Two lives of Osler, 75 years apart; BIOGRAPHY

THE BALTIMORE SUN

Canada-born William Osler (1849-1919) was professor of medicine in four cities in three countries on two continents: McGill U., U. of Pennsylvania, Johns Hopkins and Oxford. The longest segment of his professional career was the 16 years (1889 to 1905) spent at Johns Hopkins, where he was the first physician-in-chief. He is generally considered to have been the leading physician of his day, and his influence has been almost uniquely persistent.

Neurosurgeon Harvey Cushing (1869-1939) was at Johns Hopkins from 1896 to 1912. Although 20 years Osler's junior and a surgeon under Halsted, not a physician, he and Osler were particularly "simpatico." Cushing was one of the "latchkeyers," bachelor doctors who lived at 103 W. Franklin St. and were given keys to the Oslers' house next door, where they were welcome to use Osler's library and enjoy his hospitality.

After Osler's death, Cushing undertook to write "Life of Sir William Osler" (Oxford at the Clarendon Press, 1,413 pages). This and several later editions are no longer in print. He put out a call for correspondence to and from Osler. Osler was an inveterate correspondent with many friends. He was also an indefatigable note-taker and writer of medical articles, books, addresses, essays, editorials, etc. Cushing assembled a substantial part of this material into a biography that was published in 1925 and awarded a Pulitzer in 1926.

Michael Bliss, a professional historian and author of a notably iconoclastic biography of Frederick Banting, discoverer of insulin, produced the latest biography of Osler, "William Osler: A Life in Medicine" (Oxford, 581 pages, $35), in this, the 150th year after Osler's birth. He had access to a large volume of primary sources, Osleriana and Osler scholarship that have become available or accumulated since 1925. The authoritative catalog of publications by Osler has 1,628 entries; this is almost matched by the 1,588 books and articles about Osler, most written after the Cushing biography.

Cushing's biography was organized in a tightly chronological sequence. A valuable help to the reader is the provision of date (on left) and Osler's age (on right) at the top of facing pages. Bliss' more thematic biography is organized into 13 chapters, ending with one titled "Osler's afterlife," reviewing his influence and reputation in the 80 years since his death.

Bliss describes the Cushing biography as a "ponderous, repetitive narrative." He follows to state that it "was certainly uncritical." This statement seems to come from the fact that, search as you will in the Cushing narrative , it is impossible to discern any serious foibles, personality defects or misdemeanors.

As a "modern" biographer, fresh from Banting bashing, Bliss expected, as he states in his preface, to find "feet of clay." To his surprise he found none. In Bliss' own words: "Immersing myself in the sources, expecting them to make possible a reasonable amount of icon bashing, I gradually found myself becoming struck by the power of the Osler image."

It appears that in the last analysis Bliss found that Cushing "told it the way it was." Bliss' adjective "ponderous" applied to the Cushing may be appropriate. To get through it requires a snowed-in winter break on a remote Maine farm or naval duty. It was under the former circumstance as a third-year Hopkins medical student that I read Cushing's "Osler" for the first time.

I was not surprised that I found it thoroughly absorbing, especially the first volume, because it had much of medicine and much of Johns Hopkins. It was surprising to me, however, when a prominent Boston lawyer told me that he took a copy on convoy duty in the North Atlantic during WWII and became tremendously absorbed, seemingly as much as did I. He, like Bliss, had fallen under the "power of the Osler image."

"In medicine generally," writes Bliss, "and at Johns Hopkins particularly, Osler continued to be one of the most frequently cited of all dead physicians." Is that not to be expected, at least as far as Hopkins is concerned? At the Johns Hopkins Hospital, where Osler spent 16 years, there is an Osler building, Osler Medical Service, Osler necktie, William Osler chair of medicine, John Singer Sargent and Thomas C. Corner portraits, Osler's desk (or at least an Osler desk) and Osler Textbook Room where Osler wrote his famous textbook "Principles and Practice of Medicine" in 1891. Osler Hall is the auditorium at the Medical and Chirurgical Society of Maryland ("Med-Chi"), the state medical society. This and Osler Drive in Towson are indications that his influence extended beyond East Baltimore.

(Incidentally, the family and all "in the know" pronounce the name "Oh-sler", not "Os-sler"; the "O" is pronounced like the "o" in "host".)

In 1892, aged almost 43, Osler married a great-granddaughter of Paul Revere. Some readers will open Bliss' book eager to determine whether it is true that Osler, as the "boy professor" in Montreal, fathered one or more children out of wedlock. Bliss, who was looking for just this sort of crack in the veneer of a respectable and respected Victorian, states that he found, in the massive body of writings by and about Osler, not one jot of documentation. An alleged extramarital relation with one of his first cousins was a piece of gossip savored by younger generations of the extensive Canadian Osler clan but had no basis in fact, in the view of Bliss.

Themes that Bliss develops more than did Cushing include Osler's attitude toward women in medicine, euthanasia, old age and cigarettes. (Although he recognized tobacco angina and predicted its increase in women as more of them smoke, he thought moderate smoking had advantages; he did not recognize that many persons do not have the "will power" that permitted his abstemious [three or four a day] use of the addictive material. In fact, those who have reviewed Osler's medical history and final illness with complications of chronic lung disease conclude that his smoking was a contributing factor.)

One might conclude that the Cushing biography represents the gospels and the Bliss biography the exegesis. These days few will have the time or inclination to wade through the Cushing biography, but those few who do, health professionals or not, will be richly rewarded. They would do well to read Bliss' biography before or after (or both).

Victor A. McKusick, now University Professor of Medical Genetics at Johns Hopkins University, was William Osler Professor and Physician-in-Chief, Johns Hopkins Hospital, 1973-85.

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