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 Sir William Osier, b 
 
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SIR WILLIAM OSLER, Bart. 
 
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 Open Knowledge Commons 
 
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William Osler in 1906. ""'"''''^ '^ ''^^^^"'- 
 
SIR WILLIAM OSLER, Bart. 
 
 tat 
 
 Brief Tributes to His Personality, 
 Influence and Public Service 
 
 Written by His Friends, Associates and Former Pupils, 
 
 In Honor of His Seventieth Birthday and First Published in the 
 
 Bulletin of The Johns Hopkins Hospital for July, 1919 
 
 THE JOHNS HOPKINS PRESS 
 BALTIMORE, MD. 
 
 1920 
 
Copyright, 1920, by 
 The Johns Hopkins Press 
 
 S<1 
 
 BALTIMORE, MD., U. 8. A. 
 
CONTENTS 
 
 PAGE 
 
 Some Memories of the Development of the Medical School 
 
 and of Osier's Advent. By Henry M. Thomas 7 
 
 Osier as Chief of a Medical Clinic. By Lewellys P. Barker. . 19 
 Some of the Early Medical Work of Sir William Osier. By 
 
 W. T. Councilman 33 
 
 Osier as a Pathologist. By William G. MacCallum 45 
 
 Osier, the Teacher. By W. S. Thayer 51 
 
 Osier and the Student. By Thomas R. Brown 55 
 
 Osier and Patient. By Thomas McCrae 59 
 
 Osier and the Tuberculosis Work of the Hospital, By Louis 
 
 Hamman 65 
 
 Influence on the Relation of Medicine in Canada and the 
 
 United States. By Thomas B. Futcher 69 
 
 Osier as a Citizen and His Relation to the Tuberculosis Cru- 
 sade in Maryland. By Henry Barton Jacobs 75 
 
 Osier's Influence on Other Medical Schools in Baltimore. His 
 
 Relation to the Medical Profession. By Edward N. Brush. 83 
 Influence in Building up the Medical and Chirurgical Faculty. 
 
 By Hiram Woods 89 
 
 Osier and the Book and Journal Club. By J. A. Chatard 95 
 
 Osier's Influence on the Library of the Medical and Chirurgi- 
 cal Faculty of the State of Maryland. By Marcia C. 
 
 No yes, Librarian 97 
 
 Some Early Reminiscences of William Osier. By Henry M. 
 
 Hurd 101 
 
 Osier as I Knew Him in Philadelphia and in the Hopkins. By 
 
 Howard A. Kelly 107 
 
 Osier as a Bibliophile. By Thomas R. Boggs Ill 
 
 Osier's Literary Style. By Edward N. Brush 115 
 
 Bibliography. By Minnie Wright Blogg 121 
 
SIR WILLIAM OSLER, Bart. 
 
 SOME MEMORIES OF THE DEVELOPMENT OF THE 
 MEDICAL SCHOOL AND OF OSLEE'S ADVENT 
 
 By Henry M. Thomas 
 
 In thinking of the early days of The Johns Hopkins Uni- 
 versity and Hospital and the development of the medical 
 school, my memories begin with the founder — Johns Hopkins. 
 As a small boy between 10 and 12 I sat on the same bench with 
 Johns Hopkins many Sunday mornings at the Friends' Meet- 
 ing on Eutaw and Monument streets. I cannot remember that 
 he ever spoke to me, and I remember him merely as a rather 
 unkempt old gentleman. At that time he had announced his 
 intentions for his double bequest, had, in 1867, incorporated 
 the two institutions that were to bear his name, had appointed 
 his trustees, and had bought the site for the hospital. Gallo- 
 way Cheston, the president of the university board ; Francis T. 
 King, president of the hospital board ; Francis White, James 
 Carey Thomas, James Carey, and other trustees, were also 
 constant attendants at the meeting, and it is pleasant now to 
 think that in the congregation there were represented the 
 founder, his trustees, and the rising generation which was to 
 be benefited by the bequests. 
 
 Johns Hopkins believed that his wealth had been given to 
 him for a purpose, and, to use a Friendly form of speech, that 
 he would be " given to see '' how to dispose of it. He had asked 
 advice freely and much had been volunteered, and many of his 
 advisers have claimed that they suggested the objects of his 
 bequests and the forms which they should take, but I like to^ 
 think that the wise instructions that he gave to his trustees 
 were finally determined in meeting. The most important of 
 
8 Sir William Oslek, Bart. 
 
 these for the development of the medical school was his direc- 
 tion in a letter to the hospital board, dated March 10, 1873, 
 that " in all your arrangements in relation to this hospital you 
 will bear constantly in mind that it is my wish and purpose 
 that the institution shall ultimately form a part of the medical 
 school of that university for which I have made ample provi- 
 sion by my will,^^ so uniting forever the two bequests for the. 
 furtherance of medical education. 
 
 Johns Hopkins died on December 24, 1873, and in the early 
 part of 1875 the trustees received the bequests and entered into 
 active administration of the trusts. The first important de- 
 cision of the university board was the wise and fortunate choice 
 of Daniel C. Oilman as president of the university. He came 
 to Baltimore May 1, 1875, and I can remember well the expec- 
 tation and interest his coming aroused. He and his twoi 
 daughters took apartments at the old Mt. Yernon Hotel, and 
 for me a delightful friendship began. 
 
 Johns Hopkins chose his trustees well and left them un- 
 trammeled, and they in their turn gave President Gilman a 
 free hand. They had already determined upon the establish- 
 ment of a real university, which, as Gilman once said, was to 
 supplement and not supplant existing institutions. In speak- 
 ing of his first instructions which he received from the trustees, 
 he says : 
 
 Often in private conversations and in official interviews, I was 
 charged to hold up the highest standards, to think of nothing but 
 the best which was possible under the limitations of the new 
 establishment in a country where the idea of a university had not 
 been generally understood. 
 
 In furtherance of these objects. President Gilman, in the 
 summer of 1875, went abroad to visit the various universities 
 and to consult with the leaders in education. Medical educa- 
 tion was much in his mind, particularly the establishment of 
 the laboratories and courses of instruction in the fundamental 
 sciences which would be best fitted for the preliminary training 
 of medical students. The field was almost entirely unbroken, 
 and young men not yet 30 were selected for its cultivation — 
 
The Medical School and Osler's Advent 9 
 
 Rowland in physics, Martin in biology, and Eemsen in chem- 
 istry. Rowland, although not then appointed to the chair of 
 physics, had accompanied Oilman to Europe to aid him in the 
 selection of physical apparatus and books. While on this 
 journey he found time to publish some articles in the Philo- 
 sophical Magazine which Oilman, with characteristic prompt- 
 ness and prophetic vision, dated from The Johns Hopkins 
 University — the first university publications. 
 
 Oilman was inaugurated on February 22, 187G, and the 
 university received students and began instruction in the fall 
 of that year. Professor Huxley, who had taken much interest 
 in the proposed biological department, and who had recom- 
 mended a favorite pupil of his — H. Newell Martin — as its 
 director, was in America and was asked to give an opening 
 lecture. In this lecture he spoke of the importance of bio- 
 logical studies, and particularly their relation to a properly 
 organized medical course. My father, who had selected me as 
 the son most available upon whom to experiment with this new 
 method of medical education, saw to it that I attended Oil- 
 man's inauguration and Huxley's opening lecture. I have no 
 recollection of the inaugural exercises, but I do remember 
 hearing Huxley at the Academy of Music, principally, I think, 
 on account of the storm of protest that followed. This protest 
 was directed against the emphasis which the new university 
 appeared to be giving to scientific research^ especially in 
 biology, even the study of which was thought at that time to be 
 little less than impious, and was focused on the fact that 
 Huxley, the great champion of science, had been asked to 
 speak and that the lecture had not been ushered in by prayer* 
 I believe that Mr. King and my father, both devoted religious 
 workers, were responsible for this last circumstance. They 
 certainly were astounded by the public reaction to this entirely 
 consistent Quaker procedure. 
 
 Following the advice of Huxley and others the chemical- 
 biological course was designed, and was recommended to those 
 students who intended to take up the study of medicine; in- 
 deed, it was also called the preliminary medical course. It was 
 
10 Sir William Osler, Bart. 
 
 from the first the design of the "university to establish the full 
 medical course as soon as the hospital should be completed, 
 and much thought was given to it. Martin and Eemsen were 
 recognized as forming the nucleus of the medical faculty. 
 
 At the opening of the fourth academic year, September, 
 1879, Professor Acland, then Eegius Professor of Medicine at 
 Oxford, was expected to give a lecture embodying his advice 
 as to the proper co-ordination between the university and 
 hospital in the organization of an advanced medical school. 
 Unfortunately, on account of illness, he was unable to deliver 
 the address. His views, however, have been preserved in a 
 letter to the university and hospital authorities. How sur- 
 prised he would have been had he been told that it was from 
 this unborn medical school that his successor at Oxford was to 
 be chosen! 
 
 In the early days the university was a small, compact body, 
 made up, for the most part, of a young, active faculty, sur- 
 rounded by a group of advanced workers, called fellows, and 
 other post-graduate students, and a few rather over-powered 
 undergraduates. Every encouragement and opportunity was 
 given to research and to prompt publication of work accom- 
 plished. There was the closest sympathy among all the depart- 
 ments, and everyone knew and sympathized with the work of 
 the others. It was naturally around Martin that the idea of 
 the medical school germinated, and a more inspiring teacher 
 it would be hard to imagine. Besides the regular biological 
 courses, he gave lectures to medical students and practitioners 
 of the city, and graduates in medicine entered his laboratory 
 for special work. 
 
 The emphasis which the university had put upon men in 
 contrast to buildings had permitted it to function at once, and 
 to strike a remarkable pace in a very short time. With the 
 hospital it was different; buildings were absolutely essential, 
 and even though Johns Hopkins before his death had in- 
 structed his hospital trustees to begin work, time was neces- 
 sarily consumed in the formation of plans, so that it was not 
 
The Medical School and Osler's Advent 11 
 
 until June of 1877 that these were adopted and the excavations 
 were begun. 
 
 The choice by the hospital board, in 1876, of Dr. John S. 
 Billings, surgeon of the United States Army, and librarian 
 of the surgeon-generaFs office, as their medical adviser was 
 most fortunate, both as to the construction of the hospital 
 buildings and as to the future of the medical school. Dr. Bill- 
 ings was much in Baltimore, and his encyclopaedic knowledge 
 of things medical was always at the service of the university 
 as well as the hospital. He supplemented Oilman, and made 
 with him a remarkable team. He was attached to the uni- 
 versity academic staff as a lecturer on the history of medicine 
 and municipal hygiene, although I do not think he gave many 
 lectures until after the opening of the hospital. 
 
 Among the physicians who were attracted to Martinis labora- 
 tory was Wm. T. Councilman, who began work in 1878, just 
 after having received his medical degree from the University 
 of Maryland, and who, after his return from Europe in 1882, 
 was made a fellow by courtesy, and was appointed associate in 
 pathology in 1884. He busied himself about medical problems, 
 gave some courses in special subjects, and lectured at the 
 University of Maryland on pathology. 
 
 In 1879, Wm. H. Howell came from the Baltimore City 
 College and entered the chemical-biological course and began 
 a career which was to mean much to the university and medical 
 school. He soon became a favorite pupil of Martin's, and after 
 receiving his bachelor's degree, he was made in quick succes- 
 sion a fellow, an assistant, and then, in 1885, an associate in 
 biology, having received his Ph. D. the year before. He 
 resigned from the university in 1889, to return again as pro- 
 fessor of physiology at the opening of the medical school. 
 
 I, in my capacity as experimental animal, was entered in 
 the university the same year, and I can well remember Howell 
 as the model student and also on the football field where he 
 made up for his light weight by the accuracy and neatness of 
 his tackling. 
 
12 Sir William Osler, Babt. 
 
 I look back upon my course at the university with the 
 greatest pleasure. To have been under such men as Martin, 
 Eemsen, and Hastings in physics, to have read Shakespeare 
 with Sydney Lanier, and to have heard the lectures from the 
 noted men who were constantly coming to the university, could 
 not help being stimulating to a youth even though over- 
 occupied with many athletic pursuits. It had been hoped by 
 those of us who took the preliminary medical course that at 
 its completion the university would have started its medical 
 school, but this was not to be. The buildings of the hospital 
 were going up very slowly, and as there seemed no immediate 
 prospect of the completion, we were forced to go elsewhere for 
 our medical instruction. 
 
 While at the University of Maryland, I attended Dr. Council- 
 man's first lectures on pathology, and also took a course with 
 him in the biological laboratory in the histology of the nervous 
 system. We had excellent professors at the University of 
 Maryland, but it was the old lecture system, the only labora- 
 tories being the dissecting room and a newly established 
 chemical laboratory. The students had practically no chance 
 of getting close to patients, and I was graduated without ever 
 having been instructed in physical diagnosis, and I received 
 the prize in obstetrics without ever having seen a woman in 
 labor ! I took my medical degree in 1885. By this time the 
 university was on the point of establishing its medical depart- 
 ment. In the register for 1883-1884 it is announced that " The 
 medical department of the university is soon to be organized. 
 Its plan is receiving the constant attention of the trustees, and 
 it will be made known before the completion of The Johns 
 Hopkins Hospital. The nucleus of a medical faculty has been 
 instituted as follows: The president of the university; J. S. 
 Billings, M. D., lecturer on hygiene; W. H. Welch, M. D., 
 professor of pathology; Ira Eemsen, M. D., professor of chem- 
 istry; H. Newell Martin, M. D., professor of physiology.^' 
 
 In this somewhat casual way, the university announced the 
 epoch-making facts that it had recognized pathology as a full 
 university subject, and had appointed Dr. Welch to fill the 
 
The Medical School and Osler's Advent 13 
 
 chair. The first was the natural development of the university 
 idea in medicine, and the credit of the second has been claimed, 
 in a friendly rivalry between the university and the hospital, 
 both by Oilman and by Billings. However that may be, no 
 other choice now seems conceivable. 
 
 Dr. Welch's appointment was the first one that had to do 
 with practical medicine, and I remember my father's en- 
 thusiasm over it, for with it he felt that the university had 
 made a wonderful beginning in medical teaching. What a 
 wonderful beginning it was he was to learn later ! 
 
 Welch gave his first course of lectures in Hopkins Hall in 
 February and March, 1886, on microorganisms in disease. 
 The hospital trustees allowed the university to furnish the 
 autopsy house as a pathological laboratory, and so the first of 
 the hospital buildings to be used was dedicated to the common 
 purpose of the two trusts. Dr. Councilman had been appointed 
 an associate in pathology, and courses of instruction were 
 started on N'ovember 1, 1886. Halsted came from New York 
 to work in the laboratory and Mall was appointed the first 
 fellow. Other students gathered, most of them graduates in 
 medicine, and when I returned from Europe at the end of the 
 year I joined the group. Those early days have often been 
 described, and it was, indeed, a rare privilege to have taken 
 part in them. As the hospital was not yet opened, the institu- 
 tion had to depend upon other sources for its autopsy material. 
 This was obtained for the most part from the City Hospital 
 at Bay View. In the reorganization of this charity. The Johns 
 Hopkins University had assumed the care of the insane, and 
 my father. Dr. Councilman and I were appointed visiting 
 physicians. Dr. Councilman was also pathologist. 
 
 At this time everything seemed to point to the early opening 
 of the full medical school. The buildings of the hospital were 
 practically finished, and there seemed to be no reason why they 
 should not be shortly opened. The university authorities were 
 completing their plans and Welch was on the spot. It was just 
 at this time that financial calamity overtook the university. 
 The Baltimore and Ohio common stock, of which the uni- 
 
14 Sir William Osler^ Bart. 
 
 versity had nearly 15,000 shares, dropped its dividend from 
 10 to 8 per cent in 1886, to 4 per cent in 1887, and ceased 
 paying the next year; the university was struggling for life 
 and could not take on new obligations, so that the plans of the 
 medical school were indefinitely suspended. The hospital 
 income had not been affected as it was derived almost entirely 
 from real estate, and there had been no inroads on the capital 
 by the erection of the hospital buildings. It had, indeed, 
 increased, and the hospital had now become the rich member 
 of these organically joined twin bequests. 
 
 The time had come for the hospital to take up the work, but 
 for it to begin to function, men had to be found to organize 
 the various clinical departments. Above all, a physician-in- 
 ehief had to be appointed and everything depended upon the 
 choice. The question was anxiously discussed by the two 
 boards of trustees and their advisers, and the little band of 
 students in the pathological laboratory discussed the question 
 with critical, impotent anxiety. Now that adversity had fallen 
 on the university, what hope was there that the unbroken 
 series of phenomenal appointments could continue? Where 
 could a clinician be found to match Gilman, Billings, Martin^; 
 Eemsen, and Welch, and if found, would such a man come now 
 that the opening of the medical school in the near future was 
 less than probable ? We doubted, but we did not at that time 
 know Dr. Osier and how impossible it would have been for 
 him to have refused to add his strength to the endeavor to 
 bring to fruition the long-nourished idea of a real university 
 medical school. He has given an account of his reaction to 
 the proposal. In speaking of Billings' visit to him in Phila- 
 delphia, he says: "Without sitting down, he asked me 
 abruptly, ^Will you take charge of the medical department 
 of The Johns Hopkins Hospital ? ' Without a moment's hesi- 
 tation I answered, ^ Yes.' ^ See Welch about the details ; we 
 are to open very soon. I am very busy to-day ; good morning,' 
 and he was off, having been in my room not more than a couple 
 of minutes." 
 
The Medical School and Osler's Advent 15 
 
 The appointment was made in the fall of 1888, and he was to 
 begin his service at the opening of the hospital, which was 
 announced for May, 1889. It soon became evident that 
 although it was easy to announce the opening day, it was quite 
 another thing to get the complicated mechanism of the hospital 
 organized and ready to function. In this emergency the hos- 
 pital appealed to the university and induced Gilman to assume 
 the task. The work was colossal and the time was short, and it 
 speaks volumes for the estimation in which Oilman's organ- 
 izing ability was held that no one doubted the result. 
 
 The formal opening occurred on May 7, 1889, and Osier, 
 with his satellites, took his place as our guiding star. He 
 brought Lafleur from Montreal, Scott and Toulmin from 
 Philadelphia, and those of us who were able to do so joined the 
 ever-increasing group. 
 
 The hospital annexed Welch with his already organized 
 department of pathology. Halsted was given charge of the 
 surgical department and the organization of the dispensary, 
 Kelly was brought in June from Philadelphia to take charge 
 of gynaecology, and in August Dr. Hurd, as superintendent 
 took over from President Gilman the direction of the hospital. 
 
 The opening of the hospital was for the trustees, the faculty, 
 and above all for us expectant, impatient medical novices, the 
 beginning of the fulfillment of long-suppressed desires. For 
 me the reality far surpassed the fantasy of my dreams. In the 
 association that was to follow, which for my part was as close 
 as I could make it. Osier as a physician, teacher and friend, 
 constantly raised my preconceived ideal. Memories of this 
 time overwhelm me. 
 
 The dispensary was opened first and patients were admitted 
 to the wards from it, and Osier, surrounded by a few of us, 
 himself wrote the first dispensary history. Until the wards 
 were full he was constantly in the dispensary, organizing the 
 various sub departments of medicine, for it was an unique 
 feature of the system that the services were continuous, and 
 that the various special departments were grouped under 
 either medicine or surgery. As it was in the early days of the 
 
16 Sir William Osler, Baet. 
 
 ■amversit}^ so it was with the hospital at the beginning. 
 Workers formed a closely united body. All that happened was 
 of interest to each of ns. On the medical side Osier radiated 
 by his example and personality constant stimuli to careful 
 clinical work and investigation along all sorts of lines. He 
 23ointed out problems, encouraged everyone in what he desired 
 to do, and was more than liberal in his commendation of work 
 done. His absolute generosity threw open his whole clinical 
 material to the use of anyone who had a problem. He urged 
 and assisted in the publication of the results, and saw to it that 
 the young men got the whole credit of the work when often it 
 should have gone to himself. Is it to be wondered at that such 
 a chief has such devoted followers ? 
 
 The Medical Society, the Journal Club, the Historical Club, 
 and other associations, were organized in quick succession. 
 Post-graduate courses were given, but the medical school of 
 the university seemed as far from beginning as ever. The 
 university trustees were not unmindful of the question, and 
 some of them in spite of the depleted income, were constantly 
 urging the establishment of the school. I have found among 
 my father's papers the notes of an earnest appeal on the subject 
 which he appears to have made to the Board of Trustees in 
 May, 1890. Certain women, several of whom were daughters 
 of trustees, who had from the first unsuccessfully sought admis- 
 sion for themselves and other women to the university, and 
 who had been told that it was planned to admit women to the 
 medical school when it should be established, collected money 
 and offered $100,000 to the trustees on condition that it should 
 be used to help the establishment of a medical school to which 
 women should be admitted on the same terms as men. On 
 October 29, 1890, the trustees made a minute accepting the 
 gift, with the proviso, however, that the university should not 
 establish its medical school until an endowment of $500,000 
 had been secured, and that women who desired to enter should 
 receive their preliminary education somewhere else. Miss 
 Mary E. Garrett, who had contributed most of the original 
 Women's Medical Fund, completed the endowment on Decern- 
 
The Medical School and Osler's Advent 17 
 
 ber 22, 1892, by a gift of $306,977. Leading up to this gift 
 there was a protracted three-sided discussion between Miss 
 Garrett and her friends, the Medical Faculty and the Board of 
 Trustees. The outlook for an agreement was often gloomy, 
 and only one who was in a position to know, as I was, some- 
 thing of the ideas of all three parties to the negotiation, can 
 realize on how many occasions the scheme came close to being 
 abandoned. In this discussion, together with Welch and 
 Martin, Osier was deeply concerned. He had become very 
 restive under the delay of the opening of the medical school, 
 complained to me on one occasion of what he called the dry 
 bones of post-graduate teaching, and even intimated that 
 unless something were done he might be forced to go where 
 there were some real medical students. 
 
 The decision as insisted upon by Miss Garrett, to fix per- 
 manently by the terms of the gift the conditions for admission 
 to the medical school at an unprecedented standard, required 
 no little courage, and although the results have abundantly 
 justified it, it was then thought that it would greatly limit 
 the number of students who would apply for admission. The 
 first class of 17, including three women, entered in the fall 
 of 1893. When, in the third year, they began to work in the 
 hospital, first in the dispensary and then in the wards, Osler^s 
 genius as a medical teacher became more and more evident. 
 He saw to it that the students came into the closest contact with 
 the patients in the dispensary, and he organized the hospital 
 wards so that the fourth-year students took an essential part 
 in the management of the cases. Although this last had been 
 the intention since the inception of the hospital, and the main 
 building had been designed to house 20 senior students, its 
 practical application met with opposition and presented diffi- 
 culties, and it was Osier's insistence that threw open the wards 
 to the students, a fact, the thought of which, I think, always 
 gives him pleasure. 
 
 He did, indeed, put the students into the wards, but he did 
 not leave them there. He stayed with them, and if ever 
 medical students got clinical instruction on a university basis, 
 2 
 
18 Sir William Osler, Baet. 
 
 they did. It is not given to me to speak of Osier as a teacher, 
 for my chapter ends with the beginning of the medical school. 
 For me, and for others similarly situated, who had been reared 
 in the expectation of the new order in medical education, the 
 coming of Osier ushered in the complete realization of long- 
 deferred hopes. He set for ns a difficnlt goal, and helped and 
 cheered us on the way by his wise precepts, his kindly, friendly 
 commendation, his vigorous leadership, and more than all, by 
 simply being himself. 
 
 It is no fault of his that the finished product is no better, 
 but what good there is in me as a teacher and a physician I owe 
 to him, and on this, his birthday, I lay it at his feet in grateful 
 acknowledgment. 
 
1902. 
 
OSLER AS CHIEF OF A MEDICAL CLINIC 
 
 By Lewellys F. Bakkek 
 
 Internal medicine, like other branches of science, though 
 making at all times some progress, is subject in its advance to 
 fits and starts, the result of unusual concatenations of events. 
 The opening of the medical clinic at The Johns Hopkins 
 Hospital in 1889 was an opportunity for helping on the science 
 and art of medicine that might amount to either much or little, 
 depending upon its seizure. The time corresponded to the flood- 
 tide of natural science. Biology, physics and chemistry had 
 participated in the great rise. Medicine, always quick to apply 
 to its own service the results of investigations in the funda- 
 mental sciences, had responded by establishing a whole series 
 of special medical sciences (anatomy, histology, embryology, 
 physiology, physiological chemistry, pharmacology, pathologi- 
 cal anatomy and physiology, bacteriology), to be studied and 
 taught by men who gave up their lives exclusively to their 
 promotion ; these sciences were to serve as a foundation upon 
 which a great superstructure of cKnical science and art might 
 be built. The place to be filled, the professorship of medicine 
 in The Johns Hopkins University, which carried with it the 
 appointment as physician-in-chief to The Johns Hopkins Hos- 
 pital, was in several ways unique, at least as far as medicine 
 in America was concerned. For, in the first place, according 
 to the will of Johns Hopkins, the well-endowed hospital was 
 designed to be an integral part of the medical school of an 
 endowed university, and funds were provided for salaries for 
 the leaders of the clinics as well as for the chiefs of other uni- 
 versity departments, one of the circumstances that, combined 
 with others, led to the abandonment of the hitherto-prevailing 
 " proprietary medical schools '^ and to their replacement by 
 medical schools organized as parts of great universities. In 
 the second place, The Johns Hopkins University, through the 
 
 19 
 
20 Sir William Osler, Bart. 
 
 action of its trustees, and of its first president, Daniel C. 
 Gilman, had been organized, in all its departments, in the 
 interests of original research as well as of competent instruc- 
 tion ; with distinguished investigators in the arts department 
 and with men like Martin and Brooks in biology and physi- 
 ology, Rowland in physics, Remsen in chemistry, and Welch 
 in pathology, it was clear that capacity for personal research 
 and the power to stimulate others to engage in fruitful re- 
 searches were regarded, along with ability to teach and to< 
 organize, as essential requirements of the occupants of chairs 
 in the university. And, in the third place, the trustees of the 
 hospital, in consultation with the president of the university, 
 the professor of pathology, and Dtr. John S. Billings of the 
 surgeon-general's library, had planned and built (out of 
 income from the endowment), a hospital that, at the time of 
 its completion, offered better facilities for the organization 
 and conduct of clinical work than had heretofore been avail- 
 able in the IJnited States. The ideals cherished in the uni- 
 versity, the material equipment at the hospital, the oppor- 
 tunities and possible rewards open to the clinical leaders who 
 might be appointed, combined to provide unparalleled places 
 for occupancy. If, then, for these positions clinical men could 
 be found, who, by native ability and experience, would measure 
 up to the extraordinary time and the unusual opportunities, 
 success in the highest sense for the new institution would seem 
 to be ensured. The chair of medicine is, by common consent, 
 the most important clinical chair in a university medical 
 school. For this professorship the university faculty recom- 
 mended, and the trustees confirmed, the appointment of 
 Dr. William Osier, then engaged in teaching medicine in the 
 University of Pennsylvania and in consultation practice in 
 Philadelphia. A member of a distinguished Canadian family, 
 trained in medicine first in the University of Toronto and in 
 McGill University in Montreal, and, later, as a graduate stu- 
 dent, in the clinics and laboratories of England, France and 
 Germany, interested and occupied in research and teaching in 
 histology, physiology, pathology and parasitology as well as in 
 
As Chief of a Medical Clinic 21 
 
 internal medicine, and possessing personal qualities that even 
 in youth marked him as a potential leader of men, the ap- 
 pointee entered upon his work with an enthusiasm that was 
 stimulating, began to organize his department, selecting a 
 group of young men as assistants, and soon set an example in 
 practice, teaching and investigation that was contagious. The 
 office and the man were suited to one another. The time, the 
 place, and the person formed a happy conjuncture that was to 
 mean much for internal medicine in America and in the world. 
 Of the set of brief contributions here published concerning 
 Professor Osier's work in Baltimore, those dealing with his 
 practice, his teaching, and his original inquiries are written 
 by others; the part assigned to me is the preparation of a 
 memorandum outlining the principles to which he, as the 
 organizer of a medical clinic, persistently adhered, and the 
 methods he employed in their practical application. He had 
 very definite ideas of what a medical clinic should be and he 
 felt keenly the responsibility of seeing to it that the functions 
 of the clinic were faithfully performed. For him, the welfare 
 of the patients who presented themselves in the clinic for 
 diagnosis and treatment came first ; next, came into considera- 
 tion how undergraduate and graduate students could best be 
 taught; and, finally, came solicitude that every opportunity 
 for contributing to the advance of our knowledge of internal 
 medicine should be eagerly seized. He took care to promote in 
 every way possible the material, the scientific, and the moral 
 interests of all who were associated with him in his work; his 
 personal advantage concerned him but little, though to anyone 
 who aimed at such objects and achieved such purposes as he 
 did, a modicum of profit and a maximum of honor and 
 prestige were bound to accrue. The principles he fixed upon 
 and the methods he used to illustrate them were manifoldly 
 derived. In part they grew out of personal practical experi- 
 ence, in part they had their origin in other clinics in this 
 country and in Europe. Men who were familiar with clinical 
 work and clinicians in the larger centers of America, those 
 who had " walked the hospitals " of London and Edinburgh, 
 
22 SiE William Oslek, Baet. 
 
 those who knew the laboratories and the clinical institutes of 
 Austria, Germany and Holland, and those who had visited the 
 clinics conducted by the best internists in France, had no 
 difficulty in recognizing the sources of certain of the features 
 of the organization of the medical service in Baltimore. Pro- 
 fessor Osler^s clinic synthesized diverse elements into a har- 
 monious whole; it represented a new form, good in itself for 
 its time, and yet plastic enough to admit of remoulding at 
 later need. The limits of this article will permit of only brief 
 comment upon the plan of organization and upon the way it 
 was managed. 
 
 Where activities are complex, be they those of a factory, of a 
 business office, of a scientific laboratory, or of a medical or 
 surgical clinic, organization and management are two execu- 
 tive functions that must be properly exercised, if the work is to 
 be successful. Organization involves: (1) An investigation 
 of the conditions that exist and of the requirements of the 
 whole situation; (2) the planning of a scheme that will meet 
 the requirements, that will effectively and systematically cor- 
 relate the activities of the working force, the materials, the 
 equipment and the working space, so that the functions of the 
 institution shall be competently, speedily and economically 
 performed; and (3) the actual installation of the system as 
 planned. Management, or the art of conducting an establish- 
 ment after its organization has been devised and initiated, 
 involves : ( 1 ) The attainment of the results that are aimed at ; 
 (2) the overcoming of obstacles that are incident to the con- 
 ditions under which the work has to be done; and (3) the 
 application of knowledge and skill in the training of the staff, 
 in the setting up and in the maintaining of standards, in the 
 providing of suitable incentives, and in the establishing of 
 right relationships between the leader and the led. The head 
 of an institution, or of a department, who creates an organiza- 
 tion that is adequate, and who manages it with skill, demon- 
 strates his executive capacity. 
 
 On Professor Osier's appointment as physician-in-chief to 
 The Johns Hopkins Hospital in 1888, he found certain con- 
 
As Chief of a Medical Clinic 23 
 
 ditions already existing that were to some extent determining, 
 at least as far as the general organization of the institution was 
 concerned. The buildings already completed included one for 
 general administration, with a building on each side of it for 
 private patients, a long row of public ward buildings behind, a 
 building for a general out-patient department, a nurses' home, 
 a pathological laboratory, a general kitchen and a laundry. In 
 other words, a " general hospital,'' in which medical and surgi- 
 cal patients (free and pay) were to be received, distributed and 
 treated, and in which, later on, medical students were to be 
 taught, had been constructed on the pavilion system. There 
 was no spatial concentration of the work of the single depart- 
 ments in separate institutes such as had already developed in 
 some of the European centers, or, as was later adopted in the 
 institutes built for psychiatry and pediatrics on the grounds 
 of The Johns Hopkins Hospital ; on the contrary, to pass from 
 some of his private patients in Ward B at the southwest corner 
 of the grounds to some of his public-ward patients at the 
 northeast corner, the internist and his staff were compelled to 
 walk through corridors that extended along two sides of a 
 square containing 14 acres ! As in most general hospitals, the 
 functions of general superintendency, financing, accounting, 
 nursing, purveying and housekeeping had been centralized, 
 and with them the heads of the clinical departments had but 
 little to do. But, thus relieved of much administrative detail, 
 the head of the medical department, who was appointed per- 
 manently and had a continuous service, was to have a large 
 degree of autonomy in the diagnosis and treatment of patients, 
 in the selection of his staff, in the character and amount of his 
 teaching, and in the conduct of research. His staff was to con- 
 sist (1) of younger men who lived in the hospital and gave 
 their whole time to the department, and (2) of senior asso- 
 ciates who lived outside, giving part of their time to the 
 hospital and part to private practice. The chief of the medical 
 service was to be paid a salary in order that he might make the 
 work of the hospital and of the medical school his main occu- 
 pation and interest, though he was permitted to supplement 
 
24 Sir William Osler, Baet. 
 
 his income and clinical experience by private consultations. 
 The activities of the different clinical departments were to be 
 correlated partly by the general superintendent of the hospital, 
 and partly by a medical advisory board that made recommen- 
 dations to the trustees of the hospital. When Professor Osier 
 arrived, the buildings, and the general plan of organization 
 already completed, had to be accepted as they were ; the plans 
 of his department had to be drawn so as to fit into them. 
 
