A gift from Oxford: the Osler-Thomas connection

Abstract

In June 1926, Dr. Henry M. Thomas Jr. (“Hal”) received as a gift from Grace Osler in Oxford an Einhorn Duodenal Bucket Set that had belonged to Sir William Osler. The Thomases were a distinguished multigenerational physician family of Baltimore with high educational standards and major accomplishments in medicine and medical education. An extraordinary number of the Thomas women earned doctorates and made significant contributions in an era when this was a pioneering achievement. This is exemplified by Martha Carey Thomas, who earned a PhD in 1882 and served as dean and president of Bryn Mawr College for women. As a leading feminist and member of the Women's Fund Committee, she was a major force in providing the endowment that permitted the opening of the Johns Hopkins School of Medicine under the strict stipulations that admission requirements include an undergraduate degree and that women be admitted on the basis of total equality with men. Osler established relationships that extended over three generations of the Thomas family during his Baltimore tenure, an influence that proved mutually beneficial.

Max Einhorn, a pioneering gastroenterologist, was the inventor of the duodenal bucket, which combined with the string test was an important early means of localizing gastroduodenal pathology. In a show of mutual esteem, Osler described his method in The Principles and Practice of Medicine, and Einhorn was a contributor to the festschrift for Sir William's 70th birthday.

In June 1926, a small parcel from Oxford arrived in Baltimore, no doubt to the delight of the recipient, Dr. Henry M. Thomas Jr. It contained an Einhorn Duodenal Bucket Set from the desk of Sir William Osler at 13 Norham Gardens, the gift of Lady Osler whose accompanying note (Figure 1) explained:

Figure 1.

Letter from Grace Revere Osler to Henry M. Thomas Jr., June 1926.

Dear Hal

I do not think that Sir William ever used this but I fancy it will be a pleasure to you to have something I found in his desk—and so I send it.

Affec. Grace R. Osler (1)

The gift that Hal Thomas received was symbolic of the multigenerational Osler-Thomas relationship and of the ongoing humanistic spirit of William Osler that was shared by Lady Osler.

William Osler (1849–1919) was the foremost physician of his time, whose remarkable journey encompassed three nations with professorships at McGill University, the University of Pennsylvania, Johns Hopkins University, and finally Oxford University, where he was Regius Professor of Medicine (Figure 2). His wife, Grace Linzee Revere Osler (1854–1928) of Boston, was the great-granddaughter of the American patriot Paul Revere and on her mother's side was descended from Captain John Linzee of the Royal Navy. Lady Osler was an intelligent, loving, and devoted spouse who organized and shared her husband's life, allowing him to achieve his full potential (2–4). In responding to the tributes received at his 70th birthday, Osler referred to Grace as one “who has loved and worked for the profession and the sweet influences of whose home has been felt by successive generations of students” (5).

Figure 2.

William and Grace Revere Osler on the front terrace of 13 Norham Gardens, Oxford. Reproduced by permission of the Osler Library of the History of Medicine, McGill University.

The Thomases were a distinguished multigenerational Quaker medical family of Baltimore. Most were far ahead of their time, attaining undergraduate degrees before entering medical school at a time when many of these pre-Flexnerian institutions required not even a high school diploma (6). An extraordinary number of the Thomas women earned college degrees and doctorates in an era when this required great tenacity and represented an unusual accomplishment. Major achievements within the profession and higher education occurred in succeeding generations.

HENRY (“HARRY”) M. THOMAS SR. (1861–1925)

Osler's friendship and influence begun during his Hopkins tenure was felt over three generations, beginning with Hal's father, Henry (“Harry”) M. Thomas Sr., a Quaker physician of Baltimore who has been called the father of neurology in Maryland (7). Harry received his undergraduate degree at Johns Hopkins, studied medicine at the University of Maryland, and undertook 3 years of postgraduate study in Heidelberg. In 1888 he contracted tuberculosis and was sent to the Trudeau Sanitarium in the Adirondacks at Saranac Lake. He arrived bearing a note from Dr. Francis Delafield (1841–1915) (professor of pathology and the practice of medicine at the College of Physicians and Surgeons, New York) with the grim prognosis: “He has red hair and both lungs are involved, so I think there is no hope for him” (8). The following year, despite the forbidding pigmentary forecast traceable to Hippocrates (9), he had recovered sufficiently to return to Baltimore, having established a lifelong friendship with Dr. Trudeau. Later, in an elegant tribute, he named his younger son E. Trudeau Thomas (8, 10).

At Hopkins, Harry Thomas was the first neurologist and rose to clinical professor of neurology and visiting neurologist to the hospital (11, 12). A young Dr. Harvey Cushing wrote to his father in 1901: “I must work in the neurological dispensary mornings with Dr. Thomas and try to learn something in general of nerve cases—then I will have entry into the wards to see the house cases and one clinic a week with the 4th year surgical group on this material and a chance to operate on them” (11).

