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Great Moments in Medicine

Teaching at the Bedside

Sir William Osler modernized American medical education.

By Tonse N. K. Raju, MD

It is difficult to imagine medical education without clinical clerkships. But prior to the creation of the Johns Hopkins University School of Medicine, medical students in the U.S. were trained through lectures—not at the patient bedside. As the first professor in the Department of Medicine at Johns Hopkins, Sir William Osler introduced the clerkship to U.S. medical education.

Osler was born in 1849 in Bond Head, in what is now the province of Ontario. He entered Trinity College in Toronto, intending to study for the ministry (his father had been an Anglican missionary). In 1868 he transferred to Toronto Medical School and subsequently to McGill University in Montréal, Québec, graduating in 1872 with a medical degree. He traveled to and studied in medical centers throughout Europe for the next two years. In 1873 he made one of his most important medical discoveries: he identified the blood cells that would later be named platelets. In 1874 he returned to Canada, and the following year he took a professorship at McGill, where he taught physiology, pathology, and histology. It was at McGill that Osler became familiar with bedside teaching—traditional there, although unusual elsewhere. A popular teacher, he also developed a thriving private practice built on his diagnostic skills and compassionate bedside manner. In 1884 he became chair of clinical medicine at the University of Pennsylvania.

Osler joined the founding faculty of Johns Hopkins’s new medical school in 1889. Along with pathologist William Welch, obstetrician/gynecologist Howard Kelly, and surgeon William Halsted, Osler organized a medical curriculum that quickly made the new school the most famous and most rigorous in the country.

During the nearly four years before the medical school began accepting students, Osler wrote his landmark textbook, The Principles and Practice of Medicine, published in 1892. Some 23,500 copies of the first edition were sold, and by the time the sixth edition was published in 1905, more than 100,000 copies had been printed. By 1947 Osler’s book had gone through 16 editions and was one of the most popular and influential medical texts of its time. Drawing heavily on Osler’s experience in pathology, which was the basis for his skill as a diagnostician, the book helped to put American medical practice on scientific footing.

The Principles and Practice of Medicine was unusual in its wealth of historical and literary reference, as well as in its emphasis on pathological anatomy. Also unique was Osler’s frankness regarding the lack of effective treatment for many conditions. Frederick T. Gates, a member of John D. Rockefeller’s philanthropic staff, read the second edition of the book in 1897, and based on its forthrightness about the need for research to develop cures for most diseases, he advised Rockefeller to fund medical research. Rockefeller founded the Rockefeller Institute for Medical Research in 1901 and the Rockefeller Foundation in 1913. When the institute made a gift to Harvard Medical School in 1902, Gates attributed the donation to the influence of Osler’s book.

In 1905 Osler left Johns Hopkins to take a less-demanding post as Regius chair of medicine at the University of Oxford in England. Osler’s last years were darkened by the death of his only son, Revere, in the battle of Ypres in 1917. Osler died of pneumonia at Oxford two years later.

Osler’s original discoveries were few: in addition to discovering the role of blood platelets, he identified characteristics of polycythemia vera and systemic lupus erythematosus. But his contributions to medical training, and his emphasis on interaction with the patient in developing a diagnosis, helped create modern medicine.

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