 It was fortunate that The Johns Hopkins Medical School 
 was not opened until 1893 and that clinical instruction of 
 undergraduates did not begin until 1895, for six years were 
 thus available for perfecting the organization of the wards, the 
 out-patient department, the laboratories, the staff, the records, 
 the library, the hospital, the medical society, and the care of 
 patients in the hospital before the function of teaching under- 
 graduates was added. Courses for post-graduate students 
 were, it is true, offered during this period, but the number of 
 candidates was small and the work was not burdensome. With 
 few patients at first, a small staff, and a limited amount of 
 post-graduate instruction, leisure was given for making plans 
 (and for modifying them after small-scale trials in executing 
 them), for instituting standards, for writing a text-book that 
 concisely embodied the principles and practice of medicine and 
 that was destined to have an unprecedented distribution among 
 physicians and students, and, in general, for establishing tra- 
 ditions of the better sort in the clinic. With the organization 
 thus far planned and installed before the students of the 
 medical school entered upon their clinical work, it was a 
 relatively easy matter to expand it and to adapt it to the func- 
 tions of undergraduate instruction when the time for this 
 arrived. 
 
 When the definitive history of Professor Osier's work in 
 Baltimore is written, many details of his analysis of the func- 
 tions of the clinic, of his applications of the principle of 
 division of labor in the cHnic, of his methods of selecting men, 
 of assigning them to appropriate tasks, and of motivating them 
 to high endeavor, and of the personal qualities through which 
 
As Chief of a Medical Clinic 25 
 
 he exerted that profound and lasting influence upon patients, 
 students, assistants, and colleagues for which he is so widely 
 known, must be recorded. The scope of the present memo- 
 randum will permit mention of only a few of the more out- 
 standing features of his organization and management, of 
 those parts that made his clinic so successful a department of 
 a university teaching hospital as it is known to have been. 
 
 One important element of success in the new clinic was the 
 arrangement for a graded staff, particularly for a graded, 
 whole-time, resident staff, among the members of which the 
 responsibilities of the work were divided, not according to a 
 so-called " military type,'^ but rather in the manner of the 
 so-called " composite functional type " of organization. The 
 professor of medicine (physician-in-chief to the hospital), 
 though giving most of his time to the work of the clinic, lived 
 outside the hospital, as did the associate professors who 
 " visited ^^ the wards, the out-patient department, and the 
 laboratories. The resident physician, the assistant resident 
 physicians, and the medical internes lived in the hospital and 
 were in close contact with the work always by day and as far 
 as was necessary also by night. The resident staff of the clinic 
 consisted of two parts : (1) A lower resident staff constituted 
 by the medical internes appointed for a single year, usually on 
 graduation with high standing from the medical school; and 
 (2) an upper resident staff made up of the resident physician 
 and several assistant resident physicians, usually men of excep- 
 tional promise, men who had already served as hospital internes 
 and who were willing to enter upon a more or less prolonged 
 resident service, often of several years' duration, in order to 
 secure the best possible training for the " higher walks " of 
 internal medicine. This upper staff was chosen partly from 
 the lower staff, partly, in order to prevent " inbreeding/' 
 from members of the resident staffs of hospitals in distant 
 medical centers. The position of chief resident physician, 
 which carried with it large responsibilities and opportunities, 
 was a prize to be won only by men of exceptional ability, ex- 
 tensive experience, and favorable promise. Thus, those receiv- 
 
26 Sm William Oslee, Baet. 
 
 ing it in Professor Osiers time, included Henry A. Laflenr 
 (1889-1891), William S. Thayer (1891-1898), Thomas B. 
 Fntcher (1898-1901), Thomas McCrae (1901-1904), and 
 Eufus I. Cole (1904-1906). The careers of these men during 
 their terms of service and since illustrate on the one hand the 
 wisdom of him who selected them, and on the other the growth- 
 promoting influence of the duties and authority attached to 
 the office. The assistant residents, even those who did not 
 later become chief resident physicians, often continued in office 
 for several years. Such an upper resident staff, supported by 
 internes and by senior students, besides forming a whole-time 
 group of enthusiastic young internists for development under 
 ideal conditions, afforded an excellent working force for carry- 
 ing on the routine of the wards, laboratories, and out-patient 
 department: this left the physician-in-chief and his visiting 
 associates largely free for planning, standardizing, supervising 
 and controlling the practice in the clinic, for teaching, and for 
 promoting original inquiries. The historian bent on analyzing 
 the conditions of achievement in Professor Osler^s clinic will 
 do well to consider carefully the significance of this upper 
 resident staff. 
 
 A second characteristic feature of the medical clinic organ- 
 ized by Professor Osier was the introduction of more extensive 
 and more systematic courses of instruction in the practical- 
 technical methods of gathering data regarding disturbances of 
 structure and function in the sick than had before been cus- 
 tomary. The importance of careful history-making and of 
 accurate physical diagnosis had been, it is true, generally 
 recognized ; but the machinery of instruction in these forms of 
 fact-accumulation had been inadequate in the majority of 
 medical clinics, and one of the first tasks of the new clinic con- 
 sisted in planning and installing a better organization for this 
 purpose, and in seeing to it that the example set by all who 
 participated in the practical work of diagnosis in the clinic 
 was consistent with the methodological teaching. The most 
 distinctive advance made in instruction in technique was, 
 however, the establishment of a systematic course in the appli- 
 
As Chief of a Medical Clinic 27 
 
 cation of the laboratory methods of chemistryj physics, and 
 biology to the study of patients. Students in their third year 
 of the medical school were not only taught the principles of 
 these methods, but for two or three afternoons throughout the 
 year were thoroughly drilled in the practical technique of these 
 methods, so that, when the course had been completed, each 
 student had attained to real skill in the use of all the more 
 important ways of examining clinically the blood, the stomach 
 Juice, the feces, the urine, and the cerebrospinal fluid. No 
 medical school has yet devised a perfect system of training, 
 and the graduates of The Johns Hopkins Medical School, 
 like those of other schools, doubtless exhibit certain special 
 defects, but by common consent, they are well-trained in the 
 methods of gathering clinical facts and especially in the 
 technical procedures of the clinical laboratory. By many it is 
 believed that, of the several contributions made by Professor 
 Osier to the organization of the clinic, the development of the 
 clinical laboratory and of the thorough education of students 
 by competent instructors in clinical laboratory work before 
 entering upon their duties in the medical wards is pre- 
 ponderant. 
 
 A third distinctive mark of the organization in Dr. Osier's 
 clinic was the arrangement by which each student of the 
 medical school became for a considerable period a member of 
 the group that actually did the work of the diagnosis of disease 
 and of the treatment of patients in the hospital. Thus each 
 student in his third year, after having had instruction in 
 history-making and in the elements of physical diagnosis, 
 assisted, under the supervision and control of instructors, in 
 recording histories and in making physical examinations in 
 the out-patient department. More important still, through the 
 fourth year of the course, each third of the class acted suc- 
 cessively for three months as '^^ clinical clerks'' in the sta- 
 tionary medical clinic, giving their whole time to the work of 
 the medical wards. Thus the medical staff was reinforced 
 during the entire school year by 30 student assistants, who, 
 under the eye of the resident staff, took the histories of all new 
 
28 Sir William Osler, Bart. 
 
 patientS;, assisted the internes in the making of the first 
 physical examinations, made all the clinical laboratory tests 
 on these patients, and accompanied their chief on morning 
 rounds. At these rounds, the clinical clerk gave orally an 
 epitome of the findings in the patient, watched the processes of 
 control examinations used by the professor, and participated 
 at the bedside in discussions of the pathological-physiological, 
 pathological-anatomical, and etiological bearings of the case. 
 He looked up recent articles on the subject and reported them 
 at later ward rounds, followed the patient to the operating 
 room if surgical procedure were indicated, watched the effects 
 of the treatment employed in the case of each patient directly 
 assigned to him, and kept in touch with him during conva- 
 lescence at his home after discharge from the hospital, or in 
 the event of a fatal issue attended the autopsy and the patho- 
 logical-clinical conference that followed it. The fact that 
 through all this he was regarded as an integral part of the 
 working group of the clinic, the knowledge that the anamneses 
 he registered and the results of laboratory tests he made be- 
 came a part of the permanent records of the hospital, the feel- 
 ing of responsibility he had when he realized that the diagnosis 
 made and the treatment instituted were based in part upon 
 data accumulated by liim, the personal relationships estab- 
 lished between student and professor at the hospital and on 
 delightful Saturday nights at the professor's home at 1 West 
 Franklin Street-— all this combined to make the time of the 
 clinical clerkship in Professor Osler^'s clinic a period of rich 
 experience and of intense stimulation, never to be forgotten 
 by any pupil who passed through it. Even in the more formal 
 teaching of the clinic, it was Professor Osier's custom to permit 
 the clinical clerk to have a share. Thus, at the main teaching 
 event of the week, the crowded Saturday clinic in the amphi- 
 theater, where all the students of the third and fourth year, 
 the whole resident staff, many of the visiting physicians of the 
 hospital, physicians of the town and medical men from a dis- 
 tance were assembled, the clinical clerk gave a part of the 
 clinic; he was always asked to tell the audience briefly (and 
 
As Chief of a Medical Clinic 29 
 
 from memor}^ unaided by notes) the main points of the 
 anamnesis of the patient and was called upon from time to 
 time throughout the hour to report on laboratory tests and 
 X-ray findings, or to give his opinion of the significance of 
 some datum. The pupil-teacher thus grew accustomed to fac- 
 ing a large audience and to thinking and speaking on his feet, 
 an admirable preparation for some of the contingencies of later 
 professional life. The student-assistantships in the out-patient 
 department (in the third year) and the clinical-clerkships and 
 all that they implied (in the fourth year) were, then, vital 
 parts of the organization of The Johns Hopkins Medical 
 Clinic. 
 
 Though the organization of the clinic in Baltimore pre- 
 sented, as we have seen, an interesting combination of novel 
 features, no organization, no matter how well planned and 
 installed, can function effectively without the skilful applica- 
 tion of the art of management, and in the art of management 
 the director of this clinic was to prove that he was a master. 
 Thoroughly familiar himself with the principles, methods and 
 problems of internal medicine, enthusiastic about, and for his 
 time well trained in, the preclinical sciences that are funda- 
 mental, he possessed that personal experience in his subject 
 and that superior ability that are always prerequisites to 
 competence as a manager and to the command of the respect of 
 those that are to be managed. He understood human nature 
 and loved it, despite its faults and its frailties; no chief ever 
 secured in greater measure the good-will and loyalty of his 
 staff. Though he could be firm on occasion, he rarely found 
 need to act as a strict disciplinarian. He was always cognizant 
 of the good qualities of those about him, and though not blind 
 to their defects he had learned that great lesson of successful 
 management that, for most subordinates, a word of apprecia- 
 tion is of far greater value as a stimulus to good work than a 
 volume of carping criticism. He possessed to an extraordinary 
 degree the capacity of making you feel that he was interested 
 in you and in your personal welfare ; to come into contact with 
 him meant, for most, the birth of a genuine affection for him. 
 
30 Sir William Osler, Baet. 
 
 He had an orderly mind and manner; he landed punctuality 
 in a doctor and was always punctual himself. He seemed, 
 never to be in a hurry and yet he wasted no time. Many a man 
 recalling an interview that seemed leisurely when it occurred 
 has been surprised, on analyzing it afterward, to find how brief 
 it had been. He belonged to the first of the two groups — the 
 " larks ^' and the "owls" — into which men have been play- 
 fully divided. He retired early and was an early riser. At 
 one time he lived for some months in the hospital and it is 
 asserted that men learned to set their watches at 10 p. m. by 
 the sound of his boots as they dropped on the floor outside his 
 door. His more important work was done in the morning 
 hours ; for him " great business must be wrought ere noon " ; 
 private consultations were relegated to the later hours of the 
 day. His power immediately to grasp the significance of situa- 
 tions, his ability to make quick decisions, his unfailing tact 
 and discretion, together with his wide sympathies and his 
 lively sense of humor made it a pleasure to transact business 
 with him. His ideals he kept ever before him and was am- 
 bitious to realize them, and these ideals and this ambition 
 were alluring also to those whom he led. Much might be 
 written, were there space, of the ways in which he overcame 
 obstacles and met important emergencies, of the motives he 
 appealed to when he desired to excite men to action or to 
 arrive at a decision, and, in general, of those traits of character 
 that act " directly by presence, and without means,'^ or what 
 is sometimes called " personal magnetism." Many of the 
 qualities that make for successful management, though easy 
 enough to recognize when they exist, are difficult of analysis 
 and perplexing to the understanding. Some men are able to 
 secure control without contest ; " whether they stand or walk 
 or sit or whatever thing they do," they can place men under 
 their power. Of such character-control and of prestige-control 
 Professor Osier had his full share. But, more important than 
 these, he had grasped, as it were intuitively, the newer prin- 
 ciples of association and of group organization. A man of 
 many selves, he could enter into helpful association with many 
 
As Chief of a Medical Clinic 31 
 
 different groups, letting his mind interact with the other 
 minds of each group for the purpose of arriving at ideas, feel- 
 ings and impulses in common. More than most he had learned 
 how to live with other men, to discuss without antagonism, to 
 secure co-operation by the subtle psychic process of reciprocal 
 penetration. In this lay the secret of his co-ordinating power. 
 He knew not only how to bring the various activities of his 
 clinic into proper relation with one another, but also how to 
 link the clinic with other departments of the university, with 
 the medical profession, with the public near and far, and 
 with national and international associations of different kinds. 
 Through his power as an organizer and as a manager Professor 
 Osier might, then, have truthfully said, as did one of old, " I 
 magnify mine office.^^ And it is precisely capacity for such 
 magnification of office that, along with ability to plan and to 
 direct, is a distinguishing criterium of the superior executive. 
 
SOME OF THE EAELY MEDICAL WORK OF SIR 
 WILLIAM OSLER 
 
 By W. T. Councilman 
 
 William Osier, the son of the Rev. F. L. Osier, was born 
 in Tecumseh, Ontario, in 1849. He was one of a large family, 
 and his ancestors were a vigorous, long-lived race. He gradu- 
 ated from Trinity College, Toronto, in 1868, began the study 
 of medicine in the University of Toronto, and after two years 
 went to McGill University, Montreal, where he received the 
 M. D. degree in 1872. From 1872 to 1874 he studied abroad, 
 working in the various London clinics, in the laboratory of 
 University College, London, and in the laboratories and 
 clinics of Berlin and Vienna. He came in contact with many 
 eminent men, studied methods of work and of teaching, and 
 the influence of this period of European study is seen in his 
 after career. In 1873 he obtained the licentiate of the 
 College of Physicians of London, in 1878 he was made a 
 member of the college, and in 1884 was elected to the fellow- 
 ship. In 1874 he returned to Montreal, was made lecturer 
 on the institutes of medicine, and shortly afterwards was 
 given the professorship. Under the institutes of medicine 
 were comprised the courses in physiology and pathology, the 
 latter limited to 20 lectures. At the end of 1874 he was made 
 physician to the Small-pox Hospital, and in the following year, 
 owing to the interest which he showed in comparative anatomy, 
 the professorship of helminthology, in the Veterinary School 
 of the university, was taken into his already full hands. I 
 shall discuss here only his early work, extending through the 
 first four years of the Montreal period. 
 
 Beyond the bare facts, we know but little of his early 
 education. In his various writings there are only scanty 
 allusions to it save in the Toronto address, in which he men- 
 tions three men who were his early teachers and to whom he 
 3 33 
 
34 Sir William Oslkr, Bakt. 
 
 says he owes everything he has attained in life. These were 
 the Eev. W. A. Johnson, of Weston, Ontario; Dr. James 
 Bovell, of Trinity College, later professor of the institutes of 
 medicine in Toronto University, and Prof. Eobert Palmer 
 Howard, of Montreal. 
 
 I have been able to learn but little of the Rev. W. A. John- 
 son, but it is evident that he was one of the many clergymen of 
 the Church of England who have sought in various scientific 
 pursuits a wider range of intellectual activity than is given by 
 their profession.* I have gained this conception of the 
 Eeverend Johnson from two passages in the early writings of 
 Dr. Osier. In the first article published by him (Canadian 
 Diatomaceae, Canadian N'aturalist, 1870) when he was a 
 student in Toronto, he thanks him for assistance in the use of 
 books and microscopical apparatus. In this article there is an 
 admirable description of the structure, mode of division and 
 propagation of the diatom, which is evidently based upon 
 observation. The mode of motion of the organisms is dis- 
 cussed and he is inclined to accept the hypothesis advocated by 
 
 * The Scottish Church has produced very few of these men, 
 and they have been rare in America. However singular this may 
 seem, the reasons are obvious. The clergy of the Church of 
 England possessed a liberal education, and the taking of orders 
 did not demand any extensive preparation for the examinations. 
 Most of them had an assured living in pleasant country surround- 
 ings, and the dogma was simple, fixed, and did not admit of con- 
 troversy. Proselyting was not actively pursued in the English 
 church, and the souls of their simple parishioners were not a 
 serious care. They must have found little intellectual stimulus 
 in the society of the country squires, and many of them were 
 perforce driven into the study of botany and other branches of 
 natural science. The Scottish church, on the other hand, de- 
 manded long and arduous preparation for the ministry, and most 
 of its members did not have the background ol a liberal educa- 
 tion. Like the Scottish character, the church was a fierce, 
 aggressive force, its dogma logical and uncompromising, and 
 its defence and extension involved a constant controversy, which 
 left little time for the calm study of nature. In this country 
 the conflicts of the sects give suflBcient intellectual diversion. 
 
Early Medical Work 35 
 
 Professor Schultze, of Bonn. At the close he gives a list of 
 105 diatoms which he had collected and classified, giving also 
 the localities where they were found and their frequency. He 
 must have been for a long time interested in the subject and 
 the organisms were collected over an extensive area. He gives 
 credit to Mr. Johnson for having given him several of the 
 specimens. He refers also to another clergyman, the Eev. Mr. 
 Eeade, who had invented a prism by the use of which the 
 shell markings could be studied to better advantage, and which 
 was loaned to him by Professor Bovell. The article shows 
 familiarity with the microscope and capacity to use literature. 
 The second reference to Mr. Johnson I have found in an 
 article 12 years later (On Canadian Fresh Water Polyzoa, 
 Canadian Naturalist, 1882) which was read before the Natural 
 History Society. There is here also an admirable description 
 of the organisms with the differentiation of the species, but its 
 main interest is in showing how early Osier — probably through 
 the influence of Mr. Johnson — became interested in the study 
 of nature. " In the summer of 1867, during a visit of my 
 friend, the Eev. W. A. Johnson, of Weston, I showed him the 
 masses (the gelatinous aggregates of the Pectinatella mag- 
 nifica of Leidy) and we agreed to subject them to examination 
 by the microscope, not having any idea as to their real nature. 
 Judge of our delight when we found the whole surface of the 
 jelly was composed of a collection of tiny animals of surpassing 
 beauty, each of which thrust out to our view in the zoophyte 
 trough a crescent-shaped crown of tentacles.'^ A foot-note 
 speaks of another clergyman, the Eev. Thomas Hincks, as the 
 distinguished authority on British polyzoa. 
 
 His second teacher, Dr. James Bovell, seems to have been 
 an interesting character. He was born in Barbados in 1817, 
 went to England in 1834, studied at Guy's Hospital, and took 
 the medical degree in Glasgow in 1838. He then went to 
 Dublin, studied under Stokes and Graves for several years and 
 after a severe attack of typhus fever, against the advice of his 
 friends, who predicted a brilliant medical career, returned to 
 Barbados. From there he went to Canada in 1848 ; took part 
 
36 Sir William Osler, Bart. 
 
 in the establishment of the medical faculty of Trinity College, 
 became dean and professor of the institutes of medicine, and 
 also professor of natural theology. After the disruption of 
 this medical school he held a similar medical position in 
 Toronto University. In 1870 he returned to the West Indies 
 where he remained until his death. While there he took 
 orders in the English Church and published a book on Natural 
 Theology. He was regarded as an impractical, improvident 
 man, was loved by his students and friends and took great 
 delight in metaphysical discussions. Osier came under his 
 influence in Trinity College, and in Toronto University, and 
 he has dedicated to him the first pathological report of the 
 Montreal General' Hospital. It is not improbable that, through 
 these two men and the atmosphere of his home. Osier acquired 
 the interest in biblical and ecclesiastical literature which was 
 such a prominent characteristic of his later life. 
 
 The third of these men was Dr. Robert Palmer Howard, 
 professor of medicine in McGill University, whom Osier speaks 
 of as his second father. He was a greatly respected teacher 
 and practitioner of medicine and exerted a wide influence, but 
 he was not a prolific writer. 
 
 While in London, Osier published two articles from the 
 laboratory of University College. The first, " On the Action 
 of Atropia, Physostigma, and Curare on the Colorless Blood 
 Corpuscles,^^ was read before the Eoyal Microscopical Society 
 in 1873, and published in its journal. Such a paper as this 
 was rather unusual at the meetings of the society which were 
 mostly taken up with descriptions of microscopes, methods of 
 preparation of microscopic objects, etc. The object of the 
 investigation was to determine whether the antagonism be- 
 tween atropia and physostigma, which Fraser had shown to 
 exist, could be demonstrated in the behavior of colorless cor- 
 puscles under the microscope, and the result was negative. It 
 was interesting to find in the same volume with the paper of 
 Dr. Osier a long, interesting and scathing review of Bastian's 
 Beginnings of Life which had just appeared. 
 
Early Medical Work 37 
 
 The second article, "An Account of Certain Organisms 
 Found in the Liquor Sanguinis/' was published in 1874, 
 appearing in the Proceedings of the Eoyal Society. This 
 forms one of the most important of Dr. Osier's contributions 
 to medicine and demands a more detailed description in order 
 to do justice to the originality shown in this article. From 
 the massive literature on the subject four articles may be 
 singled out, each of which was an important contribution to 
 knowledge. In 1865, in the article of Max Schultze on the 
 blood, certain bodies afterwards known as blood plates were 
 for the first time adequately described; the second was the 
 article by Osier, the third by Bizzozero in 1882, in which he 
 gave a new method for their study and showed the part they 
 played in thrombus formation, and the fourth by J. H. Wright 
 in 1910, who demonstrated their histogenesis. The name 
 blood plates, given to the bodies by Bizzozero, has been adopted. 
 It would be difficult to say who first saw and described them. 
 At this period the fresh unstained blood was being actively 
 examined by many with a view to the discovery of micro- 
 organisms which might be the cause of infectious diseases. 
 Zimmermann, in Eust's Magazin f . d. gesammte Heilkunde in 
 1846, and again in Virchow's Archives, Vol. 18, 1860, saw and 
 described the bodies as small globules which he regarded as the 
 elementary corpuscles from which the blood cells develop, but 
 his description was very vague and he did not sharply separate 
 them from other granules in the blood. The very remarkable 
 article on the blood cells by Max Schultze conceals by its title 
 " Ein Heizbare Objecttisch und seine Verwendung bei Unter- 
 suchungen des Blutes " (Arch. f. Mikro. Anatomic, Bd. I, 
 1865), the subject of the article much better than usually 
 happens, in spite of the ingenuity which is often displayed in 
 doing this. After a description of the varieties of the white 
 corpuscles, the accuracy of which excites our admiration even 
 now, he says " In the blood no constituent is without impor- 
 tance, and in conclusion I will call attention to a normal form 
 constituent of the human blood which up to the present has 
 been entirely neglected. I find in my blood and in the blood 
 
38 Sir William Osler, Bakt. 
 
 of numerous persons of different ages more or less abundant, 
 irregular masses of colorless globules, the masses varying in 
 size according to the number of globules which compose them. 
 The globules themselves are from one to two micra in diameter 
 and also occur separately in the blood. I have found three, 
 four and even hundreds joined together, forming plaques of 
 irregular size, 80 or more micra in diameter. These structures, 
 on account of their irregular size and shape, give the impres- 
 sion of broken up tissue elements.'' * 
 
 This was the condition when young Osier was probably given 
 the subject for investigation in the laboratory. He showed 
 that these granular masses of Schultze were not present in the 
 circulating blood, but were formed at the moment of examina- 
 tion by a rapid aggregation of the single bodies. He showed 
 this by microscopic study of the blood, and also by the direct 
 examination in salt solution of small clippings from the 
 connective tissue of the rat in which he found the single bodies 
 and not the masses of them, within the small blood vessels. 
 He also showed that the conception of their presence in the 
 blood in aggregations was untenable because the masses could 
 not pass through the capillaries. He described the small 
 bodies as exhibiting amoeboid activity and saw filaments form 
 in connection with them, which were probably fibrin. The 
 article is admirable, clear and concisely expressed, with full 
 literature references. The next reference to the blood plates 
 is in an article "Infectious Endocarditis" (Seguin's Arch., 
 1881), and here he anticipates Bizzozero's view of the part 
 they play in thrombus formation. ^' In one case of mitral 
 stenosis a fresh vegetation when teased showed many closely 
 packed spherules, some of which were larger than those met 
 
 * I have quoted from this article for one reason because it was 
 used as a reference in the course of physiology given by Newell 
 Martin in 1878, and the plate when I opened the volume appeared 
 as a familiar friend. No one appreciated more than did Doctor 
 Osier the importance of familiarizing students with the original 
 sources of knowledge, and this was always done in Martin's 
 laboratory. 
 
Early Medical Work 39 
 
 with in the ulcerative form. [These were the masses of 
 micrococci.] I was greatly struck with the resemblance which 
 certain of these bodies, in this instance, bore to the individual 
 elements of Schnitzels granule masses — those peculiar, granu- 
 lar clumps common in the blood of some animals and of 
 impoverished * persons.^^ In 1882 there appeared a further 
 article, "Ueber den dritten Formbestandteil des Blutes," in 
 the Centralblatt f. d. med. Wissensch., ^o. 30, in which he 
 emphasized the part they played in the formation of thrombi 
 and a final article " On the Third Corpuscle of the Blood," 
 Medical News, 1883, a rather popular presentation of the 
 subject. 
 
 Osier returned to Montreal in 1874, bringing to his future 
 work a remarkable equipment. He was 25 years old, possessed 
 a vigorous healthy body, and a well-trained mind. His family 
 was well and favorably known in the community, which gives 
 no small advantage in a conservative society. He had received 
 a valuable education, probably more valuable though different 
 from that which men are now receiving. He had come into 
 close contact with men of high ideals and good methods of 
 work, he possessed the methods by which knowledge is obtained 
 and had already made important contributions which gave him 
 a reputation. He further had enthusiasm and the art of 
 inspiring this in his students, native kindness of heart, a 
 candid, open disposition, a great capacity not only for making 
 friends, but for arousing the feeling of affection, and a fine 
 sense of humor, never used to hurt, which made him a sought 
 and delightful companion. He wrote well and easily, ex- 
 pressed himself simply and clearly, leaving no doubt as to the 
 meaning, and the matter was well arranged. In spite of the 
 number of these early articles, they all show care in prepara- 
 tion. He had also great capacity for work, and ambition, with 
 a definite end in view. For such a man there are always 
 
 * Osier did not usually use such ambiguous expressions ; tlie 
 presence of such masses in the blood might be regarded as one 
 of the disadvantages of economic poverty. 
 
40 Sir William Osler, Bart. 
 
 opportunities waiting, and Osier found them in Montreal, as 
 he would have found them anywhere, even with his friend 
 Bo veil in Nevis. 
 
 In the latter part of 1874, in addition to his position in the 
 university, he was made physician to the Small-pox Hospital, 
 which gave him opportunities for clinical study and an interest 
 in the disease which he has always retained. With the salary 
 which the position gave he purchased microscopes for teaching 
 in the medical school. In 1876 he published in the Canadian 
 Medical and Surgical Journal three articles on small-pox: 
 (1) "The Initial Eashes of Small-pox ''; (2) "On Hemor- 
 rhagic Small-pox ^^; (3) "A Form of Hemorrhagic Small- 
 pox/^ which are valuable contributions to our knowledge of 
 the disease. They show accurate observation, good clinical 
 judgment and a marked power of differentiation of conditions 
 both clinical and pathological. He had studied skin diseases 
 with Tilbury Fox in England, and the influence of these 
 studies is shown here. It was an important work for him, for 
 in the Small-pox Hospital he first acquired the power of close 
 observation of skin lesions and the ability of differentiation 
 and description which was afterwards such a marked feature 
 in his clinical work. 
 
 A very interesting article appeared in the same journal in 
 1876, " On the Pathology of Miner's Lung.^' It is based upon 
 the examination of the lungs of a coal-miner who died in the 
 Small-pox Hospital, and in whom the condition was very 
 marked, and several other cases showing various degrees of the, 
 same condition. It is a good piece of work, shows much 
 originality, and is to be regarded as the best article in English 
 on the disease, which was first described by Pearson in 1813. 
 In this article for the first time the large mononuclear phago- 
 cytes were differentiated from the smaller corpuscles, and 
 Osier showed that the large cells were those most actively con- 
 cerned in the phagocytosis of the carbon. He says : " One 
 most curious specimen was observed. On an elongated piece 
 of carbon three cells were attached, one on either end and a 
 third in the middle, so that the whole had a striking resem- 
 
Early Medical Work 41 
 
 blance to a dumb-bell. I could hardly credit this at first, until 
 by touching the top cover and causing the whole to roll over, 
 I quite satisfied myself that the ends of the rods were com- 
 pletely embedded in the corpuscles and the middle portion 
 entirely surrounded by another/^ His description of the 
 position of the carbon in the lungs and its relation to the 
 lymphatics is accurate. He gives a figure of a microscopic 
 piece of coal which was found and which showed the scalari- 
 f orm tissue of ferns, thus proving its origin, and another piece 
 with two holes representing the dotted cells of firwood. In 
 conclusion, there is an experimental study of the effect of 
 foreign bodies in the tissue made by the injection of india ink 
 into the axillae and lungs of kittens. 
 
 The study of the blood plates gave him a familiarity with 
 blood examination which he utilized in the study of anaemia, 
 and there are several papers on this in 1877. The first of 
 these, " A Case of Progressive Pernicious Anaemia," was pub- 
 lished in association with Dr. Gardner in the Canadian Medi- 
 cal and Surgical Journal. It is probable that Osier wrote the 
 paper and was responsible for the blood examination and the 
 description of the autopsy, which showed the usual conditions 
 found in the disease. It is a good type of medical paper, the 
 descriptions of the blood and of the marrow changes are 
 accurate, and the relation between the blood changes and the 
 marrow, which had been described by Cohnheim in the same 
 year, is confirmed. An abstract of this article, with detailed 
 measurements of the various blood cells " Ueber die Beschaf- 
 fenheit des Blutes und Knochenmarkes in d. progressiven 
 pernicioser Anamie " was published in the Centralblatt f . d. 
 med. Wissensch., 1877, No. 15, and a second article in the 
 same journal on the study of a second case. Another article 
 on the same subject, in which he was associated with Dr. Bell, 
 appeared in the Transactions of the Canadian Medical Asso- 
 ciation, and here he gives Addison the credit for having first 
 recognized and described the disease under the name of 
 idiopathic anaemia. There is a final article in the following 
 year, " Entwickelung von Blutkorperchen im Knochenmark 
 
42 Sir William Osler, Bart. 
 
 bei pemicioser Anamie/^ Centralblatt f. d. med. Wissensch., 
 1878, in which he confirms Neumann's results of the study of 
 blood formation in the marrow. 
 
 During this period also he wrote a number of articles on 
 comparative pathology, the first on " Verminous Bronchitis in 
 Dogs, with Description of a New Parasite " was published in 
 the Veterinarian, London, 1877. He found this parasite in 
 the bronchi in an epidemic among dogs in Montreal. He gives 
 an accurate description of the parasite, and the points of 
 differentiation. It has been accepted as an original descrip- 
 tion and credited to him, the name Filaria osleri being one of 
 its synonyms. The only mistake he made was in classing the 
 organism among the strongyli and not the filariae, the main 
 difference being that the strongylus is oviparous and the para- 
 site described by him produces living embryos. The lobular 
 pneumonia which he found, associated with the presence of 
 the parasites in the bronchi, he referred to the inhalation of 
 inflammatory products produced by them. The paper closes 
 with a discussion of the mode of infection which he thought 
 was by the direct inhalation of the dried embryos and it would 
 have been more valuable had he subjected this theory to experi- 
 mental test. There is also a paper on Trichina spiralis 
 (Canadian Journal of Medical Sciences, 1876) which gives 
 a good description of the disease and the life history of the 
 organism, but which does not add anything new, and there are 
 a number of other articles which appeared at intervals up to 
 the time he left Montreal for Philadelphia. In the last article, 
 " An Investigation into the Pork Supply of Montreal," which 
 was conducted in association with one of his students in the 
 veterinary school, A. W. Clement, who was afterwards well 
 known in the early days of the pathological laboratory of The 
 Johns Hopkins, he speaks of having made 900 autopsies in 
 Montreal, in four of which trichina were found. 
 
 There are two interesting addresses in the period. The first 
 was to the graduating class in medicine in 1875. It was prob- 
 ably the habit of the faculty to place the burden of such an 
 address upon the youngest member. Eeading over this address. 
 
Early Medical Work 43 
 
 one is conscious that Osier had very little interest in it. Prob- 
 ably he looked over other addresses given on similar occasions 
 and they must have been a very poor lot. He gives the usual 
 good advice to the students, telling them to keep up their 
 reading, to observe patients well, and even at this early period 
 introduces Sir Thomas Browne, but he does not use him 
 effectively. It seems by far the worst thing he ever published ; 
 there is no trace of humor in it, and no indication of the 
 remarkable power he showed in his later addresses. 
 
