Out of the Flames

by Lawrence Goldstone

  Osler also placed heavy emphasis on dissection in his teaching curriculum. When there were insufficient cadavers for autopsy from the wards, he took groups of students to the Blockley Dead House of the Philadelphia Hospital. There, in the cavernous building where the city's unclaimed cadavers were deposited before burial, he dissected the corpses of charity cases. Osler worked while his students stood over him, watching. No one wore masks or gloves, and Osler often contracted “cadaver warts,” tubercular sores on his hands from contact with diseased tissue.

  He kept voluminous records of the results of autopsies, particularly those of his own patients, thereby matching diagnosis against actual cause of death. Occasionally, Osler found himself faced with one of his own mistakes—a condition he had failed to detect or one disease that had masqueraded as another—but he never denied his errors or tried to rationalize them away.

  Teaching and treatment were everything to him. Later in his life, when asked what he would like for an epitaph, he replied that he would prefer “He brought students into the wards.”

  Osler thrived in Pennsylvania, gaining a reputation as the finest professor of clinical medicine in America (a position for which, in truth, there was not that much competition). Still, his vast abilities had yet to be tapped by a system that largely continued to resist his approach and tenaciously clung to methods that didn't work. In order to fully mature into the teacher and clinician that he could be, Osler needed an institution that was prepared to allow him to set his own curriculum.

  He got it in 1889.

  IN 1873, A “WEALTHY Baltimore Quaker died. He was an abolitionist who had made a fortune, first in the wholesale grocery business, then in railroads. Upon his death, he created two trusts of $3.5 million each. The first was to be used to establish a premier university in his home city, the second to establish a hospital. Part of the plan was to create the finest medical school in America, with the most up-to-date teaching facilities, as a part of the university and served by the hospital. The Quaker's name was Johns Hopkins.

  The university opened in 1876, but the hospital was not ready until 1885. The board of trustees was composed of other Quakers, and they refused to dip into the principal of the endowment. According to Hop-kins's instructions, the hospital was “in construction and arrangement [to] compare favorably with any other institution of like character in this country or in Europe,” so the project moved forward slowly.

  Although the university began to organize the medical school in 1884, it took four years before the administration was ready to hire heads of the departments. Osler, “the best man to be found in the country,” according to William Welch, head of the new medical school, was hired in early 1889 as physician-in-chief at the hefty sum of $5,000 per year, and then appointed Professor of the Theory and Practice of Medicine at the university. At forty years of age, William Osler had just secured what was certainly one of the most important medical positions in the United States.

  Osler's counterpart as head of surgery, William Stewart Halstead, was even younger, with a reputation almost as towering, but his salary was only $2,000 per year. While investigating the potential of cocaine as a local anesthetic—the use of anesthesia during surgery was one the great advances of the second half of the nineteenth century—he and some other pioneers had sampled the product sufficiently to become full-blown addicts. Halstead had recently emerged from his second months-long hospital stay for treatment of his condition. Nobody talked about this to anyone outside the profession—even in 1889, people might have tended to shy away from a surgeon who was a drug addict—but the reduced salary reflected the increased risk the school felt it was assuming by hiring him.

  (Halstead did all right in the end, though. Not only did he stay at Hopkins for over twenty years, he supplemented his income with a private practice in which his fees often ran to $10,000 or more per patient. And that was 1890 dollars—with no income tax. By comparison, Osler's top private fee was $3,000 to Frederick Pabst, the Milwaukee brewer, for a four-day house call. “I'm off to Milwaukee to put a bung in old Pabst,” he told a friend.)

  It took another four years to get things completely ready, but in 1893 the Johns Hopkins School of Medicine enrolled its first class, eighteen students, three of whom, in a groundbreaking development, were women.

  The appointment of Osler turned out to be a brilliant move. Hopkins secured Osler's reputation, and Osler was the one teacher who made the school. He was knowledgeable, insightful, and funny. He had had so much experience in the wards that he could diagnose a patient from the doorway of his hospital room. Students worshipped him, forty or fifty trailing after him on his rounds.

