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 Title[ 23 The Oxford Call 1904--Not proofed yet

 Type[ Biography/Cushing

 Author[ Cushing

 Date[ 1925

 Publisher[ Oxford


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CHAPTER XXIII

1904

THE OXFORD CALL

IT was to be a hectic spring—and year. It began with rumours of Oxford. But this threat of having his equanimity again disturbed, as in the Edinburgh episode, became obscured by the smoke of the Baltimore fire ; by the ensuing rescue of the hospital and school from their financial embarrassment ; by the establishment of the National Tuberculosis Association ; by the Ingersoll Lecture, and much else besides.

Sir John Burdon Sanderson's intention to resign from the Regius Professorship had become known late in the preceding year, and there had been a good deal of agitation in regard to his successor. During his twenty years in Oxford, Sanderson had done much to advance ` the claim of Medical Science to be regarded as a University study ', and he and his colleagues, chiefly Francis Gotch, J. S. Haldane, and Arthur Thomson, being fearful of losing ground already gained, were desirous that James Ritchie, the pathologist of their own group, should continue the tradition. The London graduates, on the other hand, fearful that the earlier efforts of Acland to instil a new spirit into Oxford Medicine were not being continued, expressed themselves as strongly in favour of a clinician, preferably an Oxonian, and a number of eligible candidates were proposed—Church, Payne, Sharkey, Herringham, Schorstein, and Theodore Acland being prominently mentioned.

Who first suggested Osler's name is not certain. There are several who claim the honour. More than one may have voiced the idea. But it is certain that Sir William Broadbent mentioned the possibility to Mr. (now Sir) Herbert Warren, who wrote to Osler on New Year's Day expressing the hope that he might consider some day coming to take up his residence in Oxford. Rumours of this must have reached other ears, in view of the following letter :

From S. Weir Mitchell to W. 0. 1524 Walnut Street, Philadelphia, 13th Jan. 1904.

My dear Regius,—` My Son, verify your quotations '—or clarify them. You say yr. Fracass is at the end of Examen Poeticum-3rd part of Miscels Poems 1693—Edited by Dryden. Did he edit himself or Tate or Fracastorius—No such edition can I find in the Brit. Mus. Catl, or Watts. An interesting Memoir of Fracastorius is by Rev. W. P. Greswell 18o1. He gives a long quotation fr. the Syphilis Poems—his own translation ?—G. as unlike Tate as possible. I find no miscely of date 1693—and if Dryden filched Tate or re-translated, you may find out. However it is an ill wind etc. It sent me to Johnson's Life of Dryden—where I found that D's first poem was on the death by Small Pox of Lord Hastings—His pustules he describes as ` rose-buds and—gems ' etc. at last as stars, so that finally—being semiconfluent I presume

` No comet need foretell his change drew on (sic) Whose corpse might seem a constellation.'

Is it to be found, that Poem ? And this for you-

` Oxford to him a dearer name shall be Than his own Mother University.'

This is all until we meet—on 27. I have some very fair hash-trash stewing. Yrs, [&c.] Remsen writes me of a dinner—and that, between us, I crave less than a bit of talk with you—over books.

Meanwhile the Oxford graduates had held a meeting in London, on January 5th, and voiced their opinion in The Times that ` the Regius Professorship of Medicine should be held by a physician who is representative of Medicine in its widest sense ', a statement carrying the intimation that a science-candidate would not receive their support. Boiled down—and it took some heat—the question was, whether the Regius should be an active teacher in the Oxford group who devoted themselves almost entirely to preclinicalstudies; or whether he should be a man chosen because of his wider professional influence, who could be a link between Oxford and her medical graduates in London. Both sides felt themselves in the right. Pamphlets were circulated. The recommendations of the London group were answered in turn by a printed letter from those in Oxford.

But even the clinicians were in a quandary, for where could a man be found willing to forgo, as some one said, ` the financial rewards to which his abilities entitled him,

9 S 2

for a pittance of ,400 a year with a position to keep up and a high-sounding title ? ' The President of the College of Physicians became involved ; the Vice-Chancellor was waited upon by delegates from London ; it was even feared that Mr. Balfour might take the matter out of the hands of the contending parties and present an entirely independent nomination for ratification by the Crown. Many of the people concerned were Osler's friends, and of the controversy he must have been aware through the British journals, but if he had at that time any intimation, except from the President of Magdalen's note, that his name had even been considered, he at least made no mention of the fact. Indeed, other more engrossing things were happening in Baltimore.

The Tuberculosis Exhibition was held in McCoy Hall the last week in January. It had involved an immense deal of preparation on Osler's part, for he had been made Chairman of the Committee on Organization. But Welch and Oslerwere endowed with the administrative and

social qualities which ensured the success of any such gathering which had their support. It is to be remembered that as an outcome, in part, of Osler's castigation of the Mayor a commission had

been appointed by Act of Assembly in 1902 for the purpose of studying the prevalence of tuber- culosis in Maryland and its effect on the economic welfare of the State. The exhibition was planned to display the results of the commission's investigations in such a way as to make a powerful appeal to the public mind.

It was a well-timed meeting. Though the antituberculosis movement was gaining momentum, nation-wide propaganda regarding the curability of the disease was needed. To be sure, ever since the time when Brehmer first established an open-air sanatorium for phthisical patients in the Waldenburg Mountains twenty years before the discovery of the tubercle bacillus, people here and there had agitated such a campaign. Its germ lay in the old Climatological Society ; the community had learned through Robert Louis Stevenson about Trudeau and the cottages in the Adirondacks ; Flick's work in Philadelphia was becoming widely known—indeed as far back as 1898 he

had suggested the formation of a national society ; A. C. Klebs had organized the tuberculosis workers in Chicago, and there were many other earnest individuals scattered throughout the country who were similarly engaged.

From a purely local standpoint the exhibition, as a popular demonstration not only of the sources and extent but also of the curability of tuberculosis, was successful beyond expectation. But the meeting had a national character as well, for it brought together the leaders of the crusade from all sides. As had been suggested by Oslerin his letter of November 25th to S. A. Knopf,

advantage was taken of the occasion to urge the formation of a national society of those interested in tuberculosis, in order to harmonize, if possible, certain groups of little-known people who independently had been soliciting support, lay and political, for conflicting congresses. One of them, under the leadership of Dr. Daniel Lewis, was laying plans for an international congress to be held in Washington in April, in spite of the fact that an international Bureau Central, an outgrowth of the Berlin and London congresses, had decided on Paris for the 1904 biennial meeting. Another, which had already received government backing through the activity of its lay-leader, Mr. Clarke Bell of the Medico-Legal Society of New York, was to be held in connexion with the St. Louis Exposition in the coming October. Neither of these movements had received the approval or support of the leaders in the profession.

Consequently, on the last day of the meeting a conference of the better-known physicians who were interested in the study of tuberculosis was held in McCoy Hall. William H. Welch, whopresided, was authorized to appoint a committee, ` to consider the conditions existing with regard to the proposed Tuberculosis Congress and other national antituberculosis associations in the United States ; also to consider the formation of a National Committee to represent this country at the International Congress at Paris.' In accordance with this motion, Welch appointed Osler, Trudeau, Theobald Smith, Adami, Vincent Bowditch, Knopf, Ravenel, Klebs, E. G.

Janeway, H. B. Jacobs, Bracken, Flick, and Biggs. It was therefore representative

of the best minds in the profession ; and this committee, as will be seen, met a month later in New York to take action upon the matters they had been appointed to discuss. Though much more might well be said of the Exhibition itself, it must suffice to call attention to the collection of valuable works illustrating the history of tuberculosis which Oslerhad taken such pains to gather

together. Brief mention of this occurs in the following undated note to Chadwick in Boston :

Yes, I give the Ingersoll Lecture in May, the 18th, Science and Immortality. Eliot says I am a specialist in the subject. So glad the Fletcher fund is completed. What of the frame—is it also settled, fin ? Thanks for the pamphlet and in advance for the books. Our exhibit of the literature on Tuberculosis has been most interesting. Have you a 1543 de Fabrica of Vesalius ? Yours W. O.

On Sunday morning, February 7th, Oslerhad gone to Washington to see Senator Hanna, who

had recently been taken ill with typhoid fever. He got back in the late afternoon to find the business section of Baltimore in flames. He has laconically written in his account-book : ` Fire began at II a.m. Hurst Building—raged until Monday eve. It reached to within two blocks of 1 W. Franklin St and we were all ready to pack up.' It was a close call. There were guests as usual not only at No. t but at No. 3 West Franklin Street, and in the afternoon every one gathered in the Oslers' dining-room, where through the southern windows the conflagration could be seen approaching. That Osler, usually imperturbable, was nervous, was evident from the way he

twiddled his watch-chain and exceeded his allotted number of cigarettes through the anxious afternoon and evening. A policeman finally came to the door and said the block between Mulberry and Saratoga Streets near by was about to be blown up and that it was time they got ready to leave. Brands were already falling on the roofs in the neighbourhood. A wagon was secured ; some precious books were put in trunks ; some china picked out ; some linen ; some clothes. The faithful but agitated black servants cooked an oyster supper and served coffee ; Revere was awakened and dressed, and, just as the family was about to leave, the high wind which had been

blowing from the south all day shifted and turned the further progress of the conflagration to the south and east. By 2 a.m. they were notified that there was no further danger.