 The second address is of a totally different character. It 
 represents much more work and care in preparation, as though 
 Osier had concluded that giving addresses was to be part of his 
 future work and that they should be good. There are a num- 
 ber of quotations, many of them apt, the usual good advice to 
 students, and some really inspiring sentiments, well expressed. 
 For instance, " You will have moments when the way appears 
 rugged, and the outlook dark, but never fear; others have 
 succeeded in the face of the same difficulties, and with patience 
 and perseverance you will do so too. Banish the future. Live 
 only for the hour and its allotted work. Think not of the 
 amount to be accomplished, the difficulties to be overcome, or 
 the end to be attained, but set earnestly at the little task at 
 your elbow, letting that be sufficient for the day, for surely our 
 plain duty is ^ not to see what dimly lies at a distance, but to 
 do what lies clearly at hand.^ ^' It is difficult to give a student 
 better advice than this. Of the family physician he says " But 
 while the soldier and the statesman win honor and fame, the 
 family physician will draw to himself the love and gratitude 
 of manifold hearts; he will have no enemies, martial or 
 political; and his labors, if directed by a wise and prudent 
 skill, will be for the welfare and benefit of all." 
 
 From 1872 to 1878 was a great period in medicine; it Just 
 preceded the bacteriological era in which the nature of infec- 
 tion was established; Pasteur had completed his studies on 
 fermentation and the silk-worm disease and was in the midst 
 of his revolutionary work on anthrax; Koch, an obscure 
 country physician, was beginning his studies on bacteria and 
 
44 Sir William Osler, Bart. 
 
 developing the methods which made their scientific study 
 possible; Virchow was at the height of his fame; Cohnheim 
 and Weigert had begun in Breslau and in Leipsie their remark- 
 able work ; a new university in Strasburg had just been estab- 
 lished which became famed through its products ; physiology, 
 in England and under Ludwig in Leipsie, had taken a new 
 life; Lister in England was in the midst of the work which 
 revolutionized surgery; the modern medical clinic was slowly 
 being established, and medicine was becoming scientific, its 
 procedures based upon knowledge and not conjecture; new 
 ideals and methods in medical teaching were being everywhere 
 introduced ; America was feeling the enormous stimulus of the 
 promise given in the establishment of The Johns Hopkins 
 University. Osier was under the stimulus of all the new life. 
 He could easily have become a great scientist, but he chose the 
 path which led to the formation of the great clinician which 
 he became ; a worthy associate of the great men who have made 
 English medicine famous. 
 
OSLEE AS A PATHOLOGIST 
 By William G. MacCallum 
 
 The statement may be safely ventured that no clinician in 
 English-speaking countries has had at his command such a 
 wide and detailed knowledge of morbid anatomy as Osier. 
 There may be different opinions as to the reasons for his great- 
 ness as a teacher, as a man among men and in other ways, but 
 hardly more than one opinion as to the foundation of his 
 greatness as a clinician. 
 
 In the two small volumes of Pathological Eeports printed 
 at the McGill University, in a complete collection of reprints 
 of his papers beginning in 1877, and in the first edition of his 
 Practice of Medicine, the development of his knowledge of 
 pathological anatomy may be clearly traced. Throughout 
 there is no diminution in his keen enthusiasm and little change 
 in the character of his interests, but there is an extraordinary 
 advance in the clarity of his ideas keeping pace with the dis- 
 coveries of the European and other workers in the field of 
 pathology. 
 
 During a period of more than 40 years — years that have 
 witnessed the most phenomenal advances in medicine — his 
 attention was very largely devoted to these studies which were 
 constantly maintained as the basis of his more purely clinical 
 work. 
 
 Osier's training lay not in chemistry — the growth of bac- 
 teriology found him a spectator and experimental methods 
 seem to have had little attraction for him. ISTor did he attempt 
 any protracted researches in pathology for its own sake. In- 
 stead his interest was and has always been in the observation of 
 rather gross and striking anatomical alterations, usually on 
 account of the symptoms which they produced and not with 
 the aim of investigating their minute details or their ultimate 
 
 45 
 
46 Sir William Osler, Bart. 
 
 causes. In all this he has shown himself critical and sane and 
 quite unwilling to pursue what seemed a fantastic theory 
 unless convinced by definite proofs. He was skeptical of the 
 malarial organisms of Laveran for a time until he became 
 familiar with them himself and demonstrated them in this 
 country. He would not believe that the micrococci found in 
 acute endocarditis were anything more than accidental in- 
 vaders until he had convinced himself by actual studies of the 
 valves. 
 
 But in his early days he did not wait for others to unearth 
 new facts. He pressed ahead alone in the investigation of 
 unexplained phenomena and was perhaps the first to see clearly 
 the blood platelet which he described in 1874 as the third 
 corpuscle of the blood. 
 
 He was early in the field with his studies of the bone-marrow 
 in pernicious angemia and evidently recognized megaloblasts 
 and other cells at a time when such recognition must have been 
 very difficult. 
 
 But from the beginning he appears to have been more readily 
 interested in the physical aspects of morbid anatomy, especially 
 in so far as there could be traced a chain of events. In the 
 first volume of the McGill reports he describes a case of 
 idiopathic hypertrophy of the heart, the topography, and effects 
 of various aneurysms, cases of phthisis, pneumonia, cancer, 
 ulcer of the duodenum, typhoid fever with perforation, incar- 
 ceration of the ileum, etc. In the second volume is found a 
 series of similar miscellaneous cases. Some of these were 
 remarkable as, for example, the instance of aneurysm of the 
 hepatic artery. It is to be noted that even in his discussion of 
 these cases he showed that the special literature of foreign 
 countries was quite at his command. He met with a case of 
 hypertrophic cirrhosis of the liver — the first in his experi- 
 ence — and while he was studying it there appeared Hanot's 
 thesis, the importance of which in relation to his own case he 
 recognized at once. From this period at McGill University 
 where he performed a great many postmortem examinations 
 and supervised them in the hands of students he acquired much 
 
As A Pathologist 47 
 
 of his familiarity with morbid anatomy. It is his spirit of 
 serious research which has remained to inspire the splendid 
 work in pathology carried on ever since in that school and his 
 preparations formed the foundation of their magnificent 
 museum of pathological anatomy. 
 
 Osier was impressed from the beginning with the usefulness 
 of considering together a group of series of similar cases. 
 There is something statistical about this plan, but since no two 
 cases of any disease are precisely alike in all details, much 
 light comes from the study of a series. This method may be 
 traced through the work of his later years and in that of all of 
 his pupils. It is apparent in all the papers of his Philadelphia 
 and Baltimore periods and reveals his careful method of pre- 
 serving minute notes on all he saw, for some of the recent 
 studies refer back to cases encountered in the Montreal days. 
 
 Comprehensive papers on endocarditis, tuberculous pleurisy, 
 peritonitis, pericarditis and abdominal tumors, followed and 
 later similar analyses of long series of cases of typhoid fever, 
 meningitis, erythema multiforme, Addison^s disease, myx- 
 oedema, splenic anaemia, malaria and many other conditions. 
 In these there is a sustained and constant interest in the 
 pathological anatomical changes, but rather in their relation 
 to the general history and symptomatology of the disease than 
 for their own sake. The details of the causes and development 
 of the lesions are discussed only briefly, but an important out- 
 come of such studies was in several instances the more definite 
 outlining of disease entities from the recognition of the re- 
 peated occurrence of the same group of symptoms and patho- 
 logical alterations. 
 
 This has long been the first great step in the study of disease 
 and it is for this reason that many of the great names in 
 medicine are associated with the diseases in which they have 
 been the first to discern the constancy of the association of 
 several features. The ability to see these relations and to 
 connect a group of phenomena with a common cause is given to 
 few. It is only less difficult than to discover the hidden cause 
 of disease. 
 
48 Sir William Osler, Bart. 
 
 On the other hand, with diseases well recognized by every- 
 one, Osier's interest in new manifestations and new combina- 
 tions of symptoms or lesions has been unfailing. After the 
 long period of observation and study of typhoid fever in which 
 he associated with himself all the men on his staff he analyzed 
 the disease from every point of view. However, in these 
 studies only the grosser anatomical changes are considered and 
 there was no special advance in the knowledge of the bacteri- 
 ology or immunity reactions of the disease. 
 
 Syphilis has always claimed much of his attention and 
 interest, although he has written little on it except in the form 
 of text-book articles and papers concerning aneurysms. Never- 
 theless, the multifarious manifestations of this disease have 
 formed a prominent subject in his teaching and he believed 
 that there was much in the statement that he who knew all of 
 syphilis knew nearly all of medicine. 
 
 In his later years he worked no longer at actual dissections 
 and no longer studied the details of pathological anatomy with 
 the microscope, but he never slipped into that state of con- 
 fidence in unaided clinical diagnosis which would allow him 
 to remain away from the autopsy room. Instead he came there 
 not only to follow minutely the dissection of cases from his own 
 hospital service, but to learn what he could from those belong- 
 ing to the surgical and other services. His presence was an in- 
 spiration that led us to great efforts toward careful work, and 
 his long experience and unfailing memory, which enabled him 
 to recall the conditions found in a whole series of similar cases, 
 gave us a background upon which the case under investigation 
 stood out. 
 
 The pathological anatomy of his text-book is of this quality 
 and it is for that reason that the students in pathology are told 
 to read it. No one has written more systematically, or more 
 concisely of the changes underlying the manifestations of 
 disease ; no one has recognized more clearly the boundary line 
 between the known and the unknown or sifted more judiciously 
 and unerringly the truth from error. His long habit of con- 
 sidering each disease on the basis of knowledge gained from 
 
As A Pathologist 49 
 
 the analysis of a large series of cases has allowed him to esti- 
 mate justly the relative frequency and importance of each 
 feature and to state them in the most helpful and orderly 
 sequence. This clearness of vision with regard to the actual 
 natural history of disease, always referring to a well-remem- 
 bered series of cases, helped to make his teaching a memorable 
 delight to his students. His actual contributions to our knowl- 
 edge of pathology are many and important, but even more 
 valuable to the science of medicine in general is his example, 
 in that he has built his clinical medicine solidly on a founda- 
 tion of pathological anatomy. 
 
1913. 
 
OSLER, THE TEACHER 
 By W. S. Thayer 
 
 Observe, record, tabulate, communicate. 
 
 Use your five senses. The art of the practice of medicine is 
 to be learned only by experience; 'tis not an inheritance; it 
 cannot be revealed. Learn to see, learn to hear, learn to feel, 
 learn to smell, and know that by practice alone can you become 
 expert. Medicine is learned by the bedside and not in the class- 
 room. Let not your conceptions of the manifestations of 
 disease come from words heard in the lecture room or read 
 from the book. See, and then reason and compare and control. 
 But see first. No two eyes see the same thing. No two mirrors 
 give forth the same reflection. Let the word be your slave and 
 not your master. 
 
 Live in the ward. Do not waste the hours of daylight in 
 listening to that which you may read by night. But when you 
 have seen, read. And when you can, read the original descrip- 
 tions of the masters who, with crude methods of study, saw 
 so clearly. 
 
 Record that which you have seen ; make a note at the time ; 
 do not wait. " The flighty purpose never is o'ertook, unless 
 the deed go with it." 
 
 Memory plays strange pranks with facts. The rocks and 
 fissures and gullies of the mountain-side melt quickly into the 
 smooth, blue outlines of the distant panorama. Viewed 
 through the perspective of memor}^, an unrecorded observation, 
 the vital details long since lost, easily changes its countenance 
 and sinks obediently into the frame fashioned by the fancy of 
 the moment. 
 
 Always note and record the unusual. Keep and compare 
 your observations. Communicate or publish short notes on 
 anything that is striking or new. Do not waste your time in 
 compilations, but when your observations are sufiicient, do 
 not let them die with you. Study them, tabulate them, seek 
 the points of contact which may reveal the underlying law. 
 
 51 
 
53 Sir William Osler, Baet. 
 
 Some things can be learned only by statistical comparison. If 
 you have the good fortune to command a large clinic, remem- 
 ber that one of your chief duties is the tabulation and analysis 
 of the carefully recorded experience. 
 
 The collection and study of your own observations is much, 
 but he who works in his own small compartment leads, after 
 all, a restricted and circumscribed life. Go out among your 
 fellows, and learn of them. The good observer is not limited 
 to the large hospital. The modest country doctor may furnish 
 you the vital link in your chain, and the simple rural prac- 
 titioner is often a very wise man. 
 
 Eespect your colleagues. Know that there is no more high- 
 minded body of men than the medical profession. Do not 
 judge your confreres by the reports of patients, well meanings 
 perhaps, but often strangely and sadly misrepresenting. Never 
 let your tongue say a slighting word of a colleage. It is not 
 for you to judge. Let not your ear hear the sound of your 
 voice raised in unkind criticism or ridicule or condemnation 
 of a brother physician. If you do, you can never again meet 
 that man face to face. Wait. Try to believe the best. Time 
 will generally show that the words you might have spoken 
 would have been unjust, would have injured a good man, and 
 lost you a friend, and then — silence is a powerful weapon. 
 
 When you have made and recorded the unusual or original 
 observation, or when you have accomplished a piece of research 
 in laboratory or ward, do not be satisfied with a verbal com- 
 munication at a medical society. Publish it. Place it on 
 permanent record as a short, concise note. Such communica- 
 tions are always of value. 
 
 Mix with your colleagues; learn to know them. But in 
 your relations with the profession and with the public, in 
 everything that pertains to medicine, consider the virtues of 
 taciturnity. Look out. Speak only when you have something 
 to say. Commit yourself only when you can and must. And 
 when you speak, assert only that of which you know. Beware 
 of words — they are dangerous things. They change color like 
 the chameleon, and they return like a boomerang. Do you 
 know the story of the young physician, about to enter practice, 
 
The Teacher 53 
 
 who was sent by his father to his old friend, Sir William 
 Stokes, for advice ? A pleasant conversation, and, at the door- 
 way, a last word : " Charley, don^t say too much." Then, at 
 the gate, a voice : *^ Charley, come back a minute ; I'm very 
 fond of you, my boy ; don^t do too much." 
 
 " Don't do too much." Remember how much you do not 
 know. Do not pour strange medicines into your patients. 
 Our greatest assistance is given by simple physical and mental 
 means, and by the careful employment of such drugs as have 
 been adequately studied, with regard to the action of which we 
 have real information. Do not rashly use every new product of 
 which the peripatetic siren sings. Consider what surprising 
 reactions may occur in the laboratory from the careless mixing 
 of unknown substances. Be as considerate of your patient and 
 yourself as you are of the test-tube. 
 
 Familiarize yourself with the work of others and never fail 
 to give credit to the precursor. Let every student have full 
 recognition for his work. Never hide the work of others under 
 your own name. Should your assistant make an important 
 observation, let him publish it. Through your students and 
 your disciples will come your greatest honor. 
 
 Be prompt at your appointments; that is always possible. 
 Many are always late at a consultation; few miss a train. 
 There is no excuse for tardiness. 
 
 Live a simple and a temperate life, that you may give all 
 your powers to your profession. Medicine is a jealous mis- 
 tress ; she will be satisfied with no less. 
 
 Save the fleeting minute; do not stop by the way. Learn 
 gracefully to dodge the bore. Strike first and quickly, and 
 before he has recovered from the blow, be gone; 'tis the only 
 way 
 
 If you can practice consistently all this, .... and then, if 
 you can bring into corridor and ward a light, springing step, 
 a kindly glance, a bright word to every one you meet, arm 
 passed within arm or thrown over the shoulder of the happy 
 student or colleague; a quick, droll, epigrammatic question, 
 observation or appellation that puts the patient at his ease or 
 brings a pleased blush to the face of the nurse ; an apprehen- 
 
54 Sir William Osleu, Bart. 
 
 sion that grasps in a minute the kernel of the situation, and 
 a memory teeming with instances and examples that throw 
 light on the question ; an unusual power of succinct statement 
 and picturesque expression, exercised quietly, modestly and 
 wholely without sensation; if you can bring into the lecture 
 room an air of perfect simplicity and directness, and, behind 
 it all, have an ever-ready store of the most apt and sometimes 
 surprising interjections that so light up and emphasize that 
 which you are setting forth that no one in the room can forget 
 it ; if you can enter the sick-room with a song and an epigram, 
 an air of gaiety, an atmosphere that lifts the invalid instantly 
 out of his ills, that produces in the waiting hypochondriac so 
 pleasing a confusion of thought that the written list of ques- 
 tions and complaints, carefully compiled and treasured for the 
 moment of the visit, is almost invariably forgotten ; if the joy 
 of your visit can make half a ward forget the symptoms that it 
 fancied were important, until you are gone; if you can truly 
 love your fellow, and, having said evil of no man, be loved by 
 all ; if you can select a wife with a heart as big as your own, 
 whose generous welcome makes your tea-table a Mecca ; . . . . 
 if you can do all this, you may begin to be to others the teacher 
 that " the chief '' is to us ! 
 
 An eye whose magic wakes the hidden springs 
 
 Of slumbering fancy in the weary mind, 
 
 A tongue that dances with the ready word 
 
 That like an arrow seeks its chosen goal, 
 
 And piercing all the harriers of care. 
 
 Opens the way to warming rays of hope. 
 
 A presence like the freshening breeze that as 
 
 It passes, sweeps the poisoned cloud aside. 
 
 An ear that 'mid the discords of the day 
 
 Swings to the basic harmonies of life. 
 
 A heart whose alchemy transforms the dross 
 
 Of dull suspicion to the gold of love. 
 
 A spirit like the fragrance of some flower 
 
 That lingers round the spot that this has graced, 
 
 To tell us that although the rose be plucked 
 
 And spread its perfume throughout distant halls 
 
 The vestige of its sweetness quickens still 
 
 The conscience of the precinct where it bloomed. 
 
OSLER AND THE STUDENT 
 By Thomas R. Brown" 
 
 In a lay sermon delivered before the Yale students a few 
 years ago in which Dr. Osier offered them " A way of life " — 
 " a path in which the wayfaring man cannot err, a life in day- 
 light compartments, the main business of which is not to see 
 dimly at a distance, but to do what lies clearly at hand/^ and 
 which had been the starting point of his life-habit — he began 
 with two words which show more plainly than many pages 
 could his real relation to the student — for these two words 
 were " fellow students/^ In these words lay the real reason 
 for his unique and lasting influence upon all who studied with 
 him, for he, with his vast experience, his wonderful insight, 
 his profound knowledge, his poetic vision, his deep sympathy, 
 was still always at heart the student, always studying, always 
 delving more deeply into the mysteries of health and of disease, 
 giving always, yet always ready to receive, teaching, yet ever 
 ready to learn. 
 
 To those privileged to be his students in the early days of 
 the medical school — a truly golden age to each and every one 
 of the small, though ever-growing group, he preached, as he 
 lived, a glorious philosophy of life, a joy in work, doing the 
 day's tasks, " living for the day and for the da/s work," with 
 a wonderful belief in his f ellowmen, never losing faith because 
 some had failed him, giving without stint his best to everyone 
 with no thought that some might prove unworthy of the trust. 
 He felt with Goethe that "the classical is health, and the 
 romantic disease,'^ and he strove for the one with the Greek 
 love of perfection, while for the other he had the passion of 
 the truly adventurous spirit sailing on uncharted seas. To 
 us who were his students in the early days of The Johns Hop- 
 kins Medical School, his memory is so vivid, so fresh, that it 
 seems but as of yesterday when he worked and played in our 
 
 55 
 
56 Sir William Oslee, Bart. 
 
 midst, and we have but to close our eyes to see him in fancy, 
 almost as clearly as we saw him in fact in the late 90's, the 
 great teacher and the great student in his manifold relations 
 to his students. Now we see him riding to the hospital in the 
 Monument Street car, and to the group about him prophesying 
 with keen yet ever kindly vision the ills — physical, mental and 
 spiritual of the derelicts en route to the dispensary; here in 
 the wards demonstrating the complex psychology of Giles de 
 la Tourette's disease, as exemplified by a poor bit of sodden 
 humanity whose coprolalia but exemplified — in a way a bit 
 embarrassing at times it is true — the symptom-complex he was 
 discussing, or in an alcove off the ward playing with little 
 Theophilia as she was emerging from the night of cretinism 
 into the day of normal happy childhood under his skillful 
 guidance; now in the class-room of the dispensary — for he 
 loved the polyclinic, and believed in its wonderful potentiality 
 as a teaching factor — with one deft touch solving a case of 
 great complexity, or bringing from his vast storehouse of 
 knowledge the one last link needed in a disease-picture 
 hitherto poorly understood, listening, suggesting, directing, 
 teaching, guiding both student and patient, and all the while 
 filling countless scraps of paper with the names of one of the 
 three great teachers of his youth ; now in the clinical laboratory 
 studying a blood specimen, and suggesting to the student some 
 line of original investigation which might, perhaps, light into 
 flame the dormant investigator and research worker; now in, 
 the autopsy room studying in death the puzzles that he had 
 helped to unravel during life ; now walking through the wards 
 and corridors of the hospital with a smile or an epigram for 
 every doctor and nurse who passed, a kindly word, and his 
 ever-stimulating psychotherapy — encouragement, optimism, 
 hope — to every patient he saw ; in his myriad activities always 
 making each student feel that he also was but a student of 
 health and of disease, of men and of morals, and yet such a 
 student as to fire our minds, our souls and our bodies to re- 
 newed efforts so that we might, in some measure at least, prove 
 worthy of this fraternity. To us who were privileged to be his 
 
OSLER AND THE STUDENT 57 
 
 students — his fellow students in those days, he was — and still 
 is — always our inspiration and always our model. In him the 
 fire burned so brightly that no dross nor tinsel could survive 
 its pure flame, and he was ever " our cloud by day, our pillar 
 of fire by night." With Bossuet he taught that " le bon sens 
 est le genie de Fhumanite," and he gave to us " a golden age 
 which never rusts, a spring which never fades, eternal youth.''* 
 Always true to himself and to others, he made us think daily 
 of words of his beloved Plato " Whence has the progress of 
 cities and nations arisen if not from remarkable individuals 
 coming into the world we know not how and from causes over 
 which we have no control ? " 
 
 Is not the greatest tragedy of growing older the loss of our 
 illusions — the discovery sooner or later that so many of the 
 gods of our youth, Jove-like Olympians of those days when 
 our world was young and pregnant with possibilities, have, 
 after all, but feet of clay ? But with ^^ the chief " this could 
 never be. The more we learned, the more wonderful his bound- 
 less knowledge seemed ; the wider our vision, the more limitless 
 his appeared. 
 
 Everyone who has ever been his student is, as it were, still 
 studying with him, or peripatetically following his footstepsi 
 as he journeys through life, always teaching some new lesson 
 of medicine or of living. Every honor that has befallen him 
 has enriched us and made us prouder of our brotherhood; 
 every step upward or onward of his has made our paths easier 
 and the heights seem not so far away. We have rejoiced in his 
 happiness and in his honors, and perhaps he has been helped 
 in his sorrows by the knowledge that they are ours as well, for 
 he has shown us how work could be made play, and how the 
 real could be made ideal. Because of him our lives have been 
 better, our successes more real, our failures less hard to bear, 
 for through the tangled skein that spells life each of us knows 
 that in him he has, and will always have, a teacher, a friend, 
 and a true fellow student to the end of the chapter. 
 
OSLEE AND PATIENT 
 By Thomas McCrab 
 
 In all the relations of physician to patients there are two 
 sides — the strictly medical and the personal. Some have a 
 blind spot for the latter, but taking the profession as a whole 
 these are in the minority. ISTo one could work in close associa- 
 tion with Sir William Osier without realizing that both sides 
 were well developed in him. There was always the desire to do 
 the best for the patient in a medical way, but the personal 
 aspect was never forgotten. Patients were patients and not 
 cases. Interest in the personal side was much in evidence and 
 it was the exception for his patients to fail in appreciating this. 
 There was always a great charity for the weakness of human 
 nature and there were neither unkind nor hasty judgments. 
 We know how often in his addresses he has emphasized the 
 importance of this quality. 
 
 To the writer was given the opportunity of knowing the 
 relation of Sir William Osier to the patient both by personal 
 experience and by the observation of others. The former 
 came by my having an attack of typhoid fever while a house 
 officer in The Johns Hopkins Hospital. After the passage 
 of years it is difficult to estimate in detail one's feelings to- 
 wards his physician, but the main impression left on my mind, 
 after a long interval is that of absolute confidence. His visits 
 were usually short, but when he had gone there was a feeling 
 that everything was all right. The visit was nearly always 
 marked by some cheering saying or amusing quip. 
 
 One incident comes to memory with regard to the impres- 
 sion made by him on a patient many years ago ; it is also an 
 example of curious coincidence. Back in the eighties one of 
 my father's friends was stricken with a malady of which I 
 heard some of the details discussed without realizing that they 
 
 59 
 
60 Sir William Osler, Bart. 
 
 were to be remembered. The patient had Addison's disease 
 with an unusual degree of pigmentation which attracted great 
 attention and was naturally commented on by his friends. I 
 remembered hearing that he had gone to the United States to 
 consult a physician and had come back realizing that he could 
 not recover. These matters had apparently been completely 
 forgotten, but were recalled when 25 years later the friend who 
 accompanied the patient on the Journey said to me: "I 
 wonder if you could help me to identify the physician whom 
 Mr. X consulted in Philadelphia. His name made little im- 
 pression on me at the time.'^ This seemed rather a difficult 
 undertaking, but I asked what he remembered of the visit. 
 He gave the following details : " The examination was very 
 thorough ; he stripped Mr. X and went over him from head to 
 foot. He said very little. (At this point the thought of Sir 
 William came to my mind.) When Mr. X asked him as to the 
 outlook, he said, ^ Do you think you have enough of the grace 
 of Grod to make a clergyman,' or something like that. At any 
 rate Mr. X understood the meaning which was intended and 
 commented with approval on the way in which it was con- 
 veyed." Afterwards I asked Sir William if he was the physi- 
 cian, and found that he was and that he remembered the 
 patient very well. 
 
 This brings up another of his characteristics with regard 
 to patients — the marvellous memory which he has of the details 
 regarding many of them. On one occasion a physician brought 
 a patient to consult him. The physician began to give the 
 history when Sir William said : '^ I saw Mr. — before with so 
 and so " — mentioning the diagnosis. Both the physician and 
 the patient deified this until Sir William showed them the 
 notes of the previous visit. It seems almost impossible to 
 imagine that both should have forgotten the consultation, but 
 such was the case. On many occasions patients came back to 
 the clinic after an interval of years and Sir William could give 
 the details of the history at once. 
 
 In one of his essays, which gives the title to a book, " Aequa- 
 nimitas," he dwells on the importance of not permitting one's 
 
OsLBR AND Patient 61 
 
 poise to be disturbed or allowing the expression to show what 
 would be better concealed. He practised this in his daily 
 work and many who came in contact with him never realized 
 how much anxiety he often felt, but rarely displayed over 
 patients. This was particularly true if it was a case in which 
 a diagnosis had not been made and in which, therefore, the 
 best treatment was a question of doubt. One such instance 
 comes to mind of a young man with typhoid fever and severe 
 hemorrhages. In this case, of course, we were suspicious of 
 perforation. Sir William made a special trip to the hospital 
 at my request to try and settle this point. The decision was 
 that there was no positive evidence of perforation and explora- 
 tion was delayed, but the signs of general peritonitis next day 
 showed our error. I remember well his words on the fallibility 
 of human judgment and of the sorrow that one felt when he 
 had judged wrongly. 
 
 His influence over patients was marked and especially over 
 those unfortunates whose nervous systems had suffered. As a 
 general rule he did not spend a great deal of time over them in 
 the hospital. However, the results came; in many cases no 
 doubt, largely by faith in him. It has been said by some that 
 Sir William was not particularly interested in psychotherapy, 
 but one might say that he did not need to be — he practised it, 
 not- always consciously, perhaps, but always effectively. He 
 had extraordinary patience with querulous patients and it was 
 very rarely that he ever became irritated with them. With the 
 patient who was ready to fight and be disagreeable he never 
 argued : " Glad to see you come and glad to see you go ^^ was 
 a favorite answer. 
 
 Many interviews with patients come to memory. In one the 
 center of the stage was occupied by a nervous woman, to whom 
 something had been said in a very kindly way of the need of 
 self-control. With the tears flowing freely and a handkerchief 
 in active use she said: "Oh, Dr. Osier you misjudge me 
 cruelly." He, standing at the foot of her bed, replied with a 
 serious tone to his voice and a twinkle in his eye : " Madam, 
 I learned early in life never to judge any woman and that rule 
 
62 Sir William Osler, Bart. 
 
 I have strictly kept. Therefore, I cannot have misjudged you. 
 Good morning '^ — and he was away before she could frame a 
 reply. Later in the day the brunt of his hasty exit fell on me. 
 
 In a large private ward service it was not possible for him 
 to spend a long time with each patient. To his house officers 
 it was always a source of interest and a good lesson to observe 
 how he could get into and out of a patient's room without 
 giving a chance for the flood-gates of talk to open. Many 
 patients would lament that they had not been able to tell him 
 this or that. But with this he had a remarkable ability in 
 discerning when the patient needed a special interview and he 
 was always ready to give it. 
 
 There was one subject on which he would never listen to a 
 patient, and that was when something was said which reflected 
 on another physician. When the patient began any such state- 
 ments he showed his displeasure at once and if this was not 
 enough a very sharp rebuke followed. In fact this was about 
 the only thing which made him lose patience and was the rare 
 occasion of his showing sternness. The talkative patient was 
 a trial to him — and of whom is this not true? He used to 
 have a very characteristic look when he escaped and I can 
 remember his delight, after a particularly trying interview of 
 the kind, when I quoted to him from '^ Kim '' : " The husbands 
 of the talkative will have a great reward hereafter.'^ However, 
 he was rarely caught twice by the same person. 
 
 Of one class of his patients a word may be said — the doctors. 
 He was consulted by many of the profession and especially in 
 the latter years in Baltimore. This had grown to be a heavy 
 burden, but one which he carried willingly. He never spared 
 himself or thought of his own convenience when something 
 was to be done for a physician or a member of a physician^s 
 family. 
 
 Of the attitude of patients towards Sir William much might 
 be said. Perhaps the most striking characteristic was absolute 
 confidence. There was the cert-ainty that there would be no 
 failure from lack of skill or interest on his part. His cheer- 
 fulness had much to do with this and the ability to give the 
 
OsLEK AND Patient 63 
 
 desire to fight to those who had lost courage and hope. He 
 was always careful in giving an opinion to put matters simply, 
 so that the chance of misunderstanding would be as slight as 
 possible. In the consideration of what a patient should do he 
 always had in mind what he could do. It was a good lesson 
 to observe the care which he took to avoid saying anything in 
 the hearing of a patient which might cause disturbance or 
 increase anxiety. This was especially marked when the out- 
 look was being discussed and seemed unfavorable. He never 
 forgot to be sure that the patient was not within hearing. In 
 all the giving of advice he was sparing of words and might be 
 described as one of those " who have not the infirmity, but the 
 virtue of taciturnity, and speak not out of the abundance, but 
 the well-weighed thoughts of their hearts." 
 
OSLER AND THE TUBEECULOSIS WORK OF 
 THE HOSPITAL 
 
 By Louis Hamman 
 
 Dt. Osler^s interests were so universal that I fear I run grave 
 risk of contradiction in saying that he showed a particular 
 interest in tuberculosis. I came in contact very intimately 
 with his enthusiasm for tuberculosis study and perhaps for this 
 reason I exaggerate the position it held for him. Certainly 
 he never tired of reiterating to students the importance of a 
 thorough knowledge of the two great infectious diseases, tuber- 
 culosis and syphilis. From the beginning of his career as 
 physician-in-chief to this hospital he studied the tuberculous 
 patients with minute care. The first patient admitted to his 
 medical service on May 16, 1889, was suffering from tubercu- 
 lous peritonitis and one of the first clinical papers he published 
 was upon this aspect of tuberculous disease. In 1903 I under- 
 took at his request a study of all the cases of serous membrane 
 tuberculosis that had been in the hospital up to that date and I 
 noted that many of the histories have copious notes dictated 
 by him. 
 
 That this interest in tuberculosis extended beyond the 
 details of clinical observation is shown by the establishment in 
 1898 of a special fund for the study of tuberculosis, the 
 initiative for its inauguration and much of the money coming 
 from Dr. Osier himself. Dr. Charles D. Parfitt was appointed 
 to conduct the work and a laboratory was equipped to afford 
 him suitable opportunity for investigation. Unfortunately 
 after an active year, which gave promise of substantial con- 
 tributions to the study of tuberculosis. Dr. Parfitt was taken 
 ill and the work was abandoned to be resumed some years later 
 in the laboratory of the Phipps dispensary. 
 
 A further evidence of Dr. Osier's unfailing interest in tuber- 
 culosis, and his zeal for the dissemination of tuberculosis 
 
 5 65 
 
66 Sir William Oslee, Bart. 
 
 knowledge amongst the students, is the foundation of the 
 Laennec Society in 1900. This was the first society in this 
 country and, as far as I know, the first in the world to devote 
 itself to the study of tuberculosis. I remember clearly the first 
 meeting of the society held in the fall of 1900 in the basement 
 under Ward G. Dir. Osier presided, outlining the aims of the 
 society and explaining the appropriateness of its name; a re- 
 view of Laennec's life and work followed. Since this date the 
 society has continued to hold regular meetings and it has 
 proved itself an important and stimulating center of tuber- 
 culosis interest in the hospital. Unfortunately, there are no 
 records of the early meetings of the society, but I remember 
 Dr. Osler^s unfailing attendance at all the meetings and his 
 brilliant and stimulating discussions. 
 
 Shortly after the establishment of the Laennec -Society 
 Dr. Osier with his peculiar prescience of coming events in- 
 augurated the home visiting of tuberculous patients registering 
 in the dispensary. At first this work was undertaken by 
 medical students, Blanche N". Epler, Adelaide Dutcher and 
 Elizabeth H. Blauvelt successively giving it their service. The 
 study of Miss Dutcher reported before the Laennec Society 
 and published in the Philadelphia Medical Journal, December 
 1, 1900, is, I believe the first contribution in this country to 
 lay the proper emphasis upon the importance of the home in 
 the spread of tuberculosis. From this modest beginning grew 
 the subsequent study and care and supervision of tuberculous 
 patients in the dispensary. Dr. Osier soon enlisted the interest 
 of Mr. Victor Bloede in the work and through his generous 
 support a nurse was employed to visit and instruct patients 
 in their homes. At the same time under his guidance the first 
 steps were taken towards establishing a special clinic for the 
 tuberculous. Although no separate rooms were available for 
 this purpose, all tuberculous patients were put under the care 
 of Dr. Herman Bruelle for detailed study and advice. 
 