  Living in an age before photomicrography or any detailed documentation of many of the diseases and conditions that he needed to describe to his students, Osler enhanced his teaching with a command of language rare in scientists. For example, when describing mitral stenosis, a narrowing of the mitral valve extremely difficult to detect with just a stethoscope, he said, “Imagine that you are in Paris. It is three o'clock in the morning and the streets are empty. There is a dense fog in the air that descends all the way to the cobblestoned streets. Suddenly, a coach turns the corner. The sound of wheels on the cobblestones is mitral stenosis.”

  Osler combined his encyclopedic knowledge, clear thought, and language skills in a textbook, Principles and Practice of Medicine, which ran to over a thousand pages and was a compendium of his personal experience and all that he had seen in Europe and America. Almost from the date of publication in 1892, Principles and Practice became the seminal textbook of disease, diagnosis, and treatment. Osler personally supervised seven editions, and the book itself, updated by others, eventually ran to sixteen. It stayed in print until 1947 and was then reissued in 1968. Principles and Practice of Medicine was the primary textbook used in medical schools for decades and became almost as famous as its author.

  Also in 1892, he married for the first time. His new wife was a widow, Grace Linzee Revere Gross, a direct descendant of Paul Revere. Three years later, the couple had a son, Edward Revere Osler. Between his Hopkins salary, fees for private patients, and royalties from the textbook, Osler, who despite his professional successes had never been able to save very much money, became a rich man. Finally he could afford to begin to indulge his other passion—book collecting.

  OSLER'S INTEREST IN DEVELOPING a library dated from his first introduction to James Bovell's collection of medical and classical works back in Toronto. During his later trips overseas, he had visited the private libraries of many European physicians and seen the breadth of their collections. He now used his new wealth to buy rare and unusual books detailing the history of the development of medical science, to the point where he became as well known to the famous booksellers of his age as to other doctors.

  During breaks at Hopkins, he regularly traveled to Europe, buying books wherever he went. He bought a first-edition Vesalius, a first-edition Harvey, and rare editions of Galen and Avicenna. He collected Champier, Paracelsus, Aquapendente (Harvey's professor), and Colombo. He had books, manuscripts, documents, letters. He also had perhaps the most extensive collection of Servetus material in the world.

  Osler had first become interested in Servetus when he came across a series of articles, by a Magdeburg pastor named Henri Tollin, in a German medical journal called Virchow's Archiv für pathologische Anatomie und Physiologie. Tollin, although a Protestant, defended Servetus and denounced his execution. Then, after Robert Willis published Calvin and Servetus: A Study of an Important Epoch in the Early History of the Reformation in 1877, Osler's interest intensified. He read and acquired Wotton and other books and articles written about Servetus and became particularly fascinated by the passage on pulmonary circulation.

  Almost immediately he began to seek out a copy of Christianismi Restitutio. An original was out of the question, of course, but even the Murr 1790 reprint turned out to be virtually unobtainable. Osler enjoyed joking about its rarity. When friends
traveling to Europe asked if there was anything he'd like them to get for him, he would answer, “Oh yes. Could you pick me up a copy of Christianismi Restitutio while you're over there?” “Of course,” they would reply, pleased that there was something their friend wanted that he didn't already have.

  The story of Servetus's tragic life and obsession with pursuing truth as he saw it captured Osler's imagination, and his interest in Servetus became more than bibliographic. He began to mention Servetus in talks and letters and eventually became well known for his desire to help the Spanish physician secure his rightful place in medical history.

  His advocacy, like that of Voltaire in a previous century, spurred a good deal of interest and attention, particularly in Europe. As the 350th anniversary of the execution approached, a number of Servetus supporters around the world thought to place a monument in Geneva to commemorate the occasion. A group was formed called the Comité du Monument Michel Servet, led by a French senator, Auguste Dide. Osler readily lent both his name and support to the effort.

