodes to Osler-Weber-Rendu disease (pages ix, 182-191, 146-153, 301 and 355).
This almost strictly chronological account brings out the qualities and works that made Osler one of medicine’s most recognisable and admired figures. With a detailed narrative and simple prose, the biography is worthy of the stature of its subject. It not only highlights the highest values of the profession which Osler’s career symbolised, it particularly mapped out the humanity and goodwill his whole life espoused. His attitude to family, friends, colleagues, students, and patients is exemplary and replete with lessons for all doctors today. His dedication to the practice of medicine, and to the effective transmission of its core values to future generations, are of contemporary relevance and wholly worthy of emulation. The author also effectively complemented his biography with enlightening snippets of the history of medicine, and of the evolution of its philosophies of care and cure.
Thos book has succeeded to a great extent in bringing out the attributes that made Osler such an esteemed and effective physician, and these are the immutable aspirations of every doctor. The biography establishes why he, rather than any of his contemporaries, left an abiding legacy, and these ranged from his charming personality and bruising work ethics to his commitment to improving himself and his profession. This book masterfully sets out Osler’s philosophy and practice as perpetual examples for medicine, and I recommend it to all doctors.
Publisher, Place, Year: Oxford University Press, Oxford, 1999
Number of chapters: 13
Number of pages: 581
Star rating: 5