 It would give a very incomplete impression of Dr. Osier's 
 tuberculosis interests to omit reference to his activities outside 
 of the hospital. He was always deeply concerned about the 
 
Tuberculosis Work of the Hospital 67 
 
 social applications of medical knowledge and he played a 
 prominent part in furthering and directing the awakening 
 interest in the control of tuberculosis as a disease of the masses. 
 For instance, he took a very active interest in the Tuberculosis 
 Exposition held in January, 1904, under the auspices of the 
 State Board of Health, the first exposition of the kind held in 
 this country. Under his influence a remarkable collection of 
 books on tuberculosis were displayed, illustrating the develop- 
 ment of our knowledge of the disease from Hippocrates to 
 modern times. Before the collection was dispersed Dr. Osier 
 reviewed it with the medical students, illuminating each epoch 
 with his surprising knowledge of the historical aspects of the 
 subject. 
 
 In 1903 Mr. Henry Phipps learned of the work Dr. Osier 
 was trying to do with such modest equipment and generously 
 sent $10,000 to support his endeavors. The check came quite 
 unexpectedly and was the means for Dr. Osier to plan at once 
 to materialize one of his dreams. With great enthusiasm he 
 began to develop a special department for the study of tuber- 
 culosis and the care of tuberculous patients. Mr. Phipps' 
 additional gift of over $20,000 made it possible to remodel 
 the old stable standing between the dispensary and pathological 
 department buildings into a two-story structure with four 
 rooms on each floor. The building was formally opened at a 
 special meeting of the Laennec Society on February 21, 1905, 
 and the first patients were received on the first of March of the 
 same year. 
 
 Dr. Osier left the hospital the year the tuberculosis dis- 
 pensary was opened, but his interest in the department never 
 ceased. Messages of encouragement and appreciation came at 
 irregular intervals. Whenever an article appeared by a mem- 
 ber of the staff, usually the first and always the dearest recog- 
 nition was a postal or a brief note dashed off in his character- 
 istic way. As the dispensary gradually grew into a recognized 
 place in the medical clinic, at every turn of fortune there came 
 his cheering congratulation. It is impossible for me to look 
 back upon those years without the deepest emotion. I do not 
 
68 Sir William Osler, Bart. 
 
 know if Dr. Osier ever appreciated what these crisp, kindly 
 messages flashed from abroad really meant for us, nor am I 
 able adequately to express all we felt. Certainly this much is 
 true, they were always the brightest ray of encouragement to 
 our work, the most comforting reward that made us forget the 
 long, dreary hours of labor and the discouragement and doubt 
 that often assailed us. 
 
 Since the first few years the tuberculosis dispensary has 
 grown steadily in importance. Further gifts from Mr. Phipps 
 allowed the hospital to add to the building in 1908, doubling 
 its capacity. Eecently the generosity of Mr. Kenneth Dows 
 has further improved the building and has put the research 
 department of the dispensary upon a sound footing. The 
 tuberculosis clinic is a very different department now from the 
 modest dispensary arrangements of a physician without a room 
 to work in and with no other equipment but his stethoscope. 
 But this is the fruit that has grown from that tiny seed of 
 interest and enthusiasm planted by Dr. Osier many years ago. 
 
INFLUENCE ON THE RELATION OF MEDICINE IN 
 CANADA AND THE UNITED STATES 
 
 By Thomas B. Futcher 
 
 Sir William Osier has done more than any other member of 
 our profession to bring about cordial and intimate relation- 
 ships between its members in the United States and Canada. 
 A Canadian by birth, a graduate of McGill University, 
 Canada's most distinguished medical representative, and a 
 man with a most magnetic personality and great breadth of 
 sympathies and interests, it is only natural that he should 
 have exerted a most potent influence in encouraging close asso- 
 ciations between the members of the profession in the two 
 countries. Particularly was this the case after his call to 
 Philadelphia in 1884, and to Baltimore in 1889. While this 
 bond has naturally been more intimate between internists, his 
 influence indirectly brought about a closer contact between the 
 members of the other specialties. 
 
 Although Osier was graduated in medicine from McGill 
 University, he was born at Tecumseh, Ontario, on July 12, 
 1849, and was educated at Trinity College, Toronto. Various 
 members of his family, leaders in their respective professions, 
 have resided in the latter city. As his reputation grew, it was 
 only natural that his influence on the profession in the two 
 older provinces of Canada should have been very great. 
 
 After his graduation from McGill in 1872, he spent the next 
 two years in research work abroad, at University College, 
 London, and at Berlin and Vienna, where he formed associa- 
 tions with such men as E. A. Schafer, Virchow, Nothnagel 
 and others. While abroad, he published in 1873 his researches 
 on the blood platelets in which he established their corpuscular 
 character. Upon his return to Montreal in 1874, he was 
 appointed professor of the institutes of medicine, at McGill 
 
 69 
 
70 Sir William Osler, Bart. 
 
 University, a position he filled until 1884. During this period, 
 he was brought into intimate association with his old teacher, 
 Eobert Palmer Howard, who was professor of medicine and 
 dean of the medical faculty, and with those able clinicians, 
 Eoss and MacDonnell. His natural bent for research and 
 investigation, had been further stimulated by his experiences 
 abroad. A full appreciation of the importance of the micro- 
 scope in medical research led, upon his return, to its more 
 extensive adoption in the laboratories of McGill. While there. 
 Osier laid the foundation of his keenness as a clinician^ through 
 his recognizing the great importance of following the fatal 
 cases to the autopsy room, performing many of the necropsies 
 himself. These investigations resulted in the publication of 
 numerous important contributions to medical literature. 
 Among these may be mentioned his paper in which mycotic 
 aneurisms in association with ulcerative endocarditis were 
 described for the first time, and his account of the ball-valve 
 thrombus at the mitral orifice, which also was the first recorded 
 case. 
 
 He was very much interested in comparative pathology, and 
 performed many autopsies on lower animals with that keen 
 veterinarian, Clements, who later went to Baltimore, where he 
 died an untimely death from myocardial disease. 
 
 Many of Osier's students of this period are scattered 
 throughout Canada and the United States, and they look back 
 with pleasure and profit to the training and stimulus they 
 received under him at McGill. One of the powerful influences 
 he possesses was manifested, even in these early years, through 
 his readiness to report interesting observations before local 
 medical societies and provincial medical associations, and to 
 encourage others to do likewise. 
 
 Osier's contributions to medical literature while at McGill, 
 and his papers read before medical societies in the United 
 States, naturally attracted a great deal of attention, and, when 
 in 1884 the University of Pennsylvania was seeking the best 
 trained man to fill the chair of professor of clinical medicine. 
 Osier was its choice. While in Philadelphia he was brought 
 
Medicine in Canada and the United States 71 
 
 into close association with such men as Weir Mitchell, William 
 Pepper, Tyson, Musser, Keen, Wilson and others. His influ- 
 ence on medicine in the United States was very marked even 
 during this Philadelphia sojourn from 1884 to 1889. He was 
 one of the original members of the Association of American 
 Physicians, which was organized in 1886 with Francis A. 
 Delafield as its first president. He always took an active 
 interest in the annual meetings of the association, contributing 
 numerous original papers and entering into the discussions. 
 He was himself its president in 1895. 
 
 While at the University of Pennsylvania, Osler^s contribu- 
 tions to medical literature were numerous and important. 
 Much of his material for his monograph on the " Cerebral 
 Palsies of Children,^' published in 1889, was gathered during 
 this period. His experience at Blockley, that wonderful store- 
 house of clinical and pathological material, provided him with 
 a mass of data later freely utilized in the preparation of his 
 text-book. 
 
 In 1889, as the construction of The Johns Hopkins Hospital 
 was nearing completion, the trustees of the university and 
 hospital, seeking the best man to fill the chair of professor of 
 medicine in the university, and the position as physician-in- 
 chief to the hospital, at once thought of Osier, who was then 
 considered the most brilliant clinician available. The offer 
 was tendered and accepted, and he was on duty when the first 
 patient was admitted to the hospital on May 10, 1889. 
 
 It was during his period of residence in Baltimore from 
 1889 to 1905 that Osier's influence on medicine in the United 
 States and Canada was chiefly exerted. In making appoint- 
 ments to his hospital staff, graduates of medical schools in both 
 the United States and Canada shared the privilege of working 
 under him. Owing to his close affihations with teachers in the 
 Canadian medical schools, it was only natural that these men 
 should be appealed to from time to time to supply assistants 
 for its interne staff. His first resident physician was Lafleur, 
 of McGill, who during his tenure collaborated with Council- 
 man in the publication of their important monograph on 
 
73 Sir William Osler, Baet. 
 
 amoebic dysentery. Lalleur, as have other assistants, returned 
 to Canada and carried with him to McGill and the Montreal 
 General Hospital the stimulus and methods acquired while 
 under Osier. Hewetson, also of McGill, soon followed Lafleur 
 as an assistant. The unfortunate development of tuberculosis 
 prevented him from pursuing what promised to be a brilliant 
 career. Thayer, of Harvard, who now holds the chair in 
 medicine on the whole-time basis, succeeded Lafleur as resi- 
 dent physician and served until 1901. 
 
 J. E. Graham, who was for many years professor of medicine 
 at Toronto University, an excellent clinician and a man much 
 beloved by his students, was a close personal friend of Osier, 
 Through him several Toronto University graduates became 
 assistants of the latter. Among these may be mentioned. 
 Barker, Parsons, Thomas McCrae, the late John McCrae — 
 the immortal composer of ^^ In Flanders^ Fields," Gwyn, and 
 the writer. It may be of interest to note that all these, with 
 one exception, were previously resident physicians during the 
 summer months at the Eobert Garrett Hospital for Children 
 at Mt. Airy, Md., which was under the direction of Dr. Walter^ 
 B. Piatt. Barker, later succeeded Osier, as professor of medi- 
 cine. The writer, and Thomas McCrae, in turn succeeded 
 Thayer as resident physicians. W. G. MacCallum, now the 
 professor of pathology at Johns Hopkins, although a medical 
 graduate of this university, but a graduate in the academic 
 department of the University of Toronto, was, after gradua- 
 tion, an assistant on Osier's staff. Mention is made of these 
 various Canadians to point out how Osier acted as a magnet to 
 draw them from across the border to Baltimore, and to empha- 
 size the fact that they have, through their " chief,'' indirectly 
 constituted an important hnk helping to keep up intimate 
 associations between the profession on both sides of the line. 
 
 Following Thomas McCrae, the resident physicians, with the 
 exception of B. A. Cohoe, a medical graduate of Toronto 
 University, who served from June to September, 1908, have 
 all been graduates of The Johns Hopkins Medical School. 
 They have been in succession, Eufus I. Cole, Charles P. Emer- 
 
Medicine in Canada and the United States 73 
 
 son, Thomas E. Boggs, Frank J. Sladen, Paul W. Clough and 
 the present occupant, Arthur L. Bloomfield. Cole was the only 
 one of these who served as resident physician during Osler^s 
 occupancy of the chair of medicine, although Emerson and 
 Boggs were assistant resident physicians under him before he 
 left for Oxford, in 1905. Osier's ideals and influence have 
 been disseminated by this group of resident physicians in the 
 various fields in which their activities have been cast. 
 
 The first edition of Osier's " Principles and Practice of 
 Medicine " appeared in 1892. This, and the subsequent seven 
 editions, have been the standard text-book in medicine used 
 by students and practitioners in both the United States and 
 Canada. The influence of this work, with the fascinating and 
 practical way in which the various diseases were treated, has 
 been very great on the professions of both countries. The same 
 can be said for the two editions of "Modern Medicine," of 
 which he was chief editor, Thomas McCrae being associated 
 with him. 
 
 Throughout Osier's professorship at Johns Hopkins, courses 
 to post-graduates were given yearly. The medical school was 
 not opened until 1893, and uncler-graduate instruction in 
 medicine consequently did not begin until 1895, so that, up to 
 that year, post-graduate instruction was the only teaching 
 conducted in the medical wards. Osier's ward clinics and 
 clinical lectures were attended by physicians from all parts of 
 the United States and Canada. Members of the profession 
 rubbed shoulders, gained invaluable clinical experience, and 
 formed professional ties and friendships which have continued 
 ever since. 
 
 Although domiciled in the United States, the Canadian 
 profession always felt that it had a personal claim on Osier. 
 His trips to Canada to see his family in Toronto, to consult 
 with physicians, to read papers before societies in various parts 
 of the Dominion, and often to spend his vacation on the lower 
 St. Lawrence, enabled him to keep in close touch with the 
 profession of his native land and to exert a strong influence on 
 its members north of the border. 
 
74 Sir William Oslek, Bakt. 
 
 Almost as important a sphere of influence as The Johns 
 Hopkins Hospital was Osler^s home at 1 West Franklin Street, 
 where physicians from both sides of the line were always wel- 
 come, and where they were ever made to feel at home by the 
 " chief " and his gracious wife, now Lady Osier. 
 
 In 1905 Osier was called to Oxford to occupy the chair of 
 Eegius Professor of Medicine in that university. His interest 
 in the medical profession of both countries has not a whit 
 abated. The home of Sir William and Lady Osier, at 13 l^or- 
 ham Gardens, has been almost a daily rendezvous for the 
 khaki-clad medical officers of the American and Canadian 
 Expeditionary Forces during the last two years of the world's 
 war. 
 
OSLEE AS A CITIZEN AND HIS RELATION TO THE 
 TUBERCULOSIS CRUSADE IN MARYLAND 
 
 By Henry Barton Jacobs 
 
 Though Osier like Nathan Smith, Austin Flint and Marion 
 Sims and the philosophers of old is essentially a peripatetic, 
 a medical nomad, yet wherever his feet may take him, there 
 he establishes and identifies himself, interests himself in local 
 conditions and undertakes the responsibilities of citizenship. 
 
 In the course of his wanderings Baltimore has had the 
 privilege and the profit of halting his onward steps for fully 
 sixteen years. Here he came in the vigor of his promising 40 
 years, trained and ready, not to say anxious, to jump into the 
 life of his new surroundings. Many paths there are which lead 
 to useful citizenship — Osier chose one peculiarly his own, and 
 followed it consistently and unfailingly, guided only by the 
 unswerving conviction that whatever he might do to advance 
 and improve conditions in the profession to which he was 
 allied, in that way alone could he be of the greatest benefit, 
 not only to those immediately under his tutelage or care, but 
 to the city and to the nation at large. In his final address on 
 leaving Baltimore he says " I have lived my life in my beloved 
 
 profession I have never departed from my ambition to 
 
 be first of all a servant to my brethren." 
 
 The advancement and improvement of medicine and ser- 
 vice to his fellows, therefore, is the primary path of his en- 
 deavor. The wayside results of such a course pursued with 
 intensity, with kindness, with sympathy, with laughter and 
 Joke, with good fellowship and hospitality, also with hard 
 study and thought and work, diligently and persistently, year 
 by year, are quite unusual, and lead as is only natural to 
 wide friendships, extraordinary and general influence, both 
 
 with individuals and with peoples. 
 
 75 
 
76 Sir William Osler, Baet. 
 
 Scarcely had he arrived in Baltimore in the spring of 1889 
 when he was asked by the officers of the State Medical Asso- 
 ciation, the old Medical and Chirnrgical Faculty of Mary- 
 land, to deliver the oration at the annual meeting of the 
 society to be held in April of that year. This invitation he 
 accepted, choosing for his topic " The License to Practice/^ 
 At this period it should be recalled there were in Baltimore 
 no less than four or five medical schools with two-year courses 
 of study for a degree to practice, and this degree the only 
 license required. The argument Dr. Osier made in his ad- 
 dress was so cogent, so direct, so illustrative of the evil con- 
 ditions existing that immediate steps were taken by the 
 leaders of the medical profession of the city and state to have 
 prepared a legislative Bill for the appointment of medical 
 examiners whose duty it should be to examine candidates, and 
 to issue to the successful ones licenses to practice. This was 
 Dr. Osier's first effort in Maryland toward the advancement 
 and improvement of medicine, and coincidently his first pro- 
 nounced effort in good citizenship. As a farther resultant the 
 Dniversity of Maryland decided to lengthen its course of 
 medical study and to raise its standard. Moreover, the seed 
 was growing so fast that in February, 1890, a meeting of 
 representatives of all the medical schools of Baltimore de- 
 cided to request delegates, from the medical schools of the 
 country, to meet in Nashville with the idea of raising the 
 standard of medical schools all over the United States. At 
 this conference an agreement was reached for a three-year 
 course and other reforms. 
 
 The Legislature of 1890 passed the Bill for the appoint- 
 ment of a board of medical examiners, a bill which looked 
 to the betterment of medical practice in Maryland and to 
 the general elimination of the numerous quacks and char- 
 latans who had been permitted to carry on their trade in the 
 state. Unfortunately Governor Jackson did not give his ap- 
 proval, and so two years had to go by before its final adoption 
 by a new Legislature, and the signature of Governor Brown. 
 
Tuberculosis Crusade in Maryland 77 
 
 This was but the beginning of Dr. Osier's efforts for better 
 state and municipal laws. 
 
 The almost unrestricted prevalence of typhoid fever in the 
 United States, particularly in Baltimore, was a source of 
 deep aggravation to him, and called for the use of all his 
 powers of voice and pen to bring light into the darkness, that 
 rational legislative measures might be inaugurated to re- 
 strict its incidence. 
 
 Baltimore at this time was without a general system for the 
 disposal of its sewage. Backyard privy vaults were nearly 
 universal. Dr. Osier was strongly of the belief that typhoid 
 fever would be greatly reduced with the introduction of a 
 proper and adequate sewerage system and a pure water supply. 
 Note how vividly and forcefully he spoke at the meeting of 
 the Maryland Public Health Association held on November 
 13, 1897, upon the subject of mortality from typhoid fever 
 as related to these important city improvements : 
 
 The penalties of cruel neglect have been paid for 1896; the dole 
 of victims for 1897 is nearly complete, the sacrifices will number 
 again above 200. We cannot save the predestined ones of 1898, but 
 what of the succeeding years? From which families shall the 
 victims be selected? Who can say? This we can predict — they 
 will be of the fairest of our sons and of our daughters; they will 
 not be of the very young, or of the very old, but the youth in its 
 bloom, the man in the early years of his vigor, the girl just waken- 
 ing into full life, the young woman just joying in the happiness of 
 her home. These will be offered to our Minotaur, these will be 
 made to pass through the fire of the accursed Moloch. This, to 
 our shame, we do with full knowledge, with an easy complacency 
 that only long years of sinning can give. 
 
 Such writing as this is not only convincing, but is intensely 
 moving, and must have played no small part in securing the 
 desired end which happily came before he was to leave our 
 city, a boon and a convenience to every member of the com- 
 munity, not to speak of the aesthetics of the new order when 
 street and sidewalk gutters were no longer redolent with the 
 morning's dishwashings. 
 
 Whatever gives promise of adding to the stock of medical 
 knowledge immediately arouses Dr. Osier's enthusiasm. 
 
78 Sir William Osler, Baet. 
 
 Early he became interested in the amoebic theory of malaria. 
 Well do I remember his coming to the Massachusetts Gen- 
 eral Hospital in Boston to demonstrate amoebae in blood cor- 
 puscles to Dr. Fred Shattuck, then the young medical at- 
 tendant to that hospital. This must have been in 1887 or 
 1888. No effort of his for good citizenship, or for the advance- 
 ment of medicine was more remunerative than the stimulus 
 he gave in this country to the solving of the problem of the 
 causation, cure and prevention of malaria, a disease which 
 had so sorely afflicted the people of states south of Mason 
 and Dixon's line. Baltimore became the prime center for its 
 study outside France and Italy, and Thayer's book written 
 in The Johns Hopkins Hospital from Osier's clinic marks a 
 salutary epoch in the history of this mosquito-borne infection. 
 
 Never was it out of Dr. Osier's mind that a better educated 
 and more widely read medical profession made for better liv- 
 ing conditions of the people, greater civic comfort and dimin- 
 ished suffering and death, so in all ways possible he en- 
 couraged students and practitioners alike to greater learning. 
 To this end he insisted upon greater comradeship and larger 
 attendance upon medical societies where experience could be 
 interchanged and interesting cases seen and discussed; he 
 also insisted upon enlarged library facilities, and adequate 
 supplies of current medical magazines and standard books. 
 Under his inspiration and leadership the old state society of 
 Maryland took on a new life, and its library so long moulder- 
 ing on its shelves sprang into usefulness. To him more than 
 to any single man does the medical profession of Maryland 
 owe its present faculty building with its large and growing 
 library — a library in which he took no less interest than in 
 his own. To this extent, then, we must think of him as 
 contributing enormously to the welfare of the community 
 through an enlightened profession influencing public opinion 
 in matters pertaining to health, sanitation, and general, 
 hygiene. 
 
 iSTot less than his trenchant writing and speaking was Dr. 
 Osier's own personality of influence upon men and the com- 
 
Tuberculosis Crusade in Maryland 79 
 
 munity; so strikingly straightforward, so genial even con- 
 vivial, so playful in youthful spirit, so enthusiastic in help- 
 fulness and sympathy, so painstaking and so wise, he soon 
 had both patients and acquaintances alike in an attitude of 
 devotion, almost, I might say, of adoration. And although 
 he took no official part in the civic affairs of the city, he 
 gained through his association in the medical profession, by 
 reason of his acknowledged eminence in that profession, and 
 through his friends and acquaintances, a leadership in the 
 affairs of the city and state which was most powerful and 
 beneficent even though it was exercised in an indirect way. 
 
 From the moment when Koch discovered the germ of 
 tuberculosis in 1882, Dr. Osier has never lost interest in this 
 disease. He dwelt upon it in his teaching and he insisted that 
 his students should be familiar with it. When in 1892 the 
 use of tuberculin was thought to be specific, he was among 
 the first in this country in giving it a thorough trial in 
 the wards of the hospital. For greater encouragement to 
 the study of the disease, which so long has been such a fatal 
 enemy of mankind, he suggested and carried out the establish- 
 ment of a society whose single purpose should be the con- 
 sideration of the history and the various phases, clinical and 
 pathological, of tuberculosis, and this society he named, after 
 the great French student of tuberculosis and discoverer of the 
 stethoscope — The Laennec. 
 
 On November 14, 1899, Dr. Osier read an important paper 
 on the " Home Treatment of Pulmonary Tuberculosis," at 
 the semi-annual meeting of the faculty at Westminster, and 
 on the same day and in the same place Tk. Charles S. Millet of 
 E. Bridgewater, Mass., described his outdoor sleeping porches 
 for tuberculous patients. This was the first public discussion 
 of the value of unlimited night air in the cure of consumption 
 and marks a new epoch in the method of treatment. Inci- 
 dentally I may remark that at this same meeting mention was 
 first made by Dr. Joseph E. Oichner of the need and desira- 
 bility of a State Sanatorium in Maryland. 
 
80 Sir William Osler, Bart. 
 
 On April 19, 1901, at the invitation of Dr. Osier, Dr. 
 Lawrence F. Flick of Philadelphia came to Baltimore and 
 before the Clinical Society delivered an address on the " Regis- 
 tration of Tuberculosis/^ saying that Philadelphia and New 
 York had already inaugurated such a provision. Dr. Osier 
 urged that Maryland should do likewise, as in this way the 
 location of cases could be known to the health authorities 
 and such steps be taken as would be of advantage to the patient 
 and to the community. 
 
 By the end of the year 1901 there had arisen great interest 
 in the tuberculosis movement, and it was proposed that the 
 Legislature of January, 1902, should pass new and vital laws 
 which should be of benefit to the whole people. To this end 
 a big meeting in McCoy Hall was proposed under the auspices 
 of the Maryland Public Health Association, the Medical and 
 Chirurgical Faculty of Maryland and the Laennec Society. 
 Dr. Osier's " fiery " speech thrilled the audience : 
 
 Mr. Chairman and my long suffering, patient, inert fellow- 
 citizens: .... now what is our condition in this city, and what 
 are we doing for the 10,000 consumptives who are living today 
 in our midst? We are doing, Mr. Mayor and fellow-citizens, not 
 one solitary thing that a modern civilized community should do. 
 Through the kindness of a couple of ladies — God bless them! — 
 I have been enabled in the past three or four years to have two of 
 the medical students of The Johns Hopkins University visit every 
 case of pulmonary consumption that has applied for admission to 
 the dispensary of our hospital, and I tell you now that the story 
 those students brought back is a disgrace to us as a city of 
 500,000 inhabitants. It is a story of dire desolation, want and 
 helplessness, and of hopeless imbecility in everything that should 
 be in our civic relation to the care of this disease. 
 
 He then argues for registration, disinfection after death or 
 removal, a State Sanatorium for curable cases and a hospital 
 for advanced cases, a sewerage system and a hospital for con- 
 tagious diseases. This address and others made the same even- 
 ing had an effect, to wit: The Legislature of 1902 created a 
 Tuberculosis Commission, the Governor naming Dt. Thayer 
 as its chairman. 
 
Tuberculosis Crusade in Maryland 81 
 
 All that is progressive or worth while in the Tuberculosis 
 Crusade in Maryland followed thereafter; the commission 
 with its advisors taking the initiative in beneficial measures, 
 At Dr. John S. Fulton's suggestion the commission decided 
 upon a tuberculosis exposition in January, 1904, which 
 should show graphically and practically the general incidence 
 of tuberculosis, its methods of prevention and cure, its 
 aetiology and pathology, its relations to social and economic 
 problems, and a history of its study from the time of Hippoc- 
 rates. Such an exposition for any single disease had never 
 before been attempted. Lectures and demonstrations were 
 given and the attendance not only from Baltimore but from 
 the counties and from outside the state was remarkable. The 
 public was intensely interested and the exposition " demon- 
 strated that it is both expedient and practicable to admit the 
 general public to free participation in the scientific knowledge 
 of tuberculosis." (Editorial, Md. Med. Jour.) 
 
 Dr. Osier was the moving spirit in this most successful 
 undertaking and it was he who invited the distinguished 
 speakers who were heard. As a result of this exposition, the 
 Legislature of 1904 passed laws requiring: 
 
 (1) Eegistration of tuberculosis in Maryland, and 
 
 (2) Providing means and measures to be administered by 
 the State Board of Health for the domestic prophylaxis of 
 consumptives. 
 
 Growing out of this exposition, too, was the formation, fol- 
 lowing the suggestion of Dr. S. A. Knopf, of the National 
 Association for the Study and Prevention of Tuberculosis. In 
 this enterprise Dr. Osier had a leading part. In its organiza- 
 tion he was made vice-president, and since his residence in 
 England has been continued one of the two honorary vice- 
 presidents, Mr. Roosevelt being the second. 
 
 In December, 1904, the Maryland Association for the Pre- 
 vention and Cure of Tuberculosis was formed and again to 
 this local movement Dr. Osier lent his interest and enthusi- 
 asm. His last effort for the tuberculosis cause in Baltimore 
 was to induce Mr. Phipps to give the sum of $10,000 for a 
 
 6 
 
82 Sir William Osler, Bart. 
 
 Tuberculosis Dispensary at The Johns Hopkins Hospital. 
 This was opened with addresses on February 21, 1905, Mr. 
 Phipps being present. 
 
 In reviewing thus briefly the activities of Sir William 
 Osier during his sixteen years in Baltimore, I realize how 
 inadequately I have been able to convey any idea of his great 
 work and influence, or the universal esteem, love and honor 
 in which he was held not only by the people of Maryland, but 
 by the country at large. I cannot believe that any man ever 
 left our shores for a new work elsewhere more deeply and 
 sincerely missed by a larger army of friends. His address of 
 farewell delivered before the Medical and Chirurgical Faculty 
 of Maryland April 27, 1905, on " Unity, Peace and Concord " 
 typifies his attitude to all his fellows both professional and lay. 
 In closing he sums up this relationship in the one word which 
 he leaves as his benediction — Charity. 
 
OSLER^S INFLUENCE ON OTHEE MEDICAL 
 SCHOOLS IN BALTIMORE 
 
 HIS RELATION TO THE MEDICAL PROFESSION 
 
 By Edward N. Brush 
 
 To estimate correctly Osier's influence upon other medical 
 schools and upon professional thought and conduct would 
 require an inquiry into the methods of medical teaching in 
 vogue more than a quarter of a century ago, and into the social 
 and professional relations of the physicians of the city and 
 state toward each other. 
 
 At about the time of Osier's arrival in Baltimore to assume 
 the duties of physician-in-chief to The Johns Hopkins Hos- 
 pital there was a movement on foot to improve and enlarge 
 the medical curriculum. The University of Maryland in 1889 
 announced that after 1891 a compulsory three-year course 
 would be required in the medical department with a prelimi- 
 nary examination in English. 
 
 In March, 1890, a call was issued by the medical staff of 
 The Johns Hopkins Hospital, and the medical faculties of The 
 University of Maryland, The College of Physicians and 
 Surgeons, The Baltimore Medical College, The Baltimore 
 University and The Woman's Medical College for the organiza- 
 tion of a medical college association -with a view to the co- 
 operation of all medical teaching bodies in bringing about a 
 three-year graded course, written and oral examinations, a 
 preliminary examination in English and laboratory instruc- 
 tion in chemistry, histology and pathology. 
 
 At the meeting of the Medical and Chirurgical Faculty in 
 
 1889 the annual address was given by Dr. Osier, who took for 
 
 his theme '' The License to Practice," and undoubtedly this 
 
 address gave an impetus to a movement, already receiving 
 
 support, for higher medical education and a better qualified 
 
 student body. 
 
 83 
 
84 Sir William Osler, Bart. 
 
 My own connection with medical teaching in Baltimore did 
 not begin until eight years subsequent to this date, but I 
 realized before that period, and have had occasion to know 
 since, the great interest which Osier took in promoting reforms 
 in medical teaching not only here, but in the country at large, 
 the great and lasting influence of his advice, and above all, his 
 example as a teacher. 
 
 Trained as he had been as a laboratory man, realizing to the 
 fullest extent the results which flowed from his laboratory 
 studies and their bearing upon the practical work of the 
 hospital ward and the consulting room, as well as in the lecture 
 hall, he urged the establishment of laboratories. 
 
 Thoroughly equipped lahoratories, in charge of men thoroughly 
 equipped as teachers and investigators, is the most pressing want 
 to-day in the medical schools of this country. 
 
 The hospital was, from his point of view, a college — a place 
 of teaching, the most essential part of the machinery of a 
 medical school. 
 
 The systematic use of the resources of the hospital which he 
 inaugurated and which he urged upon other communities and 
 described in detail in his address before the New York 
 Academy of Medicine in 1903 found in the minds of the more 
 progressive teachers of the Baltimore schools a ready accept- 
 ance. 
 
 For those working in my own special field, it is gratifying 
 to believe that it was a few words spoken in his farewell address 
 at the university, February 22, 1905, which gave an impetus 
 that resulted in the establishment of a psychiatric clinic at the 
 hospital. 
 
 From his address at the dedication of the Wistar Institute 
 of Anatomy and Biology of the University of Pennsylvania,, 
 1894, I take the following: 
 
 What, after all, is education but a subtle, slowly effected change, 
 due to the action upon us of the externals; of the written record 
 of great minds of all ages, of the beautiful and harmonious sur- 
 roundings of nature and art, and of the lives good or 111 of our 
 fellows — these alone educate us, these alone mould the developing 
 minds. 
 
Relation- to Other Medical Schools 85 
 
 The whole career of Osier in Baltimore, his life here as a 
 teacher, hospital physician, consultant and citizen was devoted 
 to the better teaching of medicine, to better ideals in educa- 
 tion ; and from his life, from his example, proceeded influences 
 which not only moulded developing minds, but stimulated all 
 who had a real ambition, to teach and, in teaching, to learn 
 also, and develop. 
 
 To emphasize sufficiently his influence upon medical educa- 
 tion is most difficult. One of his constant pleas for other 
 schools was for larger clinical advantages, and better use of 
 those already provided. In 1897 in his address on Internal 
 Medicine as a Vocation, before the ISTew York Academy of 
 Medicine, he says: 
 
 To-day the serious problem confronts the professors in many of 
 our schools — how to teach practical medicine to large classes; 
 how to give them protracted and systematic ward instruction. 
 I know of no teacher in the country who controls enough clinical 
 material for the instruction of classes, say of 200 men, during the 
 third and fourth year. 
 
 Never a controversialist, none the less did he bear a large 
 share in the controversies of 30 or more years ago, which 
 preceded and eventually brought about the changes in the 
 methods of medical education which have taken place since 
 that time. His influence was exerted not in argument or 
 controversy, but in the force of example, by the way in which 
 he lived his ideals and induced others to share them with him. 
 
 He studied " to be quiet " and do his " own business,^^ " to 
 walk honestly toward them that are without" and one of his 
 chief pleasures was " to work among [us] as a friend sharing 
 actively in [our] manifold labors." 
 
 Some years ago I had occasion to apply to him a quota- 
 tion from the presidential address of the late Dr. Charles M. 
 Ellis before the Medical and Chirurgical Faculty in 1898. 
 These words seem to me particularly appropriate to Dr. Osier : 
 
 Many [doctors] by reason of natural endowments and acquired 
 fitness elevate their lives to a professional plane on which it is 
 possible for an intellectual life to develop; and on which it does 
 develop, not only to individual suflaciency, but to public usefulness 
 
86 Sir William Osler, Baet. 
 
 and a public influence, that on the one hand meets and supplies 
 public emergencies and, on the other, largely directs and controls 
 public thought and movement. 
 