From this devastating fire Baltimore reacted courageously, and a newer and better-built city soon emerged, but for a time many individuals and institutions were hard hit. Among them was the Johns Hopkins Hospital, whose major properties from which rentals were returned now lay in ruins in the wake of the fire. Of all this there is little reference in his letters—except a word, after some days, to let Trudeau know that ` we are doing the Phoenix trick here '. And later in the month to F. C. Shattuck in Boston :

I was perfectly delighted with the Gentle Reader. I have been much entertained. We have so many friends in common that I almost feel as if I knew the author. We had a devil of a time here with the fire. We shall be out about $400,000 at the hospital, but I daresay all will turn out well, and we are not worrying specially.

It was not in Osler's make-up to worry, even though at this time he had been carrying an extra load owing to Mr. Hanna's illness, which required almost daily visits to Washington. Nor was he one to occupy himself by sticking coloured pins in maps to follow the progress of the Russo-Japanese War, which had begun on the day of the Baltimore fire. He hated wars. But there was one episode with which he was concerned later in that month, of sufficient historic interest to deserve the telling. The Canal Treaty with Panama was ratified by the Senate on February 23rd by an overwhelming vote, and Roosevelt was to appoint without loss of time the seven members of the Isthmian Canal Commission—an army officer, a naval officer, and five engineers. He was promptly waited upon by a delegation of physicians, whose spokesman, Dr. Welch, tells the story as follows

The visit to President Roosevelt relating to Panama Canal affairs was to press upon him the importance of making Gorgas a member of the commission, the creation of which had been authorized shortly before by Congressional action. The members of this delegation represented various organizations such as the A. M. A., the New

York Academy of Medicine, the Philadelphia College of Physicians, etc. An appointment had been made with the President at the White House at 1z noon. I was selected to be the spokesman. We passed through a room crowded with persons waiting to see the President, and I felt that he must begrudge every minute we occupied, especially as what I had to say I had previously communicated to him by letter, and I knew that Leonard Wood had already urged upon him all that I could say and more. I did not occupy more than ten minutes. Curiously enough I cannot remember who else was present in the delegation or whether anyone else spoke, but if Osler and Keen were there they probably did.... When we finished presenting our argument, which altogether could not have lasted more than fifteen minutes, President Roosevelt began talking to us and continued for at least twenty minutes, in a very interesting, dramatic and amazingly outspoken fashion. He told us that he did not frame the law enacted, by Congress, and it did not meet his ideas of what the situation demanded. He would have preferred a single director, who should select engineers, sanitarians and other experts. Instead of that, he had to pick out seven members to make up a commission and the law provided that no less than five of these should be engineers, without one word about a doctor or a sanitarian. ` How can I under these circumstances ', he said, ` put a doctor on the commission i ' He said that he fully appreciated the importance of what we had told him, and he asked me to go at once to General Davis and tell him all about Gorgas and the importance of the sanitary side of the work. He sat down and dictated the letter to Davis. I wonder if Osler did not go with me to see Davis ? I think that he must have done so... .

The upshot was that Gorgas, then only a Major in spite of the record behind him of having rid Havana of yellow fever, went to Panama as a subordinate sanitary officer—not as a commissioner with powers of independent action. The old scandal of ` a life given for every tie ' in building the Panama railway was likely to be repeated. When Gorgas demanded screens he was told that shovels were what was needed, and there is many an unnecessary tombstone dating from the early days in the Canal Zone in consequence. All manner of difficulties were put in his way. Indeed, an effort was finally made to have him removed altogether, and it was not until Roosevelt's personal visit to the canal a year or two later that he fully realized for what Welch, Osler, and the others had been appealing. Not until then was Gorgas made a member of

the commission, and the President wrote to his former Secretary of War, Elihu Root, saying that if there were only more unselfish and public-spirited men in the country like Welch and Oslerwilling

to advise him, his executive life would be simplified.

As already stated, the probability that the Baltimore fire might seriously curtail the work of the hospital did not appear to disturb Osler's equanimity. There were possible ways out, and remembering a certain letter of March 4, 1902, telling how his Text-book had so interested certain people with large funds at their disposal that an Institute for Medical Research had been founded, he ventured to write to Mr. Gates to learn whether John D. Rockefeller might be induced to come to the aid of the Hopkins in its embarrassed condition. In response, Mr. Rockefeller sent to Baltimore his personal representative in his benefactions, Starr J. Murphy, who made a survey of the hospital and an accurate calculation of its losses, with which information he returned to New York. Meanwhile, Oslersent the following characteristic note to the President

of the Hospital Board :

7. iii. 04.

Dear Judge Harlan, In case we do not get a supplementary endowment for the Hospital I shall be very glad to place my salary ( $5,000) for ten years at the disposal of the Trustees to be used in maintaining our publications. Please say nothing of it outside of the Committee. Sincerely yours, &c.

The purport of Mr. Murphy's visit must have leaked out, if one may judge from a letter to Mr. H. M. Hanna written the same day. Mr. Hanna was a brother of the Senator and an equally remarkable man, with whom Oslerhad come in contact even before the Senator's fatal illness. He

was a friend of many doctors : indeed, had leanings towards the profession which in his father's footsteps he had once intended to follow. He was himself a great benefactor of Medicine in his own community at Cleveland, where he had been a former business associate of- John D. Rockefeller and Oliver H. Payne, both of whom he had influenced in their benefactions in the same direction. ` Mel ' Hanna, as he was known among his intimates, passed his winters in

Georgia, where he was accustomed to go about with Osler's Practice ' under his arm prescribing for the negroes , on his plantation who might be ill. Hence Osler's title :

To H. M. Hanna from W. O.                                 7. iii. '04.

Dear Dr. Hanna, I do hope the ` Sun' may be right. We have no news so far. Mr. Rockefeller has sent for full information as to our funds &c. We shall be ` out ' about $6o,000 a year. It is interesting to note the spirit of loyalty shown by the Doctors & Nurses. There have been many offers of salaries on the part of officials of the Hospital & many nurses have offered to come back & take wards for 3 to 12 mos, without any pay. With kind regards Sincerely yours, Wm OSLER. Thanks all the same for your kind letter & for your congratulations to Mr. Rockefeller.

Betweentimes, the hospital life went on as before : classes continued ; Ehrlich came and gave the first of the Herter Lectures series on the new subject of physical chemistry ; H. B. Jacobs, one of the ` latch-keyers ' of 3 West Franklin Street, got married ; Flexner was called to the new Rockefeller Institute ; new patients came and went ; even old ones were not forgotten. Whenever the memory of some one passed into Osler's mind, off went a note or a postcard :          11/3/04.

Dear Mrs. Curtis, We have come to the conclusion that it is time you returned to Ward C. We means your entire staff including several of the men on the Surgical side. I am sure your storage batteries need re-charging & six weeks—say April 15 to June 14—would be a most favourable time. Dr McCrae was never in better form & Dr. Howard has an additional experience which would be most invaluable in your case. At present he is devoted to a St Louis widow stowed in Ward B. under my guardianship ! Someone showed me a photograph of a lady said to be you with two chicks, but there was a mistake. 'Twas an elder sister of the chicks I know ! I hope you keep in good form, but if you feel the slightest inkling of relapse—return—there is danger in delay. Yours (on behalf of the staff) most sincerely,      Wm OSLER.

Or in place of a note or a postcard it would be flowers, a book—even a barrel of apples to Pierre Marie, who declares they are the best in the world : ' Quel admirable pays que celui où les pommes et les hommes sont aussi excellents ! ' What happened as the outcome of Mr. Murphy's survey is well known. Early in April came a letter from John D.

Rockefeller, jr., to Osler, stating that ` in view of the high work which the hospital and medical

school are doing in medical instruction and research, including the training of nurses, which work he understands will otherwise be materially curtailed because of losses, my father will give $5oo,000 to Johns Hopkins Hospital.' To this Osler

replied :                                                                   Friday eve.

Dear Mr. Rockefeller, Your letter brought joy to us all, not only to those of us immediately connected with the work of the Hospital, but to all the citizens. Indeed to a larger circle, as shown by the letters & telegrams which we have received, it has given the liveliest satisfaction. Please express to your father my sense of the deep appreciation of his generosity With kind regards, [&c.]

While all this was going on, the muddle among the tuberculosis experts had come to a head. Into this Osler, as Chairman of the recently appointed committee, had been unwillingly drawn. It

would appear that he was in favour of joining forces with the Lewis faction ; to this Dr. Flick was utterly opposed, and threatened to withdraw the support of the group at the Phipps Institute unless an entirely new and third organization was formed. The committee which had been appointed by Welch at the Baltimore conference was brought together, on February 27th, at a dinner given by Oslerin New York. They agreed upon a number of delegates who should

represent the various groups of people and institutions interested in tuberculosis, .and adjourned to meet again a month later. Subsequently, Dr. Flick suggested that this next meeting, one of actual organization, be held in Philadelphia on March 28th, on which date Maragliano, an Italian, was to give one of the series of addresses arranged by the Phipps Institute. A vast deal of correspondence passed. The position taken by Welch and Osleris evident from their letters to

Dr. Flick :

I do not see at all [Oslerwrote, March 18th], if the organization of the Lewis Congress is practically handed

over to us, what possible reason you could have for keeping out. A third organization is out of the question, and enough good leaven can be inserted into the present dough to make a really good loaf. What would you propose as an alternative? We ought to have the matter pretty definitely settled among us before the meeting, or there will be no end of :onfusion.