  The Comité moved with the glacial speed that comités are wont to do, raising some money here and there and trying to decide what sort of monument could best glorify Servetus's memory. Hearing of the project, members of the Protestant clergy and other Calvin supporters in Geneva proposed a preemptive monument of their own. Their idea was a simple stone tablet placed in Champel. However, instead of the Plateau de Champel at the top of the hill, where the execution had actually occurred, the Calvinists proposed a more obscure spot farther down the hillside. The stone was to be set between two streets at the back of the hospital.

  The city council of Geneva leapt at the plan, even renaming a tiny adjoining street “rue Michel Servet.” On October 27, 1903, the stone was dedicated. At the ceremony, there was a good deal more said about Calvin's greatness than Servetus's martyrdom. The rear inscription on the stone stated:

  Duteous and grateful followers of Calvin our great

  Reformer, yet condemning an error which was that

  of his age, and strongly attached to liberty of

  conscience according to the true principles of his

  Reformation and the Gospel, we have erected this

  expiatory monument. Oct. 27, 1903.

  The front inscription, the only place where Servetus's name and the fact that he was burned at the stake actually appear, was impossible to read without hiking twenty feet up a steep incline through grass and weeds. Almost no one, therefore, who passed the monument on the much more easily accessible rear side, would have the slightest idea what the duteous and grateful followers of Calvin were atoning for.

  Members of the Comité were outraged and more determined than ever to erect their own monument. They intended it to be a good deal more compassionate and far less forgiving of Calvin—to say nothing of placing it where people could see it. They finally raised the money they needed and commissioned a local artist, Clothilde Roch, to sculpt an affecting image of a wretched Servetus suffering in prison in the days before he was condemned, clothes in tatters, hands clasped in despair. The entire process took over three years, but finally, in late 1907, everything was ready.

  When Dide and the Comité requested permission to mount the sculpture on a large pedestal and place it in the public square on the Plateau de Champel, however, the council harrumphed and said merely that it would consider the request. Then, after dithering about for months, in May 1908, just days before the Comité's proposed dedication ceremony, the council rejected the sculpture on the grounds that the city had already dedicated a monument to Servetus.

  Rather than fight it out in Geneva, Dide offered the sculpture to the town of Annemasse, four miles southeast of the city, just across the French border in Haute-Savoie. The mayor, Joseph Cursat, accepted instantly. The monument was placed in the main town square in front of city hall and dedicated on October 25, 1908.

  The rectangular pedestal on which the sculpture was mounted contained an inscription on each side. One of them was from Voltaire:

  The arrest of Servetus in Geneva, where he did neither

  publish nor dogmatize, hence he was not subject to its

  laws, has to be considered as a barbaric act and an

  insult to the Right of Nations.

  On another side was inscribed an excerpt from Servetus's letter to the Council of September 15:

  I beg you, shorten please these deliberations. It is clear

  that Calvin for his pleasure wishes to make me rot in this prison. The lice eat me alive. My clothes are

  torn and I have nothing for a change, no shirt, only

  a worn out vest.

  Dide said at the dedication, “Glorifying Servetus we honor… what is the most precious and the most noble in our human nature: a generosity of heart, independence of the spirit, heroism of convictions.”

  While all this was going on, the town fathers of Vienne, not to be outdone, decided to erect their own monument to Servetus, to be unveiled in August 1909. The town even sponsored the production of a particularly awful, overwrought play entitled Michel Servet: épisode dra-matique en deux actes en vers (Michel Servet: A Dramatic Episode in Two Acts in Verse). The playwright, Fernand Raymond, had all the characters right, but was prone to throw people together for dramatic effect who had either never met or were not both present at the moment Raymond describes. Guillaume de Trie, for example, was placed in Vienne to personally accuse “Dr. Villeneuve,” and Calvin was present at Champel to again denounce Servetus (in verse) just before the fire was lit.

  Despite all the public relations, the Vienne sponsors were unable to raise nearly enough money for a monument. They then appealed to known Servetus supporters in England and America.

  Osler was by now in England. He had remained at Hopkins for twelve years, but just after the turn of the century, he was offered the chair of Regius Professor at Oxford, the highest honor that Great Britain could bestow on a physician. With his Canadian roots, Osler had always felt more English than American, and he accepted.

