PATHOLOGICAL COLLECTIONS

THE PATHOLOGICAL COLLECTIONS OF THE LATE SIRWILLIAM OSLER AND HIS RELATIONS WITH

THE MEDICAL MUSEUM OF McGILLUNIVERSITY

I. THE PATHOLOGICAL COLLECTIONS

IN the passing of Sir William Osler, Canada mourns the loss of oneof the greatest of her sons and the Canadian profession its most

beloved and distinguished member; one whose name has been as ahousehold word among us, whose scientific enthusiasm has leavened,and clinical acumen inspired the medical teaching of the pastthree generations and whose warm-hearted hospitality has beenshared by the Profession of two continents these many years.Those portals now are darkened, and the light of mingled humankindness and genius that shone from those burning eyes has beenfo&rever quenched. To us there remains a great sadness, and aninheritance that is inviolate,-the name of the great Canadianphysician, and the tradition of his early formative years.

At this time of retrospect it is of great interest to know that thiscountry possesses what may be termed a unique memorial of thesefirst twelve years of his professional life, in the form of the Patho-logical Collections which he made during his term as pathologistto the Montreal General Hospital, and which are housed, in anexcellent state of preservation and with full records pertainingthereto, in the Medical Museum of McGill University. Thesecollections are of the utmost biographical interest, and as such theyare an asset of immense value in the history of modern medicine.

It is common knowledge that Dr. Osler came from Toronto toMcGill in the final years of his medical course, graduating fro'mthis school in 1872; that after two years df post-graduate study inBerlin and Vienna he returned to Montreal in 1874 and was ap-pointed, at McGill, Professor of the Institutes of Medicine, whichChair comprised the subjects of Physiology and Pathology; that in1877 he became Pathologist to the Montreal General Hospital, andthat he held these two posts until he left Montreal for Philadelphiain 1884. So that, as in the case of so many of the great cliniciansand Masters of Medicine who went before him and whose lives

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he loved to study, the foundations of the skill and knowledge ofhis later life were built upon strenuous and' studious years, spentnot only at the bedside, but in the observation, study and demon-stration of the great science of pathological anatomy.

The fact is not so well known that during these years, andeven earlier, in his student`days, he was not only a pathologist,but also, essentially and to a remarkable extent, a museum col-lector. Just as he was, throughout his life, to use his own words, anote-book man, jotting down for future reference every pointdf interest as it occurred, so it was natural to him to set aside forpreservation, as a permanent record of important facts, any re-markable material which he came across in his autopsies, whichillustrated points of teaching value, or which had served him, asit did in almost every case of interest, as a basis for intensive study.In this way he quickly assembled a pathological collection which,while especially rich in spetimens of cardiac and arterial disease,is representative of the whole range of human morbid anatomy,and is sfignificant also of his activities in veterinary and medico-legal me'dicine. Each specimen has been neatly chiselled downby 'him to show the lesion freed from encumbering details, andremains of pathological interest in the advanced knowledge ofto-day. All are fully desorib'ed in his hospital autopsy-notes,which fill three large 'volumes, chiefly written in his own flowinghand, every page of which gives evidence of his powers of cleardiction and minute observatidn, as do the specimens df his skillin dissection and selective faculty. Viewed in the light of theserecords they undoubtedly present, in vrisible and tangible form, thefirst stepping-stones in a great career.

From his literary facility and his habit of communicating toothers everything of scientific interest within his knowledge, itcomes that nearly every specimen in the collection has been re-ported either in the Transactions of the Montreal Medico-ChirurgicalSociety, the Montreal General Hospital Reports, the Canada Medicaland Surgical Journal, or the Philadelphia Medical News of the day,while many have been made also the subject of exhaustivestudies published in French, German or other American or Canadianperiodicals. The origin of much of his later work is to betraced to these cases, notably that on typhoid fever, tuberculosis,angina pectoris and cardiac lesions. The beautiful series otspecimens df malignant endocarditis on which he based his Gul-stonian Lectures of 1885 are here intact, as also his anomalies ofthe semilunar cusps which have been the subject of several