And Welch a few days later wrote :

I understand your position with reference to the Bell and Lewis Congresses. The Bell affair is absolutely out of any consideration. The question is whether the Lewis Society is as bad as you think it is. I confess that I do not know much about it, but it has the support of men who will have to be reckoned with on account of their official positions as for other reasons in a National Crusade against Tuberculosis, and whom it would not be desirable to alienate. The organization seems to be almost inchoate, and probably could be moulded into any desired form by those who took hold of it. It is too bad that there should have arisen such a muddle, and possibly the best course may be to let the troubled waters settle before the leading men in the profession take any positive course of action. I feel that men like you and Trudeau who have given strength and direction to the antituberculosis movement in this country should have the main say in determining what it is best to do under these circumstances.

At the last moment Maragliano cabled that because of ill-health he would be unable to appear. Nevertheless the meeting was held, with Osler in the chair, and sixty-five of the most eminent tuberculosis workers in the country in attendance. After some heated discussion, the motion made by Dr. Flick, that a United States Society for the Study of Tuberculosis be organized, was carried. Though it was contrary to his judgement, as would appear, Osler submitted with good grace to his defeat and, as Chairman, appointed a committee of five, consisting of Trudeau, Biggs, Flick, Welch, and Sternberg, to prepare a constitution. This committee met a month later in New York, when a board of directors was chosen ; these gentlemen in turn met on June 6th at Atlantic City, where Trudeau was enthusiastically elected the first Fresdent of the new society, with Osler and Biggs as Vice-Presidents ; and Osler was also made Chairman of the International Committee empowered to represent the society in accordance with the constitution of the International Central Bureau.

As the Baltimore years rolled on he had become more and more overwhelmed with strictly professional work, and in this spring of î9o4 it had almost reached the breaking-point. Recognized from Hudson Bay to the Gulf, from Nova Scotia to California, as the doctor's doctor, even though he

might curtail the number of ordinary professional consultations this could not be done when some member of a physician's immediate family was concerned. Love of his profession meant love of his professional kind, and the afternoon was rare indeed that some doctor from somewhere, ill himself, or with an ailing child or mother or wife, was not in his consulting-room----what is more, at tea or at his hospitable table, or both. Much of his treatment was psychotherapeutic, and though he thoroughly despised the chicanery of psychoanalysis his personality was such that he could effectively administer at a single session commonsense advice which was usually followed. ` She has been worried and apprehensive [he wrote to a patient's doctor] over the possibility of a third operation on her stomach. I have urged her to take more food, to live out-of-doors, and to keep her mind out of her bread-basket.' And this to a neurasthenic doctor : ` It is very satisfactory to feel that you have got a good grip on your grey cortex. Go slowly and attend to your work, live a godly life, and avoid mining shares. I doubt if quinine could have very much influence.'

To C. F. Martin of Montreal.                                     Sunday.

Dear Martin, I shall twist my Fraülein's neck ! She is a daughter of the Philistines. I suppose she thôt (Lord Strathcona's usage, to be adopted by the Dept. of Eng. at McGill so Pr. Pet. [Principal Peterson] informs me !) you were in the Ass. of Am. Phy. list. I am sending them with my own hand, with inscription &c. so your forgiveness I know is assured. Is your name up for A A P ?, I asked Stewart about it. I hope Billy Francis is working well. He knows more about Astrophel & Stella than amyotrophic lateral sclerosis. I have not sent your bill yet to those Cincinnati people. I will enclose it with mine—they are well to do, but the poor soul is ` in the dust '. Yours, &c., Wm OSLER. Love to Hamlet. Campbell H. is  a great success. Working like a Trojan.

To yohn H. Musser.                                                      1 /5/4.

Dear J. H., How the deuce do you find time to make such good revisions ? I have just been reading the section on Blood pressure in your New Edition. Many thanks for it. 'Tis a bully book & a great credit to you. I have been swamped with work lately—& the wards are surcharged—we reached a high water mark in the private rooms-30 this week. Nine cases of pernicious anaemia in the house since March 1st & three cases outside—'Tis epidemic ! Hope to see you in Washington next week. Yours        W. O.

Indeed, his being so swamped had much to do with a momentous decision soon to be made. With all this pressure upon him the date of the Ingersoll Lecture was approaching, and though he had been making notes and giving thought to it during the preceding months there had been scant time for the sort of preparation the subject, once entered upon, really deserved. He, indeed, had agonized over it perhaps more than any of his previous addresses and it was rewritten and redrafted many times. The following letter to the Dean written at this time not only mentions his expected absence but dwells upon other matters which give an idea of the meagre salaries of clinical teachers of twenty years ago :

To W. H. Howell from W. O.                           Baltimore,

May 14, 1904.

I have to go to Boston next Wednesday, to give the lecture on Science and Immortality ' which Welch has so kindly written for me. There are one or two things which I wish you would bring up at the Faculty Meeting :

In the first place, Futcher who is Associate Professor of Medicine and does a great deal of work, and good work too, has a beggarly salary for that position : $300. Do you not think it could be increased to some decent rate ? He does a great deal of teaching, and he ought to get at least $700 ; but whatever the Committee thinks.

Secondly, if there is no objection I should like to have some of my Instructors in Medicine lifted to the rank of Associates : Rufus I. Cole, Thomas R. Brown and L. P. Hamburger. They have been doing good work for some years.

Thirdly, would you please talk to Abel about McCrae and the question of practical therapeutics. McCrae leaves the house this year. He is a very valuable man, a good teacher, fond of materia medica and therapeutics, and could, I think, add greatly to the strength of the section if he could be appointed on the therapeutical side in clinical therapeutics, either as an Associate Professor or whatever Abel thinks, and take charge of systematic instruction in the third and fourth year in out-patient and ward therapeutics., It is a weak point in our teaching which I am sure he could strengthen with great advantage. We need not pay him much salary at first. I should think five or six hundred dollars a year would be sufficient.. .

There is hardly any place but Harvard that could have been left a bequest of $5,000, the income to be devoted to an annual lecture on ` The Immortality of Man '. Given such a bequest, there is hardly any place but Harvard,

under a president like Charles W. Eliot, which could have kept such a lectureship going. Osler's

predecessors in the Ingersoll Lectureship series had been George A. Gordon, William James, Benjamin Ide Wheeler, Josiah Royce, and John Fiske—a theologian, a philosopher, a philologist, a psychologist, a historian. How Oslerwas captured as the sixth lecturer has been told.

As Welch had said in refusing the lectureship, ` science has nothing to do with immortality ' ; and "after Osler's lecture Mr. Eliot expressed himself as greatly disappointed, for instead of hearing a scientific discourse on the subject, if there could be such a thing, he had listened merely to a brilliant and charming essay. Indeed, the lecturer in an early paragraph had shifted the burden on to the shoulders of his ` lifelong mentor ' :

One of my colleagues, hearing that I was to give this lecture, said to me : What do you know about immortality ? You will say a few pleasant things, and quote the " Religio Medici ", but there will be nothing certain.' In truth, with his wonted felicity, my lifelong mentor, Sir Thomas Browne, has put the problem very well when he said : ` A dialogue between two infants in the womb concerning the state of this world might handsomely illustrate our ignorance of the next, whereof methinks, we yet discourse in Plato's denne—the cave of transitive shadows—and are but embryon philosophers.'

The only portion of the address that met with Mr. Eliot's genuine approval was the brief reference to the study Oslerhad made of the last sensations of the dying. For the head nurses in

the wards had taken down at his request, for some time, the exact words of dying patients. ` The great majority gave no sign one way or the other : like their birth their death was a sleep and a forgetting.' Raised in a rectory, destined in his early days for the ministry, conversant as few men of his time with Holy Writ, a thorough-going Christian, to stand before a lay audience and discuss with frankness, clear sanity, and kindliness of spirit whether ` mankind's conquest of nature has made the individual more or less hopeful of a life beyond the grave ' must have been an ordeal. Some said afterwards that he offended neither side ; others that he offended both. But as to the brilliant quality of the essay there could be no doubt. The

dthenaeum, in a review of the series as a whole, referred to them as superb examples of the art of lecturing, but added that, of the six, Osler's was ` the most common-sense and at the same time the most literary '. He made as a framework the triple classification of mankind into the Laodiceans who accept a belief in immortality, yet live their lives uninfluenced by it ; the Gallionians who put the supernatural altogether out of their lives ; and the Teresians with whom this faith is the controlling influence. In his conclusion he thus addressed himself to the young men in the audience

As perplexity of soul will be your lot and portion, accept the situation with a good grace. The hopes and fears which make us men are inseparable, and this wine-press of Doubt each one of you must tread alone. It is a trouble from which no man may deliver his brother or make agreement with another for him. Better that your spirit's bark be driven far from the shore—far from the trembling throng whose sails were never to the tempest given—than that you should tie it up to rot at some Lethean wharf. On the question before us wide and far your hearts will range from those early days when matins and evensong, evensong and matins, sang the larger hope of humanity into your young souls. In certain of you the changes and chances of the years ahead will reduce this to a vague sense of eternal continuity, with which, as Walter Pater says, none of us wholly part. In a very few it will be begotten again to the lively hope of the Teresians ; while a majority will retain the sabbatical interest of the Laodicean, as little able to appreciate the fervid enthusiasm of the one as the cold philosophy of the other. Some of you will wander through all phases, to come at last, I trust, to the opinion of Cicero, who had rather be mistaken with Plato than be in the right with those who deny altogether the life after death : and this is my own confessio frdei.

