Why did Osler not perform autopsies at Johns Hopkins?
Article Type: Letter to the editor
Subject: Physicians (Practice)
Author: Wright, James R., Jr.
Pub Date: 11/01/2008
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 College of American Pathologists ISSN: 1543-2165
Issue: Date: Nov, 2008 Source Volume: 132 Source Issue: 11
Topic: Event Code: 200 Management dynamics
Product: Product Code: 8011000 Physicians & Surgeons NAICS Code: 621111 Offices of Physicians (except Mental Health Specialists)
Organization: Organization: Johns Hopkins Hospital
Persons: Named Person: Osler, William, Sir
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 230246850
Full Text: To the Editor.--Lucey and Hutchins (1) investigate whether Sir William Osier, who performed almost 1000 autopsies during his career, performed even a single autopsy while at Johns Hopkins. Their article focuses on a patient with bilateral congenital cystic kidney disease and then quibbles with Bliss's biography as to whether the autopsy was performed by Osler (ie, as the "prosector") or whether Osler merely assisted William MacCallum, a Hopkins pathologist. Although it is admirable that the authors were able to identify the case in question within the records of the autopsy service at the Johns Hopkins Hospital and build a case for Osler being at the autopsy table as an assistant, the article does not address the more interesting question of why Osler never functioned as an independent autopsy pathologist at Hopkins.

Osler was recruited to Hopkins from Philadelphia, where he was a professor of medicine at the University of Pennsylvania and a "visiting physician" at Blockley Hospital, an almshouse for treating indigent patients. It was at Blockley that Osler performed his 162 Philadelphia autopsies, and it is well documented that Osler and his residents played very loosely with institutional autopsy consent regulations, that Osler was constantly in trouble with Blockley administration because of this, and that Osler totally ignored the authority of Blockley's 2 staff autopsy pathologists, E. O. Shakespeare and H. F. Formad. According to Bliss, "Complaints about post-mortem abuses reached the Blockley trustees, both from the public and from the pathologists whom Osler and his acolytes tended to ignore. ... Blockley gradually tightened its procedures to rein in Osler and his residents." (2) During Osler's 4 years at Blockley, the autopsy consent procedures were adjusted several times to regulate or prohibit performance of autopsies by "visiting physicians." (3,4)

According to Henry Ware Cattell, a pathologist at the University of Pennsylvania and Blockley in the 1890s, the custom at Blockley, even though it was not strictly legal, had been to permit postmortem examinations on "all persons dying in charitable institutions" and that "this custom prevailed ... with practically no opposition, until lawsuits, arising out of this custom, caused it to be discontinued." (5) Essentially, Blockley was the Wild West on the North American autopsy frontier, and Osler and his deputies succeeded in stretching the limits even there.

In stark contrast, Hopkins was not a charitable institution specializing in indigent patients, and William Henry Welch was not a pathologist who could be ignored. Welch was not only the founding physician at Hopkins; he was responsible for hiring Osler. It seems inconceivable that Welch, at the time of Osler's hiring, was not fully aware of these issues in Philadelphia. Undoubtedly, Welch made it clear that the autopsy room at Hopkins belonged to Welch and that Osler would be a welcome guest, but that he was not going to be doing autopsies on his own and duplicating his Philadelphia behaviors at Hopkins. Osler clearly played by "the rules" while he was in Baltimore, and this fact is reinforced by the article by Lucey and Hutchins. (1)

(1.) Lucey BP, Hutchins GM. Did Sir William Osler perform an autopsy at The Johns Hopkins Hospital? Arch Pathol Lab Med. 2008;132:261-264.

(2.) Bliss M. William Osler: A Life in Medicine. Toronto, Ontario: University of Toronto Press; 1999:141.

(3.) Krumbhaar EB. The history of pathology at the Philadelphia General Hospital. Med Life. 1933;40:162-177.

(4.) Landis HRM. The pathological records of the Blockley Hospital. In: Abbott M, ed. Sir William Osler Memorial Number: Appreciations and Reminiscences. Bulletin No. IX of the International Association of Medical Museums and Journal of Technical Methods. 1926:234-239.

(5.) Cattell HW. Postmortem Pathology: A Manual of Technic of Post-mortem Examination and the Interpretations to be Drawn Therefrom: A Practical Treatise for Students and Practitioners. 3rd ed. Philadelphia, Pa:JB Lippincott Co; 1906: 5-6.

The author has no relevant financial interest in the products or companies described in this article.

James R. Wright, Jr,

MD, PhD

Department of Pathology and

Laboratory Medicine

University of Calgary/Calgary

Health Region

Diagnostic and Scientific

Centre

Calgary, Alberta, Canada

T2L 2K8

In Reply.--As we noted in our article, (1) Harvey Cushing wrote that Sir William Osler gave up "without question" autopsy work at Johns Hopkins after assuming the position of professor of medicine. (2) We hypothesized that Dr Osler asked permission of Dr Welch to participate in the autopsy we described. Dr Wright makes an excellent point in detailing how Osler and Welch may have come to an understanding regarding postmortems before Osler joined the hospital staff. Certainly, this would explain Dr Cushing's comment, as Osler would have agreed to not pursue autopsy work if he wanted to work at Johns Hopkins.

Shortly after receiving notification of Dr Wright's letter, we received correspondence regarding the use of handwriting analysis to resolve whether or not Dr Osler wrote the autopsy report from our article (J. S. Krauss, MD, e-mail communication, February 23, 2008). Many examples of Osler's handwriting are available in the archives at Johns Hopkins, and contemporary examples of his handwriting were compared with the autopsy report from case 1498. Based on samples from Osler's papers, his signature is remarkably consistent during a period of 27 years (1892-1919), even to the untrained eye. (3) The results of this analysis demonstrate that William Osler did not write any of the autopsy notes for this case. (4) Figure 1, A, shows an example of handwriting known to be from William Osler, and Figure 1, B, shows an example of handwriting from the autopsy report. We continue to postulate that Dr Osler dictated part of the report while participating in the dissection.

[ILLUSTRATION OMITTED]

(1.) Lucey BP, Hutchins GM. Did Sir William Osler perform an autopsy at The Johns Hopkins Hospital? Arch Path Lab Med. 2008;132:261 264.

(2.) Cushing H. The Life of Sir William Osler. Oxford, England: Oxford at Clarendon Press; 1926.

(3.) The William Osler Collection, The Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions, Baltimore, Md.

(4.) Koppenhaver KM. Report from Forensic Document Examiners regarding comparison of samples of Sir William Osler's handwriting to autopsy report 1498. Forensic Document Examiners, Joppa, Md. April 2008.

The authors have no relevant financial interest in the products or companies described in this article.

Brendan P. Lucey, MD

Department of Neurology

Brigham and Women's

Hospital

Harvard Medical School

Boston, MA 02199

Grover M. Hutchins, MD

Department of Pathology

Johns Hopkins Hospital

Baltimore, MD 21287
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