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monographs, and the collection of aneurysms which he has left hereis among the finest in the world. So also with the chronic valvulardise'ase, cardiac anomalies, pneumokoniosis, gastric ulcer andcarcinoma, etc. His "Practice of Medicine" was built up out ofhis rich memories of these cases and the foregoing clinical ex-periences, and abounds in such references as " that wonderfulparchment heart in the McGill Museum", "the two ball-thrombioccluding a stenosed mitral valve," "that beautiful healed aneur-ysm," etc., etc., which apply, not only to his own material, butalso to the remainder of the Museum collection placed there byothers before his time, with every specimen of which he was mostintimately familiar. How deeply this familiarity had sunk intohis consciousness and had become as it were a part of his person-ality and even of his affections, is realized only by those who wereprivileged to share the daily round of his work in later years, andwho heard the quotations from his McGill experience constantlyupon his lips.

The early history of the Museum and of the Faculty, and theircondition at the time of Osler's sojourn as a student, are in placehere, for they are among the sources on which his genius fed, andfrom which he drew his inspiratidn.

The oldest and the parent Faculty df McGill was its MedicalFaculty, which was organized under the name of the MontrealMedical Institution in the year 1824 and through nearly thirtystrenuous years carried on practically the whole work of the Uni-versity. Its Founders and their immediate successors were nearlyall graduates of Scottish Universities, men of vigorous personalityand brc(ad education who brought with them the traditions andprinciples of the Edinburgh School, whiich taught its clinical medi-cine and surgery, its obstetrics, and gynecology, by direct ob-servation at the bedside, in the light of the autopsy findings. TheMuseum was from the first an essentiat part of the organizationof the Faculty, and the repository of cherished pathological speci-mens which had been obtained through the personal exertions ofthe clinician with the interest and often in the presence of the'whole staff, from cases upon which during life his best skill hadbeen expended.

Into this environment there entered, in the year 1870, as a studentin the final years of his course, the youth of twenty-two years of age,who was destined to rank among the leaders of Medicine. Wemay picture him at this time, with his lithe, slight figure, anddark, almost Spanish colouring, alert, keen, enthusiastic, yet withal

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retiring, with the kindly, whimsical, humour that tempered hisevery thought shining in his eyes, and the fires of a passion forknowledge by direct observation and of consecration to the day'swork and to the service of distressed humanity aflame withinhim, fresh from the counsels of the teachers whp had unlocked thedoors of Nature to him by the aid of the microscope and had fosteredthe love of God a;nd man in his heart, replete with the charm thatsprings from a heart overflowing wth affection and good-will tohis fellows and that made him the most human and the mostlovable of men-so William Osler stood, on the threshold of theunknown future, whose keynote and masterword for him wasthen and always, work, at the parting of the ways.

His interest in the post-mortem room in these student days andhis uinderstanding even then of the bearing of a knowledge ofanatomy upon clinical medicine, and his free use of the microscope,are among the most interesting facts in his history, illustrating asthey do the quick grasp of essentials, which was the most out-standing feature of his genius. With characteristic simplicity ofthought and direct action he chose as his graduation thesis thebroad subject of Pathological Anatomy itself, illustrated by micro-sc-opic slides and by specimens, some of which, those on TyphoidFever, are probably among those preserved in the Museum to-day.Years afterwards he expressed the vision of the scope and idealsof his profession which had come to him in those youthful days ofinsight and which coloured his life to its latest hour, in those beauti-ful words which have sunk into all our hearts:

"When he is satisfied with the beautiful proportions of theinterior, its vast and varied dimensions, the intricate and astound-ing action of its machinery, obeying laws of a singular stability,whose very conflict produces harmony under the government ofsecondary laws-if there be anything secondary in nature!-whenhe is satisfied (and such are not satisfied until informed), he willbe led to his ultimate object, to take his last lessons from the poorand suffering, the fevered and frenzied, from the Jobs and Laz-aruses,-into the pesthouses and prisons, and here, in these maga-zines of misery and contagion, these Babels of disease and sin,he must not only take up his abode, but following the example ofhis Divine Master, he must love to dwell there,-this is Pathology.