It was not a particularly well-delivered address. Oslerdid not shine in this regard, and though

dignified, was without oratorical bearing on a platform. On this occasion his wife, who sitting with her mother and among her own people was a distinctly agitated member of the audience, is said to have remarked that she ` wished Willie would not rub the calf of his leg with his other foot to stir up his ideas '. But even if this were true, probably no one else observed it. At an informal reception after the lecture President Eliot mentioned in the presence of Mrs. Revere that her son-in-law seemed to have a great reluctance to come and live among his relatives, whereupon Oslerquickly replied that

it was Mrs. Oslerwho objected. What for a year or more had been lurking in the President's mind

is explained by the following letter :

To F. C. Shattuck from President Eliot.   Harvard University, May 23, 5904.

The Corporation would like very much to get Dr. Oslerof Johns Hopkins to spend one year at

Harvard—that is, from October 1st to June 1st or July 1st--on the endowed professorship of hygiene which is waiting to be filled. The professorship has been established for the benefit of the students in Cambridge and not as a Medical School professorship. The incumbent is supposed to advise and generally befriend the students in Cambridge, to give some lectures but not many, to act as a consulting physician among them on occasion, but not ordinarily to practise among them or to give stated instruction either in Cambridge or at the Medical School. He would be free to do any hospital work which seemed to him desirable, and to act as a consultant anywhere.

The duties of this professorship are really to be invented ; and that is a strong reason, in the minds of the Corporation, for getting Dr. Oslerto hold the Chair for a year. When he was in Cambridge to give the Ingersoll

Lecture I talked with him on the subject, but found that on account of his great interest in developing clinical instruction he would bring himself with difficulty to leave even for eight or nine months his opportunities at the Johns Hopkins Hospital.

.. It occurred to me, after I had talked with him, that he had some hesitation about coming to Boston temporarily with freedom to act as consulting physician, lest he might interfere with the practice of some Boston physician. Could you not relieve him entirely of this apprehension, and therefore persuade him to undertake this peculiar and interesting job as a pioneer and inventor ? .. .

He would have been an ideal person for such a free-lance position, the duties of which were ` to be invented '. What he subsequently made out of his position in Oxford was just what Mr. Eliot felt was needed at Harvard. And before leaving this account of the Ingersoll Lecture it may be said that the honorarium thereof was donated to the Boston Medical Library for the purchase of some much-needed show-cases in which a few of the bibliographical treasures Chadwick was gathering might be laid out for display in the D. W. Holmes reading-room.

Dear Musser, Just back from Boston. I leave on Tuesday next. [ have promised to go to the country next Sunday, a patient of 3uitéras & an old patient of yours from Havana is here. Guitéras

2923.1                                T t

wishes you to see him also. He came last eve. I have not yet seen him. Will let you know & if you come down arrange to spend the night. Your address is A.i. Get it into the hands of the Hospital Managers. Have your secretary make out a list. They are the people to attack. Yours, W. O.

It was Musser's year as President of the American Medical Association and he must have submitted his address on ` Some Aspects of Medical Education' for Osler's criticism. It was indeed on Osler's favourite theme : that every hospital should function as a school. The meeting,

which was held in Atlantic City, June 7-10, brought out what was then regarded as a record attendance of over 2,000 members. On the preceding afternoon, of Monday, June the 6th, Oster presided as usual at the meeting of medical librarians, and as a body they dined as his guests at the Hotel Traymore that evening. On the same day the delegates of the new Association for the Study and Prevention of Tuberculosis met as appointed, with Osleragain in the chair. Of this

meeting the following incident is recalled by W. H. Bergtold of Denver :

Among many topics relating to the function and scope of the new organization, mention was made of the spread of the disease among the blacks, and the question had been raised of including coloured people in the membership. To this a Southern physician made answer, repeatedly referring to the black race as ` niggers '. When it came time to close the discussion, Osler made appropriate remarks on the various matters which had been brought up, and in alluding to the admission of coloured members he was obliged to refer to the physician who had used the term ` nigger'. Not knowing, or having forgotten, this gentleman's name he hesitated just a second, and then quickly said with his kind smile and characteristic good humour : ` Oh, you know. I mean my melanotic friend,' which brought down the house, the Southern physician included.

The story of the Regius Professorship, interrupted by the Baltimore fire, may now be resumed. The impasse was broken when two names, those of Sir Patrick Manson and Dr. Osler, had

finally been suggested to the Prime Minister as eligible candidates outside of the University circle ; and Balfour must at once have written to Burdon Sanderson, who had been away on a long vacation because of ill-health, Professor Thomson meanwhile acting as his deputy.

Sanderson apparently had never considered his old pupil as a possible successor, and Osler's earlier refusal to stand for the Edinburgh position was supposed to be due to his unwillingness to comply with the traditional regulations concerning testimonials. This, however, for a Crown appointment was not required, and no sooner was his name mentioned to Sanderson than he clapped his hand to his forehead and said, ` That 's it—the very man ! '

To W. O. from Sir f ohn Burdon Sanderson. Oxford,

June 8, 1904.

Dear Professor,—You are no doubt aware that I am on the point of vacating the Regius Professorship of Medicine here. The appointment of my successor is in the hands of the Prime Minister (Mr. Balfour) who in this matter acts independently of the University. He appears at present to be unable to decide on the proper course to be taken. My colleagues and I have placed before him our opinion in favour of appointing our ` Reader in Pathology ' who is also Director of the Pathological Laboratory, he being in our judgement a man of higher scientific position than any one to be had in the United Kingdom at present. It appears, however, that certain objections have been suggested to Mr. Balfour which from a statesman's point of view have value, however groundless they may seem to us.

This being the position of matters, it has seemed desirable to communicate to the Minister our hope that if, for the reasons referred to, he is unable to take the course we suggested several months ago, he should as the next best course ask some distinguished representative of the science of Medicine, outside of this University, to consent to occupy the position. I now write to ask you whether we may venture to entertain the hope that you might be induced to accept the position if it were offered to you.

I think I should add that my only reason for resigning my post is that declining health and strength make me unable to do the work efficiently. As you will see from the paper sent by this post the work is very light. The Regius Professor need not reside more than one-third of the year, so that he can, if he likes, avail himself of the proximity of London for any work or purpose that may require his presence.

I understand that you are to be in Oxford at the meeting of the B. M. Association. Will you and Mrs. Oslerbe our guests ? You would find my house conveniently situated for the business of the meeting. I would have written sooner but I have been ill and have only lately found myself in a position to make any arrangements.

The story may be continued by the following account

T t 2

supplied by Lady Osler, who at this juncture was visiting her mother :

As we never paid any attention to birthdays, I was surprised to hear that W. O. would arrive at Canton, Sunday morning, June 19, 1904, to be with me on my birthday. Revere and I were then on our way to Murray Bay where we had taken a cottage for the summer. Ned Revere drove Revere and me to meet the early train from Boston. A twinkle in W. O.'s eye made me feel something unusual was in the air. He sat on the back seat with me. Directly we started he thrust a letter into my hand and placed his finger on his lips to signify I must not exclaim. It was Sir John Burdon Sanderson's letter suggesting his appointment as his successor to the Regius Professorship at Oxford. As I read the letter I felt a tremendous weight lifted from my shoulders as I had become very anxious about the danger of his keeping on at the pace he had been going for several years in Baltimore. When we reached the house, Mother was on the verandah and there was no moment for explanation. Immediately after breakfast we went into the garden alone, and I said : ` Thank Heaven, relief has come ; but unfortunately the telegraph-office is closed here on Sunday and we cannot cable your willingness to be a candidate.' He jokingly reproached me for my readiness to leave America, and returned to Baltimore on the night of the 20th, sending the cable as he passed through Boston, telling Sir John he would consider it, and discuss the matter when he reached Oxford.

Sir y. Burdon Sanderson from W. O. 1 West Franklin Street,

[Tuesday June] 21st.

Dear Sir John,--I feel highly flattered that my name should be mentioned in connection with the Chair. I am sorry that so good a man as Ritchie should be passed over. There are so many things to be considered that I cabled you asking if an immediate decision was wanted or whether I could confer with you upon the question in Oxford. In many ways I should like to be considered a candidate. While very happy here and with splendid facilities, probably unequalled in English-speaking countries, I am over-worked and find it increasingly hard to serve the public and carry on my teaching. I have been in harness actively for thirty years, and have been looking forward to the time when I could ease myself of some of the burdens I carry at present. With the income from my book we have a comfortable competency, so that I am in a measure independent. My only doubt relates to the somewhat relative duties of the Chair. I am interested in clinical teaching, am fond of it and have acquired some degree of aptitude for bedside work which gives me a certain value in the profession. I should miss sadly the daily contact with the students, unless I could arrange for clinical work in London. On the other hand, I have a mass of unfinished literary material on hand

which the academic leisure of a new place would enable me to complete. Thanks for your kind invitation. Mrs. Oslerdoes not accompany me. I have already accepted an offer from the Dean of Christ Church... .

