Physicians, Scientists, and the Wider Culture: Sir William Osler

Sir William Osler (1849–1919) is regarded by many in the English-speaking world as the greatest physician of his time (1, 2). He made significant research contributions during his early career and was an accomplished pathologist. However, his most important legacy is his contribution to clinical medicine and medical education. Throughout his life he was also extensively involved in creating a professional and academic infrastructure for science-based medicine, which included setting up learned societies, journals, and laboratories. Osler was born in Canada and studied medicine at the Toronto School of Medicine and subsequently at McGill University. After graduation he visited Europe. On his return to Canada, after a short spell in general practice, he moved to McGill University, where he became a professor in 1875. In 1884 he moved to the US and became the chair of clinical medicine at the University of Pennsylvania. In 1889 he went to Johns Hopkins University, where he became chief of medicine and one of the pillars of the School of Medicine, contributing to its transformation into one of the world's leading medical institutions. In 1905 he retired and moved to England, taking the post of Regius Professor of Medicine at Oxford University, where he remained the rest of his life. King George V conferred a baronetcy on Osler in 1911. Anton Chekhov, discussed earlier in this series (3), was a physician who became a world-renowned fiction writer. Sir William Osler's writing remained close to medicine. His seminal book, entitled The Principles and Practice of Medicine, was published in 1892. It remained the most influential medical textbook for decades; 16 editions were printed. His literary talents also surfaced spectacularly in his reflections on medicine and on the nature of a doctor's calling. The Way of Life, a lecture to the students of Yale University, illustrates how for him there was no boundary between medicine and any other aspects of life (4). He had a phenomenal ability to formulate aphorisms and epigrams, many of them eminently usable today (5). Osler was also a notable book collector. Books and libraries were a major part of his life. His writings quite explicitly represent the cumulative wisdom of his lifelong reading. He saw books as a means of contact with great people of the past and as an opportunity to learn from exceptional minds. He bequeathed his library to McGill University (6). He strongly believed that the education of a physician should combine science and the humanities. He expressed this in his last major talk, the Presidential Address delivered to the Classical Association at Oxford in 1919 (7). This lecture is again an example of his erudition: he effortlessly weaves in quotes from the ancient Greeks, the Romans, the Bible, Shakespeare, and Enlightenment writers and philosophers, to name only some. Osler sat for several portraits during his lifetime. The one shown at (8) was his favorite. It is by an American painter, Seymour Thomas (1868–1956), born in San Augustine, Texas (9). Thomas studied art at the Art Student's League in New York under William Merrit Chase (1949–1916), a fashionable contemporary of Thomas Eakins. He subsequently travelled to Paris, where he studied at L'Academie Julien and at L'Ecole Des Beaux Arts. He remained in France for 25 years and had several successes, including the awarding of a bronze medal at the Paris Exhibition in 1900, and gold medals at the Paris Salon in 1901 and 1904. He was also decorated Chevalier de la Légion d'Honneur. Thomas returned to the US in 1914, eventually settling in California. He achieved yet more fame by painting 3 portraits of President Woodrow Wilson. He was a traditional, “academic painter,” as they were called. However, in his works he managed to enrich academicism with a fascinating modern twist. He painted both polished formal portraits and landscapes, the latter ranging from pieces with discernible impressionist influence to mixed media works on paper with very disciplined, clear lines. The Osler portrait looks more elegant than formal, and is painted using a soft-toned palette where the tie adds a splash of maroon, giving it a flamboyant flavor. The portrait was painted in Paris while Osler was on a sabbatical in December 1908 (10). The artist retained it for over 40 years and eventually gifted it to the Royal College of Physicians in London. It was subsequently hung in the Radcliffe Science Library in Oxford. Its copy by Joyce Aris (1904–1986) remains in the Royal College of Physicians. Another copy, by Philippa Abrahams, hangs in the Royal Society of Medicine, also in London. There is also a replica at the University of California in Los Angeles, in the Charles E. Young Research Library (11). Osler lived at the end of an era, both professionally and culturally. Professionally, he witnessed the transformation of medicine into a science-based discipline, but it was also the end of an era in a wider cultural sense. He witnessed the Enlightenment vision of linear progress of humanity descending into the catastrophe of the First World War. His son Revere was killed in Belgium in 1917 while serving with the British Royal Field Artillery Brigade. Osler saw the art of medicine in a physician's contact with individual patients. He thought that a physician's background in humanities enriches the patient-doctor contact. Unfortunately, promoting humanities as part of the makeup of a medical person was one battle that he lost; some would say it was unwinnable. The massive move of medical education toward science, the essence of the Flexnerian reform, excluded humanities by default. Later in the 20th century, the role model of a medical leader whose mind spanned science and the humanities has also been eroded—or substituted with guidelines and pronouncements of regulatory bodies. As Osler had predicted, specialization took over. Interestingly, a version of individualism might be returning to medicine as part of individualized genome-based medicine. It remains to be seen whether it will change, again, the role of a physician. All in all, as a background to his many achievements, the quality of Sir William Osler's writing enabled wide dissemination—and acceptance—of his views in the medical world and beyond. He thus remains a very important physician writer, an example that literary ability adds power to a professional voice. And Osler's ideal of a physician who keeps in touch with wider culture remains as valid as ever. My thanks to Jacky Gardiner for her excellent secretarial assistance.

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