 These words from what I know of the intimate and friendly 
 relations between the two men may well have been brought 
 to the mind of Dr. Ellis by his knowledge not only of the 
 intellectual life of Dr. Osier, but by his appreciation of the 
 controlling influence of his mind upon public thought and 
 movement, particularly in professional circles. 
 
 Very early in his residence in Baltimore, notwithstanding 
 that he " studied to be quiet/^ he became a by no means unim- 
 portant factor in the social life of Baltimore physicians. 
 
 He so regulated his work that he always had a certain 
 amount of time to give to his friends in social converse, or in 
 conference over the more serious things of their everyday lives 
 and work. 
 
 He appreciated the difficulties and perplexities which sur- 
 rounded the lives of many of his professional brethren and 
 many a burden has been made lighter, many dark hours bright- 
 ened, by his wise and thoughtful advice and his cheering 
 optimism. 
 
 More than one doctor laboring amid discouragement and 
 the indifference of open opposition of his fellow-citizens, whose 
 lives he was manfully trying to make more tolerable, whose 
 surroundings he was endeavoring to make more healthful, has 
 found to his surprise that Osier had learned of what he sup- 
 posed was unknown beyond the bounds of his own community, 
 and has received from him words of cheer and commendation, 
 which were a powerful incentive to renewed effort, just when 
 all the uses of the world appeared to him " weary, stale, flat 
 and unprofitable." 
 
 His farewell address " Unity, Peace and Concord " is an 
 eloquent recital of his consuming eagerness to be " a servant " 
 to his brethren to do all in his " power to help them.'^ 
 
 He strove always to live in unity, peace and concord with 
 his fellows. He strove with none — not that none were worth 
 the strife, but because of a deep conviction of the hatefulness 
 
Relation to Other Medical Schools 87 
 
 of strife. Those worth the strife he won by other and gentler 
 means, and bound them to him by the everlasting chains of 
 friendship. 
 
 In 1881 there was formed in Baltimore the Baltimore 
 Monthly Medical Eeunion. It met at the home of members in 
 turn and around the dinner table and at the fireside many 
 friendships were made and consolidated. Very soon after 
 coming to Baltimore, Dlr. Osier became a member of the 
 Reunion and always when he was present at the monthly 
 gatherings, as with The McGregor, where Osier sat was " the 
 head of the table,^' the center of conversation, the focus of wit 
 and wisdom. 
 
 As in the past, so in the future in all that makes for truth 
 and righteousness, in all that holds forth high ideals, in all 
 that encourages culture and all the virtues of the Christian 
 gentleman and the ideal physician the name of Osier will be 
 one to conjure with. From time to time, as on the present 
 occasion, his friends for many years, let us hope, will send 
 him greetings across the sea. He has given us the master word 
 and with that in our hearts all things are possible. Have we 
 not seen it exemplified in his life and character ? 
 
88 SiE William Oslee, Baet. 
 
 ON A PORTRAIT OP SIR WILLIAM OSLER, BART. 
 
 William tlie Fowler, Guillaume I'Oiseleur! 
 I love to call him thus and when I scan 
 The counterfeit presentment of the man, 
 I feel his net, I hear his arrows whir. 
 Make at the homely surname no demur, 
 Nor on a nomination lay a ban 
 With which a line of sovran lords began, 
 Henry the Fowler was first Emperor. 
 
 Asclepius was Apollo's chosen son. 
 
 But to that son he never lent his bow, 
 
 Nor did Hephaestus teach to forge his net; 
 
 Both secrets hath Imperial Osier won. 
 
 His winged words straight to their quarry go. 
 
 All hearts are holden by his meshes yet. 
 
 Basil L. Gildersleeve 
 
Painted by Seyninur Tliomas, 190S 
 
 Sir Willia:\e Oslek, Bart. 
 
INFLUENCE IN BUILDING UP THE MEDICAL AND 
 CHIEUEGICAL FACULTY 
 
 By Hiram Woods 
 
 " Influence in Building Up the Medical and Chirurgical 
 Faculty '^ is a theme one might approach from numerous 
 paths. So great was Dr. Osier's influence, in so many direc- 
 tions did it work, so broad was his conception of the possi- 
 bilities for good in the organization, so keen his appreciation 
 of the obstacles to progress, some traditional, some personal, 
 that the many-sided subject is bound to appeal to his friends 
 in different ways. Adequate organization of the library ; reve- 
 lation to the younger man of what the library even in those 
 days afforded ; provision for the purchase of new books — these 
 are themes which have been selected for special review and 
 will be presented by others. I shall try to give some idea of 
 his work from another standpoint — that of personal influence. 
 Yet, with the selection of this special topic, I am aware that 
 I shall speak from my own personal impressions and memory 
 and may fail utterly to express the feelings of another just as 
 indebted to Dr. Osier as am I. 
 
 I have asked myself. What were Dr. Osler^s basic thoughts 
 and principle in his work for, and devotion to, the State 
 Medical Society? He held the most influential position 
 medicine in Baltimore could give ; he had at command greater 
 powers than any one medical man had ever possessed in the 
 city ; his teaching and organization duties in the new medical 
 school were exacting enough to take all his time, and yet he 
 went to work on the state society in a way which soon gathered 
 recruits happy to work under — not his direction — but his 
 mind and heart. What led him to do it ? I think he felt that 
 the biggest medical foundation Baltimore had ever had ought 
 to benefit the existing profession. He thought there should 
 be a high valuation of the profession itself ; realization of the 
 
 89 
 
90 Sir William Oslee, Bart. 
 
 obligation of self -improvement ; a breaking-down of the 
 " middle wall of partition " between those, who, by a connec- 
 tion with the new school, seemed to possess an advantage, more 
 or less adventitious, and those who found, or thought they did, 
 a definite obstacle to practice in the new Foundation. He felt 
 the meaning of " Unity .'^ He told us of this — at least in 
 words — only on the eve of his departure. And yet he had told 
 us about it previously in a better way. Go over the papers he 
 brought to the faculty meetings and the smaller gatherings of 
 the local society and you will, if I mistake not, see that he 
 presented the problems of disease, cause, prevention and cure, 
 as the same for the hard-worked country doctor, with little 
 time to read, and the man with hospital and laboratory 
 advantages, plus trained nurses and competent assistants. But 
 here the roads parted, in a sense. The practitioner brought 
 his experiences and difficulties. Modern methods of investi- 
 gation were not at his command. Dr. Osier felt that the man 
 with greater advantages should, in the first place, qualify him- 
 self to understand the point of view of his less fortunately 
 placed colleague, and then, from his greater advantages, make 
 up the deficiency. 
 
 Sometimes a chance thing makes a life-long impression, and 
 such an occurrence has come back to me time and again. At a 
 society meeting typhoid fever was the topic. I believe I am 
 quoting accurately : " Typhoid fever, the monster that de- 
 stroys the best of our sons and claims the fairest of our 
 daughters ; are we to let it continue or stop it ? " And then 
 followed a clear, scientific and yet almost a domestic demon- 
 stration of preventive measures which could be taken home 
 and taught to those who did not know, but who, if they knew, 
 might save their own and others' lives. This, I believe, was 
 Dr. Osier's motive force : aim to realize the other man's point 
 of views and his needs, and to reach these needs if he could. 
 But if such was the self-imposed task, success could come from 
 no wiser-than-thou attitude. There had to be a comradeship ; 
 not the assumed, patronizing variety, but the sort that cements 
 the minds and hearts of men earnest after the same thing — 
 
Medical axd Chirurgical Faculty 91 
 
 knowledge. How many of ns have met him browsing around 
 in the library, and soon found ourselves just talking? Yet 
 from that talk we afterwards found we had gleaned a great 
 deal. It was from one such talk that I took away definite 
 impressions about the evils of narrow specialism. Again, after 
 we got to know him better, we would sometimes find him in 
 deep conversation with a beginner in medicine, or a man we 
 hardly knew, and we shied oif. It was perfectly clear what he 
 was doing. But the comradeship was the real thing; there 
 was nothing professorial about it. This comradeship extended 
 beyond the confines of men who were active students for their 
 own good or those who needed prodding. It went after and 
 reached those who had something to give, and who did not 
 know how to give it; maybe they did not know they had it. 
 There are matters of importance to the faculty and profession, 
 bearing others^ names, which would never have come into being 
 without William Osier's realization of their importance and 
 pointing out the way to achievement. I cannot speak more 
 definitely; but men familiar with the faculty's history will 
 know. This comradeship went farther. It reached those who 
 for one reason or another had met with little or no success. 
 It made them feel that in spite of what might be termed 
 failure, honesty of purpose gave standing to a man in medicine 
 and brought him into unity with his brothers upon whom 
 fortune had smiled more kindly. 
 
 Work for the library, teaching its value by precept and 
 example, demonstrating the unity of the medical profession 
 and the spirit of comradeship soon won the esteem, confidence 
 and affection of men throughout our state. This feeling was, 
 possibly, best expressed in a telegram sent to Dr. Osier's 
 mother in April, 1905, when he was about to leave Baltimore. 
 The telegram was sent by vote of the faculty at its annual 
 meeting and signed by the president, Samuel T. Earle. It 
 reads : 
 
 The greetings of the Medical and Chirurgical Faculty of Mary- 
 land to Mrs. Osier, asking her to share their sentiments in taking 
 leave of William Osier, congratulating Mrs. Osier first on the 
 
92 Sir William Osler, Bart. 
 
 distinguished career of her son, but most on the innate qualities 
 which have endeared him to his associates in Maryland. 
 
 A few days later the following reply was received : 
 Mrs. Osier, who is unable from her great age to write, asked 
 me to express her heartfelt thanks to you for the very kind tele- 
 gram of greeting sent through you from the Medical and Chi- 
 rurgical Faculty of Maryland, and to say that the receipt of the 
 message gave her the greatest pleasure, more especially in the 
 expression of affection and appreciation called forth by the 
 personal qualities of her son, since these are, in her eyes, more 
 precious than all his honors. 
 
 She knows that it must be hard for him to sever his connection 
 with such kind confreres, and she is sure that the friendships he 
 has made during his residence in the States will be among his 
 most cherished memories. I am, sir, yours sincerely, 
 
 Jeannette Oslee. 
 
 One who had thrown his heart and soul into an enterprise 
 would be keenly disappointed if his work fell through in later 
 years. There seems no danger of this while there survive the 
 men who came under Dr. Osier's leadership. The funds 
 obtained through his influence^ and others, which have come 
 sincC;, because of the spirit he put into the organization, are 
 keeping the faculty up to date. But these material things, 
 important as they are, would fail in their purpose, unless 
 something else lived and permeated the faculty's life. I 
 mean the mental attitude which I have tried to present. It is 
 interesting to go over a book in a public library even if one 
 owns a copy himself. The latter he feels free to mark, but it 
 demands a certain amount of bad taste to mark passages in a 
 book which does not belong to you. However, this bad taste 
 does exist here and there and sometimes it may not be without 
 its advantages. It shows the other fellow's thought. Eecently 
 I picked up ^' Aequanimitas " at the library and opened by 
 chance at the delightful essay " Teacher and Student." That 
 a library-worn book like this should open right there is not 
 without significance. It means that there are youngsters 
 coming on now who are getting from the printed page some 
 of the things others got from personal intercourse. This 
 passage is marked with a heavy lead pencil : 
 
Medical and Chirurgical Faculty 93 
 
 The measure of value of a nation to the world is neither the 
 bushel nor the barrel, but mind; — Wheat and pork, though useful 
 and necessary, are but dross in comparison with those intellectual 
 products which alone are imperishable. 
 
 In " Unity, Peace and Concord," written in 1905, 13 years 
 after the essay to which allusion has been made, Dr. Osier 
 speaks of " the petition in the Litany in which we pray that 
 to the nations may be given unity, peace and concord/^ Then 
 follows this, which I do not attempt to summarize : 
 
 Century after century from the altars of Christendom this 
 most beautiful of all prayers has arisen from lips of men and 
 women, from the loyal souls who have refused to recognize its 
 hopelessness, with the war-drums ever sounding in their ears. 
 The desire for unity, the wish for peace, the longing for concord, 
 deeply implanted in the human heart, have stirred the most 
 powerful emotions of the race, and have been responsible for 
 some of its noblest actions. It is but a sentiment, you may say, 
 but is not the world ruled by feeling and by passion? .... As 
 with the nations at large, so with the nation in particular; as 
 with people, so with individuals, and as with our profession, so 
 with its members, this fine old prayer for unity, peace and con- 
 cord, if in our hearts as well as on our lips, may help us to 
 realize its aspirations. 
 
 Now, 14 years later, with the world still ^^ refusing" to 
 recognize its '^ hopelessness " and struggling toward the reali- 
 zation of permanent unity, peace and concord, these words 
 seem almost prophetic. From the " nations at large " through 
 successive steps, this great principle of unity, peace and 
 concord reaches the medical profession and ^' individual " 
 doctor. His comprehension and use of it will depend on his 
 relative valuation of the " barrel and bushel " and " mind." 
 Dr. Osier's method of upbuilding the faculty differed from 
 others' in that he aimed to increase the individual's receptivity 
 for what the faculty had to offer. So long as the faculty sees 
 its responsibility to offer only the best; so long as its members 
 appreciate the nature of what is offered and remember that 
 
94 Sir William Osler, Bart. 
 
 profit is a question of their own hearts and minds, there will 
 be no danger of deterioration ; but both are necessary. While 
 we are congratulating Dr. Osier and gratefully acknowledging 
 our debt to him, let us not forget what his example taught ; 
 for it is only thus that we can keep what he had so large a 
 share in giving us. 
 
OSLER AND THE BOOK AND JOURNAL CLUB 
 By J. A. Chatard 
 
 Of all the varied activities and interests that occupied Sir 
 William Osier, while in Baltimore, possibly none appealed to 
 him personally, and to the little group of supporters that he 
 gathered about him in the early days of 1896, more than the 
 idea of getting together a few of the men of the profession at 
 periodic times for the discussion of old books on medical sub- 
 jects and the presentation of papers on the historical side of 
 medicine. At the same time the members, by their interest 
 in the work and by the voluntary subscriptions offered, helped 
 much in the improvement of the library of the Medical and 
 Chirurgical Faculty by the purchase of new books and journals. 
 
 In these early 90's the faculty was in a quiescent mood with 
 few regular meetings at which, for the most part, only routine 
 business was transacted. Eor lack of funds the library was 
 much neglected and the book and journal files were far from 
 complete. This Dr. Osier saw and at once put his great 
 store of knowledge and earnestness, at the disposal of the 
 members of the faculty, with the result that the Book and 
 Journal Club was soon in a flourishing condition. 
 
 Those of us who went to the early meetings can still remem- 
 ber the enthusiasm of Dr. Osier in his presentation of rare old 
 historical medical subjects or in the enlightening discussion 
 that he gave following someone else's paper. x\fter some 
 time he would then show some of the fine old books illustrating 
 the talk, these books not infrequently coming from his own 
 medical library. 
 
 But for one man's enthusiasm and zeal we might have 
 missed so many interesting talks on the " Hippocratic Writ- 
 ings," the " Plague of 1630 in Milan," " Harvey as an Embry- 
 ologist," " Some Diseases Bearing the Names of Saints," 
 " The Resurrectionists of London and Edinburgh," " The 
 
 95 
 
96 Sir William Osler, Bart. 
 
 Books of Yesalius/^ "Assyrian Medicine/' and last but not 
 least;, our old friend Sir Thomas Browne. These and so many 
 other historical subjects he was instrumental in bringing be- 
 fore us^ leading us on to browse among the old masters and 
 find there the very things we may be looking for to-day. 
 
 During his presidency^ the Book and Journal Club collected 
 over five thousand dollars by voluntary subscription and in 
 addition to paying for the binding of many journals, we were 
 able to purchase annually about 270 books and subscribe to 
 56 journals. To those of us who know how crippled the 
 finances of the faculty were at that time, and how little was 
 available for the library fund, this money from the Book and 
 Journal Club was a treasure indeed. 
 
 To the older members of the faculty his work and zeal for 
 their interests was of wonderful help and assistance, and his 
 close association with them will always be looked back on 
 with the deepest and most lasting pleasure. To the younger, 
 some of whom are now among the older members of the 
 faculty, who knew him at that time and worshipped from afar, 
 his example should be a help to be better students and workers. 
 To the youngest members of the faculty, who, alas, knew him 
 not, it becomes a duty to emulate his efforts in historical study 
 and so join in the company of those who can find that all is 
 not dry and musty in the old discolored books upon our shelves. 
 It is only by thus fostering and helping along a search for old 
 truths that the newer ones assume a more crystalline appear- 
 ance and we are better able to value them in the light of 
 advancing thought. 
 
OSLEE^S INFLUENCE ON THE LIBRARY OF THE 
 
 MEDICAL AND CHIRURGICAL FACULTY 
 
 OF THE STATE OF MARYLAND 
 
 By Marcia C. Notes, Librarian 
 
 Associations of Dr. Osier are so interwoven with the library 
 of the Medical and Chirurgical Faculty that what we have 
 become is, in reality, but an expression of what we felt he 
 would have us be. 
 
 The name of Osier is writ large in the history of the library 
 from the time of his first connection with it in 1890; and the 
 impression made by his character on the lives of those with 
 whom he came in contact has been a powerful influence for 
 the betterment of medicine in Maryland and in the upbuild- 
 ing of the state society and its library. 
 
 Dr. Osier was elected a member of our Library Committee 
 in 1892 in which jeai the committee reported difficulties, finan- 
 cial and otherwise, in the management of this " most valued 
 and noble inheritance." Although never serving as chairman, 
 that he lent himself to the surmounting of these difficulties 
 we know, and what was accomplished between 1892 and 1905, 
 his tenure of office on the Library Committee, is given, in 
 part, herewith.* From a collection of a few thousand old 
 books in 1892, it grew to 14,590 volumes in 1905, and has 
 grown steadily ever since. 
 
 The library, which dates from 1830, had been partially 
 revived in 1881 and was housed in rooms in the basement of 
 the old Maryland Historical Society in 1885; but it was 
 Dr. Osler^s interest which brought about its renaissance and 
 the purchase of and its removal to the home at 847 N. Eutaw 
 
 * When abroad for his annual outing, Dr. Osier always had the 
 needs of our Library in mind, and we owe many of its greatest 
 treasures to his interest. Some of these were a direct gift from 
 him, and others selected for purchase on the Frick Fund. 
 
 97 
 
98 Sir William Osler, Bart. 
 
 Street (Hamilton Terrace) in 1895. After a year without 
 proper supervision it was owing to Dr. Osier, who personally 
 saw to it, that the Library Committee employed a trained 
 worker and the present librarian took charge. To him we owe 
 the founding of the Charles Frick section of the library, in 
 1896, which was made possible by the generosity of Messrs. 
 William F. and Frank Frick; and the establishment of the 
 Book and Journal Club at about the same time. These funds 
 gave the library a definite income for the first time in its 
 history. 
 
 Dr. Osier was president of the Faculty in 1896-1897, and in 
 his presidential address, April, 1897, in outlining the purpose 
 of the Book and Journal Club, and of the Frick memorial 
 said : " I envy Charles Frick the good fortune to go down to 
 the future generations in this Faculty with his name linked 
 to an important section of our library. Posthumously and by 
 proxy, as it were, thus to carry on, though dead, the work 
 he was interested in while living, is the nearest approach a 
 man can make to cheating the great enemy, and in Charles 
 Frick^s case it is in a measure a compensation for the untime- 
 liness of his taking off.^^ He also spoke of the approaching 
 centennial as follows : " We can try in the centennial year to 
 obtain a proper endowment for the Faculty from our friends 
 among the citizens. We shall need a larger hall, more in 
 keeping with the rank and work of the profession of this 
 city — quarters as complete as our brethren enjoy in Philadel- 
 phia and 'New York. And an endowment yielding a few 
 thousand dollars annually is absolutely essential for the proper 
 development of the library." At the centennial of the Faculty 
 in 1899 he gave the first thousand dollars toward such an 
 endowment fund; and it may safely be said that it was prin- 
 cipally due to his influence that the Charles M. Ellis bequest 
 was made in 1910. 
 
 It was because of the widespread desire to honor Dr. Osier 
 that the present home of the library, at 1211 Cathedral Street, 
 became a fact in 1909; and because of a further expression of 
 this desire that the Osier Testimonial Fund for the purchase, 
 
Medical and Chirurgical Faculty Library 99 
 
 in his name, of books on medicine was presented to us in 1917. 
 It is singularly fitting that his name should be linked for all 
 time with that of the Medical and Chirurgical Faculty and 
 its library, for he delighted so keenly in the phrasing of the 
 old title — the chirurgical, so hard for the uninitated to pro- 
 nounce — and in the usage of the word faculty instead of 
 society. The development of the library, to its fullest extent, 
 interested him beyond measure, for he was not only a lover, 
 but a user of books, and he insisted that his students should 
 learn the art. The familiar slip bearing his reference was 
 presented almost daily by some one of them, and our reading 
 room on Saturday afternoons became a rendezvous for students 
 and physicians who thought to meet him there to seek his 
 advice. In those days, the pausing of a hansom at the door, 
 if followed immediately by a cheery whistle, presaged his 
 advent to the initiated. Hardly a Saturday passed without 
 Dr. Osier coming to scan the shelves containing the new 
 journals and to browse among the books to be found in the 
 Charles Frick Eeading Eoom. 
 
 Akin to his interest in books is his interest in medical 
 libraries in general, and he was intimately familiar with and 
 always a welcome guest at the library of the Surgeon General's 
 Office, the College of Physicians of Philadelphia, the N"ew 
 York Academy of Medicine, the Boston Medical Library and 
 the library at McGill University, as well as the libraries in 
 Baltimore and many of the smaller medical libraries elsewhere, 
 some of which he fostered. He was not only familiar with the 
 books in these collections, but he knew intimately the cata- 
 logers and workers who do not usually come in contact with 
 the readers, as well as the Librarians in charge. 
 
 This interest found expression in the founding, in conjunc- 
 tion with Dr. George M. Gould, of Philadelphia, of the Medical 
 Library Association in 1898. Owing to his generosity our 
 library was a member from the beginning, and has become an 
 influence in the medical world because of this membership and 
 our connection with the exchange of the association. 
 
100 Sir William Osler, Bart. 
 
 ISTo one man has so left his imprint on the libraries of two 
 continents as has Sir William Osier, and a quotation from his 
 address " Books and Men " delivered in 1901 at the opening 
 of the new building of the Boston Medical Library, at 8 The 
 Fenway, sums up what his example has meant to this library 
 and Faculty: 
 
 It is hard for me to speak of the value of libraries in terms 
 which would not seem exaggerated. Books have been my delight 
 these thirty years, and from them I have received incalculable 
 
 benefits For the teacher and the worker a great library 
 
 such as this is indispensable. They must know the world's best 
 
 work and know it at once For the general practitioner 
 
 a well-used library is one of the few correctives of the premature 
 senility which is so apt to overtake him. Self-centered, self- 
 taught, he leads a solitary life, and unless his everyday experi- 
 ence is controlled by careful reading or by the attrition of a 
 medical society it soon ceases to be of the slightest value and 
 becomes a mere accretion of isolated facts, without correlation. 
 
I 
 
 fe 
 
o 
 
SOME EARLY REMINISCENCES OF 
 WILLIAM OSLER 
 
 By Henry M. Hurd 
 
 In September, 1883, while on a vacation trip with a friend, 
 I stopped at Kingston, Ontario, and found myself in a busy 
 throng of physicians in attendance upon the Canadian Medical 
 Association in annual session there. The physicians were 
 diligent in their attendance upon the meetings of the associa- 
 tion, proud of their mutual calling and eager to advance it. 
 The secretary of the organization, and one of the leading 
 spirits, was Dr. Osier, a resident of Montreal, a young man of 
 34 years, who then, as always, appeared younger. He knew in 
 person every physician present and was easily the guiding 
 force in the association. He participated freely in the discus- 
 sions which followed the reading of papers and did not hesi- 
 tate to express his mind freely and frankly on all important 
 questions. In the meetings there were the usual differences of 
 opinion between the rank and file of the profession and the 
 members of the medical examining board and verbal en- 
 counters sometimes took place between many men of different 
 minds. Osier spoke boldly and without reserve and had an 
 opinion upon all matters, but never seemed to excite ill feeling 
 or lasting resentment on the part of those who differed with 
 him. He was an excellent secretary and carefully watched 
 the progress of the special work of the meetings. He was 
 spare in figure, with a sharp, piercing eye, and although of 
 sallow complexion, was vigorous and in excellent health. He 
 was neatly and quietly, but carefully dressed and in manner 
 and bearing displayed the characteristics which I later learned 
 to recognize and appreciate as peculiar to him. One circum- 
 stance in the meeting attracted my attention in a special way ; 
 a prominent member read a paper entitled " The Conduct of 
 Medical Men Towards Each Other and Towards Each Others' 
 
 101 
 
103 Sir William Osler, Bart. 
 
 Patients/^ wMch displayed great wrong-headedness and per- 
 versity of feeling in reference to the relations of physicians to 
 each other in the matter of consultations over very ill patients. 
 He held that a physician was justified, when called in con- 
 sultation, in getting control of his brother practitioner's 
 patient and concluded by saying : ^' Take all the cases you 
 can get and keep them if you can without reference to the 
 rights of any other attending physician.^' He also deemed it 
 justifiable to report one's cases of operations or extraordinary 
 cures in the newspapers and inquired, "Why should not 
 medical men report their cases as well as a lawyer his speeches 
 or a clergyman his sermons ? " When he had concluded read- 
 ing his paper he was called sharply to order by several members 
 and referred to the Code of Ethics which existed in Canada to 
 govern the relations of physicians to each other. Whereupon 
 the offender announced that he had never seen any such code 
 and that it had no meaning to him. Dr. Osier sprang to his 
 feet and drew from his pocket a pamphlet copy of the Code of 
 Ethics which he waved about his head and in a loud, clear 
 voice announced that he took great pleasure in supplying a 
 copy to his innocent and untutored friend and was glad to 
 learn that he had " sinned unwittingly through ignorance." 
 
 In 1889, when I came to Baltimore, I found Dr. Osier in 
 temporary charge of The Johns Hopkins Hospital, which had 
 been open in part for a few weeks. He lived at the hospital 
 and guided its work in company with Dr. Halsted and such 
 members of the early staff as Lafleur, Brockway, Clarke and 
 others. I remember on my first visit while walking along 
 Broadway in company with Osier and President Oilman, the 
 day being very hot, the latter, as usual, had an umbrella which 
 he used to protect himself against the rays of the sun. He 
 invited Osier to walk with him, who declined saying, " The 
 chill of nearly 40 Canadian winters is still in my veins and I 
 do not need any such shelter." 
 
 He was a delightful companion with children and took much 
 pleasure in conversing with them and even mystifying them 
 by detailing remarkable personal experiences and sometimes 
 
Early Reminiscences 103 
 
 tragedies. Once he invited two young girls to a luncheon at 
 his house on Monument Street, where his niece, now Mrs. 
 Abbott, kept house for him. He came late to luncheon and 
 explained his delay by the fact that he had been caught in a 
 down-pour of rain when crossing Monument Square which 
 had produced a flood sweeping him off his feet; that he had 
 escaped only after vigorous swimming and had barely saved 
 himself by grasping the shaft of the Washington Monument 
 with both arms. A more harrowing tale was that of the loss 
 of a young friend by falling from his row-boat into the 
 St. Lawrence River. He explained that he might have rescued 
 her had he not resolved never to act hastily and without due 
 consideration. He had accordingly tossed up a coin to deter- 
 mine what his action should be. It fell adversely and he 
 rowed ashore alone weeping bitterly ! Fancy the difficulty of 
 duly impressing high moral precepts upon the young in the 
 light of such a confusing example. Children delighted in his 
 presence and were charmed by him, but very naturally were 
 always uncertain as to the logical nature of his conclusions 
 and equally puzzled by his apparent indifference to conven- 
 tional conceptions of duty and obligation. There was also in 
 his attitude towards pupil nurses a similar light-hearted 
 irresponsibility which marked some portion of two addresses 
 to nurses to which reference is made later. It is possible, 
 however, to perceive that under the cloak of these apparent 
 trivialities there lurked a seriousness of purpose and a keen 
 desire to point a painful moral in a kindly way. With 
 children, however, it was simply an expression of his ample 
 imagination and of his desire to please and puzzle them. Even 
 older people were sometimes at a loss to follow his moods and 
 strange fancies. He was invariably cheerful, hopeful, and 
 optimistic even under circumstances of discouragement and 
 doubt. I remember on one occasion one of his colleagues, 
 mystified by his imperturbability in a trying emergency said, 
 " Osier drop your mask, let us know what you actually think 
 of the situation," but no one ever did gain that knowledge. 
 
104 Sir William Osler, Bart. 
 
 Osier's habits of work, wMle lie resided at The Johns Hop- 
 kins Hospital, were exemplary and somewhat "unusual for a 
 man of literary taste. Such men are usually inclined to turn 
 night into day. but he rose promptly at 7 a. m., took his bath 
 and breakfast and was ready for work at 8 o^ clock. He seemed 
 to have a faculty for setting his mental machinery in motion 
 immediately and accompKshed effective work without delay. 
 When his secretary- came he generally began to dictate and by 
 practice acquired great facility in terse and vigorous expres- 
 sion. This quality also was undoubtedly assisted by his 
 famiharit}" with King James' version of the Bible, the 
 Prayer Book, and Sir Thomas Browne. His method of the 
 preparation of the Principles of Medicine was worthy of 
 being followed by other writers. He gathered the literature 
 of any subject which he had on hand by judicious foraging in 
 his library and elsewhere. The volumes thus collected were 
 piled four square generally, open at the page to be consulted 
 upon the table, as long as room sufficed and later upon the 
 floor until movement about the room was much restricted. I 
 remember that when after seven months of strenuous labor 
 he completed the first draft of his treatise on medicine I 
 chanced to look into his room and found that it contained an 
 immense heap of books piled as high as the table like an 
 ancient sacrificial altar. The first draft was carefully revised 
 with no great amount of change in sentences and forms of 
 expression. Such changes as were made, however, did not 
 destroy the crisp, breezy style or the epigrammatic form of 
 expression which has always been characteristic of his literary 
 work. The book contained many personal references which 
 gave peculiar satisfaction to his friends by reason of the good- 
 natured personal touches he frequently gave to the cherished 
 beliefs and traditions which he did not share. I remember 
 in speaking of the use of turpentine in typhoid fever, he said, 
 " The routine administration of turpentine in typhoid fever 
 is a useless practice for the perpetuation of which, in this 
 generation, H. C. Wood is largely responsible." This some- 
 what pointed condemnation of a generally recognized method 
 
Early Eeminiscences 105 
 
 of treatment at that time brought forth a vigorous rejoinder 
 from Dr. Wood in a medical journal, but fortunately there 
 was no loss of friendship on the part of either Osier or Wood. 
 
 Osier was also very scrupulous in fulfilling his duties in 
 attendance upon the meetings of medical societies. When 
 once informed by a student that he did not attend the meeting 
 of a medical society because he was not sure that he could get 
 anything out of it he replied, " Do you think I go for what 
 I can get out of it or for what I can put into it ? '^ Those who 
 knew him felt a deep impression that in all activities in 
 medical societies and in behalf of his students he labored solely 
 to inspire them with a love of work for its own sake and for 
 what he felt to be its final effect upon their growth and 
 development. 
 
 This fact was brought out in his relations to the Training 
 School for Nurses, established at the hospital in October, 1889, 
 which were of an ideal character. He had a warm friendship 
 for Miss Hampton, the organizer of the school and its first 
 principal, and also for Miss Nutting, her successor. He gave 
 much assistance in the way of advice and in teaching and was 
 warmly interested in its success. He gave two graduating 
 addresses also, one entitled, " Nurse and Patient,'^ and the 
 other, " Doctor and Nurse." He was appreciative of the work 
 of nurses and touched lightly and gracefully upon the mutual 
 relations of the nurse to her co-worker, the doctor, and to the 
 object of her care, the patient. There was, however, a sus- 
 picion of an attitude of reserve towards trained nurses as a 
 class as may be inferred by the quotations which preceded 
 these addresses when published. One, for example, had this 
 significant motto, from the Psalms of David, " I said I will 
 take heed to my ways that I offend not in my tongue. I will 
 keep my mouth as it were with a bridle." The other quotation 
 was from Sir Thomas Browne, " Think not silence the wisdom 
 of fools, but if rightly timed the honor of wise men who have 
 not the infirmity, but the virtue, of taciturnity and speak not 
 out of the abundance, but the well-weighed thoughts of their 
 
106 Sir William Osler, Bart. 
 
 hearts. Such silence may be eloquence and speak thy worth 
 above the power of words." 
 
 Osier in fact seemed always appreciative and helpful while 
 at the same time he had an air of detachment as one who was 
 endeavoring to see whither the movement for the education of 
 nurses would ultimately lead. In the end I am sure that he 
 learned to understand and appreciate the work of the training 
 school and felt the great importance ©f it to physicians and to 
 the advance of the science of medicine. 
 
OSLER AS I KNEW HIM IN PHILADELPHIA AND 
 IN THE HOPKINS 
 
 By Howard A. Kelly 
 
 I find myself wondering, in these days of pleasant retro- 
 spection, now that our much loved friend Sir William Osier 
 is so splendidly rounding out his seventh decade, whether, of 
 all his friends here, I may not claim the credit of having 
 known him first. 
 
 I was living in Philadelphia up in the big mill district of 
 Kensington, culling a surgical out of a large general practice, 
 and at the same time keeping in close touch with things at the 
 University of Pennsylvania, for eight years my college, when 
 it became manifest that some fresh and stirring blood had 
 entered the college life. 
 