When such an one re-enters the wo?ld, he is a physician; hisvast labours have not only taught him how little he knows, butthat he knows this little well. Conscious of this virtue, he feelsno necessity of trumpeting his professional acquirements abroad,

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R. PALME HoIWAX.RDProfessor of..Medicine..............an::ano Faut of Meiie MEGl Univrst

PATHOLOGICAL COLLECTIONS

but with becoming modesty and true dignity, which constitutegenuine professional pride, he leaves this to the good sense of hisfellow citizens to discover." *

Small wonder was it that at this time he attracted first theinterest, and then the appreciation and affection, of Professor R. P.Howard, whom he accounted the third great influence in his life,and who opened to him the doors of immediate advancement.In his Introductory Lecture delivered at the opening of the Sessionin September, 1873, Dr. Howard made the following statement ofhis pride and faith in his young favorite, and of his aspirations forhis immediate future:

"In connection with this new subject of scientific interest the older studentspresent, as well as my colleagues, will be pleased to hear that Dr. Osler, who graduatedhere in 1872, has just made a discovery of great interest, and that promises well for thefuture of our young countryman.

He has discovered in his own blood, while in health, large and small masses com-posed of minute corpuscles agglutinated together. These had been met with by others,but Dr. Osler has discovered what had not hitherto been known, the actual develop-ment of bacteria from these masses when a drop of blood is mixed with a weak solution(l per cent.) of common salt and maintained at the temperature of the body.

I wish that some friend of the University would endow a Chair of Physiologicaland Pathological Histology, and that our young friend might be invited to acceptthe appointment and devote himself solely to the cultivation of his favourite subject,and at the same time bring honour to bimself and to Canada."

How quickly these hopes of Dr. Howard's were realized welearn from Dr. Osler's own Introductory Lecture to his practicalcourse on the Institutes of Medicine, delivered by him in October,1875,t immediately after his appointment as professor in this sub-ject. In it we find him instructing the students in the use of themicroscope, informing them that a supply of microscopes for theirpersonal use had been ordered from Paris and Potsdam, promisingthem well-equipped Physiological Laboratories under his chargein the near future, and outlining the session's work in this practicalcourse in a comprehensive and for that date remarkable synopsiswhich covers what he was able to teach them of clinical and medico-legal microscopy as well as microscopic technique and normal andpathological histology.

*"An Alabama Student," Johns Hopkins Historical Club, January, 1895.t Published in the Canada Medical and Surgial Jounal, and in Volume 1 of his

Collected Reprints.

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MAUDE'E. ABBOTT

II. DR. OSLER'S RELATIONS WITH THE MUSEUM IN MORERECENT YEARS

In the year 1898 the writer of this memoir was appointedAssistant-Curator and shortly thereafter Curator, of this Museum.Dr. Osler was at that time Dean of the Faculty and Professor ofMediecine at the Johns Hopkins Medical School. But his affectionfor the scene of his old labours, and his vivid interest in all thatpertained to his own collections and to those of his colleagues andpredecessors here, led to the establishment of an intercourse whichwill be of interest to students of his life, in that it discloses in a veryreal way, certain vital characteristics, namely, his suI;tained interestin every subject which had once come within his range of studyor observation, his capacity for seizing upon relevant facts, as il-lustrated in these old records, and applying them to the elu&idationof the questions which absorbed his present attention; and last, butnot least, that instantaneous response and whole-hearted sympathyand support with which he met every earnest worker in medicalresearch, and by which he supplied a stimulus and an inspiration,through hope and discouragement alike, which saved many avirgin effort from failure, and brought to fulfilment the aspirationsof hundreds of young lives throughout the length and breadth ofthis continent, during the twenty years that intervened betweenhis McGill and his Oxford days. For these reasons the necessarilypersonal nature of the following reminiscence will be excused.

