Why Did Osler Not Perform Autopsies at Johns Hopkins?

To the Editor.—Lucey and Hutchins1 investigate whether Sir William Osler, who performed almost 1000 autopsies during his career, performed even a single autopsy while at Johns Hopkins. Their article focuses on a patient with bilateral congenital cystic kidney disease and then quibbles with Bliss's biography as to whether the autopsy was performed by Osler (ie, as the “prosector”) or whether Osler merely assisted William MacCallum, a Hopkins pathologist. Although it is admirable that the authors were able to identify the case in question within the records of the autopsy service at the Johns Hopkins Hospital and build a case for Osler being at the autopsy table as an assistant, the article does not address the more interesting question of why Osler never functioned as an independent autopsy pathologist at Hopkins.Osler was recruited to Hopkins from Philadelphia, where he was a professor of medicine at the University of Pennsylvania and a “visiting physician” at Blockley Hospital, an almshouse for treating indigent patients. It was at Blockley that Osler performed his 162 Philadelphia autopsies, and it is well documented that Osler and his residents played very loosely with institutional autopsy consent regulations, that Osler was constantly in trouble with Blockley administration because of this, and that Osler totally ignored the authority of Blockley's 2 staff autopsy pathologists, E. O. Shakespeare and H. F. Formad. According to Bliss, “Complaints about post-mortem abuses reached the Blockley trustees, both from the public and from the pathologists whom Osler and his acolytes tended to ignore. … Blockley gradually tightened its procedures to rein in Osler and his residents.”2 During Osler's 4 years at Blockley, the autopsy consent procedures were adjusted several times to regulate or prohibit performance of autopsies by “visiting physicians.”34According to Henry Ware Cattell, a pathologist at the University of Pennsylvania and Blockley in the 1890s, the custom at Blockley, even though it was not strictly legal, had been to permit postmortem examinations on “all persons dying in charitable institutions” and that “this custom prevailed … with practically no opposition, until lawsuits, arising out of this custom, caused it to be discontinued.”5 Essentially, Blockley was the Wild West on the North American autopsy frontier, and Osler and his deputies succeeded in stretching the limits even there.In stark contrast, Hopkins was not a charitable institution specializing in indigent patients, and William Henry Welch was not a pathologist who could be ignored. Welch was not only the founding physician at Hopkins; he was responsible for hiring Osler. It seems inconceivable that Welch, at the time of Osler's hiring, was not fully aware of these issues in Philadelphia. Undoubtedly, Welch made it clear that the autopsy room at Hopkins belonged to Welch and that Osler would be a welcome guest, but that he was not going to be doing autopsies on his own and duplicating his Philadelphia behaviors at Hopkins. Osler clearly played by “the rules” while he was in Baltimore, and this fact is reinforced by the article by Lucey and Hutchins.1

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