Owen J. Wister, M.D. (1825–1896) acquired one of the busiest “outdoor” practices in nineteenth-century Philadelphia, conducted throughout the city’s large northwest district. Through letters, he described events in his daily rounds to his wife, the writer Sarah Butler Wister, when she was traveling to restore her own health. Wister’s practice was filled with the mundane details of any general doctor’s existence but also with confrontations with sudden and overpowering disease, and sometimes the grisly deaths of friends and family. Often he worked from early morning until late evening, seeing as many as thirty or forty patients scattered over a thirty-mile range. He endured as well frequent calls at night for real or imagined emergencies and maternity cases. In 1869 he collapsed from overwork and was able to resume his career only after a three-year respite. This lecture describes Wister’s practice and his emotional responses to it, as inscribed in the letters. In addition, I explore what attributes he had as a physician and as a man that accounted for his popularity and why the social environment of his practice made it virtually impossible for him to control its demands, even at the cost of his own well-being.