My first meeting with Dr. Osler was in December, 1898, whenI was sent by the Faculty to Washington to see the Army MedicalMuseum and other institutions en route. Arrived at Baltimore andfollowing the instinct that impelled nearly everyone where Dr.Osler was concerned, I sought him out, first, with my introduction.I found him, at ten minutes to nine, just leaving his lecture-roomfor the ward-round, which I was invited to join and followed himwith the usual crowd of students, initernes and gTests. The visitover, the procession had just left the wards when an unpleasant,but certainly fortunate, accident befell me, which threw me suddenlyinto persdnal contact with him to an extent that even my connectionwith McGill was not likely to have done. Standing for a momentwith my hand on the lintel of the half-closed door, someone swungthe other heavy half-door to, crushing my finger and neatly ex-tracting the nail. Dr. Osler's concern took the form, after thefinger had been dressed gy an interne, and a profitable morning

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given to me in the Pathological Depaxtment on his introduction,of an invitation to dinner that evening. "Come at a quarter toseven," he said in the hospital lunch-room where I had been con-ducted at his request, "and be sure to take a rest this afternoon."The appointed time saw me at No. 1 West Franklin Street and Iwas shown to Dr. Osler's study where I found him alone amonghis books. After a few minutes I ventured to ask him if he wouldgive me a reprint of his "Internal Medicine as a Vocation". "Oh,do you like reprints," he said, "come in here." And he led theway into a small room off his study which seemed to me to be com-pletely lined with reprints, arranged in piles on the shelves. "Thereyou are,-and there,-and there," handing me one after the other."Thomas Dover", "John Keats", "William Pepper", "Locke as aPhysician", etc., etc., until I had a great pile. "And this, he said,handing me a blue pamphlet, "is the one I like better than any-thing else I have ever written." It was An Alabama Student.That night, alone at The Clifford, and examining my treasure-trove of reprints, I read for the first time that charming essay, andcaught in its familiar opening words a glimmering of insight intothe simplicity of thought and springs of action of one, the secretof whose greatness lay in the fact, that in a widely different age andscene, he was still, as it were, The Servant in the House, and theprototype of the followers of the divine Physician of whom hespeaks.

"Chief among the hard sayings of the Gospels," it begins,"is the declaration, He that loveth father or mother, or son ordaughter more than me is not worthy of me. Yet the spirit thatmade possible its acceptance and which is responsible for Christian-ity as it is, or rather, perhaps, as it was, is the same which in allages has compelled men to follow ideals, even at the sacrificde ofthe near and dear ones at home. In varied tones, to all at one timeor another, the call comes: to one, to forsake all, and follow Him;to another, to scorn delight and live the laborious days of a student;to the third, to renounce all in the life of a Sunnyasi. Many arethe wand-bearers, few are the mystics, as the old Greek has it,or in the words which we know better, many are called but feware chosen. The gifts were diversified, but thfe same spirit inspiredthe flaming heart of St. Theresa, the patient soul of Palissey thepotter, and the mighty intellect of John Hunter."

Dinner over, the great experience of the evening came, for thiswas one of Dr. Osler's students' nights, in which I had been invitedto participate. Seated at the head of the long dinner-table, now

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covered with a dark cloth, with nine young men and three womenranged around it and me beside him at the end, and with a littlepile of books before him, he began by introducing four rare editionsfrom the classics of medicine to his hearers, with a few wise wordsof appreciation on each. Then followed a delightful talk uponpoints of interest or difficulty in the week's work, for these were allhis clinical clerks, the reporters of cases in his hospital service."Well, Miss , what is your trouble this week?" he began."And yours?" turning to another. And then, as I sat there withheart beating at the wonderful new world that had opened so un-expectedly before me, he turned suddenly upon me, "I wonder,now, if you realize what an opportunity you have? That McGillmuseum is a great place. As soon as you go home look up theBritish Medical Journal for 1893, and read the article by Mr.Jonathan Hutchinson on 'A Clinical Museum'. * That is- whathe calls his museum in London and it is the greatest place Iknow for teaching students in. Pictures of life and death together.Wonderful. You read it and see what you can do." And so hegently dropped a seed that dominated all my future work. Thisis but an illustration of how his influence worked in many lives.