 The university, with so many eminent men camping on her 
 very doorstep in Philadelphia, and with that tendency to 
 nepotism, a form of paternal pride seen in all successful 
 institutions, had, as we younger men thought, driven John 
 Guiteras of brilliant promise in general medicine, away from 
 her doors to protect Pepper from rivalry, and now, not without 
 great hesitation as we understood, she had actually broken 
 her shackles, thrown traditions to the winds and pulled 
 William Osier down from McGill in Montreal. 
 
 Fresh invigorating currents of life and new activities in our 
 stereotyped medical teachings began at once to manifest them- 
 selves, and every sturdy expectant youngster in short order 
 lined himself up as a satellite to the new star. Osier breezes 
 were felt everywhere in the old conservative medical center, 
 and yet it was not without some difficulties that he securely 
 established himself. Weir Mitchell, who had reason in his 
 later days to cultivate kindlier feelings towards the university 
 than in his young manhood, was from the first Osier's devoted 
 and intimate friend, and one by one the faculty was won to 
 
 107 
 
108 Sir William Osler, Bart. 
 
 appreciate him, perhaps including even Pepper too, though I 
 am not so sure. My own life touched Osier's in the Kensing- 
 ton mill district in northeast Philadelphia. Aside from 
 anatomy and chemistry, I got most of my real medical educa- 
 tion while a resident in the Episcopal Hospital and next in 
 the homes of the Kensington folk. Wood's physiological 
 therapeutics and Stille's didactic lectures on medicine seemed 
 deadly to me, and worst of all was Tyson's pathology elucidated 
 by Formad's quizzes. So it remained to get the education at 
 the bedside, and here Osier came to my aid. It was more than 
 a Sabbath day's journey in those days to go to Kensington 
 from the heart of the city; it was an hour in the street car, 
 and a long drive over bad, very bad, Philadelphia streets, but 
 Osier came and Agnew came with their lamps in their hands 
 to illuminate a few of the problems in the vast domain in which 
 all medical graduates are presumed to be exj)erts. 
 
 I think the first patient that Osier saw was suffering from 
 anorexia nervosa, a condition which I had never seen before, 
 and of which I was ignorant. He stayed to dine in Morris 
 Square, and was particularly interested in my collection of 
 old medical books. 
 
 Then he was whisked awa}^ to Baltimore, and then after a 
 yearns time, I followed at his behest, glad to have a more 
 concentrated field of work. 
 
 Here I can add nothing, for his record is known and read 
 of all men, and what a blessing he, and Welch, and Halsted, 
 and Hurd proved to be in this community. I leave others to 
 appreciate Osier's skill as a medical man, and his love of the 
 classics. I always think of him first of all as one who brought 
 order out of the chaos in the medical profession of this city, a 
 great task effected by his kindly personality, his insight into 
 human nature, and the genuine affection he ever felt for all 
 men who were even half way good. 
 
 It was a settled poHcy of Osier's life never to speak ill of 
 any one but always to find the good, and in that way he con- 
 verted the hostile camp of Baltimore into a kindly family of 
 cooperating doctors. 
 
In Philadelphia 109 
 
 Medicine here had fangs in the old days. Osier and Welch 
 more than any others drew them ; and so made possible medical 
 progress. 
 
 I want to lay claim to the gift of prophetic insight (a role 
 I doubt not in which many of my colleagues have anticipated 
 me) ; I had said from the first that Osier was bound for 
 London, and in the old days I longed to be ready to go with 
 him when he went. The outcome has exceeded, I think, all our 
 anticipations, and who but he would have maintained unabated 
 the same interest in all his old friends, and who else could 
 have turned the ocean into a highway, and his new position, 
 detached as it is from any vast clinical facilities, into a veri- 
 table medical Mecca for all our American medical world. That 
 many lustra may still be added to the kindly years of Lady and 
 Sir William Osier is the wish of many hearts. 
 
OSLER AS A BIBLIOPHILE 
 By Thomas E. Boggs 
 
 Adequate treatment of this important side of Dr. Osier's 
 activities would far transcend the present writer's abilities and 
 the space allotted to this article. But it may be of some value 
 to discuss briefly Dr. Osier's interest in old books as reflected 
 in his informal talks with the students. 
 
 In looking back it seems to the writer that the interest in 
 the early editions was a development of the fundamental value- 
 he placed in the study of the history and evolution of the 
 science and art of medicine, and that it was in connection with 
 his studies of the fathers of medicine in all times and countries 
 that he began that collection of first and rare editions which 
 has now reached such remarkable proportions. 
 
 When the plan of collecting the works of the founders of 
 British Medicine was first originated is unknown to the writer, 
 but it had already reached a large degree of perfection at the 
 time when the class of 1901 began to make the Saturday even- 
 ing visits to the old house at No. 1 West Franklin Street. 
 
 Most of us will ever retain the delightful recollection of 
 those informal gatherings about the big table in the dining- 
 room, when after the discussion of the week's work in the 
 wards was finished, " the chief " would bring out some of the 
 books from the special shelves devoted to the masters of 
 medicine and show us the first editions, tell us the story of 
 their discovery and acquisition, point out the notable passages, 
 and give the salient facts in the author's life history. For 
 many of us this was the beginning of our knowledge of the 
 history of medicine and of our own feeble attempts to follow 
 in his steps as collectors. 
 
 How reverently we handled and admired the rare little 
 volumes, of Linacre's grammar, or the spurious first edition 
 of the Eeligio, or Digby's Animadversions, with their choice 
 
 8 111 
 
112 Sir William Oslee, Bart. 
 
 bindings hj Eiviere or Zaehnsdorff. How thrilled by the story 
 of the discovery of snch a treasure on a York bookstall, boimd 
 in with an Almanack and bought for half a crown. With what 
 delight we turned the pages of the tall copy of the Pseudoxia 
 Epidemica and dipped into the grave Sir Thomases discussion 
 of the verity of the pictures of God, or the popular idea " that 
 elephants have no knees." A beautiful Aldine from Mead's 
 own library brought out the story of that great collector and 
 his testamentary instruction that his library be sold so that 
 others might have some of the pleasures of acquisition which 
 he had so much enjoyed. We were given a glimpse into the 
 special lore of the bibliophile, and learned something of the 
 work of the pioneer printers and of the great presses of a later 
 date. We learned a little of the fonts of type and the water- 
 marks of papers, as well as the characteristics of the bindings 
 peculiar to certain periods. The nature of book auctions was 
 disclosed to us and we became familiar with the magic names 
 of Sotheby and Quaritch, until some of us found the perusal 
 of a good catalogue as exciting as a detective story. Still more 
 important, we heard about the more famous collections of 
 medical works, and began to project personal visits to the 
 Bodleian, the Eoyal College of Physicians and the Bibliotheque 
 Rationale. 
 
 But best of all and doubtless the ultimate object of all was 
 the gradual acquisition of an epitome of the history of medi- 
 cine which has kept us interested ever since those days. 
 
 Moreover, it was not merely the cultural value of a knowl- 
 edge of the beginnings of the profession, but the constant 
 lesson of the individual worker's triumph over handicaps of 
 isolation, poverty, ridicule or personal peril, to add some con- 
 tribution to the sum of knowledge, and the reiteration of the 
 theme that the painstaking and observant physician, even 
 though removed from the centers of learning and wide oppor- 
 tunity, has in the past contributed fundamentally to the 
 advancement of knowledge, and may hope to do so in th^ 
 future. 
 
As A Bibliophile 113 
 
 Again, Dr. Osier stimulated in us an interest in the medical 
 writers of the early days of our own country and showed how 
 much might be found by the investigation of the early journals 
 and books, and this has led to the substantial contributions by 
 his associates and pupils to the history of medicine in the 
 colonies, the United States and Canada. 
 
 In conclusion, another side of Dr. Osier's bibliophilic 
 activity must be noted, that is, his generous interest in the 
 medical libraries of the country. He was not satisfied to 
 acquire rare and interesting volumes for himself, but was 
 constantly giving such books to the various professional 
 libraries with which he had been associated; thus, McGill, 
 Boston, The College of Physicians in Philadelphia and our 
 own Maryland Faculty and Johns Hopkins have repeatedly 
 received valuable acquisitions from him or from others whom 
 he had induced to give rare volumes or even whole collections. 
 
 We are happy to know how vastly " the chiefs '' collection 
 has grown since he removed to the University of Oxford, so 
 that it is now one of the very best in existence. The catalogue, 
 bibliographic, biographic and literary, of this great collection 
 of the epoch-making works of science occupies most of his 
 leisure, and will form another great contribution to the 
 literature of medicine, second only to the immortal Practice. 
 
OSLER^S LITEEARY STYLE 
 By Edward N. Brush 
 
 There are in connection with the task which has been 
 assigned to me many very pleasant aspects. To make a critical 
 analysis, to present a clear picture of Dr. Osier's literary style 
 demands, however, more time and space than are at my dis- 
 posal and above all more ability as a literary critic than I am 
 endowed with. 
 
 In reading Dr. Osier's contributions to the literature of 
 medicine, as well as his occasional addresses and essays, I am 
 tempted to linger here and there, to point out the clarity of 
 expression, the simplicity and beauty of diction and quote 
 passage after passage in illustration of my thesis. Such a 
 course would simplify the task before me because these quota- 
 tions would show the author's style better than any powers of 
 description or any ability of analysis I possess. 
 
 In his purely scientific work, as for example, in The 
 Principles and Practice of Medicine, the author's method and 
 his grasp of his subject are admirable. He follows the advice 
 of the friend of Cervantes when the author of Don Quixote 
 was in a quandary over the preparation of his preface, 
 " Nothing but pure nature is your business ; her you must 
 consult, and the closer you can imitate, your picture is the 
 better." 
 
 In my student days some one placed in my hands a cojDy 
 of Watson's Practice.* While it was not recommended as a 
 text-book to follow as an exponent of the then recognized 
 principles of medical thought and practice, I found it one of 
 the easiest works to read and one from which I obtained much 
 of lasting value. Commenting upon this fact to my preceptor 
 I was told that I had fallen upon a book which possessed, 
 something not common in medical treatises, a good style. 
 
 * Lectures on the Principles and Practice of Phj^ic. By Thomas 
 Watson, M. D., etc., London, 1843. 
 
 115 
 
116 SiK William Osler, Bart. 
 
 The same is true of Osier's writings upon the strictly 
 scientific aspect of medicine. Unity, order, clarity of descrip- 
 tion and ease of diction abound throughout his text-book and 
 his various monographs. A master of his subject, having made 
 the nature of disease his business, he imparts his information 
 in such a manner that the reader at no time finds it difficult, 
 because of ambiguous phraseology or doubtful expression, to 
 grasp his meaning. His thoughts are " linked with the wants 
 of his readers,'' and by the invisible chains which bind mind to 
 mind, he and his reader become one. 
 
 The reader finds that he has a message to impart, a principle 
 to establish, a rule of conduct to promulgate, and that he has 
 done so in a logical, attractive maner which compels attention ; 
 and that to my mind is the test and measure of good writing. 
 
 Another view of Osier as an author is revealed in his occa- 
 sional addresses and essays. In the two volumes before me — 
 " Aequanimitas and Other Addresses" and *^^ An Alabama 
 Student and Other Biographical Addresses " — Osier's style in 
 all its directness, strength and grace is shown in full measure. 
 
 In these volumes, as in other addresses not therein con- 
 tained, notably his farewell to his professional associates and 
 friends in Maryland under the title " Unity, Peace and Con- 
 cord," Osier exemplifies Buffon's dictum: "The style is the 
 man himself." 
 
 Sir Thomas Watson in his memorial of Latham, whose 
 "Lectures on Clinical Medicine" are examples of the best 
 English style, says : " His letters are treasures of good sense, 
 of lively and epigrammatic comments on men and things and 
 of shrewd and weighty reflections, wise advice and affectionate 
 greetings " ; and this can be with great truth applied to the 
 addresses and essays of Dr. Osier. Lively, epigrammatic, 
 shrewd, weighty and affectionate are all terms which well suit 
 my purpose, which reveal the man through his writing. 
 " Talent alone cannot make a writer," says Emerson, " there 
 must be a man behind the book, a personality which by birth 
 and quality is pledged to the doctrines there set forth." 
 
Literary Style 117 
 
 With Byron one ^^ hates an author that's all author/' In 
 Orsler's case the author is all man, and the man reflects him- 
 self in his work. It is an easy task for those who have had the 
 pleasure and advantage of intimate association with him to 
 invoke his presence when reading his addresses, as for example, 
 "Internal Medicine as a Vocation,'^ "Medicine in the Nine- 
 teenth Century," "The Hospital as a College" and "The 
 Master Word in Medicine." 
 
 What, if any, are the secrets of Osler^s style ; upon what does 
 it depend? The answer, I think, is simply a love for and 
 thorough mastery of good literature and a message to convey 
 full of high ideals. One William Harrison, writing in 1577, 
 speaks of " an excellent vein of writing not beforetime re- 
 garded" which has become manifest in England. This he 
 intimates is the result not only of a knowledge on the part of 
 writers of their own tongue, but of an acquaintance with the 
 Latin and Greek and often with French and Spanish. 
 
 This excellent vein of writing soon became the glory of the 
 Elizabethan age. The development of higher ideals in English 
 national life was rapidly followed, as well as fostered, by the 
 great authors of the age of England's literary glory. Style, 
 literary excellence, came to be recognized as desirable, and 
 reached its highest manifestation. Back of it all, however, were 
 the ideals which fostered and gave material for the expression 
 of literary style. There was an atmosphere of a great elevation 
 of ideals, public and private, and at the same time tangible 
 objects of national ambition and glory. England was " con- 
 tending in the cause of the world as well as her own " and there 
 was an outburst of genius which found its counterpart in a 
 smaller degree many years later when England was contending 
 again the world-ambition of Napoleon. 
 
 Will a similar development follow the world's war out of 
 which we are just emerging? 
 
 When a man who has ideals and honesty of purpose and has 
 filled his mind with the productions of the master spirits of the 
 ages feels the call to write or speak, a beauty of literary style 
 almost inevitably results. 
 
118 Sir William Oslee, Bart. 
 
 What were the Pierian springs from which Osier drank, 
 from which he attained, as has been said of him, " a breadth of 
 learning and a knowledge of general literature that astound 
 one?^' 
 
 I would place first the English Bible. How often either by 
 direct quotation or paraphrase does one find in his addresses 
 and essays sentences and phrases from this well-spring of good 
 English. 
 
 Of a liberal knowledge of the classics abundant evidence is 
 found and a ready ability to take text, and illustration as well, 
 from mythology. 
 
 With the masters of the English tongue from the early dawn 
 of English literature till the present he has clearly dwelt on 
 terms of greatest intimacy. 
 
 That half-hour devoted every day to communion with the 
 minds of the past finds lessons reflected in writing, but never 
 with any indication of servile cop3dng, Osler^s style is his own. 
 
 The last page of Aequanimitas has a list of books which 
 Osier has called a Bed-side Library for Medical Students. 
 This is: 1. Old and New Testament; 2. Shakespeare: 3. 
 Montaigne; 4. Plutarch's Lives: 5. Marcus Aurehus: 6. Epic- 
 tetus; 7. Eeligio Medici; 8. Don Quixote; 9. Emerson; 10. 
 Oliver Wendell Holmes — Breakfast-Table Series. 
 
 John Brown, of Edinburgh (Horae Subsecivae, p. -±00), 
 gives a list which he commends to the medical student. These 
 are ^' Shakespeare, Cervantes, Milton, D'ryden, Pope, Cowper, 
 Montaigne, Addison, Befoe Goldsmith. Fielding. Scott. Lamb, 
 Macaulay, Jeffrey, Sydney Smith, Helps and Thackeray." 
 Bro^Ti's list has nearly twice as many names as that given by 
 Osier, but in solid worth the shorter list outweighs the longer. 
 
 Dr. Osier's list fulfills in brief compass the requirements of 
 a liberal education and presents to the reader examples of the 
 best in literature. 
 
 Eeference has already been made to the fact that Dr. Osier 
 is reflected in his writings, that in the words of Taine " behind 
 the document there was a man." 
 
Literary Style 119 
 
 In this instance that man had for years exercised, as I have 
 tried to show elsewhere, a singular and powerful influence on 
 medical education, hospital methods and in binding together 
 for harmonious action the members of his profession. 
 
 lie had encouraged the study of medical history and biog- 
 raphy and found time in the midst of duties, which might well 
 have availed as an excuse from further intellectual labors, to 
 contribute in large measure to these subjects. 
 
 Always, witli no false note, his cry has been for scientific 
 righteousness. He has had ideals and, as an idealist, he has 
 done what he has himself said other idealists have often done, 
 " gradually moulded to their will conditions the most adverse 
 and hopeless.'' 
 
 All of this and much more is reflected in the text of Osler'.^ 
 writing, presented often in epigrammatic form, reinforced by 
 text and example from many sources, enlivened by a humor 
 that is irresistible. 
 
 No medical contributor to general literature since Holmes 
 has possessed the saving sense of humor to the degree shown 
 in Osier's writings and no one could have used it with greater 
 discrimination or more certain effect. 
 
 Often when apparently writing in a most humorous vein he 
 has been the most serious in his meaning, and how often and 
 with what delicate touch does he expose some of our human 
 faults and foibles. I yield to the temptation to quote here an 
 illustration of that to which I have just referred. " Curious, 
 odd compounds are these fellow-creatures, at whose mercy you 
 will be ; full of fads and eccentricities, of whims and fancies ; 
 but the more closely we study their little foibles of one sort 
 and another in the inner life which we see, the more surely is 
 the conviction borne in upon us of the likeness of their weak- 
 nesses to our own. The similarity would be intolerable if a 
 happy egotism did not often render us forgetful of it. Hence 
 the need of an infinite patience and an ever-tender charity 
 toward these fellow creatures; have they not to exercise the 
 same toward us ? " 
 
120 Sir William Osler, Bart. 
 
 To Osier's style may be applied part of his own estimate of 
 some of the older writers, Burton, Browne and Fuller: "A 
 rare quaintness, a love of odd conceits and the faculty of apt 
 illustration." 
 
 In his writings he reminds us of what he has said of Browne, 
 " The charm of high thoughts clad in beautiful language may 
 win some readers to a love of good literature ; but beyond this 
 is a still greater advantage .... the Religio is full of the 
 counsels of perfection." 
 
 So, too, is there with Osier a " charm of high thoughts clad 
 in beautiful language" and always the "counsels of perfec- 
 tion." 
 
 Osier's literary work is yet unfinished, the three score years 
 and ten which he has attained have but ripened his judgment 
 and enlarged his field of vision. He has seen many of his ideals 
 become realities. The stress of the great world war has pressed 
 heavily upon him and brought to him a great sorrow. The 
 iron has entered into his soul. His future work will bear the 
 stamp of all these. 
 
 He has made his own estimate of the " princes of the blood " 
 in literature from our profession. He places Sir Thomas 
 Browne, Holmes and John Brown, of Edinburgh, in a group 
 high in the circle. 
 
 Osier possesses many things in common with these three in 
 literary style and in literary excellence, and deserves a place 
 in the same exalted fellowship. 
 
^ZlUJJL^icjLCUT ^ 
 
 
 
 fTd^^^ 
 
BIBLIOGEAPHY 
 
 OF 
 
 SIR WILLIAM OSLER, Bart., M. D., F. R. S. 
 
 compiled by 
 
 Minnie Wright Blogg 
 
 librarian, the johns hopkins hospital 
 
 Sir William Osier's bibliography covers a period of 49 years 
 (1870-1919). The 773 titles include both books and articles. 
 Many of these are in the library of The Johns Hopkins Hos- 
 pital and have added value as being personal gifts from the 
 author. 
 
 1870 
 
 On Canadian diatomaceae. Canad. Naturalist, Montreal, 1870, n. s., 
 V, 142-151. 
 In his: Published Mem. & Communicat, Montreal, 1882, 8". 
 [Collect, repr., 1872-1882, i, no. 1.] 
 
 1873 
 
 Action of certain reagents — atropia, physostigma and curare — on 
 the colorless blood-corpuscles. Quart. J. Micr. Sc, Lond., 1873, 
 n.s., xiii, 307-309. 
 In his: Published Mem. & Communicat., Montreal, 1882, 8°. 
 [Collect, repr., 1872-1882, 1, no. 2.] 
 
 1874 
 
 An account of certain organisms occurring in the liquor san- 
 guinis. FRep. by J. B. Sanderson.] Proc. Roy. Soc, Lond., 
 1874, xxii, 391-398. 
 In his: Collect, repr., 1872-82, i, no. 3. 
 
 1875 
 
 Uterine thermometry. (Cohnstein, Die Thermometrie des Uterus.) 
 Translated from Virchow's Archiv, Bd. Ixii, Heft i. Canada 
 M. & S. J., Montreal, 1874-5, iii, 294-297. 
 
 Valedictory address to the graduates in medicine and surgery, 
 McGill University. Canada M. & S. J., Montreal, 1874-75, iii, 
 433-438. 
 In his: Published Mem. & Communicat., Montreal, 1882, 8^. 
 [Collect, repr., 1872-82, i, no. 4.] 
 
 121 
 
122 Sir William Osler^ Bart. 
 
 1876 
 
 Introductory remarks to, and synopsis of, practical course on 
 institutes of medicine. Canada M. & S. J., Montreal, 1875-76, 
 iv, 202-207. 
 
 Histological characters of the tumour, [A case of melano-sarcoma 
 of the choroid, by A. Proudfoot.] Canada M. & S. J., Montreal, 
 1875-76, iv, 298-300. 
 
 Histological and general description of the tumors. [Case of 
 glioma of both retinae. Extirpation of both eyes, by G. B. 
 Fenwick.] Canada M. & S. J., Montreal, 1875-76, iv, 306-308. 
 
 Notice of the recent researches on the pathology of small-pox. 
 Canada M. & S. J., Montreal, 1875-76, iv, 341-343. 
 
 On the pathology of miner's lung. Canada M. & S. J., Montreal, 
 1875-76, iv, 145-168. 
 In his: Collect, repr., 1872-82, 1, no. 7. 
 
 Case of scarlatina miliaris. Canada M. & S. J., Montreal, 1875-76, 
 iv, 49-54. 
 In his: Collect, repr., 1872-82, i, no. 5. 
 
 On the histology of leucocythemia. Canada M. & S. J., Montreal, 
 1875-76, iv, 439-477. 
 In his: Collect, repr., 1872-82, i, no. 6. 
 
 Clinical notes on small-pox. I. The initial rashe^. II. Haemor- 
 rhagic small-pox. III. A form of hsemorrhagic small-pox. 
 Montreal, 1876. Gazette P't'g House, 35 p., 8°. 
 Also: Canada M. & S. J., Montreal, 1876-77, v, 241; 289. 
 In his: Published Mem. & Communicat., Montreal, 1882. 
 [Collect, repr., 1872-82, i, nos. 8, 9, 10.] 
 
 Trichina spiralis. Extract from a lecture on " Animal parasites 
 and their relation to public health," being one of the Somer- 
 ville lectures of the Natural History Society. Canad. J. M. Sc, 
 Toronto, 1876, i, 134-135. 
 
 1877 
 
 Introductory lecture on the opening of the forty-fifth session of the 
 medical faculty, McGill University, Oct. 1, 1877. Montreal, 
 1877, Dawson Bros., 19 p., 8°. 
 Also: Canada M. & S. J., Montreal, 1877-78, vi, 193-210. 
 In his: Published Mem. & Communicat., Montreal, 1882, 8°. 
 [Collecl. repr. 1872-82, i, no. 14.] 
 
 Post-mortem, eleven hours after death. [Case of cerebral aneur- 
 ism, by J. Bell.] Canada M. & S. J., Montreal, 1876-77, v, 57-58. 
 
 Verminous bronchitis in dogs; read before the Montreal Veterinary 
 Medical Association, March 29. Veterinarian, Lond., 1877, i, 
 387-397. 
 In his: Published Mem. & Communicat, Montreal, 1882, 8°. 
 [Collect, repr., 1872-82, i, no. 12.] 
 
 Beschaffenheit des Blutes und Knochenmarkes bei pernicioser 
 Anamie. Centralbl. f. d. med. Wissensch., Berl., 1877, xv, 498. 
 Ih his: Published Mem. & Communicat., Montreal, 1882, 8°. 
 [Collect, repr., 1872-82, i, no. 18.] 
 
Bibliography 123 
 
 Osier, W., and Bell, J.: Case of progressive pernicious anaemia. 
 Clinical report, by John Bell. Pathological report, with re- 
 marks, by William Osier. Montreal, 1877, Lovell Print. & 
 Publ. Co., 12 p., 12^ 
 In Ms: Collect, repr., 1872-82, i, no. 16. 
 
 Osier, W., and Gardner, W. : Case of progressive pernicious anaemia 
 (idiopathic of Addison). Canada M. & S. J., Montreal, 1876-77, 
 V, 385-404. 
 In his: Collect, repr., 1872-82, i, no. 15. 
 
 Osier, W., and Gardner, W.: Ueber die Beschaffenheit des Blutes 
 und Knochenmarkes in der progressiven perniciosen Anamie. 
 Centralbl. f. d. med. Wissensch., Berl., 1877, xv, 258-260. 
 In his: Published Mem. & Communicat., Montreal, 1882, 8^. 
 [Collect, repr., 1872-82, i, no. 17. J 
 
 1878 
 
 On the pathology of the so-called pig-typhoid. London, 1878, Bail- 
 li^re, Tindall & Cox, 20 p., 8°. 
 Vet. J. & Ann. Comp. Path., Lond., 1878, vi, 385-402. 
 In his: Published Mem. & Communicat., Montreal, 1882. 
 [Collect, repr., 1872-82, i, no. 20.J 
 
 Over-strain of the heart, as illustrated by a case of hypertrophy, 
 dilatation and fatty degeneration of the heart, consequent 
 upon prolonged muscular exertion. Montreal, 1878, Gazette 
 P't'g House, 13 p. S\ 
 
 Also: Canada M. & S. J., Montreal, 1877-78, vi, 385-395. 
 
 In his: Published Mem. & Communicat., Montreal, 1882, 8'. 
 
 [Collect, repr., 1872-82, i, no. 19.] 
 
 Phthisical cavities in left lung; gangrene of pulmonary tissue 
 about one of them. Canada M. & S. J., Montreal, 1877-78, vi, 
 114. 
 Also: Montreal Gen. Hosp. Rep. (1876-77), 1878, i, 37. 
 
 Pleura. Small fibroid thickenings on visceral layer. Canada M. 
 & S. J., Montreal, 1877-78, vi, 115-116. 
 Also: Montreal Gen. Hosp. Rep. (1876-77), 1878, i, 40-41. 
 
 Fracture of Ist and 2d ribs near vertebrae, from direct violence; 
 deep abscess of the neck; obliteration of subclavian artery; 
 empyema. Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 
 11-12. 
 
 Necrosis of tibia. Ulcerative endocarditis, pyaemic pneumonia. 
 Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 12-13. 
 
 Necrosis of femur, pyaemic pneumonia; abscesses in superficial 
 muscles; pustular eruption on skin. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 13-14. 
 
 Primary cancer of bodies of 2d and 3d vertebrae and heads of 
 corresponding ribs on right side. Secondary masses in ribs, 
 liver and brain. Chronic phthisis. Lobar pneumonia. Mon- 
 treal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 14-16. 
 
 A case of hypertrophy and dilatation of the heart; no valvular or 
 arterial disease; no chronic kidney affection; hydrothorax; 
 pulmonary apoplexy; general venous stasis. Montreal Gen. 
 Hosp. Path. Rep. (1876-77), 1878, i, 16-20. 
 
124 Sir William Osler, Baet. 
 
 Aneurism of comnLencement of thoracic aorta, unsuspected during 
 life; death, from general tuberculosis. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 20-21. 
 
 Sacculated aneurism of ascending portion of arch of aorta; rup- 
 ture into the right pleural sac. Montreal Gen. Hosp. Path. 
 Rep. (1876-77), 1878, i, 21. 
 
 Sacculated aneurism of aorta, at termination of the arch, un- 
 suspected during life. Death from pneumonia. Montreal Gen. 
 Hosp. Path. Rep. (1876-77), 1878, i, 22. 
 
 Aneurism of hepatic artery. Right branch almost obliterated. 
 Multiple abscesses in the liver. Montreal Gen. Hosp. Path. 
 Rep. (1876-77), 1878, i, 22-30. 
 
 Aneurismal dilatation of branches of pulmonary artery on the 
 walls of phthisical cavities. Death from haemoptysis. Mon- 
 treal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 30. 
 
 Aneurism at second bifurcation of the right middle cerebral 
 artery; rupture; extravasation of blood into the Sylvian fis- 
 sure, and laceration of substance of the temporosphenoidal 
 lobe, death in 36 hours. Montreal Gen. Hosp. Path. Rep. 
 (1876-77), 1878, i, 30-32. 
 
 Ossification of greater portion of mucous membrane of trachea. 
 Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 32. 
 
 Pneumonia of the upper lobe of the right lung; extensive menin- 
 geal inflammation. Montreal Gen. Hosp. Path. Rep. (1876-77), 
 1878, i, 33-34. 
 
 Almost entire hepatization of left lung; with small pneumonic 
 area in right. Extensive diphtheritic colitis. Montreal Gen. 
 Hosp. Path. Rep. (1876-77), 1878, i, 34. 
 
 Diabetes, phthisical cavity in right lung surrounded by hepatized 
 tissue. Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 
 34-35. 
 
 Chronic phthisis, almost entire destruction of both lungs. Healthy 
 portion involved in a pneumonia. Montreal Gen. Hosp. Path. 
 Rep. (1876-77), 1878, i, 35. 
 
 Simple pneumonia of left lung, right-side,d pleurisy. Montreal 
 Gen. Hosp. Path. Rep. (1876-77), 1878, i, 35. 
 
 Pneumonia of right lung, uniform involvement of pleura covering 
 it. Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 35-37. 
 
 Fibroid contraction and induration of entire right lung; cavity at 
 apex; displacement of heart; hypertrophy with dilatation of 
 right chambers. Montreal Gen. Hosp. Path. Rep. (1876-77), 
 1878, i, 38-39. 
 
 Chronic phthisis; perforation of lungs; pneumothorax; dermoid 
 cyst of right ovary. Montreal Gen. Hosp. Path. Rep. (1876-77), 
 1878, i, 39-40. 
 
 Epithelioma of right side of tongue, extending from base to near 
 the apex. Removal of organ with galvanic ecraseur. Suppura- 
 tion beneath cervical fascia. Pysemia. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 41-42. 
 
Bibliography 125 
 
 Chronic phthisis. Miliary tubercles in lungs and pharynx. Mon- 
 treal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 42-43. 
 
 Cancer of the cardiac orifice, involving the oesophagus. Secondary 
 masses in other parts of the organ. Montreal Gen. Hosp. Path. 
 Rep. (1876-77), 1878, i, 43-44. 
 
 Medullary cancer, involving the pyloric zone of the stomach; 
 perforation, peritonitis. Montreal Gen, Hosp. Path. Rep. 
 (1876-77), 1878, i, 44. 
 
 Passage of two feet of the ileum through a loop attached to the 
 sigmoid flexure. Montreal Gen. Hosp. Path. Rep. (1876-77), 
 1878, i, 45. 
 
 Round ulcer of duodenum. Montreal Gen. Hosp. Path. Rep. (1876- 
 77), 1878, i, 45-46. 
 
 Perforation of typhoid ulcer during convalescence, owing to an 
 indiscretion in diet. Montreal Gen. Hosp. Path. Rep. (1876- 
 77), 1878, i, 46. 
 
 Perforation of a deep ulcer at end of second week. Montreal Gen. 
 Hosp. Path. Rep. (1876-77), 187^ i, 46-47. 
 
 Typhoid fever. Perforation. Peritonitis. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 47. 
 
 Four round ulcers in the ileum. Peyer's patches not generally in- 
 volved. Slight hypostatic pneumonia. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 48. 
 
 Slight swelling of Peyer's glands, only one small spot of ulceration. 
 Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 48. 
 
 Round ulcer of caecum, perforation, general peritonitis. Montreal 
 Gen. Hosp. Path. Rep. (1876-77), 1878, 1, 49. 
 
 Abscesses in the mesentery. Suppuration of portal vein. Empyema. 
 Perforation of appendix, general peritonitis. Montreal Gen. 
 Hosp. Path. Rep. (1876-77), 1878, i, 51. 
 
 Acute tubercular inflammation of the peritoneum. Small caseous 
 mass in left lung. Right-sided pleurisy. General hyperplasia 
 of the bone marrow. Montreal Gen. Hosp. Path. Rep. (1876- 
 77), 1878, i, 52-56. 
 
 Cirrhosis of liver, with enlargement; jaundice; no ascites; delir- 
 ium tremens (?) : erysipelas of the head. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 56-60. 
 Also: Canada M. & S. J., Montreal, 1877-78, vi, 249-253. 
 
 Syphilitic ulceration of left frontal bone; large node on left tibia; 
 gummata in liver. Montreal Gen. Hosp. Path. Rep. (1876-77), 
 1878, i, 60-61. 
 Also: Canada M. & S. J., Montreal, 1877-78, vi, 253. 
 
 Primary cancer of the liver; ascites; jaundice; secondary mass in 
 tail of pancreas; small se,condary nodules in kidneys. Mon- 
 treal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 61-64. 
 Also: Canada M. & S. J., Montreal, 1877-78, vi, 254-256. 
 
126 Sir William Osler, Bart. 
 
 Cancer of neck of the gall-bladder and lymphatic glands in the 
 portal fissure; compression of the hepatic ducts; secondary- 
 masses in liver; enormous distension of gall-bladder, and 
 haemorrhage into it; gall-stones. Montreal Gen. Hosp. Path. 
 Rep. (1876-77), 1878, i, 64-65. 
 
 Extensive abscesses in the mesentery, following typhoid fever. 
 Suppuration of the portal vein and its branches in the liver. 
 Empyema. Perforation of the appendix vermiformis; peri- 
 tonitis; miliary tubercles in lungs. Amyloid degeneration of 
 spleen, liver, and mucous membrane of small intestine. Mon- 
 treal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 65-71. 
 
