Osler and the Pathologic Specimen

“To investigate the causes of death, to examine carefully the condition of organs, after such changes have gone on in them to render existence impossible, and to apply such knowledge to the prevention and treatment of disease, is one of the highest objects of the Physician… ”
Osler Graduation Thesis
McGill University, 1872

Osler became interested in pathology as a medical student at McGill University between 1870 and 1872, when he reviewed specimens brought to lectures by Palmer Howard (Professor at the McGill School of Medicine) and attended autopsies at the Montreal General Hospital. Howard gave Osler a copy of Samuel Wilks’ Lectures on Morbid Anatomy, which had an important influence on his concept of medicine and his subsequent practice in Montreal.

“Wilks’ Pathological Anatomy was my handbook, and the postmortems were worked out from its pages.”
Francis WW, Hill RH
Malloch A: Bibliotheca Osleriana, 1969 p xxiii.

Osler’s graduation thesis – for which he was awarded a special book prize – included a discussion of 20 autopsies, illustrated by over 30 gross and microscopic preparations.

These were donated to the Medical Museum, but most likely have been destroyed. After graduation from McGill, Osler went to Europe to “round out” his medical education.

During the two years he spent traveling and studying, he had the opportunity to observe the famous Rudolph Virchow at the Charité Hospital in Berlin. This experience must have impressed Osler, as he subsequently followed the autopsy technique published by Virchow in 1876. 

 

 

Above: Osler’s copy of the 1880 English translation of Virchow's book Post-mortem Examination.

Right: Montreal General Hospital 1881

 

 

In 1874, Osler accepted a position at the McGill Institutes of Medicine, replacing the ailing Professor Morley Drake (see Specimen 52) who could no longer fulfill his teaching responsibilities. Soon thereafter, he was appointed Pathologist at the Montreal General Hospital (MGH), where he agreed to perform autopsies for the entire house staff. The task was onerous: between 1876 and 1884, he performed approximately 800 post-mortem examinations, most in an inhospitable environment.

“He did the autopsies in an old outbuilding in which were a wooded table and a stove. In the winter it was only heated when required, and many a day I have made a fire in the little stove, that at the same time warmed the room more or less, often less, and heated the water.”
George Armstrong (McGill 1877).
Bull International Association of Medical Museums 1926 IX: 176.

Osler documented his autopsy findings by hand in five autopsy logbooks, only three of which remain. The first was “lost” until 1954, when it was “discovered” in the Osler Library at McGill University in Montreal. Books two and three were kept by Maude Abbott in her Museum and were transferred to the Library in 1945 when the Museum closed. Osler took the books with him to Baltimore in 1890 to refer to while writing his textbook, and it is believed that volumes four and five were lost there.

Many of Osler's autopsy cases were also published in the Montreal General Hospital Reports. Some of the descriptions are more or less transcriptions of the log book records; others contain additional clinical or pathological information as well as a discussion of the disease process illustrated by the pathologic abnormalities.

To the left Osler’s Montreal General Hospital Post-mortem book.

Below Montreal General Hospital Reports, 1880.
One of Osler’s goals in performing the MGH autopsies was to use the organs derived there from for teaching. Thus, many of these were demonstrated to medical students at weekly teaching sessions and to fellow physicians at meetings of the Montreal Medico-Chirurgical Society. Some of these presentations were documented in the minute book of that Society and/or were printed in the Canada Medical and Surgical Journal or other scientific periodicals. Osler also donated many of the more interesting or illustrative specimens to the McGill Medical Museum, for the benefit of future students. The specimens that remain of these donations form the basis of the current exhibit.

“An excellent plan copied from the custom of the Lancet, was for the clinical clerk to report the cases of special interest under Hospital Practice in the local medical monthly. My first appearance in print is in the Canadian Medical and Surgical Journal, reporting cases from Dr. MacCallum’s wards.”

William Osler. The Medical Clinic British Medical Journal, 1914.

 

Additional Reading

H. E. MacDermot (1949) Osler’s Original Autopsy Books.
Arch Intern Med (Chic). 1949;84(1):7-11.
(PDF Version)

Alvin E. Rodin (1973). Osler’s Autopsies: Their Nature and Utilization. Medical History, 17, pp 37-48. doi:10.1017/S0025727300018172
(PDF Version)

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