The following note written the same day to Lafleur intimates in a brief sentence what is on his mind :

Dear L. So glad to hear that you had a good rest & a profitable trip. I am working hard this spring—good p.g. class & have stood the work very well considering that it is my 3oth consecutive session. 'Tis time to quit ! I go to Boston on Tuesday to get the LL.D. at Harvard. Then on to Montreal on Wednesday eve. Look out for me Thursday. I shall lunch with you D V & take the boat to Quebec in the eve. McCrae goes out of the house in July. He, C— & I sail July 16th for a short run. Mrs. O was afraid to risk the damp &c after her sad experience last summer with the asthma. Yours ever, W. O.

On June 3oth, the day after his LL.D. was conferred at the Harvard Commencement, a long session of the Executive Committee of the Tuberculosis Association was held in Boston ; and from there he went on to spend a fortnight at Murray Bay, whence issued a shower of hand-written notes on various subjects, some of which tell of trout-fishing with ` Isaac Walton', who is very happy ; whereas matters in which he had become involved are mentioned in others :

To Miss Charlton. -           Caribou Cottage, Pointe-à-Pic.

[undated]

I was sorry that you left so soon, as there were many things I wished to talk to you about. I hated to trouble you on the holiday but it was my only day in town [Montreal] and I had to arrange about the photographing of some of the old familiar specimens. I shall ask you to send a few books. I. wish you would look among your duplicate Amer. Jr. of the Med. Sciences for the Jan. 1902 no. with a paper by Dr. Delafield on Treatment of Pleurisy. I would like it very much. We all missed you so much at the Librarians' Meeting. Everyone asked after you, &c.

To Ex-President Gilman.                                     7th [July]

Thanks for your note received here to-day--& for the additions, which pleased me greatly. I am publishing this summer a little volume [` Aequanimitas &c.'] of collected addresses—for the boys !and I have dedicated it to you—without your knowledge and

consent ! You will not mind I know. With love to Mrs. Gilman, Sincerely yours, &c. I sail for England next week—short trip, as Mrs Oslerand the boy are here.

To Professor Russell H. Chittenden.                    9th [July]

I have undertaken to edit a System of Medicine for Lea Bros, & I write to ask if you will not contribute a section of 75 pp. to Vol I on Metabolism & Nutrition. General considerations—Disturbances in disease—over & under nutrition &c. You have the matter so well in hand that it should not be much trouble and a presentation of the question from the modern standpoint would be very helpful. Would you send me a line to the University Club, New York, before Friday as I am sailing on Saturday. Lea Bros. pay at the rate of $4. a page. With kind regards to Mrs. Chittenden.

Not long before this time there had been started at Trudeau's Sanitarium a semi-popular journal to encourage the open-air treatment of tuberculosis. This had come to Osler's attention the month before, when he wrote the first of these two characteristic notes to the anonymous editor ; and now, though busy with other matters, he found time to send them something for publication :

To Lawrason Brown :

I enclose five dollars for five subscriptions to the Outdoor Life, the addresses to which they are to be sent being given below.

1.  Dr. Wm. Osler, 1 W. Franklin St., Baltimore.

2.  Library of the Med. & Chir. Faculty, 747 N. Eutaw St.

3.  Miss Adelaide Proctor, 47 Green St., Cumberland, Md.

4.  Mrs. John J. Gibson, Room 1220, N.Y. Life Bldg., Chicago.

5.  To someone who you think would enjoy it.

To the Same :                        Pointe-à-Pic, P.Q. vii. 11. 04.

I enclose you a little memo of Fracastorius on the contagiousness of Phthisis which may be of interest enough to put in your useful paper. It was nice to see Trudeau looking so well. I leave for England on Saturday the 16th by the Campania from New York. I hope you will have a good summer—do not overwork. You must get a good holiday in Europe. Wm OSLER.

To judge from the following letter, on his way through Montreal he must have seen with C. F. Martin a patient with an obscure malady, and he had evidently passed his afternoon before sailing at the New York Academy of Medicine in search of information regarding it :

To C. F. Martin :                            University Club, New York. Friday [July z 5].

I have been looking up the Hughlings Jackson triad to-day & have not been able to find a very good account. Bruce in Gibson's textbook is the best. An Italian article has all the cases, but the reference is at home. I would like very much to refer to Judge B 's case when I publish my paper. Would you ask Roddick if I could have a photo of the tongue protruded &, if possible in the mouth too. The lip points in different directions in the two positions, & could you see if the left side of the palate is paralysed—it usually is. If the Judge could stand a camera on the back of his neck also—to show the atrophy of the upper Trapezius 'twould be pleasant. Let him mask the upper face when the tongue is photographed. Send me a memo of the cost of the photo. I wish you were coming with us. I have been beguiled into editing a 7 (! ! !) volume System of Medicine, (McCrae to do the dirty work) & shall need your help. What would you like to write—think & say. Yours ever, W. O.

Early the following morning he sailed with his two young friends—the three occupying the same cabin. The night before, they had dined unwisely and too well at the University Club, and Osler for a few days was somewhat stricken —below decks. On being offered the assistance of a paregoric tablet he inserted the minute object not in his mouth but in a crevice under McCrae's upper berth, where he could contemplate it as though it were Digby's Powder of Sympathy. And so he was cured. His habits aboard ship were interesting. His first act was to fill to overflowing the rack in his berth with the books and papers he intended to use. Always the first awake, he stayed in his bunk all morning reading and writing for some four or five hours, and there was plenty for him to do, as his paper for the British Medical Association had to be put together. By noon he would appear on deck, free from care, the liveliest person aboard ; and soon the half-dozen doctors on the passenger list, together with Francis Verdon, the ship's surgeon, were organized into the ` North Atlantic Medical Society' which met every afternoon at tea-time, and held its final meeting on July 22nd, when a fictitious programme of papers was presented, with amusing jibes on the various members.

Any one who would keep on Osler's trail during a first

day in London must needs have good staying qualities. It is recalled that on this occasion, having been roused at . a.m. in the Mersey for an early landing, and having reached London by the boat train at noon, nothing would do but that the remnants of the N. A. Medical Society should go out to Haslemere and visit Jonathan Hutchinson. This was done, a delightful afternoon and evening being spent there, but when at midnight they got back to town the eldest member of the ` society', Dr. James Tyson, handed in his resignation. The pace was too much for him. The next day, a day of shopping and sight-seeing, was even more strenuous. It began with the White Star Office ; to Brown, Shipley's ; to the tailor's in Savile Row, where it took about ten minutes to order and be measured for four suits of clothes; to the Ulster House ditto for overcoats; to the College of Physicians ; to Sotheby's auction rooms in Wellington Street ; to Maggs Brothers, &c.—to account for the morning alone. It was, of course, done in one of the picturesque old hansom cabs long since vanished from the London streets. That evening, on dining with H. D. Rolleston, he casually remarked : ` Do you think I'm sufficiently senile to become Regius Professor at Oxford ? 'a remark which so misled Rolleston that when told later that Osler would accept, he emphatically denied it.

During the Oxford meeting of the British Medical Association, Osler, at least in the eyes of his two young companions, occupied the centre of the stage, and it was not long before they heard to their dismay some rumours of the pressure that was being brought to bear upon him to accept the Regius Professorship. On the evening of the 26th, in the Sheldonian Theatre, came Dr. Collier's presidential address on the ` Growth and Development of the Oxford Medical School '—a timely subject. The customary vote of thanks was moved by Clifford Allbutt, and Osler in seconding it spoke most effectively in regard not only to traditions and ideals, but to the necessity of combining them with common sense. Though an impromptu speech, his familiarity with Oxford traditions and Oxford medical worthies was shown by his pointing out that John Locke should have been included among the long list from

Roger Bacon to Henry Acland whom Dr. Collier had mentioned.

On the following afternoon, before a brilliant assemblage again in the Sheldonian, the Doctor of Science degree was conferred in Convocation upon Allbutt, Sir William Macewen, Jonathan Hutchinson, Sir Patrick Manson, and one or two more, with Oslerthe last  he receiving an

unexpected and prolonged ovation which brought an unusual colour even to his dark skin. It was a busy and exciting week, with the usual festivities : a soirée at the Museum, a concert in the garden of St. John's, a garden-party at Blenheim and another at Warwick Castle, excursions on the river and elsewhere, in addition to the scientific sessions, at one of which he gave his paper, written on the steamer, on the Treatment of Pleurisy ; and at the annual dinner in Christ Church Hall he must reply to a toast` the Guests '.

In spite of the fact that he had often said his ideal of life would be to live within an hour of the British Museum and to have The Times on his breakfast-table, he had difficulty in coming to a decision, and so wrote to his wife. She got his letter at Murray Bay one Sunday morning, routed out Madame Rousseau at the telegraph-office and

cabled : ' DO NOT PROCRASTINATE ACCEPT AT ONCE.' This

message he showed to his anxious young friends, though it was folded over, with only the ` do not procrastinate ' portion visible, so that they were left uncertain until the return home whether ` accept' or ` refuse' was the next word.

Oslermeanwhile had gone to North Berwick for a visit with Schafer, leaving an impression on

Oxford which is indicated by the following letter, written by the President of Magdalen to the Prime Minister the day after the B. M. A. adjourned :

Magdalen College, Oxford, July 31, 1904.

