Osler: The Saint of Baltimore

By Nuland, Sherwin B. | Medical Economics, April 24, 2000 | Go to article overview

Osler: The Saint of Baltimore


Nuland, Sherwin B., Medical Economics


He "may have been the greatest clinical teacher of any day, and any country," says the author, in this review of a new biography.

On a brilliantly clear day in early May 1889, six young physicians and scientists looked on in eager but apprehensive anticipation as the opening ceremonies were held in Baltimore for a new kind of hospital, on which they had staked their careers. Ranging in age from 31 to 39, each of the men was riding the upward arc of a brilliant academic trajectory; each of them had been recruited away from a university position that would have assured him the facilities and the support for a productive career. But each of them wanted more than mere professional success. These rising medical stars were risking a great deal in order to take part in an incompletely formed project that would succeed or fail on the basis of their individual and collective abilities to create a novel and quite independent atmosphere of research, teaching, and patient care. On that spring day, however, the entire enterprise was still only a dream in the minds of its planners.

The Johns Hopkins Hospital and the associated medical school that was to be founded four years later held the promise of launching American medicine on excitingly novel adventures, in which each of the new professors would essentially create from scratch the conditions that he considered ideal for his work and for the development of his specialty But it also held the threat of failing in a welter of poor planning, pedagogical squabbles, and inadequate financing. Franklin P. Mall in anatomy, John Jacob Abel in pharmacology, Ira Remsen in chemistry William Welch in pathology, Howard Kelly in gynecology and William Osler in medicine formed the vanguard of a potential revolution in medical science and education, and they knew it.

They also knew that the entire bubble of fantasy might explode in their faces. Even four years later, when the 33-year-old William Howell joined them to be professor of physiology at the opening of the medical school, a great deal was still uncertain. The only sure thing was the conviction of those who observed them that they were all caught up in what one commentator called "the contagion of excellence."

In spite of a bundle of obstacles-not excluding their own philosophical differ

ences and the inevitable personality clashes that might have undone lesser men-the seven 30-somethings did succeed. Soon they would be the envy of the world. One of the seven would become, as Michael Bliss calls him in his eminently readable new biography "the high priest of his emerging profession." William Osler is remembered as the greatest clinical teacher of his day; a judgment so universal that it needs no modifying by such trendy adverbs as "arguably." In fact, he may have been the greatest clinical teacher of any day, and any country too.

Primarily by means of Osler's great textbook, The Principles and Practice of Medicine (which went through 16 editions, the last being published in 1947, 26 years after his death), but also by means of Osler's widely circulated lectures and many published articles, English displaced German as the language of medical discourse, the language that one had to know in order to comprehend the new advances beginning to appear so rapidly near the end of the 19th century. An immensely wellliked man and a catalyst to the accomplishments of others, he became the most sought-after medical speaker in America. He served as president, and often founder, of so many cultural and scientific organizations that even an Osler addict like myself is constantly surprised to come across yet another one not previously known to him.

Bliss writes: "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. …

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