 Tuberculous disease of right kidney, pelvis, ureter and bladder. 
 Tubercles in left kidney and lungs. Perforation of tuberculous 
 ulcer in bladder. Peritonitis. Montreal Gen. Hosp. Path. Rep. 
 (1876-77), 1878, i, 72-73. 
 
 Old scrofulous disease of right kidney, which is converted into 
 cysts. Recent affection of the left. Montreal Gen. Hosp. Path. 
 Rep. (1876-77), 1878, i, 73-74. 
 
 Old disease of the right kidney, which is converted into five or six 
 cysts, filled with a putty-like material. Extensive tuberculous 
 disease of the organ. Miliary tubercles in lungs. Albuminoid 
 spleen. Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 
 74-75. 
 
 Suppuration about right kidney. Pysemic abscesses in elbows, 
 ankles and anterior mediastinum. Peritonitis. Pleurisy. 
 Montreal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 75-76. 
 
 Stone in the bladder. Prostatic tumors around the urethral orifice. 
 Ulceration on mucous membrane. Pyelitis; ulceration of 
 apices of renal pyramids. Montreal Gen. Hosp. Path. Rep. 
 
 (1876-77), 1878, i, 76-77. 
 
 Epithelioma of cervix; obstruction of the canal; dilatation of the 
 uterine cavity. Pyometra. Montreal Gen. Hosp. Path. Rep. 
 
 (1876-77), 1878, i, 77-78. 
 
 Dermoid or piliferous cyst of right ovary. Chronic phthisis. 
 Pneumothorax. Montreal Gen. Hosp. Path. Rep. (1876-77), 
 1878, i, 78-79. 
 
 Small cavity and caseous masses in lung. General tuberculosis. 
 Meninges of brain unaffected; central softening. Spinal men- 
 inges extensively involved. Montreal Gen. Hosp. Path. Rep. 
 
 (1876-77), 1878, i, 79-81. 
 
 Meningeal affection slight. Ventricles distended, walls soft. Very 
 few miliary tubercles in the organs. Montreal Gen. Hosp. 
 Path. Rep. (1876-77), 1878, i, 81-82. 
 
 Meningeal affection very extensive on the cortex, slight at the base. 
 Ventricles large, walls not soft. Large caseous mass in left 
 lung. Miliary tubercles in lungs and on peritoneum. Mon- 
 treal Gen. Hosp. Path. Rep. (1876-77), 1878, i, 82-83. 
 
 Slight meningeal inflammation. One caseous mass and a few 
 tubercles in lungs. Old morbus coxae. Montreal Gen. Hosp. 
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 Profound anaemia without discoverable lesion. Fatty degeneration 
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 Case of obliteration of vena cava inferior, with great stenosis of 
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 In his: Collect, repr., 1872-82, i, no. 24. 
 
 Two cases of rare kidney tumors. Canada M. Rec, Montreal, 1879, 
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 Miner's phthisis (Rep. by R. Dawson). Canada M. & S. J., Mon- 
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 Also: Montreal Gen. Hosp. Rep., 1880, 1, 297-299. 
 
 Acute Bright's disease in a child; remarkable persistence of blood- 
 corpuscles and casts in the urine after disappearance of 
 albumin. (Rep. by A. Henderson.) Canada M. & S. J., Mon- 
 treal, 1878-79, vii, 455. 
 
 Aphasia, with right-sided hemiplegia, coming on fifteen days after 
 delivery. [Rep. by D. Mignault.] Canada M. & S. J., Montreal, 
 1878-79, vii, 492-493. 
 
 Acute rheumatism treated with salicylate of soda. Delirium ap- 
 parently caused by the remedy. [Rep. by B. E. Mackenzie.] 
 Canada M. & S. J., Montreal, 1878-79, vii, 493-494. 
 
 Cohnheim's theory of tumors. Transl. and condensed from vol. I 
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 1880 
 
 Concussion of brain; temporary hemiplegia; general convulsions; 
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 1879-80, viii, 8. 
 
 Aggravated stuttering, following fall on the head. Canada M. & 
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 Extreme irregularity of the heart. [Rep. by E. J. Rogers.] Canada 
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 Chronic pleurisy; flattening of sides of chest. Canada M. & S. J., 
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 9 
 
128 Sir William Osler, Baet. 
 
 Croup or diphtheria; which? Canada M. & S. J., Montreal, 1879-80, 
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 In his: Collect, repr., 1872-82, i, no. 23. 
 
 Three cases of brain disease. Canada M. & S. J., Montreal, 1879-80, 
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 Anomalous case of pyaemia; suppuration about tissues in left 
 inferior carotid triangle; pysemic abscess beneath tensor 
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 Catalogue of a series of specimens illustrative of the morbid 
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 Case of congenital and progressive hypertrophy of the right upper 
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 In Ms: Collect, repr., 1872-82, i, no. 25. 
 
 Two cases of striated myo-sarcoma of the kidney. J. Anat. & 
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 Cases of cardiac abnormalities. Montreal Gqn. Hosp. Rep., 1880, i, 
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 In his: Collect, repr., 1872-82, i, no. 27. 
 
 On the condition of fusion of two segments of the semilunar valves. 
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 Wound of the central part of the 1st and 2d frontal convolutions 
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 Bullet wound of right frontal lobe; entire absence of cerebral 
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 Cases of aneurism of the aorta. Montreal Gen. Hosp. Rep., 1880, i, 
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 Aneurism of innominate-rupture of saccular dilatation of aorta 
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 Aneurism of splenic artery; perforation into transverse colon. 
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 Small aneurism of renal artery. Montreal Gen. Hosp. Rep., 1880, i, 
 268. 
 
 Four cases of intracranial aneurism. Montreal Gen. Hosp. Rep., 
 
 1880, i, 268-275. 
 
 Aneurisms of branches of pulmonary artery on wall of cavities; 
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 1880, i, 275-276. 
 
 Two cases of hypertrophy of the heart. Montreal Gen. Hosp. Rep., 
 1880, i, 276-282. 
 
 Perforation of pulmonary artery by ulcer of left bronchus; sudden 
 death from haemoptysis; chronic bronchitis, emphysema, 
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 Instance of four pulmonary valves. Montreal Gen. Hosp. Rep., 
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 CEdema of right lung; hydrothorax of left pleura; contracted 
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 Three cases of cancer of the stomach. Montreal Gen. Hosp. Rep., 
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 Three cases of simple ulcer of duodenum. Montreal Gen. Hosp. 
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 Typhoid fever; rapidly fatal, with nervous symptoms. Montreal 
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 Perforation of appendix vermiformis; circumscribed abscess; per- 
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 Liver; hydatid cyst. Montreal Gen. Hosp. Rep., 1880, i, 314-316. 
 
 Primary cancer of liver. Montreal Gen. Hosp. Rep., 1880, i, 316-317. 
 
 Cirrhosis of liver; collateral circulation by means of an enlarged 
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 Small contracted kidneys; left organ affected to an unusual 
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 Large cirrhotic kidneys (congested); hypertrophy of heart; 
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 Dermoid of ovary; ulcerative colitis. Montreal Gen. Hosp. Rep., 
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 Cancer of neck of uterus; constriction of right ureter; pyoneph- 
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 Ruptured follicle in right ovary; peritonitis. Montreal Gen. Hosp. 
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 Extra-uterine (abdominal) pregnancy. Montreal Gen. Hosp. Rep., 
 1880, i, 333-335. 
 
 Cryptorchidismus. Montreal Gen. Hosp. Rep., 1880, i, 335-336. 
 
 Medullary sarcoma of axillary glands; secondary masses in heart, 
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 336-339. 
 
 Sarcoma of retro-peritoneal glands; Lobstein cancer. Montreal 
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 Lympho-sarcoma of deep cervical glands, involving the thyroid and 
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 1884 
 
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 Cartwright lectures. Delivered before the Association of Physi- 
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 certain problems of the blood corpuscles. 1. The blood plaque 
 or third corpuscle. 2. Degeneration and regeneration of the 
 corpuscles. 3. The relation of the corpuscles to coagulation. 
 Phila., 1886, 55 p., 8°. 
 
 Also: Med. News, Phila., 1886, xlviii, 365; 393; 421. 
 
 Also: Med. Rec, N. Y., 1886, xxix, 377; 405; 433. 
 
 Also: N. York M. J., 1886, xliii, 341; 369; 397. 
 
 In his: Collect, repr., 1882-92, ii, no. 71. 
 
 Abstracts of the Cartwright lectures on certain problems in the 
 physiology of the blood corpuscles. Brit. M. J., Lond., 1886, i, 
 807; 861. 
 
 The bicuspid condition of the aortic valves. Tr. Ass. Am. Physi- 
 cians, Phila., 1886, i, 185-192. 
 In his: Collect, repr., 1882-92, ii, no. 72. 
 
 On the use of arsenic in certain forms of anaemia. Detroit, 1886, 
 G. S. Davis, 14 p., 8°. 
 Also: Therap. Gaz., Detroit, 1886, 3. s., ii, 741-746. 
 Also: Coll. & Clin. Rec. Phila., 1886, vii, 231-233. 
 In his: Collect, repr., 1882-92, ii, no. 73. 
 
 Embolism of right middle cerebral artery; chronic nephritis. Med. 
 News, Phila., 1886, xlix, 554. 
 
 On the treatment of pleurisy with effusion by Hay's method. 
 [Abstr.] Med. News, Phila., 1886, xlix, 645. 
 
 Pyopneumo-thorax subphrenicus. Semi-Month. J. Proc. Path. Soc, 
 Phila., Wilmington, 1886, i, 5. 
 
 The relation of the corpuscles to coagulation and thrombosis. Brit. 
 M. J., Lond., 1886, i, 917-919. 
 
136 Sir William Osler, Bart. 
 
 Osier, W., and Henry F. P. Atrophy of the stomach, with the 
 clinical features of progressive pernicious anaemia. Am. J. M. 
 Sc, Phila., 1886, n. s., xci, 498-511. 
 In Ms: Collect, repr., 1882-92, ii, no. 70. 
 
 Osier, W., and Hughes, W. Haemorrhagic pancreatitis with 
 swelling of semilunar ganglia and pacchionian corpuscles. 
 Semi-Month. J. Proc. Soc, Phila., Wilmington, 1886, i, 7. 
 
 1887 
 
 Extracts from Pathological Society of Philadelphia, 1885-1887, xii- 
 xiii, Philadelphia [1887], 69 p., 8°. 
 
 Duodenal ulcer; clinical and anatomical considerations based on 
 nine cases. Canada M. & S. J., Montreal, 1886-87, xv, 449-461. 
 In his: Collect, repr., 1882-92, ii, no. 74. 
 
 The irritable heart of civil life. (Proc. Toronto Med. Soc, April 
 14, 1887.) Canada M. & S. J., Montreal 1886-87, xv, 617-619. 
 
 An address on the haematozoa of malaria. Brit. M. J., Lond., 1887, 
 i, 556-562. 
 In his: Collect, repr., 1882-92, ii, no. 76. 
 
 Antifebrin. Therap. Gaz., Detroit, 1887, 3. s., iii, 163-167. 
 In his: Collect, repr., 1882-92, ii, no. 77. 
 
 The cardiac relations of chorea. Am. J. M. Sc, Phila., 1887, n. s., 
 xciv, 371-386. 
 In his: Collect, repr., 1882-92, ii, no. 78. 
 
 Notes on haemorrhagic infarction. Boston M. & S. J., 1887, cxvii, 
 325-328. 
 Also: Tr. Ass. Am. Physicians, Phila., 1887, ii, 133-141. 
 In his: Collect, repr., 1882-92, ii, no. 79. 
 
 On the general etiology and symptoms of chorea, based on the 
 records of 410 cases at the Infirmary for Nervous Diseases, 
 Philadelphia. Med. News, Phila., 1887, Ii, 437; 465. 
 In his: Collect, repr., 1882-92, ii, no. 80. 
 
 Case of cholesteatoma of floor of third ventricle and of the in- 
 fundibulum. J. Nerv. & Ment. Dis., N. Y., 1887, xiv, 657-673. 
 In his: Collect, repr., 1882-92, ii, no. 81. 
 
 1888 
 
 Hereditary angio-neurotic oedema. Am. J. M. Sc, Phila., 1888, n. s., 
 xcv, 362-367. 
 In his: Collect, repr., 1882-92, ii, no. 82. 
 
 Note on nitro-glycerine in epilepsy. J. Nerv. & Ment. Dis., N. Y., 
 1888, n. s., xiii, 38-39. 
 In his: Collect, repr., 1882-92, ii, no. 83. 
 
 The diagnosis of small-pox. Med. Standard, Chicago, 1888, iii, 97. 
 In his: Collect, repr., 1882-92, ii, no. 84. 
 
 Glioma of the medulla oblongata. J. Nerv. & Ment. Dis., N. Y., 1888, 
 n. s., xiii, 172-176. 
 In his: Collect, repr., 1882-92, ii, no. 85. 
 
Bibliography 137 
 
 The cerebral palsies of children. Med. News, Phila., 1888, liii, 29; 
 57; 85; 113; 141. 
 In his: Collect, repr., 1882-92, ii, no. 86. 
 
 Cases of diseases of the appendix and caecum. Med. & Surg. Re- 
 porter, Phila., 1888, lix, 419-422. 
 In his: Collect, repr., 1882-92, ii, no. 87. 
 
 Puerperal anaemia, and its treatment with arsenic. Boston M. & 
 S. J., 1888, cxix, 454. 
 Also: North Car. M. J., Wilmington, 1888, xxii, 359-363. 
 In his: Collect, repr., 1882-92, ii, no. 88. 
 
 On the diagnosis of duodenal ulcer. Med. Rec, N. Y., 1888, xxxiv, 
 609-610. 
 In his: Collect, repr., 1882-92, ii, no. 89. 
 
 Note on pachymeningitis hemorrhagica. J. Nerv. & Ment. Dis., 
 N. Y., 1888, n. s., xiii, 608-612. 
 Also: Med. News, Phila., 1888, liii, 563-565. 
 In his: Collect, repr., 1882-92, ii, no. 90. 
 
 On lesions of the conus medullaris and cauda equina, and on the 
 situation of the ano-vesical centre in man. Med. News, Phila., 
 1888, liii, 669-671. 
 In his: Collect, repr., 1882-92, ii, no. 91. 
 
 On a form of purpura associated with articular, gastro-intestinal, 
 and renal symptoms. N. York M. J., 1888, xlviii, 675-677. 
 In his: Collect, repr., 1882-92, ii, no. 92. 
 
 Notes and comments. Canada M. & S. J., Montreal, 1887-88, xvi, 
 189; 316; 375; 445; 508; 573; 732. 
 
 An accouchement in a railway closet. Canada M. & S. J., Montreal, 
 1888, xvi, 377. 
 Also: Med. Rec, N. Y., 1888, xxxiii, 97. 
 
 Note on a case of Friedreich's ataxia, with exhibition of patient. 
 Tr. Coll. Physicians, Phila., 1888, 3. s., x, 277-278. 
 
 Pulsating pleurisy. Tr. Ass. Am. Physicians, Phila., 1888, ill, 330- 
 338. 
 Also: Am. J. M. Sc, Phila., 1889, n. s., xcvii, 43-50. 
 In his: Collect, repr., 1882-92, ii, no. 95. 
 
 Enlargement and congestion of the right arm following exercise of 
 its muscles. Med. News, Phila., 1888 lii, 330. 
 Also: J. Nerv. & Ment. Dis., N. Y., 1888, n. s., xiii, 246-248. 
 
 A case of local syncope and asphyxia of the fingers. J. Nerv. & 
 Ment. Dis., N. Y., 1888, n. s., xiii, 207-208. 
 
 1889 
 
 The cerebral palsies of children; a clinical study from the In- 
 firmary for Nervous Diseases, Philadelphia. Phila., 1889, 
 P. Blakiston, Son & Co., Ill p., 8°. 
 
 Aequanimitas. Valedictory remarks to the graduates in medicine 
 of the University of Pennsylvania, May 1, 1889. Phila., 1889, 
 W. F. Fell & Co., 10 p., 8°. 
 In his: Collect, repr., 1882-92, ii, no. 97. 
 
138 Sir William Osler, Bart. 
 
 The mortality of pneumonia. PMla., 1889, 7 p., 8°. 
 Also: Univ. M. Mag., Phila., 1888-89, i, 77-82. 
 In his: Collect, repr., 1882-92, ii, no. 93. 
 
 Two cases of ulcerative endocarditis. Univ. M. Mag., Phila., 1888- 
 89, 1, 31-32. 
 
 The mortality in pneumonia. Univ. M. Mag., Phila., 1888-89, i, 225. 
 
 Cancer of the stomach, extreme mobility of tumor. Univ. M. Mag., 
 Phila., 1888-89, i, 368-370. 
 
 On the conditions of the brain suitable for operative interference. 
 [Abstr.] Univ. M. Mag., Phila., 1888-89, i, 465-468. 
 Also: Canad. Pract, Toronto, 1889, xiv, 165-167. 
 
 On certain symptoms of floating kidney. Montreal M. J., 1888-9, 
 xvii, 416-418. 
 
 The anatomical tubercle. Montreal M. J., 1888-9, xvii, 418. 
 
 Aortic aneurism; hemorrhage from the lungs. Phila. M. Times, 
 1888-9, xix, 223. 
 
 Typhlitis and appendicitis. Canada Lancet, Toronto, 1888-9, xxi, 
 193-196. 
 
 On phagocytes. An address before the Alumni Association of 
 Bellevue Hospital, New York, delivered April 3, 1889. Med. 
 News, Phila., 1889, liv, 393; 421. 
 
 Also: Med. Rec, N. Y., 1889, xxxv, 393-399. 
 
 Also: N. York M. J., 1889, xlix, 393-400. 
 
 In his: Collect, repr., 1882-92, ii, no. 94. 
 
 Annual address. The license to practice. J. Am. M. Ass., Chi- 
 cago, 1889, xii, 649-654. 
 Also: Maryland M. J., Bait, 1889, xxi, 61-67. 
 Also: Tr. M. & Chir., Pac. Maryland, Bait., 1889, 70-82. 
 In his: Collect, repr., 1882-92, ii, no. 96. 
 
 Note on intrathoracic growths developing from the thyroid gland. 
 Med. News, Phila., 1889, Iv, 257. 
 In his: Collect, repr., 1882-92, ii, no. 98. 
 
 On a case of simple idiopathic muscular atrophy, involving the 
 face and the scapulo-humeral muscles. Am. J. M. Sc, Phila., 
 1889, n. s., xcviii, 261-265. 
 In his: Collect, repr., 1882-92, ii, no. 99. 
 
 Case of syphiloma of the cord of the cauda equina; death from 
 diffuse central myelitis. J. Nerv. & Ment. Dis., N. Y., 1889. 
 n. s., xiv, 499-507. 
 In his: Collect, repr., 1882-92, ii, no. 100. 
 
 Idiocy and feeble-mindedness in relation to infantile hemiplegia; 
 a report of twenty-two cases at the Pennsylvania Institution 
 for Feeble-Minded Children. Alienist & Neurol., St. Louis, 
 1889, X, 16-23. 
 
 1890 
 
 On the value of Laveran's organisms in the diagnosis of malaria. 
 The Johns Hopkins Hosp. Bull., Bait, 1889-90, i, II. 
 In Ms: Collect repr., 1882-92, ii, no. 101. 
 
Bibliography 139 
 
 On fever of hepatic origin, particularly the intermittent pyrexia 
 associated with gallstones. Johns Hopkins Hosp. Rep., Bait., 
 1890, ii, 3-31. 
 In his: Collect, repr., 1882-92, ii, no. 102. 
 
 Cases of post-febrile insanity. Johns Hopkins Hosp. Rep., Bait., 
 1890, ii, 46-50. 
 In his: Collect, repr., 1882-92, ii, no. 103. 
 
 Rare forms of cardiac thrombi. Johns Hopkins Hosp. Rep., Bait., 
 1890, ii, 56-61. 
 In his: Collect, repr., 1882-92, ii, no. 104. 
 
 Note on endocarditis in phthisis. Johns Hopkins Hosp. Rep., 
 Bait., 1890, ii, 62-64. 
 In his: Collect, repr., 1882-92, ii, no. 105. 
 
 Tubercular peritonitis; general considerations; tubercular ab- 
 dominal tumors; curability. Johns Hopkins Hosp. Rep., Bait., 
 1890, ii, 67-113. 
 In his: Collect, repr., 1882-92, ii, no. 106. 
 
 Acute nephritis in typhoid fever. Johns Hopkins Hosp. Rep., 
 Bait, 1890, ii, 119-128. 
 In his: Collect, repr., 1882-92, ii, no. 107. 
 
 On the amoeba coli in dysentery and in dysenteric liver abscess. 
 Johns Hopkins Hosp. Bull., Bait., 1889-90, i, 53-54. 
 In his: Collect, repr., 1882-92, ii, no. 108. 
 
 On the form of convulsive tic, associated with coprolalia, etc. 
 Med. News, Phila., 1890, Ivii, 645-647. 
 In his: Collect, repr., 1882-92, ii, no. 109. 
 
 On the symptoms of chronic obstruction of the common bile-duct 
 by gallstones. Ann. Surg., St. Louis, 1890, xi, 161-185. 
 
 Ueber die in Dysenteric und dysenterischen Leberabscess vor- 
 handene Amoeba, Centralbl. f. Bacteriol. u. Parasitenkr., 
 Jena., 1890, vii, 736-737. 
 
 Multiple thrombi-multiple gangrene. (Proc. Johns Hopkins Hosp. 
 Med. Soc, Oct. 22, 1889.) Johns Hopkins Hosp. Bull., Bait., 
 1889-90, i, 12. 
 
 Fatal hemorrhage into a large bronchocele. (Proc. Johns Hop- 
 kins Hosp. Med. Soc, Nov. 18, 1889.) Johns Hopkins Hosp. 
 Bull., Bait., 1889-90, i, 23. 
 
 Congenital heart disease. (Proc. Johns Hopkins Hosp. Med. Soc, 
 Dec 2, 1889.) Johns Hopkins Hosp. Bull., Bait, 1889-90, i, 34. 
 
 Filaria sanguinis hominis. (Proc. Johns Hopkins Hosp. Med. 
 Soc, Jan. 6, 1890.) Johns Hopkins Hosp. Bull., Bait, 1889-90. 
 i, 48. 
 
 Weir Mitchell. Remarks on the occasion of the presentation to 
 the College of Physicians, Phila., of the portrait of Dr. S. Weir 
 Mitchell, April 22, 1890. Johns Hopkins Hosp. Bull., Bait, 
 1889-90, i, 64. 
 
 Aortic insufficiency. (Proc. Johns Hopkins Hosp. Med. Soc, Oct. 
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140 Sir William Oslee, Bart. 
 
 Hereditary chorea. (Proc. Johns Hopkins Hosp. Med. Soc, Oct. 
 20, 1890.) Johns Hopkins Hosp. Bull., Bait, 1889-90, i, 110. 
 In his: Collect, repr., 1882-92, ii, no. 114. 
 
 General bronchiectasis of left lung, foetid bronchitis; incision 
 of cavity; death. (Proc. Johns Hopkins Hosp. Med. Soc, 
 Oct. 20, 1890.) Johns Hopkins Hosp. Bull., Bait, 1889-90, i, 
 109. 
 In his: Collect repr., 1882-92, ii, no. 115. 
 
 1891 
 
 A case of sensory aphasia; word-blindness with hemianopsia. Am. 
 J. M. Sc, Phila., 1891, n. s., ci, 219-224. 
 In his: Collect repr., 1882-92, ii, no. 110. 
 
 Rudolf Virchow; the man and the student. Boston M. & S. J., 
 1891, cxxv, 425-427. 
 Also: Johns Hopkins Univ. Circ, Bait, 1891, xi, 17-19. 
 In his: Collect repr., 1882-92, ii, no. 111. 
 
 Diagnosis of tuberculous broncho-pneumonia in children. Arch. 
 Pediat., Phila., 1891, viii, 825-829. 
 Also: Tr. Am. Pediat Soc. (N. Y.), 1892, iii, 25-29. 
 In his: Collect repr., 1882-92, no. 112. 
 
 Doctor and nurse; remarks to the first class of graduates from 
 the Training School for Nurses at The Johns Hopkins Hos- 
 pital. Bait., 1891, J. Murphy & Co., 11 p. 4". 
 In his: Collect repr., 1882-92, ii, no. 113. 
 
 Obstruction of the superior vena cava. (Proc. Johns Hopkins 
 Hosp. Med. Soc, Jan. 5, 1891.) Johns Hopkins Hosp. Bull., 
 Bait., 1891, ii, 40. 
 In his: Collect repr., 1882-92, ii, no. 116. 
 
 Case of multiple cysticerci. (Proc. Johns Hopkins Hosp. Med. 
 Soc, Feb. 2, 1891.) Johns Hopkins Hosp. Bull., Bait., 1891, 
 ii, 61. 
 In his: Collect repr., 1882-92, ii, no. 117. 
 
 Disease of the coronary arteries; fibroid heart Tr. Path. Soc 
 Phila. (1887-9), 1891, xiv, 106-108. 
 
 Acute phthisis; erosion of a large branch of the pulmonary 
 artery; sudden fatal haemoptysis. Tr. Path. Soc Phila. 
 (1887-9), 1891, xiv, 169. 
 
 The diagnosis of broncho-pneumonia (acute and chronic) from 
 tuberculosis. N. York M. J., 1891, liv, 666. 
 
 Report on the Koch treatment in tuberculosis. Johns Hopkins 
 Hosp. Bull., Bait., 1891, ii, 7-14. 
 
 Remarks on hysteria with paroxysmal inspiratory spasm. (Proc. 
 Johns Hopkins Hosp. Med. Soc, Nov. 17, 1890.) Johns Hop- 
 kins Hosp. Bull., Bait, 1891, ii, 18. 
 
 Two cases of pernicious malaria. (Proc. Johns Hopkins Hosp. 
 Med. Soc, Oct 5, 1891.) Johns Hopkins Hosp. Bull., Bait., 
 1891, ii, 161-162. 
 
 Richard Lea MacDonnell (Obituary). N. York M. J., 1891, liv, 162. 
 
BiBLIOGKAPHY 141 
 
 1892 
 
 The principles and practice of medicine. Designed for the use 
 of practitioners and students of medicine. New York, 1892, 
 D. Appleton & Co., 1079 p. 8°. 
 
 Teacher and student. An address delivered on the occasion of 
 the opening of the new building of the College of Medicine 
 and Surgery of the University of Minnesota. Minneapolis, 
 Oct. 4, 1892, Bait, 1892, J. Murphy & Co., 22 p. 8°. 
 In his: Collect, repr., 1882-92, ii, no. 123. 
 
 Collected reprints. Second series. (January 1, 1882-January 1, 
 1892.) [Bait., 1892.] 8°. 
 
 Remarks on specialism. Boston M. & S. J., 1892, cxxvi, 457-459. 
 Also: Med. News, Phila., 1892, Ix, 542-544. 
 Also: Arch. Pediat., Phila., 1892, ix, 481-488. 
 In his: Collect, repr., 1882-92, ii, no. 118. 
 
 The healing of tuberculosis. Climatologist, Phila., 1892, ii, 149- 
 153. 
 In his: Collect, repr., 1892-7, iii, no. 119. 
 
 On the association of congenital wry-neck, with marked facial 
 asymmetry. Arch. Pediat., N. Y., 1892, ix, 81-85. 
 In his: Collect, repr., 1882-92, ii, no. 120. 
 
 Interstitial processes in the central nervous system. Tr. Cong. 
 Am. Phys. & Surg., 1891, N. Haven, 1892, ii, 144-146. 
 In his: Collect, repr., 1892-7, iii, no. 121. 
 
 The cold-bath treatment of typhoid fever. Med. News, Phila., 
 1892, Ixi, 628-631. 
 In his: Collect, repr., 1892-7^ iii, no. 122. 
 
 Notes on the diagnosis and treatment of cholera. Med. News, 
 Phila., 1892, Ixi, 290. 
 
 License to practice. Northwest-Lancet, St. Paul, 1892, xii, 383. 
 
 An acute myxoedematous condition occurring in goitre. (Proc. 
 Johns Hopkins Hosp. Med. Soc, Dec. 7, 1891.) Johns Hop- 
 kins Hosp. Bull., Bait., 1892, iii, 42. 
 
 Chronic cerebro-spinal meningitis. (Proc. Johns Hopkins Hosp. 
 Med. Soc, Oct. 17, 1892.) Johns Hopkins Hosp. Bull., Bait., 
 1892, iii, 119. 
 
 Localized pyo-pneumothorax. (Proc. Johns Hopkins Hosp. Med. 
 Soc, Oct. 17, 1892.) Johns Hopkins Hosp. Bull., Bait, 1892, 
 iii, 19. 
 
 1893 
 
 Note on arsenical neuritis following the use of Fowler's solution. 
 (,^4 31 mis.) Montreal M. J., 1892-3, xxi, 721-724. 
 In his: Collect, repr., 1892-7, iii, no. 130. 
 
 Note on a remarkable house epidemic of typhoid fever. Univ. 
 M. Mag., Phila., 1892-3, v, 522-524. 
 In his: Collect, repr., 1892-7, iii, no. 131. 
 
 Tuberculous pericarditis. Am. J. M. Sc, Phila., 1893, n. s., cv, 
 20-27. 
 In his: Collect repr., 1892-7, iii, no. 124. 
 
142 Sir William Osler, Bart. 
 
 On dilatation of the colon in young children. Arch. Pediat, N. Y., 
 
 1893, X, 111-119. 
 Also: (Proc. Johns Hopkins Hosp. Med. Soc, Jan. 16, 1893.) 
 
 Johns Hopkins Hosp. Bull., Bait, 1893, iv, 41-43. 
 In his: Collect, repr., 1892-7, iii, no. 125. 
 
 Physic and physicians as depicted in Plato. Boston M. & S. J., 
 1893, cxxviii, 129; 153. 
 In Ms: Collect, repr., 1892-7, iii, no. 126. 
 
 Case of arterio-venous aneurism of the axillary artery and vein 
 of fourteen years' duration. Ann. Surg., Phila., 1893, xvii, 
 37-40. 
 In his: Collect, repr., 1892-7, iii, no. 127. 
 
 The chronic intermittent fever of endocarditis. Practitioner, 
 Lond., 1893, 1, 181-190. 
 In his: Collect, repr., 1892-7, iii, no. 128. 
 
 Remarks on the varieties of chronic chorea, and a report upon 
 two families of the hereditary form, with one autopsy. 
 J. Nerv. & Ment. Dis., N. Y., 1893, xx, 97-111. 
 In his: Collect, repr., 1892-7, iii, no. 129. 
 
 Cases of sub-phrenic abscess. Tr. Ass. Am. Physicians, Phila., 
 1893, viii, 257-267. 
 Also: Canad. Pract, Toronto, 1893, xviii, 565-574. 
 In his: Collect, repr., 1892-7, iii, no. 132. 
 
 Shattuck lecture. Mass. Med. Soc, 1893. Tuberculous pleurisy. 
 Boston M. & S. J., 1893, cxxix, 53; 81; 109; 134. 
 Also: Med. Communicat. Mass. M. Soc, Boston, 1893, xvi, 49-112. 
 In his: Collect, repr., 1892-7, iii, no. 133. 
 
 Profound toxemia with slight tuberculous lesions. Med. News, 
 Phila., 1893, Ixiii, 632. 
 
 Jean Martin Charcot, memorial notice. Johns Hopkins Hosp. 
 Bull., Bait., 1893, iv, 87-88. 
 
 On sporadic cretinism in America. Tr. Am. J. Am. Physicians, 
 Phila., 1893, viii, 380-398. 
 Also: Am. J. M. Sc, Phila., 1893, n. s., cvi, 503-518. 
 In his: Collect, repr., 1892-7, iii, no. 136. 
 
 Notes on tuberculosis in children. Arch. Pediat, N. Y., 1893, 
 X, 979-986. 
 In his: Collect repr., 1892-7, iii, no. 137. 
 
 Hirt, Ludwig. The diseases of the nervous system. A text-book 
 for physicians and students. Transl. with permission of the 
 author by August Hoch, assisted by Frank R. Smith, with 
 an introduction by William Osier, N. Y., 1893. D. Appleton 
 & Co., 698 p. 8°. 
 
 1894 
 
 Lectures on the diagnosis of abdominal tumors, delivered to the 
 post-graduate class, Johns Hopkins University, 1893. New 
 York, 1894, D. Appleton & Co., 192 p, 8°. 
 Also: N. York M. J., 1894, lix, 129; 161; 193; 260; 385; 417; 
 
 481; 545; 577: Ix, 65; 97. 
 In his: Collect repr., 1892-7, iii, no. 146. 
 
Bibliography 143 
 
 On chorea and choreiform affections. Phila., P. Blakiston, Son 
 & Co., 1894, 125 p. 8°. 
 In his: Collect, repr., 1892-7, iii, no. 149. 
 
 Tuberculosis. 
 
 In: Am. Text-Bk. Dis. Child. (Starr), Phila., 1894, 94-126. 
 In his: Collect, repr., 1892-7, iii, no. 134. 
 
 Diseases of the blood. 
 In: Text-book Theory & Pract. Med. (Pepper), Phila., 1894, ii, 
 
 182-233. 
 In his: Collect, repr., 1892-7, iii, no. 135. 
 
 Diseases of the suprarenal capsules and ductless glands. 
 
 In: Text-book Theory & Pract. Med. (Pepper), Phila., 1894, ii, 
 234-246. 
 
 Toxaemia in tuberculosis. Practitioner, Lond., 1894, Iii, 26-30. 
 In his: Collect, repr., 1892-7, iii, no. 138. 
 
