Is Osler Dead?

Some months ago at a medical meeting, I heard a prominent academic, an expert in the application of electronic methods in medicine, announce that Oslerian medicine is dead. He meant low-tech medicine, medicine expressed especially in clinical sophistication based at the bedside, coupled with masterful command of most of the content of the physician's field, including the relevant clinical literature as well as the science base. Interestingly, the audience understood, almost intuitively, what he meant.

The very fact that the comment was made is worth noting. Why, 112 years after he came to Johns Hopkins, and 82 years after his death, is Osler still invoked?What was so powerful about the man and his impact that we still either measure ourselves against his template, or feel it necessary to dismiss it? In part it was his image as a clinical ideal, and in part it was a wider Oslerian medicine, not confined to his immediate environs, or to the bedside, but rather medicine broadly shaped and impacted by his example and teaching, at least in North America and the United Kingdom. The idea that his presence reshaped medicine and helped it to emerge in the form in which we now know it may seem grandiose, but he was a towering figure, possibly the most important change agent of his time for medicine, and that was because his time, in fact, was ripe for Osler, and Osler, as it turned out, was ripe for his time.

How were the times ripe for Osler? Cyril Houle (1969) has pointed out that, as Osler started his career, science was beginning to stir medicine as never before. The intellectual world was battling over Darwinism, and during Osler's life span "he saw established some of the greatest contributions to biology and medicine the world had yet witnessed, including those of Pasteur, Koch . . . Virchow, Charcot, Lister, Roentgen . . . Ehrlich, the Curies, Wassermann, Walter Reed, Trudeau, and Freud." The scientific base of modern medicine, it is not too strong to say, erupted during Osler's clinical career. Speaking just 100 years ago, in the first month of the 20th century, he said of the 19th:

measure as we may the progress of the world . . . materially . . . sociologically . . . intellectually . . . morally . . . there is no one measure which can compare with the decrease of physical suffering in man, woman and child when stricken by disease or accident.This is the one fact of supreme personal import to every one of us. This is the Promethean gift of the century to man. (Osler 1904, pp. 227-76)

A century later, it is difficult to improve on that epitome: the 20th century has brought immense further progress--it has brought us to the threshold of an understanding of life processes that holds incredible promise for medicine, as well as the likelihood of enormous demands on our wisdom. It has justified the faith in research Osler articulated so effectively in a time when its acceptance was not a foregone conclusion.

It is difficult for us to understand Osler's stature in his own era. We have no current equivalent model, and probably have not had one since his death. The concatenation of his personal charisma, talent, and energy, together with the characteristics of the new university model medical center just invented at Johns Hopkins, lent special power to his example. And power is the right word: after the outpouring of memorial volumes following his death, including especially Cushing's great biography (1940), he has, in a genuine sense, persisted. The medical service of the Johns Hopkins Hospital is named for him and he is still a palpable presence there, and there are Osler clubs and societies in this country, in the United Kingdom, Canada, Japan, and in numbers of other countries. A new biography has just been published (Bliss 1999) and has been widely reviewed and well received. The American Osler Society is about to publish the third decennial volume of selections from its Transactions...