... What I have to say is this. Dr. Oslerhas been here this last week. I had some little talk with

him. I found that the idea of his coming had been mooted to him by Sir John Burdon Sanderson. He gave me the impression that if he were offered the post he would take it. And if he did come I believe he would really practically

unite parties as no one else could. Over and above this I understand Sir Victor Horsley would approve this appointment. But I have in particular one very strong and interesting piece of evidence. Sir William Broadbent who is of course a man of special eminence and standing and has the advantage of being quite outside our schools and their interests (and prejudices) was as it happened staying here as my guest, last week. He told me he thought this appointment of Dr. Oslerwould be a magnificent one for us and full of advantage for the

cause of medical education and science in this country and would be recognized and welcomed as such by the medical world generally.

Further than this, I could not but be struck by the very good reception and welcome which Dr. Oslerreceived both when he spoke on several occasions and when he came up for his honorary degree at the Theatre. His speeches, too, impressed me very much. He is a philosophic and cultivated man, a student and lover of Locke and Burton and so far the kind of man whom Oxford generally, I believe, would welcome. It would also, I think, be a very interesting and pleasing thing from the Imperial point of view just now to appoint a Professor to Oxford who is a Canadian by birth and a Professor in the United States. I might say more, but will not trouble you with a still longer letter. If you have not yet decided to prefer Dr. Oster perhaps you will let these considerations have what weight in your own exhaustive and deliberate estimate you think they are entitled to.... With apologies for writing so much—I hope not more than the situation deserves—I have the honour to be, Yours very faithfully,

T. HERBERT WARREN (P. of M.)

Balfour's letter asking him to take the Chair reached Osleron August 4th, the day before he

sailed on the Cedric for home, and he accepted with the request that the fact be not made known for a fortnight. He said no word of his decision to the survivor of his two companions, until landing, though the fact that the writing-room steward, long before the end of the voyage, ran out of U.S.A. postage-stamps, indicated that something unusual was being communicated to countless people by an olive-complexioned man who sat in the corner and industriously scribbled for several hours each day—notes like the following :

To W. S. Thayer :                               S.S. Cedric, Aug. 6th.

You will be surprised when I tell you that I have accepted the Chair of Medicine at Oxford ;—to leave next Spring ! 'Tis a serious step, but I have considered it well from all points. I am on the down grade, the pace of the last three winters has been such that I knew

I was riding for a fall. Better to get out decently in time, & leave while there is still a little elasticity in the rubber. It will be an awful wrench to part with all you dear boys, but I shall only cut off 4 years as I had firmly decided to chuck everything at 6o. We can have a last good winter's work together, I hope, before I lapse into a quiet academic life. Mrs Osleris strongly in favour of the move, which is a mercy. The offer or suggestion

came last spring from Sanderson, the present occupant. I told him I would decide when I came over. Balfour formally offered me the post—'tis a crown appointment—yesterday, & I accepted. Love to Sister Susan. Yours ever, W. O.

This was the general tenor of the notes. Most of the recipients have kept them. His mother was told that ` it will be much better for Revere in every way & I will have a quieter life. We can come out every year & I dare say see more of you than we have done of late '. To Weir Mitchell he wrote : ` Just twenty years ago you & Mrs. Mitchell were important factors in inducing me to come to Philadelphia and you have been ever since a guide Sc friend. To you then one of the first I must tell of another change in my life.' To his colleague Halsted, that he is tired of the rushing life and that the peace and. repose of the ald university appeals to him, for he has been heading down hill and the pace has told. ` The worst will be parting from my old colleagues ', he added. ` No man ever had better, & I hate to think that I should be the first to break the happy circle.' And to Dock, the day before landing :

... Sanderson, who is an old friend and teacher, has been urging it strongly, and I looked over the ground during the Association week. I shall be able to work over a lot of my material—Typhoid, Aneurysm, heart, &c which has been accumulating hopelessly. [ go through to Pointe a pic, Quebec, from New York. Shall you ;o to St. Louis ? Let me know, as we might go from Chicago together... .

Even after he landed and joined his family at Murray Bay, his shower of explanatory notes continued ; and soon letters .ike the following began to pour in upon him when people .earned where he was :

From S. Weir Mitchell to W. O.       Bar Harbour, Maine. 14th August, 1904.

I read your letter with very mingled feelings—pained because your great example—so various in its values is to be lost to the

profession—pleased because of what Oxford will gain in an untrammelled, clear-headed American physician. Yes, American—you will let me insist on that. I think you are wisely counselled to go. Twice in the last year I was on the point of writing to ask you to consider whether you were not being worked beyond your strength. Selfishly speaking I am filled with the most honest regret. One by one the older men who shared with me the fates of war and the contests of peace, have died. I have picked up new friends—the younger ones, men and women—and among the best, you—and is it twenty years indeed ? When I read your letter to my wife, she said isn't it splendid ? And I--isn't it sorrowful ?—for of course this does take you out of my life, and at 74 the arithmetic of opportunity is easily summed up and made out. We shall see you I fear but rarely, and very soon you will be saying raily for really and H's will be lost all over the house, and you will say Gawd for God, as is Oxford as she is spoke—Do be careful of your English. I am chaffing you to keep from saying more of the personal loss to me. As to Jn. Hopkins—perhaps you do not know that the Med. School at J. H. is or was Wm. Osler. Are we not to see you before you go ? My news is small. I have a novel done, and am made an

Honorary something of the French Académie.

His own notes were to the effect that his act was one of preservation. For the daily grind of a consulting practice into which he had become drawn was growing worse from year to year, with less and less time for teaching and clinical work. The new post he insisted was chiefly ornamental, though he hoped to make it useful and would at least find congenial work to do ; that he had had his day and it had been a good one, but a younger man could do better—one who does not ` trade largely as we pre-seniles have to do on our past reputation '. Such a letter he wrote, among others, to Flexner on September 1st, with this postscript :

PS. What do you know of ` healed .splits' of the intima in connection with dissecting aneurysm & rupture of the aorta and healed dissecting aneurysm ? Have you had any cases of the latter ? I am working at my aneurysm material.

To Dr. Maude Abbott from W. O. Pointe-à-Pic, P. Q. Sept. 5.

It is awfully good of you to send all those abstracts & the books. It wag exactly what I wanted. I will return the books in person next week. I can then look over the other references. which you have given. The subject is one of really great interest. Remind me, please, to go over the aneurysm cases in my post-mortem notes. There are 29 or 3o of them. No. 180 I see is a perforation of pul-

monary artery. I enclose you a list on a slip which please keep for me.... PS. Your letter & the translation of Thoma just arrived. Thank you so much. Do not mind about the others. I have been going over the Eppinger paper carefully. Thoma supplements it splendidly. I remember its appearance, but I had forgotten how good it was. I shall be glad to look over your paper—' The Museum in Medical Teaching' would be a good title. A good deal has been written I think in English journals—look in Neale's Medical Digest under Museum & under teaching.

To 7oseph H. Pratt from W. O.          Pointe-à-Pic, Sept. 6th.

Thanks for your kind note & the slips. Very glad of the reference in the Gazette des Hôpitaux. Somebody told me of a study in progress on the strength of the Aorta, but I have forgotten who it was. I wish you would look in the Harvard Museum if there are any specimens of rupture of the Aorta, or of splits of the intima. I am to edit for Lea Brothers a new system of medicine. I shall get only the younger men to contribute. Give me a few hints from Boston : (I) what would you like to write ? (2) send me a list of the younger fellows & the special work they have been doing. Cabot will take the blood section. I suppose there could be nobody better than McCollom for Diphtheria and Scarlet Fever. One of Councilman's men should do the pathology... .

Working at his aneurysm material and scarcely a fortnight passed ! Nevertheless his wife writes to one of the ` latchkeyers ' that he ` is looking very well and really having a holiday except for stacks of mail. We leave here on the i4th for Toronto, spending a day in Montreal, and I shall stay there while he is in St. Louis.'

To Edward Milburn from W. O.                  Pointe-à-Pic, 9th.

Dear Ned, I was on the point of writing to you when your letter came. Mrs Hinneman has told me of your sorrow & trouble about your son—how terribly sad for you all. And your account is not very satisfactory. Though the early cases with haemorrhages often start very badly & later the disease is arrested. I hope you are keeping him in the ` open' in these fine days. While he has fever he should be flat on his back but the continuous out of door life seems so good for the digestion & for the fever. Who is your doctor ? Why not let him write me a description of the case ? I might be able to be of help. I do not leave until next Spring. It will give

1 The International Congress of Arts and Sciences was held in connexion with the St. Louis Universal Exposition, Sept. 19-25, under the presidency Df Simon Newcomb the astronomer.

me a change I much need of a quieter life. Do let me hear how the boy gets on. I shall be in Baltimore on the 24th.

His old schoolboy friend, one of the triumvirate of ` Barrie's Bad Boys', will be recognized; and hardly a week passed without some word of counsel or encouragement until the end came two months later, when he wrote :

Dear Ned, How heart-breaking to part from your dear boy

& an only son ! I feared all along from the symptoms that it was one of these acute types for which there is rarely any hope. Better so perhaps than a slow lingering two or three years of illness with all its illusive hopes & anxious dreads. Do give my love & heartfelt sympathy to your wife & the girls. They will be unconsolable, poor things ! Affectionately yours, W. O.

