The greatest physician

He rose early and worked late. He performed hundreds of autopsies and wrote a landmark medical textbook. At a time when medical students weren't even allowed near patients, he brought them into the hospital wards. It was there, at the bedside, that William Osler believed doctors should be: listening, examining, scribbling down notes.

A hundred years after he practiced medicine, many physicians still consider him the greatest doctor of all time. They train in the system he set up, they follow his strategies in examining patients. They keep his books on their bedside tables, and many hang up his picture. Osler is the doctor they want to be, a man who relied on his soul as much as his science.


"Everybody needs a hero, and for physicians, Osler really is that hero," said Dr. Stephen Achuff, professor of cardiology at the Johns Hopkins School of Medicine, where Osler worked in the late 1800s and early 1900s. "He really is of almost mythic proportions."

This year, with three new Osler books being published, the master physician's spirit is once again being celebrated. Hopkins residents produced The Osler Medical Handbook for their peers. Doctors' Work pairs photographs by Ted Grant of modern physicians at work with words from Osler. And The Quotable Osler was put together by doctors who love Osler's ideals and wanted to introduce him to a new generation of physicians. That volume is being given to medical students across the country.


"I definitely say to myself, 'How would Osler have handled this?'" said Dr. Mark Silverman, professor of medicine at Emory University and the book's editor.

Noted Dr. Jim Dutton, a cardiac surgeon in Canada who is on the cover of the new book, Doctors' Work: "Here's a guy who at the start of modern medicine got it. He knew what it was to be a great physician, and he could tell you what it took, and he lived it."

Osler (pronounced Oh-sler) grew up in a family of nine children in a remote part of Canada and was expected to become a minister. Instead, he fell in love with the microscope and science in boarding school, and in 1872 graduated from McGill University's medical school.

Back then, much of medicine involved half-truths and hucksters, but historians say Osler was among the first to take a more rigorous approach, dissecting rotting corpses to learn about the human body and seeking out which treatments worked. He took care of smallpox patients, even contracting a case himself. He became one of the most charismatic and popular professors at McGill.

Osler saw all sorts of cases, from common colds to tumors and exotic diseases. According to Michael Bliss' 1999 biography, William Osler: A Life in Medicine, Osler used to march cheerfully into a room, pull up a chair and look over the patient closely. He was a master of distinguishing sounds in the stethoscope, peering across the chest and abdomen, squeezing toes and using other methods to figure out what was wrong. He often detected aneurysms, liver abscesses and tumors missed by other physicians.

That ability created the legend that he could stand in the door and diagnose what was wrong with the patient, Bliss wrote. Patients and students idolized him.

"In a room full of discordant elements he entered and saw only his patient and only his patient's greatest need, and instantly the atmosphere was charged with kindly vitality, and everyone felt that the situation was under control," wrote Edith Gittings Reid, a writer, Baltimore neighbor and patient of Osler's, as quoted in the Bliss book.

In 1889, Osler was recruited to be the first chief of medicine at the new Johns Hopkins Hospital, where he wrote the medical textbook, The Principles and Practice of Medicine, so literate and thorough that it became an instant classic, in demand until recently. It was so good, historians say, that it convinced John D. Rockefeller to make the first major donation to biomedical research.


Then Osler set up the medical school at Hopkins, putting in place the training system he had seen in Europe, where students worked in the wards and gradually took on more responsibility. He believed they could learn more in 15 minutes at the bedside than hours in the classroom.

He developed a philosophy of what it meant to be a doctor. He believed it was a calling. He preached that physicians should never leave a patient without hope. And he urged his colleagues to cultivate "aequanimitas," or equanimity, a calm, unflappable demeanor, especially in a crisis. "The physician needs a clear head and a kind heart," he wrote.

His smarts and sensibility made him a world celebrity, so well-known and respected that he was called to the White House and 10 Downing Street. His patients included Nancy Astor, Walt Whitman and Frederick Pabst, the Milwaukee brewer.

Osler was a Renaissance man, a voracious reader who often wove references to the Bible, Shakespeare and Greek mythology through the hundreds of articles, essays and books he wrote. He wasn't always serious, though. He pulled many pranks, and he liked to poke at the arrogance of medical journals by submitting fake case reports under a pen name.

At Hopkins, students and interns are inducted into the Osler tradition every year, taking tours of the hospital's trademark dome and the nearby room where Osler labored on his textbook. "We're passing down the legacy," said Dr. Victor McKusick, one of the world's foremost medical geneticists. He and Achuff have raised about $200,000 to restore the room and set up a lectureship as a living memorial to Osler.

For many years, internal medicine residents on the Osler Medical Service, affectionately called "the O," have referred to themselves as "Osler Marines." One of the most coveted awards is the "Most Oslerian Intern." And no matter where they're practicing in the world, physicians trained on the famously intense Osler service wear a navy and white "aequanimitas" tie or scarf on Fridays. It's considered a badge of honor


Dr. David Hellmann, an internist who now heads Johns Hopkins Bayview's department of medicine, remembers his days as a Hopkins resident, wheeling patients from the emergency room up to the Osler building and seeing Osler's large portrait towering over him.

"I'd see his piercing eyes and say, 'Hey, I'll try to keep it going,'" Hellmann said. "You felt a sense of a baton being passed."

Homage to Osler takes on an almost religious tone. At Hopkins, his successors as chief of medicine are considered to be in an "apostolic succession," disciples of a founding father. There are Osler societies in Japan, Canada and the United States dedicated to keeping "WO" and his ideals alive. Medical students have been known to seek Osler's blessing at the McGill Library, where his extensive book collection is housed, along with his ashes.

As the years pass, though, physicians worry that fewer medical students have heard of Osler. Even at Hopkins, the aging Osler Building is slated to be torn down. But more than ever, Osler's fans say, medicine needs him - especially for his lessons about looking to the patient for the answer, and being humble when there isn't one.

When a former student at Hopkins was dying, he called Osler, hoping that the master doctor could do something. According to an account from a nurse, Osler couldn't save the young man, but he always believed a physician could offer some healing. So he sat down by the student, began to talk gently, and put his arm around him.