Book Review

William Osler: A Life in Medicine

By Michael Bliss. Pp. 600. Price, $35.00. Oxford University Press, 198 Madison Ave., New York, NY 10016, 1999. Phone: 800-445-9714. ISBN: 0-195-12346-8.

Given the opportunity (and the excuse) to read a biography of William Osler, I jumped at the chance. Like many doctors, I had often heard Osler quoted reverentially during my training. I knew nothing about his life, vaguely imagining him as a humanist and a founder of modern clinical medicine. Reading William Osler: A Life in Medicine would allow me to find out, finally, who this man really was.

After completing this volume of 500-plus pages, I have certainly learned a great deal about William Osler and about the history of institutional medicine at the turn of the 19th century. Much in Osler's life and the medical climate of his day is utterly fascinating. Osler was the last-born of eight children, the son of a minister. He built his career on skills derived from countless autopsies, while pursuing academic advancement, first at McGill University in Montreal and later at the University of Philadelphia and Johns Hopkins University. He was a masterful clinician and an extraordinary teacher. He also wrote prolifically, authoring The Principles and Practice of Medicine, a medical textbook that saw many editions and sold hundreds of thousands of copies. Osler was deeply involved in the world of medicine—to the near exclusion of anything else (he married late and kept so little abreast of politics that he was hardly aware of international conflict until the day Britain entered the war in 1914), remaining constantly active until the end of his life as a scholar, a teacher and a practicing physician.

His lifetime coincided with an era of great medical progress and improvement in medical education. Although infectious diseases such as tuberculosis, smallpox and pneumonia still killed their victims while doctors looked on helplessly, with little to offer but opium, the microbial origins of these illnesses were beginning to be understood. During Osler's lifetime, preventive measures, such as vaccines (including Koch's unsuccessful tuberculin vaccine) and public health measures to improve housing and hygiene, began to offer new hope for the conquest of disease; in addition, quinine became available for the treatment of malaria. Surgical techniques and anesthesia had also advanced, and Osler's surgical colleagues had booming, lucrative careers.

At Johns Hopkins, where Osler sailed to professional maturity, high standards were being developed for medical student admissions. Osler himself helped institutionalize the practical training that remains the mainstay of today's clinical education. At the same time, aspects of his history show the distances we have covered since those days. I refer primarily to the development of new treatments, such as insulin and antibiotics, which, as much as we now take them for granted, have completely altered the practice of medicine. Bliss's biography also informs us of details that hint at other important changes that have revolutionized values and attitudes in medicine.

Most striking of these details, perhaps, is the fact that a group of wealthy women—notably Mary Garrett, heiress to a railroad fortune—provided the financial wherewithal to launch Johns Hopkins Medical School, on the stipulation that women be admitted as medical students. Without Garrett's money, the school could not open, and the condition of coeducation had to be accepted. And yet, as Bliss notes, no one even suggested naming the medical school after its benefactress, in spite of her spectacular gift.

Other details that are as telling as they are fascinating include photographs of autopsies being performed with bare hands, and the disclosure that Osler remained silent about the morphine addiction of his colleague, William Halsted, a brilliant surgeon whom he had helped to bring to Johns Hopkins.

Yet more compelling than Bliss's descriptions of institutional politics and medical progress, more intriguing even than Osler's many creditable accomplishments, is the impact of Osler's legendary personality. Osler seems to have inspired in those he met an almost supernatural awe. He was apparently loved by everyone—his extended family, students, patients, neighbors, colleagues and armies of young children. He had a kind of Midas touch, turning all those he met into friends, so that when he settled in Oxford for the final stretch of his career, his home became a permanent guest house, informally named “Open Arms,” and a pilgrim's destination for visitors from all over the world.

This charisma, no doubt the sine qua non of Osler's illustrious career, is difficult to illustrate in words. Bliss can say as much as he likes about the profound impression Osler made almost universally, but the reader still feels one had to have been there to know it. Osler's life began with no special promise—he was an eager, loyal student with a prankish nature and initially an awkward, inarticulate teacher. How, from this background, he rose so meteorically is something of a mystery. Certainly in the era of the “old boys' network,” when amiable backslapping and letters of introduction opened many a professional door, a magnetic, deeply charming personality must have had a powerful impact. Be that as it may, by the end of the book, the reader has been fully absorbed into the legend, and Osler's death—following on the heels of a family tragedy—feels like the loss of a dear friend.

Bliss's book is a well-researched, empathetic enterprise, with more focus on Osler's daily affairs than on his legacy as a humanist and clinician. We read a great deal about Osler's income and travels, the luxuries he enjoys and the friends who admire him; we too are guests at his house and his table. This approach has its appeal—we take an almost sensationalistic pleasure in sharing Osler's ever-growing fortune and entourage—but the chumminess at times takes a gossipy turn. There are gratuitous speculations about whether Osler masturbated or enjoyed sex with his wife; there is a digression about penile curvature that includes mention of Bill Clinton's anatomy; we run across an unfortunate sentence that likens the aftermath of a controversial speech to the “lingering odors of flatulence.” The occasional descent into minutiae can leave the reader bored or confused. No matter—the more time we spend with Osler, the better we like him, and the more we wish we too could have shared in his aura.

Not until the last pages does Bliss distance himself from his subject to address important contextual questions. He wonders how much of Osler's clinical and philosophical legacy is still relevant to contemporary readers; he recognizes that Osler's almost cloudless life was made possible by the enormous fees he charged (from which he exempted professional colleagues and the poor); he notes that Osler's was a paternalistic world in which patients had neither authority nor autonomy. These issues in no way call into question Osler's accomplishments, but they do show how even a great man creates his world within the historical limitations of his time.

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