And on the last day of his four weeks at Pointe-à-Pic he wrote to W. S. Thayer :

Dear T. I have been so overwhelmed with correspondence that I have neglected to answer your nice letter of the 28th.... I am so glad to hear that the Dispensary rooms are nearly ready. What a comfort it will be to have plenty of room. I doubt very much the wisdom of taking the men from the wards. So far as I know it is never successful—they always regard the work as extra & neglect one or the other. There should be enough good young fellows, who have time enough in their waiting years. The difficulty with such men as Brown & Hamburger is a serious one—they are so good

& so busy. I am sure the St. Louis address will be A. r. Send me word to Fischel, where you are. F's address is—see the Trans Ass. I have forgotten it. Thanks for the papers. The typhoid heart & arteries sequelae has I see been widely noticed. I have been deep in Aneurysm literature, & have gone thro. Thoma's five papers

& Eppinger's colossal arbeit. I have spent a couple of mornings with Dr Maude Abbott at the McGill Museum going over my old specimens... .

They left the comparative seclusion of Murray Bay on the 4th and returned to the noisy world in whose press since the middle of August his name had been much headlined. A week later from Dundas Mrs. Oster wrote of their eagerness to get back to Baltimore, and added : ` I am already weary of the triumphal procession through Canada of the Regius Professor and his family ; do pray ask all his friends to make it easy for him : he will find it hard to say adieu.' There is no gainsaying that his decision was con-

sidered as a great blow to the Johns Hopkins. How his colleagues felt is evident from their letters to him. ` If talents, self-sacrifice and high devotion to the good of the profession deserve any reward you certainly have earned the promotion', wrote one of them. ` But what are we to do here in the hospital and medical school and in the community at large, where you have done so much and are likely to leave so much still to do that nobody can do so well ? The success of the hospital and medical school has been largely your achievement and you have done the most to bind together the different departments and to establish a high standard of professional work.'

Outpourings of this sort from his professional colleagues were natural enough and to be expected ; but no one could have foreseen what effect his decision would have upon the community at large, among whom as an unnaturalized citizen he had resided for a short fifteen years. There was an actual wail of regret mingled with the congratulations from press, pulpit, and public on all sides. Whether he would have been able to make up his mind in favour of Oxford had he attempted to do so while in Baltimore may be doubted. He was now in for such a back-breaking autumn, winter, and spring as made the preceding ones lazy in comparison. For to his customary activities was added not only the painful duty of severing his American contacts—and such a man is not let go easily by his admirers —but also the need of picking up some threads of the complicated life ahead of him in Oxford. There were many duties in connexion with the new post—the ` R. P. M.'—in which he had to receive instruction. The Vice-Chancellor had written during the autumn that among other things he was ex officio  Senior Examiner for Degrees in Medicine, so substitute must be provided ; and further :

I may add a few words as to the formalities of becoming a member if the University. With our curious double system it is necessary, )r at least desirable, to be a member of one of the Colleges. May [ say, in case you have not yet fixed upon a College, that it would

)e a special pleasure to me and, I venture to say, to all the Fellows

)f Oriel, if I might put your name on the books of the College I Ile next step is matriculation, or becoming a member of the Unirersity. This follows immediately upon being admitted to a college.

Then Convocation passes a decree conferring the Degree of Doctor of Medicine. You are then a member of Convocation with the vote and all rights and privileges... .

There had been other proposals, and he was strongly drawn towards Magdalen, which was Sanderson's college and to which ` that delightful man Walter Raleigh has just been elected'. With all this, he found time to help other people with their personal projects :

To Dr. Maude Abbott from W. O.                        Sept. 1904.

The report is most encouraging. The stenographer will be a great help. I wonder how you got through so much writing. I think it would be quite feasible to get the necessary money for the printing by private subscription. Let me try what I can do. I will write to the members of the Faculty—and some others. It would be one of the very best advertisements of the School. I will try to look up R. J. B. Howard's notes to-day. I have been simply swamped with work since my return. I wish I could get free for a year. I return the notes as they may be needed... .

On October 5th exercises were held to commemorate the opening of the much-needed new clinical amphitheatre in which Osler was to carry on his teaching for only a few months longer. There were many guests, and addresses were made by Louis A. Stimson of New York, by Clifford Allbutt, Osler's ` brother Regius' from Cambridge, who happened to be in the country, by Abraham Jacobi, by ex-President Gilman, by Welch, and others. In the afternoon the audience reassembled to unveil the tablet in memory of Jesse Lazear of the Yellow Fever Commission. Osler presided, and before introducing the chief speaker, James Carroll, who with Lazear had shared in Walter Reed's epochal experiments, he spoke feelingly as follows :

It has been well said that Milton's poem ` Lycidas ' touches the high-water mark of all poetry. This is true not only because the poem appeals to us by its intrinsic merit and worth, but because it touches that chord in each one of us which responds to the personal loss of some young man to whom we had become attached. Those of us who have got on in years mourn many young fellows whom we have seen stricken by our sides. We have had in this hospital fortunately only a few such losses. We have lost on the medical side Meredith Reese, Oppenheim and Ochsner ; and we have also lost a man of rare worth, in whose memory we meet to-day, whose story

will be told you by Dr. Carroll and Dr. Thayer : Jesse William Lazear, a Baltimore boy, a Hopkins graduate of the Academic Department, a graduate of Columbia University in Medicine and a resident physician of this hospital, the first man to take charge of our clinical laboratory, who, in Cuba, sacrificed his life in the cause of humanity... .

Beset as he was at all times, and particularly- at this period, by representatives of the press, few of them ever got by the faithful Morris at the door, and when they did by feigning an appointment, the interview was brief. A reporter had broken in upon him one day to get his comment upon a cable dispatch published that morning in the New York Herald regarding a new cure for pneumonia (an electrical solution of gold and silver) discovered by a Professor Robin of Paris. Osleris reported to have read the clipping, to have folded it carefully and to have remarked on

returning it : ` You can say that New York Herald medicine, especially the Paris variety, is discredited by the medical profession.' But there were times when, cornered by a reporter, his M'Connachie got the better of him, as it did in connexion with Jacobi's visit to attend the ceremonies of the 5th. Jacobi, a small man of frail physique despite his leonine head and shock of hair, was a guest at i West Franklin Street and the house was besieged by reporters, one of whom Oslerfinally saw. The press that evening contained a long account of Professor Jacobi's athletic

prowess, for though

he was incidentally a children's specialist he was chiefly

known as a pole-vaulter and high jumper, in ,which events he held the record of the New York Athletic Association, &c. For this and similar pranks Oslerwas to be severely penalized in a few

months' time.

Early in October his Ingersoll Lecture 1 was ready for distribution, and the first of the many reprintings and editions of the ` Aequanimitas ' volume, dedicated to D. C. Gilman, had been issued both in England and America. Both of these publications were widely reviewed, and though the twelve collected addresses rescued from the oblivion of professional journals had been written for ` medical students, nurses, and practitioners of medicine ',

1 Published by Houghton, Mifflin & Co.

2923.1

vu

they proved to contain ` a deep mine of golden counsel ' equally suited for others. A series of lay sermons they are, and, as one reviewer 1 said : ' It would be well for society in general if all the sermons preached from the pulpits in Christendom showed the lofty feeling for all that is good and true, the genial wisdom and the energizing quality of these discourses.' They showed not only lofty feelings but a sense of humour and a love of good literature ; appended to the volume was a list of ten items constituting a ' bedside library for medical students', who were advised not to rest satisfied with their professional training but to get the education, if not of a scholar, at least of a gentleman. The list began, of course, with the Scriptures and Shakespeare, and ended with the ' Breakfast Table' series.

To Mrs. Gurney Curtis from W. 0.                Oct. ro, 1904.

Your name has been on the list to send that wretched [Ingersoll] Lecture to for weeks, but I have not had your address, and Miss Humpton has not been able to get it. This morning your letter comes, and I at once send you off the lecture with the greatest pleasure. I know you are a Teresian—in disguise. Dr. McCrae has left the hospital, but Dr. Howard is still faithful and good. I hope you have had a good summer. Please come into the hospital for a few weeks at least before I leave. Make it this time a biceps tendon so that you will be able to walk about.

Sincerely yours, &c.

With all his multiplying obligations he did not relinquish his old ones nor fail in his customary regular attendance at meetings. This was ingrained, and particularly when there was up-hill work to be done he was to be counted on. The Executive Committee of the National Association for the Study and Prevention of Tuberculosis, to give a single example, held frequent meetings—in New York on October i 8th and again on November 16th, in Philadelphia on December 1st, in New York again January 9th, and so on ;

1 Another wrote : ` We have made a rough calculation that there are 650 examples of the quotatio recta in the less than 400 small octavo pages of good-sized type ; while as for the examples of the quotatio obliqua—the " tags " and reminiscences of browsings among well-loved books, the words and phrases that in a flash bring to mind the inspirations of great men, and what our fathers in literature have declared unto us—their name is legion : they are not to be counted.'

and as Trudeau's health rarely permitted him to be present Oslerwas usually in the chair.

The two-hundredth anniversary of John Locke's death was observed by a large gathering at McCoy Hall on October 28th, and he entered enthusiastically into the preparations for the occasion—indeed did most of the preliminary work—made one of the several afternoon addresses, his topic being ` Locke as Physician '—and in the evening gave a large dinner at the Maryland Club for which he had prepared a special John Locke menu with many appropriate quotations from the philosopher's writings. So he delighted to take trouble ; and one may be sure that at the corner of West Franklin Street no opportunity was lost to celebrate other anniversaries, one of them on the 5th of November, when Revere had his chance at ` gunpowder, treason, and plot ', and more than the usual explosions occurred in the cellar, accompanied by hair-raising groans disseminated through the house by way of the furnace pipes.