  Of those whom the Vienne sponsors contacted, Osler was the only one who agreed to help. He was made Membre du Comité de Patronage, wrote letters of appeal to the Lancet and the British Medical Journal, contributed a hefty sum of his own money to the project, and offered to be present at the unveiling of the monument.

  As the months stretched on and no work was done, the Comité de Patronage tried to persuade Osler to underwrite the entire project. In June 1909, they wrote, “Please excuse our insistence. We were hoping that you could find some more money in England and America. We are very embarrassed to have to ask.” Two months later, they wrote, “There is nothing more on the monument to Servetus at Vienne. The statue is ordered, the artist is ready to work… but the money is not there.” Eventually, Osler, nobody's fool, washed his hands of the affair. As a Christmas card that year, he sent many of his friends a photograph of the sculpture on the monument at Annemasse.

  Vienne finally finished its monument in 1911. Osler was invited to attend the unveiling but declined.

  DURING THE PERIOD “WHEN he was actively supporting the monument efforts, Osler immersed himself in historical records to prepare a lecture on Servetus. In April 1908, he traveled to Vienna to see the Szent-Iványi copy at the national library, and in December of the same year went to the Bibliothèque Nationale to view the Colladon copy. While he was in Paris, he read trial transcripts and city records and corresponded regularly with the bibliophile L. L. Mackall, who was eventually to uncover the truth about Mead's ownership of the Colladon copy and his role (or lack of it) in the commissioning of the reprint. The more Osler read, the more fascinated he became. “His lectures on Judicial Astrology scandalized all the Faculties,” he wrote to Mackall “and they had to make it a Parlement (de Paris) matter”

  Curiously, during the bulk of his research, he was unaware of the Edinburgh copy, even though it had been thirty years since it had been discovered on the shelves and Willis and Turner had published an article
on it shortly afterward. In a letter in 1908, he noted that he had gone to Vienna, “anxious to see the copy of Christianismi Restitutio… in which for the first time lesser circulation is described. This is one of only two copies in existence.” He would remain ignorant of Calvin's edition for another year, until David Cuthbertson, an associate librarian at Edinburgh, prepared a small book on Servetus and the third copy.

  Osler had continued to search “high and low” for the 1790 reprint with no success. Even the world-famous booksellers with whom he regularly did business, such as Maggs Brothers and Bernard Quaritch, had been unable to locate an available copy. It wasn't until 1910, when a friend and fellow collector, J. F. Payne, the Harveian librarian at the Royal College of Physicians at Oxford, died and bequeathed him his copy, that Osler finally had his book.

  So enormous had his collection become, over ten thousand books and manuscripts in all, that for the last ten years of his life, Osler worked on a massive annotated listing, the Biblwtheca Osleriana. The completed catalog ran to almost eight hundred pages in folio. By the time of his death in 1919, Osler owned the Murr reprint, both a genuine first edition and a counterfeit copy of De Trinitatis Erroribus, Syrups, a first-edition Geography, a first-edition Pagnini Bible, and a copy of almost everything that had been published about Servetus in any language. He left his entire library to McGill University.

  IN MAY 1909, Osler completed his research and gave his lecture on Servetus at the Hopkins Historical Club in Baltimore. It was published in pamphlet form that same year. He would later refine the lecture and deliver it regularly to medical students in both America and England.

  Osler's lecture recounted the story of Servetus's life and detailed both the significance of his scientific discovery and the principles upon which he based his philosophy. Osler very specifically attempted to portray the man as a whole rather than depicting him as a symbol or victim, not glossing over the flaws in his personality or the lapses in his critical thinking. He opposed the use of the Servetus case for political purposes. After the Vienne unveiling, a friend sent him some newspaper articles about the event. “Thanks for your cuttings about Servetus, over whom they seem to have poured a good deal of oleo-margarine,” he wrote back in a letter. “The difficulty is that the liberals use him as a stick with which to beat the clericals.”