The next episode came in the following year, that of 1899,when, in working over the collection, I came upon a remarkablethree-chambered heart with pulmonary artery given off from asmall supplementary chamber placed at the right upper angleof the common ventricle. No information about it seemed avail-able, until I inquired of Dr. Osler, who immediately replied: "Iremember the specimen you describe perfectly, and have oftendemonstrated it to the students. It was presented before theEdinburgh Medical Society by old Dr. Andrew Holmes, the firstDean of the Faculty, very many years ago, and you will find itreported in one of the early Edinburgh Journals." And I did findit, published with a fine copper-plate engraving of the heart and fullclinical history and post-mortem findings, in the Transactions ofthe Edinburgh Medico-Chirurgical Society for 1823, the year inwhich the Medical Faculty of McGill had been organized, atwhich time it had been obtained by Dr. Holmes from an autopsydone byhimself, in the presence of the other Founders of the school. t

*See The Clinical Museum: an Explanatory Address, by Jonathan Hutchinson,F.R.C.S., F.R.S., Bri2ih Medical Journal, 1893, II, pp. 1295-1296.

t Museum notes, Cor Biatriatrum Tricloculare, by A. F. Holmes M.D., Trans.action Edinburgh Medico-Chirurgical Society, 1824, presented by br. Alison in1823. Republished with biographical sketch by Maude E. Abbott, Montreal MedicalJournal, 1899.

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PATHOLOGICAL COLLECTIONS

The renewal of Dr. Osler's active interest in the Museummay be said to date from this time, and a succession of kindlynotes of help or encouragement began then, which culminated, inthe years 1904 to 1906 in an active correspondence and substantialsupport, which it is my purpose to retail here.

A word upon the condition of the collection at this time isfirst necessary.

Up to the time of my appointment, the office of curator hadbeen a purely voluntary one, so that the specimens had been placedon the shelves and had been cared for there chiefly by those who hada personal interest in them, and practically no cataloguing hadbeen done. A bare title with the name of the donor, and some-times the hospital reference, was the utmost information themuseum presented. It became my task to assemble, from thesevarious sources the archives of the collection, and I began by asearch of the Montreal General Hospital Autopsy Records and ofthe contemporary Medical Journals, in which many of thesespecimens had been undoubtedly recorded.

The real interest of this search began with the discovery,among the Montreal General Hospital Records, of three volumes ofDr. Osler's own poSt-mortem notes. I shall never forget the im-pression which these clearly written pages and accurately portrayeddescriptions, and above all, the exquisite orderliness of this, theunseen daily task of his youth, made upon me at this time. Geniuswas written broad upon these pages, and there is no joy givento us greater than that of the first moment of recognition of theMaster mind.

Case after case was recorded here by the name or hospitalnumber which the specimens bore and there were many otherswhich apparently referred from the descriptions to specimenswithout reference. So also with the old journals, the Transactionsof the Medico-Chirurgical Society and the Montreal General HospitalReports, both of which were published as bound volumes underDr. Osler's editorship, during the years of his Montreal period.All these were crowded both with the cases to which the numbersstated on the specimens referred and with others which from thedescriptions were dubbed by us "possible cases", and which awaitedDr. Osler's confirmation when a chance visit from him might bringthe opportunity.

In the spring of 1904 he came, for the first time in my curator-ship. Five years had elapsed since I first saw him in Baltimore,and much progress had been made in the museum, for the Faculty

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had actively supported its development, and the seed which hehad himself implanted, of the value of correlating clinical data ofimportance with the findings shown by the pathological specimenshad borne ample fruit. All the specimens of the old collectionfor which a reference had been obtained stood, with full clinicalhistory inscribed upon its catalogue sheet, among the new material,and a plan of "collaboration with clinicians" had been evolved,under which the cataloguing of each section was being proceededwith under the revisioln and co-operation of the chiefs in medicineand surgery, as well as pathology, with whose help a short didacticintroduction to each section, emphasizing the points of interestof the specimens, had been appended; and an active system d1museum teaching had grown up, which owed its vitality largely tothe correlation of the "clinical aspects" with the pathologicalfeatures of the case.