To the Pres. of Magdalen from W. O.                      Nov. to.

Dear Mr. Warren,—I am glad you liked the lecture—not an easy subject to handle. I will ask Constable & Co. to send a copy to Lord Tennyson. ` In Memoriam ' has always been to me a great sermon on Immortality. You will get in a week or two a volume of addresses, some of which may interest you. I have accepted a Professorial Studentship at Christ Church. I had left the matter in Sir John's hands, as I had had invitations from Oriel and Lincoln and New. I hope I have not made a faux pas in accepting at Christ Church, but I had no time for consultation with anyone as I only had the letter on the 8th and the election is on the 16th, so I had to cable... .

To George Dock from W. O.                                    Nov. to.

What fools these publishers make of us ! I do not see the slightest objection to your transposing verbs and adjectives and a few prepositions and making the one stone kill two birds. Is there anything that you would like better than the group of diseases associated with internal secretion ? I think we shall cut the thymus out of that section and put it with the lymphatics, as it is uncertain whether it has any internal secretion. It would be a pretty full section with the suprarenals and the thyroid, including Graves' disease. Would you prefer to take disease of the lungs ? That would come in Volume III, and we should want it earlier. Let me know, please, it once. Thanks for the note. I am trying to make a new book of

uu2

the old quiz-compend, rewriting a number of the important sections and rearranging the whole thing. Send me the reference to the recent work showing the possibility of disinfecting diphtheritic throats. Sincerely yours, &c.

Evidently he was in for the triennial revision of the Textbook, which came at this inopportune time. There were other things enough, besides, as the following letters indicate.

To 7. George Adami.                                       Nov. i7, '04.

Miss Abbott has sent me the estimates for printing &c for the Museum Catalogue. We need $1000—possibly 1zoo as it would be very nice to give her some recognition when the volume appears. I would like to raise the fund if possible [which he did : J. G. A.]. Let me know as soon as convenient the names of 15 or 20 business men who are interested in the College, to whom I might write. I will attack the doctors too. Who is the Treasurer of the faculty now—or to whom should cheques be made payable ? I will start with the enclosed [the largest contribution of all : J. G. A.], which please turn over to the proper person. Love to L. M. C. and the chicks.

To George W. Norris.                                               Nov. 22.

Thanks for your papers with which I am very pleased, not only for the evidence of good work they show, but for the memory of your father and grandfather. The tuberculous endocarditis paper is most interesting and will be very useful, as I have just been going over all of our material on the subject. Could you not come down some evening and give us a little talk at our Laennec Society ? I send you our programme, and you will see the sort of work we are trying to do. We have rather a short programme for the 27th. Perhaps you will have some brief communication which would do for that day, or perhaps it would be better to give us a longer one at one of the early meetings next year. By the way, as you have been going over the post-mortems at the Philadelphia Hospital, have you any statistics on aneurysm ?

To A. C. Klebs.                                                         Nov. 23.

... At the meeting of the Board of Directors it was quite evident that, with the exception of our President, Dr. Trudeau, none of us had done much (either to get money or members for our National Association). If it is to be a great success, we must individually try to get as many members in and out of the profession, and urge our wealthy friends to help with liberal contributions. Mrs. Colby, the assistant Secretary, will furnish you with a circular before long, which you could enclose to your correspondents. The sub-committee in charge of the arrangements for the annual meeting meets within

the next ten days. Do let me have any suggestions.... Do find out who the good young fellows are, working at tuberculosis in Chicago. We must catch the workers to make the affair go... .

To Dr. Lewellys F. Barker.                                     xi. 27. 04.

In a weak moment I consented to edit for Lea Bros a new System of Medicine. McCrae will do all the rough work as assistant editor. I would like you to chip in with your pen—a good introductory section to the Nervous System—like one of Cohnheim's chapters —would suit you—& me. Anything else i Throw an eye on the question of classification of the Diseases of the N. S. for such a system. What modifications would you suggest in that given in my textbook. I am sweating away at a new edition—am almost rewriting the Infectious diseases and knocking many of the other sections to splinters—I am tired of the sequence of paragraphs ! I hope all goes well with Mrs. B. & the twins.

A short two years before this time there had been buried in the solid granite of the Matoppos a remarkable Englishman whose work by no means ended at his death. To judge from the following letter the Rhodes bequest had been drawn upon to help endow the Chair of Pathology so as to hold Ritchie in Oxford. For, though some of the colleges might be rich, the university itself had scant funds, as Osler was to learn :

To Professor Arthur Thomson from W. 0.           28th [Nov.]

Thanks for yours of the 16th. I am delighted to hear that the Rhodes fund has contributed £200 a year. I have been in correspondence with Parkin the Secretary, who sent me Rhodes' will with its interesting Medico-Chirurgical aspiration—not likely to be realized in our day. So sorry to have you bothered with my letters. I hope to be able to fix a date for my departure before very long. My two associates would do the work at the school very well. I am really tied by a heavy literary venture for which I had signed the contract in June--a new System of Medicine—and the publishers would not let me free. I must arrange the details before leaving tho it is very slow work, assigning the articles, and making all the plans for a seven volume work. Fortunately McCrae will see to the proof reading &c on this side. I hope to be able to get away in May at the latest. I think it would be best if we took a furnished house for a few months. Mrs. Osler has been put by friends in communication with ` Brooks '. Let me know should you hear of anything. I would like to be in the outskirts, though I suppose for consultation work I should not be too far away. I was delighted to hear of my election to Christ Church.

Osler's feeling about clubs in general has been mentioned. He was not gastronomically inclined, despite the tuneless chant which a stodgy pudding usually evoked. But clubs sought him—even dinner clubs, and there were many more to follow. The next letter is from his old friend of London days in the 'do's :

Sir George Savage to W. 0.    3 Henrietta St., Cavendish Sq., Nov. 30, 1904.

Dear Osler,—I now write in a semi-official position. I happen to be Secretary to what is called ` The College Club '. I enclose a list of members, it is very old and very exclusive. Its chief objects being meetings for dinner, which meetings are held on the last Mondays of about seven months in the year. Of course the few Fellows residing out of London cannot be expected to dine regularly but would always be welcome. I write thus privately, as you are to come to reside with us, to ask if you would be inclined to become a member if you were unanimously elected i I shall be glad to hear from you on this point early, though our next meeting will not be till the end of January.

About this time, too, a club of Washington and Baltimore book-lovers was started, the Stultifera Navis Club, which until Oslerleft in the spring, met with enthusiasm once a month and

then died. It seemed lifeless in his absence. Alfred Parsons, Herbert Putnam, and Worthington Ford of the Congressional Library ; William H. Buckler, J. H. Hollander, W. S. Thayer, Robert Garrett and a few others from Baltimore, were members. And there was another, the Charaka Club, composed largely of New York doctors who were bibliophiles, and though he did not often attend, perhaps for that very reason pressure was brought to bear on him to come to a meeting arranged in his honour. It was then that he read his paper on Fracastorius, about whom he had been in correspondence with Weir Mitchell earlier in the year, some products of his reading having already gone to Lawrason Brown for his Saranac journal. The essay thus begins :

Upon few pictures in literature do we dwell with greater pleasure than that of Catullus returning to his home near Verona, wearied with the pleasures of the Capital, sick at heart after the death of his much beloved brother, and still, we may fancy, aching with the pangs of misprized love ; but at the sight of ` Paeninsularum Sirmio,

insularumque ocella', he breaks out into joyful song and all his cares vanish.

Fifteen centuries later another `Bard of Sirmio' sang the joys of the Lago di Garda, ` mid Caphian hills ', and while we cannot claim for Fracastor a place beside his immortal townsman, he occupies a distinguished position in our annals as the author of the most successful medical poem ever written, and as the man from whom we date our first accurate knowledge of the processes of infection and contagion... .

To Mr. Henry Phipps from W. O.                  Dec. 23rd, 1904.

Many thanks for your kind remembrance, which I appreciate very much. I have asked Blakiston & Co. Phila. to send you a volume of addresses which I have just published. They are a bit medicated as Oliver Wendell Holmes would say, but you have mingled enough with doctors to understand them. I am just off to Boston for Xmas. We hope to open the Tuberculosis dispensary in January. Could you come down ? What date would be most convenient for you. With kind remembrances to Mrs Phipps & your family.

Christmas was passed with Mrs. Osler's sister in Jamaica Plain, and the last few days of the year with his own people in Canada. There he was heavily subjected. In Toronto he opened on the 29th the new Library of the Ontario Academy of Medicine, towards the erection of which he had himself contributed a generous sum and many volumes. The next day he was tendered a public luncheon by the Canadian Club, his sensible and amusing remarks on this occasion, entitled ` The Anglo-American Relations of Canada', being widely quoted in the Canadian papers. And the year ends with a note enclosing his usual Christmas gift to his old friend of Barrie days :

xii. 31. 04.

Dear Ned, You must have had a very sad Xmas—with your poor boy away. I wish I could have seen you while I was in Toronto this week, but I was up to my ears in engagements. We do not leave until May. I shall be in Toronto in April. I wish we could meet then. With love to all at home & best wishes for the new year, Ever yours, Wm OSLER.



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