 Parotitis in pneumonia. Case of pericarditis treated by incision 
 and drainage. Univ. M. Mag., Phila., 1893-4, vi, 245-249. 
 In his: Collect, repr., 1892-7, iii, no. 139. 
 
 The army surgeon. An address delivered at the closing exer- 
 cises of the Army Medical School, Washington, D. C, Feb. 28, 
 1894. Med. News, Phila., 1894, Ixiv, 318-322. 
 In his: Collect, repr., 1892-7, iii, no. 147. 
 
 The leaven of science. An address delivered at the opening of 
 the Wistar Institute of Anatomy and Biology of the Univer- 
 sity of Pennsylvania, May 21, 1894. Univ. M. Mag., Phila., 
 1893-4, vi, 573-586. 
 In his: Collect, repr., 1892-7, iii, no. 148. 
 
 Oliver Wendell Holmes. Johns Hopkins Hosp. Bull., Bait., 1894, 
 V, 85-88. 
 In his: Collect, repr., 1892-7, iii, no. 150. 
 
 The heart in chorea minor. Med. Chron., Manchester, 1894, n. s., 
 1, 321-332. 
 
 Clinical remarks on a case of typhoid fever, complicated with 
 bronchitis and laryngitis. Maryland M. J., Bait., 1894, xxxi, 
 1-3. 
 
 The registration of pulmonary tuberculosis. Phila. Polyclin., 
 
 1894, iii, 65. 
 
 Case of hereditary chorea. (Proc. Johns Hopkins Hosp. Med. 
 Soc, Oct. 1, 1894.) Johns Hopkins Hosp. Bull., Bait., 1894, 
 V, 119-120. 
 
 1895 
 
 The principles and practice of medicine. Designed for the use 
 of practitioners and students of medicine. 2. ed. New York, 
 
 1895, D. Appleton & Co., 1143 p. 8°. 
 
 Report on typhoid fever. I. General analysis and summary of 
 the cases. II. Treatment of typhoid fever. III. A study of 
 the fatal cases. IV. Notes on special features, symptoms 
 and complications. Johns Hopkins Hosp. Rep., Bait., 1894-5, 
 iv, 1-72. 
 In his: Collect, repr., 1892-7, iii, nos. 140-143. 
 
 10 
 
144 Sir William Osler, Bart. 
 
 On the neurosis following enteric fever, known as " the typhoid 
 spine." Johns Hopkins Hosp. Rep., 1894-5, iv, 73-82. 
 Also: Am. J. M. Sc, Phila., 1894, n. s., cvii, 23-30. 
 In his: Collect, repr., 1892-7, iii, no. 144. 
 
 Typhoid fever in Baltimore. Johns Hopkins Hosp. Rep., Bait., 
 1894-5, iv, 159-167. 
 In Ms: Collect, repr., 1892-7, iii, no. 145. 
 
 Introductory remarks to course of clinical demonstrations on 
 typhoid fever. Maryland M. J., Bait., 1894-5, xxxii, 79-82. 
 In his: Collect, repr., 1892-7, iii, no. 151. 
 
 Cancer of the stomach with very rapid course. Univ. M. Mag., 
 Phila., 1894-5, vii, 248-252. 
 In his: Collect, repr., 1892-7, iii, no. 152. 
 
 Teaching and thinking; the two functions of a medical school. 
 Montreal M. J., 1894-5, xxiii, 561-572. 
 In his: Collect, repr., 1892-7, iii, no. 153. 
 
 Case of sporadic cretinism (infantile myxoedema) treated success- 
 fully with thyroid extract. Arch. Pediat., N. Y., 1895, xii, 
 105-108. 
 In his: Collect, repr., 1892-7, iii, no. 154. 
 
 Diseases, the direct or indirect result of infection. Text-hook 
 Nerv. Dis. Am. Authors (Dercum), Phila., 1895, 203-226. 
 In his: Collect, repr., 1892-7, iii, no. 157. 
 
 Studies in typhoid fever: Five years' experience with the cold- 
 bath treatment. Johns Hopkins Hosp. Rep., Bait., 1895, v, 
 321-326. 
 
 Also: Canada M. Rec, Montreal, 1895-6, xxiv, 56-60. 
 
 Also: Med. News, Phila., 1895, Ixvii, 393-395. 
 
 Also: Canada Lancet, Toronto, 1895-6, xxviii, 261-263. 
 
 In his: Collect, repr., 1892-7, iii, no. 158. 
 
 Studies in typhoid fever: Analysis and summary of the cases; 
 special features, symptoms, and complications; a study of 
 the fatal cases. Johns Hopkins Hosp. Rep., Bait., 1895, v, 
 281; 283; 459. 
 In his: Collect, repr., 1892-7, iii, no. 159. 
 
 Neuritis during and after typhoid fever. Johns Hopkins Hosp. 
 Rep., Bait, 1895, v, 397-416. 
 In his: Collect, repr., 1892-7, iii, no. 160. 
 
 Chills in typhoid fever. Johns Hopkins Hosp. Rep., Bait., 1895, 
 V, 445-457. 
 In his: Collect, repr., 1892-7, iii, no. 161. 
 
 The practical value of Laveran's discoveries. Med. News, Phila., 
 1895, Ixvii, 561-564. 
 In his: Collect, repr., 1892-7, iii, no. 162. 
 
 On the visceral complications of erythema exudativum multi- 
 forme. Am. J. M. Sc, Phila., 1895, n. s., ex, 629-646. 
 Also: Select essays and monog., Lond., 1897, 321-347. 8°. 
 In his: Collect, repr., 1892-7, iii, no. 163. 
 
 Case of cerebral haemorrhage in a foetus. Teratologia, Lond. & 
 Edinb., 1895, ii, 13. 
 
BiBLIOGliAPHY 145 
 
 Hyperpyrexia in typhoid fever. (Proc. Johns Hopkins Hosp. 
 Med. Soc, Oct. 7, 1895.) Johns Hopkins Hosp. Bull., Bait, 
 
 1895, vi, 143. 
 
 Abscess of the liver, perforating the lung. (Proc. Johns Hopkins 
 Hosp. Med. Soc, Oct. 7, 1895.) Johns Hopkins Hosp. Bull., 
 Bait, 1895, vi, 144. 
 
 President's address. Tr. Ass. Am. Physicians, Phila., 1895, x, xi-xv. 
 
 1896 
 
 An Alabama student. Baltimore, Friedenwald Co., 1896, 19 p. 
 12°. 
 Also: Johns Hopkins Hosp. Bull., Bait., 1896, vii, 6-11. 
 In his: Collect, repr., 1892-7, iii, no. 166. 
 
 Typhoid fever in country districts. Maryland M. J., Bait, 1895-6, 
 xxxiii, 55-62. 
 In his: Collect, repr., 1892-7, iii, no. 155. 
 
 Visible contractile tumor of the pylorus following ulcer of the 
 stomach. Montreal M. J., 1895-6, xxiv, 81-86. 
 In his: Collect, repr., 1892-7, iii, no. 156. 
 
 John Keats, the apothecary poet. Baltimore, Friedenwald Co., 
 
 1896. 18 p. 12°. 
 
 Also: Johns Hopkins Hosp. Bull., Bait, 1896, vii, 11-16. 
 In his: Collect, repr., 1892-7, iii, no. 164. 
 
 Thomas Dover, M. D. (of Dover's powder), physician and buc- 
 caneer. Baltimore, Friedenwald Co., 1896. 18 p. 12°. 
 Also: Johns Hopkins Hosp. Bull., Bait., 1896, vii, 1-6. 
 In his: Collect, repr., 1892-7, iii, no. 165. 
 
 Addison's disease. Med. Bull., Phila., 1896, xviii, 81-84. 
 In his: Collect, repr., 1892-7, iii, no. 168. 
 
 On the association of enormous heart hypertrophy, chronic pro- 
 liferative peritonitis and recurring ascites, with adherent 
 pericardium. Arch. Pediat, N. Y., 1896, xiii, 1-10. 
 In his: Collect, repr., 1892-7, iii, no. 169. 
 
 Hemiplegia in typhoid fever. J. Nerv. & Ment Dis., N. Y., 1896, 
 n. s., xxi, 295-304. 
 In his: Collect, repr., 1892-7, iii, no. 170. 
 
 Diseases of the blood and the ductless glands. 
 
 In: Am. Text-book Applied Therap., Phila., 1896, 902-927. 
 In his: Collect repr., 1892-7, iii, no. 171. 
 
 The cerebral complications of Raynaud's disease. Am. J. M. Sc, 
 Phila., 1896, n. s., cxii, 522-529. 
 In his: Collect repr., 1892-7, iii, no. 172. 
 
 Lectures on angina pectoris and allied states. N. York M. J., 
 1896, Ixiv, 177; 249; 281; 346. 
 In his: Collect, repr., 1892-7, iii, no. 173. 
 
 The study of the fevers of the South. J. Am. M. Sc, Chicago, 
 1896, xxi, 999-1004. 
 
 Treatment of fevers. Maritime M. News, Halifax, 1896, viii, 
 183-186. 
 
146 Sir William Osler, Bart. 
 
 Association of American Medical Colleges. Bull. Am. Acad. M., 
 Easton, Pa., 1895-6, ii, 508-510. 
 
 Chills in typhoid fever. Univ. M. Mag., Phila., 1895-6, viii, 77-85. 
 
 Pleuro-peritoneal tuberculosis. (Proc. Johns Hopkins Hosp. Med. 
 Soc, Nov. 4, 1896.) Johns Hopkins Hosp. Bull., Bait., 1896, 
 vii, 79. 
 
 Case of Addison's disease; death during treatment with the 
 suparenal extract. (Proc. Johns Hopkins Hosp. Med. Soc, 
 Oct. 19, 1896.) Johns Hopkins Hosp. Bull., Bait., 1896, vii, 
 208-209. 
 
 Ephemerides, 1895: 
 I. Introduction. 
 II. Heberden's nodes. 
 
 III, Geographical tongue. 
 
 IV. Buccal leucoplacia. 
 
 V. Acute gout in the United States. 
 VI. Calcification of the auricle. 
 VII. Arthritis deformans in childhood. 
 VIII. Unusual types of night-terrors; day-terrors. 
 IX. Tobacco angina. 
 X. Unusually persistent oxyuris. 
 XI. Is the coin sound distinctive of pneumothorax? 
 XII. Head-swaying in children. 
 
 Montreal M. J., 1895-6, xxiv, 518; 631; 694; 777; 877; 969. 
 
 1897 
 
 Lectures on angina pectoris and allied states. New York, 1897, 
 D. Appleton & Co., 160 p. 8°. 
 
 Collected reprints. Third series. (January 1, 1892- January 1, 
 1897.) [Bait, 1897.] 
 
 On six cases of Addison's disease, with the report of a case greatly 
 benefited by the use of the suprarenal extract. Internat. M. 
 Mag., Phila., 1896-7, v, 3-11. 
 In his: Collect, repr., 1892-7, iii, no. 167. 
 
 On the classification of the tics or habit movements. Arch. 
 Pediat., N. Y., 1897, xiv, 1-5. 
 In his: Collect, repr., 1897-1902, iv, no. 174. 
 
 On certain features in the prognosis of pneumonia. Am. J. M. 
 Sc, Phila., 1897, n. s., cxiii, 1-10. 
 Also: North Car. M. J., Wilmington, 1897, xxxix, 295-307. 
 In his: Collect, repr., 1897-1902, iv, no. 175. 
 
 Mitral stenosis; sudden death; ball thrombus in the left auricle. 
 Montreal M. J., 1896-7, xxv, 729-731. 
 In his: Collect, repr., 1897-1902, iv, no. 176. 
 
 The diagnosis of malarial fever. Med. News, N. Y., 1897, Ixx, 
 289-292. 
 In his: Collect, repr., 1897-1902, iv, no. 177. 
 
 On certain unusual forms of paraesthetic meralgia. J. Nerv. & 
 Ment. Dis., N. Y., 1897, xxiv, 131-137. 
 In his: Collect, repr., 1897-1902, iv, no. 178. 
 
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 the 99th annual session, Baltimore, Md., April 27, 1897. 
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 Maryland, Bait, 1897, 21-29. 
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 A case of leprosy, with exhibition of patient. Maryland M. J., 
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 XIII. Rheumatic neuritis associated with subcutaneous fibroid 
 
 nodules. 
 
 XIV. Bright's disease or myxoedema. 
 
 XV. Remarkable noisy expiration in chronic emphysema. 
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 XVII. Lineae albicantes. 
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 XIX. Vertigo and ocular defects. 
 
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 A clinical lecture on the ball-valve gall-stone in the common duct. 
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 Nurse and patient An address. Baltimore, 1897, J. Murphy & 
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 Influence of Louis on American medicine. Johns Hopkins Hosp. 
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 British medicine in Greater Britain. The address in medicine 
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 Internal medicine as a vocation. Med. News, N. Y., 1897, Ixxi, 
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 Pneumonia: A review of the cases studied by the third and 
 fourth classes, Johns Hopkins Hospital, session of 1896-97. 
 Nat M. Rev., Wash., 1897-8, vii, 177-180. 
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 Occasional notes on American medical classics; introductory 
 lecture to a course of clinical observations in the Pennsyl- 
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148 SiE William Oslee, Bart. 
 
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 Address in medicine. Brit. M. J., Lond., 1897, ii, 576-581. 
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 Address in medicine, at the sixty-fifth, annual meeting of the 
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 1897. J. Am. M. Ass., Chicago, 1897, xxix, 507-512. 
 
 La medicine anglaise dans la Nouvelle Angleterre. [Trans.] 
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 Relapses in typhoid fever. J. Am. M. Ass., Chicago, 1897, xxix, 
 97. 
 
 The disguises of typhoid fever. Gaillard's M. J., N. Y., 1897, 
 Ixiv, 350-352. 
 
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 The principles and practice of medicine. Designed for the use 
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 1898, D. Appleton & Co., 1181 p. 8°. 
 
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 Pneumonia. J. Pract. Med., N. Y., 1897-8, viii, 308-311. 
 
 On chronic symmetrical enlargement of the salivary and lach- 
 rj^mal glands. Am. J. M. Sc, Phila., 1898, cxv, 27-30. 
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 Ein Fall von Fistula oesophago-pleuro-thoracica. Arch. f. Ver- 
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 The relation of typhoid mortality and sewerage. Maryland M. J., 
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 Leprosy in the United States, with the report of a case. Johns 
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 On diffuse scleroderma; with special reference to diagnosis, and 
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 The arthritis of cerebro-spinal fever. Boston M. & S. J., 1898, 
 cxxxix, 641-643. 
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 Ephemerides, 1897: 
 
 XX. The blood coagulation time in jaundice. 
 XXI. Facial paralysis with herpes zoster. 
 XXII. Paralysis of the ocular muscles in albuminuria. 
 
 Montreal M. J., 1898, xxvii, 36-38. 
 
 Tuberculosis. Am. Text-Bk. Dis. Child. (Starr), 2. ed. Phila., 
 
 1898, 270-302. 
 
 1899 
 
 On the study of pneumonia. St. Paul M. J., St. Paul, Minn., 1899, 
 i, 5-9. 
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 The problem of typhoid fever in the United States. Baltimore, 
 
 1899, J. Murphy Co., 13 p. 8°. 
 
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 In his: Collect, repr., 1897-1902, iv, no. 199. 
 
 An acute myxoedematous condition with tachycardia, glycosuria, 
 melaena, mania, and death. J. Nerv. & Ment. Dis., N. Y., 1899, 
 xxvi, 65-71. 
 In his: Collect, repr., 1897-1902, iv, no. 200. 
 
 The clinical features of sporadic trichinosis. Am. J. M. Sc, Phila., 
 1899, n. s., cxvii, 251-265. 
 In his: Collect, repr., 1897-1902, iv, no. 201. 
 
 In memoriam, William Pepper. Phila. M. J., 1899, iii, 607-611. 
 In his: Collect, repr., 1897-1902, iv, no. 202. 
 
 Chronic splenic enlargement with recurring gastro-intestinal 
 haemorrhages. Edinb. M. J., 1899, n. s., v, 441-453. 
 In his: Collect, repr., 1897-1902, iv, no. 204. 
 
 Cavendish lecture. On the etiology and diagnosis of cerebro- 
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 Also: West. Lond. M. J., Lond., 1899, iv, 145-188. 
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 Also: Boston M. & S. J., 1899, cxli, 1; 32. 
 
 Also: Canad. Pract. & Rev., Toronto, 1899, xxv [xxiv], 447-455. 
 Also: Lancet, Lond., 1899, i, 1699-1709. 
 Also: Phila. M. J., 1899, iv, 26-41. 
 In his: Collect, repr., 1897-1902, iv, no. 205. 
 
 After twenty-five years. An address at the opening of the session 
 of the medical faculty, McGill University, Sept. 21, 1899. 
 Montreal M. J., 1899, xxviii, 823-833. 
 In his: Collect, repr., 1897-1902, iv, no. 206. 
 
 The diagnosis of typhoid fever. A discussion at the New York 
 State Medical Association, October 25 1899. N. York M. J., 
 1899, Ixx, 673-676. 
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 Clinical remarks on hypertrophic cirrhosis of the liver with 
 bronzing of the skin: haemochromatosis. Brit. M. J., Lond., 
 1899, ii, 1595-1596. 
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150 Sir William Oslee, Bart. 
 
 On the medical tests for admission to the public services (Dis- 
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 The preventive and remedial treatment of tuberculosis (Discus- 
 sion). Brit. M. J., Lond., 1899, ii, 1155. 
 
 Blood parasites of frog's. N. York M. J., 1899, Ixix, 63. 
 
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 1900 
 
 On splenic anaemia. Am. J. M. Sc, Phila., 1900, n. s., cxix, 54-73. 
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 The home treatment of consumption. Maryland M. J., Bait., 1900, 
 xliii, 8-12. 
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 A case of multiple gangrene in malarial fever. Johns Hopkins 
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 The visceral lesions of the erythema group. Brit. J. Dermat., 
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 An address on the importance of post-graduate study. Lancet, 
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 Elisha Bartlett, a Rhode Island philosopher. An address delivered 
 before the Rhode Island Medical Society, Dec. 7, 1899. With 
 an appendix containing Dr. Bartlett's sketch of Hippocrates. 
 Providence, 1900, Snow & Furnham, 43 p. 8°. 
 
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 An address on John Locke as a physician. Delivered before the 
 Students' Societies of the Medical Department of the Uni- 
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 1900, viii, 363-371. 
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 Analysis and general summary of the cases [of typhoid fever] 
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 1901 
 
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 1902 
 
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 1903 
 
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154 Sir William Oslee, Baet. 
 
 On the so-called Stokes-Adams disease (slow pulse with syncopal 
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 In his: Collect, repr., 1902-1907, v, no. 246. 
 
 Chronic cyanosis with polycythaemia and enlarged spleen; a new 
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 In Ms: Collect, repr., 1902-1907, v, no. 247. 
 
 The master-word in medicine. An address to medical students 
 on the occasion of the opening of the new buildings of the 
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 Baltimore, 1903, J. Murphy Co., 33 p. 8°. 
 
 Also: Brit. M. J., Lond., 1903, ii, 1196-1200. 
 
 Also: Canad. J. M. & S., Toronto, 1903, xiv, 333-347. 
 
 Also: Montreal M. J., 1903, xxxii, 771-785. 
 
 Also: Johns Hopkins Hosp. Bull., Bait, 1904, xv, 1-7. 
 
 In Ms: Collect, repr., 1902-1907, v, no. 248. 
 
 The master-word is work, 1903 (?) Date of publication not ascer- 
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 Typhoid fever and tuberculosis. Am. Med., Phila., 1903, vi, 1015- 
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 Diabetes in infancy. Phila. M. J., 1903, xi, 538. 
 
 The significance of cutaneous angiomata. Med. News, N. Y., 1903, 
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 The varieties of linese albicantes. Med. News, N. Y., 1903, Ixxxiii, 
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 Aneurism of upper part of thoracic aorta. (Proc. Johns Hopkins 
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 1904 
 
 Aequanimitas, with other addresses to medical students, nurses 
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BiBLIOGRArHY 155 
 
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 The Ingersoll lecture, 1904. Science and immortality. Boston, 
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 The " phthisiologia " of Richard Morton, M. D. Med. Libr. & Hist. 
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 Ochronosis: the pigmentation of cartilages, sclerotics, and skin 
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 On the surgical importance of the visceral crises in the erythema 
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 In his: Collect, repr., 1902-1907, v, no. 254. 
 
 Angina pectoris and arterio-sclerosis. J. Am. M. Ass., Chicago, 
 
 1904, xliii, 775. 
 
 Chronic cyanotic polycythaemia with enlarged spleen. Brit. M. J., 
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 Korsakoff's disease. N. York M. J. [etc.], 1904, Ixxix, 570. 
 
 Vasomotor mottling. (Proc. Johns Hopkins Hosp. Med. Soc, 
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 Aneurism of arch of aorta and innominate. (Proc. Johns Hopkins 
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 Remarks at the unveiling of the memorial tablet to Dr. Jesse W. 
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 The home in its relation to the tuberculosis problem. Sanitarian, 
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 Also: Canada Lancet, Toronto, 1904-5, xxxviii, 600-612. 
 
 1905 
 
 The principles and practice of medicine, designed for the use of 
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 1905, D. Appleton & Co. 1143 p. 8°. 
 
 Counsels and ideals from the writings of ... . [Selected and 
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 Unity, peace, and concord; a farewell address to the medical pro- 
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 Also: J. Am. M. Ass., Chicago, 1905, xlv, 365-369. 
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 The student life. A farewell address to Canadian and American 
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156 SiE William Osler, Baet. 
 
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 Acute tuberculous pneumonia. Brooklyn ]\L J., 1905, xix, 57-61. 
 
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 1905, i, 141-154. 
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 The Roval Dental Hospital of London: address. Lancet, Lend., 
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 On the medical aspects of carcinoma of the breast. Brit. M. J., 
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 XL George Bodington. 
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162 Sir William Oslee, Bart. 
 
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 The proposed general catalogue of incunabula. Bull. Med. Library 
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 Men and books: 
 
 XXIV. Israel and medicine. Canad. M. Ass. J., Toronto, 1914, 
 iv, 729-733. 
 
 XXV. "Looking back." 1889. 
 Ihid., 1012-1014. 
 
 XXVI. Nathan Smith. 
 Idid., 1109-1111. 
 
 An address on the medical clinic; a retrospect and a forecast. 
 Brit M. J., Lond., 1914, i, 10-16. 
 
 Early printed medical books. Brit. M. J., Lond., 1914, i, 205. 
 Also: Lancet, Lond., 1914, i, 255. 
 
 The visceral lesions of purpura and allied conditions. Brit. M. J., 
 Lond., 1914, i, 517-525. 
 
 Some MSS. and books in the Bodleian Library illustrating the 
 evolution of British surgery. Brit. M. J., Lond., 1914, i, 825- 
 826. 
 
 An address at the new pathological laboratory at the Royal Mineral 
 Water Hospital, Bath. Brit M. J., Lond., 1914, i, 1314-1315. 
 Also: Lancet Lond., 1914, i, 1689-1690. 
 
 Bacilli and bullets ; an address to the officers and men in the camps 
 at Churn. Brit. M. J., Lond., 1914, ii, 569-570. 
 Also: Med. Mag., Lond., 1914, xxiii, 580-583. 
 
 Sir James Y. Simpson and anaesthesia (Correspondence). Lancet, 
 Lond., 1914, ii, 1067. 
 
 Long and anaesthesia (Correspondence). Lancet, Lond., 1914, ii, 
 1219-1220. 
 
164 Sir William Osler, Bart. 
 
 Syphilis of tlie liver with the picture of Banti's disease. Clin. J., 
 Lond., 1914, xliii, 462-464. 
 
 Appreciation of Silas Weir Mitchell. Brit. M. J., Lond., 1914, i, 
 120-121. 
 
 The war and typhoid fever. Brit. M. J., Lond., 1914, ii, 909-913. 
 Also: Tr. Soc. Trop. M. & Hyg., Lond., 1914-15, viii, 45-74. 
 
 Burton's Anatomy of melancholy. Yale Rev., N. Haven, 1914, iii, 
 
 251-271. 
 
 Osier, Sir W. & Churchman, J. W. Syphilis. 
 In: Mod. Med., 2. ed. (Osier & McCrae), Phila. & N. Y., 1914, ii, 
 144-215. 
 
 Osier, Sir W. & McCrae, T., eds. Modern medicine, its theory 
 and practice. In original contributions hy American and 
 foreign authors. 2. ed., v. 2-3, Phila. & N. Y., 1914, Lea & 
 Febiger. 8°. 
 
 1915 
 
 Science and war. Oxford, 1915, Clarendon Press, 40 p. 8°. 
 
 Nerve & " nerves." Address given at the Leeds Luncheon Club, 
 Oct. 1, 1915. 7 p. 8°. (Privately printed.) 
 
 War, wounds and disease. Quart. Rev., Lond., 1915, ccxxiv, 150-161. 
 
 Special discussion on the epidemiology of cerebrospinal meningitis. 
 Proc. Roy. Soc. Med., Lond., 1914-15, viii, Epidemiol. & State 
 Med., 41-45. 
 
 The Jonathan Hutchinson iconography. A preliminary note. 
 Johns Hopkins Hosp. Buil., Bait., 1915, xxvi, 82, 
 
 A tribute to Dr. Edward L. Trudeau; a medical pioneer. Am. 
 Med., Burlington, Vt. & N. Y., 1915, n. s., x, 20. 
 
 Remarks on the diagnosis of polycystic kidney. Internat. Clin., 
 Phila., 1915, 25. s., i, 1-5. 
 
 The coming age of internal medicine in America. Internat. 
 Clin., Phila., 1915, 25. s., iv, 1-5. 
 
 Remarks on arterio-venous aneurysm. Lancet, Lond., 1915, i, 949- 
 955. 
 
 Note on acute infectious jaundice. Lancet, Lond., 1915, ii, 605. 
 
 An address on science and war. Delivered at the University of 
 Leeds Medical School on October 1, 1915. Lancet, Lond., 1915, 
 ii, 795-801. 
 
 Cold-bite + muscle-inertia = trench-foot. Lancet, Lond., 1915, ii, 
 1368. 
 
 Medical notes on England at war. J. Am. M. Ass., Chicago, 1915, 
 Ixiv, 679-680; 1512-1513; 2001-2002. 
 Also: West Canada M. J., Winnipeg, 1915, ix, 59-65. 
 Also: Dominion M. Month., 1915, xliv, 41; 12b. 
 
 Remarks on cerebrospinal fever in camps and barracks. Brit. 
 M. J., Lond., 1915, i, 189. 
 
 Discussion on the treatment of cerebrospinal meningitis. Brit. 
 M. J., Lond., 1915, ii, 604. 
 
Bibliography 165 
 
 In: Mod. Med. 2* ed. (Osier & McCrae), Phlla. & N. Y., 1915, iv, 
 148-165. 
 
 Diseases of the arteries. 
 In: Mod. Med. 2. ed. (Osier & McCrae), Phila. & N. Y., 1915, iv, 
 449-471. 
 
 Aneurism. 
 Jn: Mod. Med. 2. ed. (Osier & McCrae), Phila. & N. Y., 1915, iv, 
 
 472-525. 
 
 Raynaud's disease. 
 
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 iv, 975-997. 
 
 Angioneurotic oedema, Quincke's disease. 
 
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 Osier, Sir W. & Gibson, A. G. Diseases of the valves of the heart. 
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 212-274. 
 
 Osier, Sir W. & McCrae, T., eds. Modern medicine, its theory and 
 practice. In original contributions by American and foreign 
 authors. 2. ed., v. 4-5, Phila. & N. Y., 1915, Lea & Febiger. 8°. 
 
 Macmichael, William, The gold-headed cane; with an introduction 
 by Sir William Osier; and a preface by F. R. Packard. N. Y., 
 
 1915, P. M. Hoeber, 261 p. 8°. 
 
 1916 
 
 Science and war; an address delivered at the University of Leeds 
 Medical School. N. Y., 1916, Oxford Univ. Press, 39 p. 8°. 
 
 Intensive work in science at the public schools in relation to the 
 medical curriculum. School World, Lond., 1916, Feb., pp. 41-44. 
 Also: World's Work, Lond., 1916, Apr., pp. 434-438. 
 Also [Abstr.]: Nature, Lond., 1915-16, xcvi, 554-555. 
 
 Illustrations of the bookworm. Bodleian Quart. Rec, Oxford, 
 1914-16, i, 355-357. 
 
 Creators, transmuters and transmitters. As illustrated by Shakes- 
 peare, Bacon and Burton. Remarks made at the opening of 
 the Bodley Shakespeare Exhibition, April 24, 1916. Lond., 
 
 1916, Oxford Press, 8 p. 12°. (Privately printed.) 
 
 Discussion on paratyphoid fever. Proc. Roy. Soc. Med., Lond., 
 1915-16, ix, Med. Sect, 38. 
 
 An address on the tuberculous soldier. Lancet, Lond., 1916, ii, 
 220-221. 
 
 Local tetanus (Correspondence). Lancet, Lond., 1916, ii, 877. 
 
 Osier, Sir W., Brown, W. L., \et. al.^ Discussion on trench nephri- 
 tis. Proc. Roy. Soc. Med., Lond., 1915-1916, ix, Med. & Therap. 
 & Pharmacol. Sect., 1-xl. 
 
166 Sir William Osler, Bart. 
 
 Osier, Sir W., Robb, G., [et. at.] Discussion on the treatment of 
 cerebrospinal meningitis. Proc. Roy. Soc. Med., Lond., 1915-16, 
 ix, Therap. & Pharmacol. Sect., 1-26, 
 
 Osier, Sir W., Rolleston, H. D., [et. al.] Treatment of cerebro- 
 spinal meningitis. Practitioner, Lond., 1916, xcvi, 1-18. 
 
 1917 
 
 The campaign against syphilis. Delivered before the Medical 
 Society of London. May 14, 1917. Lancet, Lond., 1917, i, 
 787-792. 
 Also: Brit. M. J., Lond., 1917, i, 694-696. 
 
 The anti-venereal campaign. Annual oration of the Medical So- 
 ciety of London. Tr. M. Soc. Lond., 1917, xl, 290-315. 
 [Same as: "The campaign against syphilis."] 
 
 The library school in the college. An address at the opening of 
 the summer School of Library Science, Aberystwyth, July 31, 
 
 1917. Library Ass. Rec, Lond., 1917, xix, 287-308. 
 
 The " Anatomic universelle " of Ambroise Pare (Editorial). Ann. 
 Med. Hist., N. Y., 1917, i, 424. 
 
 The problem of the crippled. Recalled to Life, Lond., 1917, i, 265. 
 
 The problem of the crippled and the maimed. Am. J. Care 
 Cripples, N. Y., 1917, v, 243. 
 
 War wastage : a note of warning to examiners of recruits. J. Am. 
 M. Ass., Chicago, 1917, Ixix, 290. 
 
 Recurrence or redeposit of cancer? Brit. M. J., Lond., 1917, i, 455. 
 
 Home-bred malaria (Correspondence). Lancet, Lond., 1917, ii, 621. 
 
 Viets, H. A patronal festival for Thomas Willis (1621-1675) with 
 remarks by Sir William Osier, Bart., P. R. S. Ann. Med. Hist., 
 N. Y., 1917, i, 118-124. 
 
 1918 
 
 Essai de bibliographic hippique. Edinburgh & Lond., 1918, W. 
 Green & Son, 4 p. 8°. 
 
 The science of librarianship. Bull. Med. Library, Ass. Bait., 1917, 
 18, vii, 70-74. 
 
 Typhoid spine. Bull. Canadian Army M. Corps, 1918, i, 78-79. 
 
 Graduated exercise in prognosis. Lancet, Lond., 1918, i, 231. 
 
 The primary examination for the P. R. C. S. Eng. : An appeal to 
 the President of the Royal College of Surgeons. Lancet, Lond., 
 
 1918, i, 715. 
 
 Medicine in America (Speech to University Extension Students, 
 summer meeting at Cambridge). The Hospital, Lond., 1918, 
 Ixiv, 433. 
 
 Trench fever: a critical analysis of the report of the American 
 Commission. Lancet, Lond., 1918, ii, 496-499. 
 
Bibliography 167 
 
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 Roy. Soc. Med., Lond., 1917-18, xi, Sect. Hist. Med., 65-69. 
 Also: Ann. Med. Hist., N. Y., 1917, i, 329-332. 
 
 Note on Boerhaave's position as a scientific observer. Read Octo- 
 ber 17, 1917, at Proc. Roy. Soc. Med., Lond., Sect. Hist. Med. 
 (Not published.) 
 
 1919 
 
 The old humanities and the new science. An address before the 
 Classical Association, Oxford, May 16, 1919. J. Murray, Lond., 
 1919, 32 p. 8°. 
 Also: Brit. M. J. Lond., 1919, ii, 1-7. 
 
 Observations on the severe anaemias of pregnancy and the post- 
 partum state. Brit. M. J., Lond., 1919, i, 1-3. 
 
 Influenzal pneumonia: bilateral rigidity, spinal meningitis with 
 haemorrhage into the theca vertebralis and nerve roots. Lan- 
 cet, Lond., 1919, i, 501. 
 
 Typhoid spine. Canad. M. Ass. J., Toronto, 1919, ix, 400-496. 
 
 Currie's " journal." Ann. Med. Hist, N. Y., 1919, ii, 81. 
 
 Aspects of death and correlated aspects of life in art, epigram and 
 poetry. 3. ed. By Frederick Parkes Weber. N. York, 1918. 
 P. B. Hoeber, 786 p. 8°. (Book review.) 
 Ann. Med. Hist. N. Y., 1919, ii, 84-85. 
 
 Note. — Messrs. Constable & Company have published later im- 
 pressions of "Man's redemption of man" (1918); "A way of 
 life" (1918); and "Science and immortality" (1906 and 1918). 
 
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