The whole met with Dr. Osler's approval, and his enthusiasmwas great over the fact that a catalogue of his own beloved speci-mens and of the older part of the collection was at last being placedon paper. His first impulse was to suggest that funds be providedfor its immediate publication, and to say that he himself wouldlike to be allowed to raise these by a circular letter to McGillgraduates, which he subsequently sent out. Then, dropping intoa chair, and fingering with tender affection the old autopsy booksand journals, which, with the corresponding or "possible" specimenswere ranged before him for his inspection or identification, hebegan rapidly eliminating uncertainties with characteristic runningcomments as he did so. "That fellow, now, I remember well,"scribbling rapidly on the back of a card that belonged to a case of alarge aneurism of the ascending arch of the aorta that was innocentof any trace of laminated clot, the so-called "healing" process,and which had ruptured into the right pleura. "It took a longwhile b'ef&e the diagnosis was made, but he came back to thehospital at last with a pulsation in the second and third rightinterspace. So we put him to bed and tried to cure him with bigdoses of Pot. Ibdid. He got 120 grains a day, and our effortswere crowned with success, for the pulsation had disappeared.We were talking of discharging him in triumph when one day hedied suddenly, and we found-that!" "And this," seizing suddenlyupon a small unlabelled specimen which had completely mystifiedme, for it represented a small piece of a quite healthy thoracicaorta with a round hole in its wall leading into a sac, the sizeof a tangerine orange, which lay between it and the cesophagus,

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and opened into this by a small jagged tear. "This is that extra-ordinary case of mycotic aneurism df the aorta rupturing intothe cesophagus. She died suddenly without any warning at all.It is repotted in the International Clinics. There is a beautifulcoloured frontispiece of it done by did Mr. Raphael. Have youany other cases of mycotic aneurism to go along with this?-Ohthat one, that's a new specimen, magnificent-whose is it-McCrae'sI say McCrae," turning to Dr. John McCrae who stood amongthe little throng of chosen ones who were following him in hisperegrinations through college and hospital, "you'll report thiscase, won't you? It will be one of the best cases in the litera-ture." And John McCrae did report it.*

The same running commentary with dictated or scribblednotes upon the points of interest which attracted him, went onnot only through the rest of that morhing but through manysubsequent visits, of hours' duration, which he paid both thatsummer and in January, 1905, when he was in Montreal sittingfor his Harris' portrait, and again in July and August of 1905when he was staying at Murray Bay on his second return visit toAmerica, from Oxford.

His interest took the practical form, too, of raising, in theautumn of 1904, by means of a printed circular issued by himself toMcGill graduates and their friends, funds for the publication of thefirst part of the catalogue, and himself revising every sheet of thatportion of it then being prepared for the press, and finally in super-vising) in the year 1914, the publication of the first volume by theOxford University Press. More than forty letters written by himduring the year 1904-1907 on these subjects have fortunately beenpreserved, and, with the notes inscribed by him on the manuscript ofthe catalogue, remain to attest these activities. Always short andto the point, overflowing with his lively and persistent interest in allthat had once attracted his observation, and with the encouragementand thestimulating suggestionswith which he invariably directed theenergies of the younger generatioh to fresh sources of informationand research, these letters form an eminently characteristic record.A short quotation here must suffice. "I see you have a specimenof calcification of the pericardium. It would be well to speak ofit in the introduction. There is a very good article two or threeyears ago in the Pathological Society's Transactions." "I haveread the Endocardium section with the greatest interest. Some-

* "A case of Mycotic Aneurism of the Aorta with Malignant Endocarditis," byJohn McCrae, M.D., M.R.C.P., Journal of Pathology and Bacteriology, 1905.

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thing should be said of feetal endocarditis, just to clear the mindsof the students."

The veil, by which.intimacy of contact and innate modestyof heart screens the personality of the truly great from the fullvision of their contemporaries, has been lifted for us now by thehand of death, and we see Sir William Osler among those whomCarlyle has called the heroes of the race. His exact position inthe history of medicine is for posterity to adjudge; but the reve-lations made by his pioneer work in pathological anatomy as shownin his collections and early publications, and his perennial interestin the facts of nature which this work had declared to his searchinggaze, yields no uncertain forecast. Where the palm is given toversatility of genius and power of its expression, unfailing accuracyof observation, instantaneous recognition and correlation of sig-nificant data, and that all-embracing creative faculty which forms,out of the multitudinous details of a crowded experience, new,fresh, and clear concepts of humanitarian value,-there the nameof William Osler will be written large, beside that of RudolphVirchow, the apostle of his youth, aiid Jonathan Hutchinson, theenthusiasm of his maturer yeaTs.

MAUDE E. ABBOTT

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