Thomas' assistance in preparing the section on neurological diseases in Osler's magnum opus, The Principles and Practice of Medicine (13), was formally acknowledged in the first eight editions (excepting the seventh). Osler, in his alter ego EYD persona, expressed his appreciation in a doggerel poem tipped into the second edition:

Dear Harry Tee

Please accept from me

This small Billee

Do. As a small Appree

Citation of thy energee

Appleton et Cee

Thank thee aussee

Me too

Ever yours

Egerton Y. Davis (14)

Thomas also wrote the chapter “Diseases of the Cerebral Bloodvessels” in Osler's Modern Medicine (15), for which Osler effusively expressed his thanks in a note of January 1910:

Your section is AA.1 and no mistake! It is one of the best things I have read & you have taken the whole subject so sensibly and on quite new lines. I do not know of any system in which the question is considered so thoroughly and so clearly (16).

For his part, Harry Thomas reciprocated this friendship, and his unbounded admiration is evident in his memoir about the opening of the hospital:

For me the reality far surpassed the fantasy of my dreams. In the association that was to follow, which for my part was as close as I could make it, Osler as a physician, teacher and friend, constantly raised my preconceived ideal. Memories of this time overwhelm me.

… [Osler's] absolute generosity threw open his whole clinical material to the use of any one who had a problem. He urged and assisted in the publication of the results, and saw to it that the young men got the whole credit of the work when often it should have gone to himself. Is it to be wondered at that such a chief had such devoted followers? … For me, and for others similarly situated, who had been reared in the expectation of the new order in medical education, the coming of Osler ushered in the complete realization of long-deferred hopes. … What good there is in me as a teacher and a physician I owe to him (17).

HENRY (“HAL”) M. THOMAS JR. (1891–1966) AND HIS WIFE, CAROLINE BEDELL THOMAS (1904–1997)

Henry M. Thomas Jr., known as “Hal” to his friends, was the fourth Baltimore physician in the Thomas line (Figure 3). When he began his medical studies at Johns Hopkins, Osler wrote to his father in August 1912 expressing that he was “so glad Hal is now at the medical school. He should make a good student” (18). A “billy-doo,” with some elements of mock fierceness, was enclosed for the new student:

Figure 3.

Henry M. Thomas Jr., MD, and Caroline Bedell Thomas, MD, at Johns Hopkins. Photo from Images from the History of Medicine, National Library of Medicine.

Dear Hal,

Tear off the over-leaf & shake it in the face of some banker and he will give you $100.00 in cash—which is the face value of my signature. If he demurs tell him to go to— that I was 500 miles from home & had no cheque book. Buy with it your books and anything that you need for your studies. I am sure you will do splendidly in the medical school; 5th or is it 6th generation? Good luck to you (18).

Hal graduated from Haverford College and then from Johns Hopkins School of Medicine in 1916. He interned at the Massachusetts General Hospital, followed by a residency at Boston City Hospital and a postwar residency at Johns Hopkins, where he rose to associate professor. World War II brought a second round of military service during which he served as consultant to the Southwest Pacific Theater, emerging with the rank of colonel and the Legion of Merit. Thomas practiced internal medicine in Baltimore and was the author of 57 publications, with a special interest in diseases of the thyroid and the pathophysiology of the heart and circulatory system in thyrotoxicosis. He served as president of the American Clinical and Climatological Association and of the Johns Hopkins Medical and Surgical Association (7, 19).

Hal's wife, Caroline Bedell Thomas, MD, received her medical degree from Johns Hopkins and did postgraduate fellowships at Harvard and Hopkins (Figure 3). She embarked upon a distinguished career as a cardiologist/epidemiologist, researcher, and educator at her alma mater, focusing her attention on hypertension and a pioneering study using sulfa drugs in the prevention of streptococcal infections and acute rheumatic fever. Caroline launched the Johns Hopkins Precursors Study, an important long-term (1948–1964) prospective study of disease risk factors and health outcomes, to determine precursors of hypertension and coronary heart disease among medical students. She was one of the first women to be elected to the Association of American Physicians (20–22).

When Osler left Hopkins to assume the Regius Professorship at Oxford, he distributed some of his possessions to the “latch-keyers,” a group of young doctors who had keys to his Franklin Street home and the use of his library (23). The ornate wooden chair that Osler often used in his office went to Henry M. Thomas Sr. and then passed to his son Hal and then to Hal's wife, Caroline, who bequeathed the chair to Hopkins. Her son Henry (“Harry”) M. Thomas III, MD (1936–), a retired internist/pulmonologist and Johns Hopkins graduate, revealed:

The chair was greatly valued in the family. … My mother felt that she and the Precursors Study were quintessentially Hopkins, in the tradition of Osler, and proudly kept the Osler chair in the study offices. In 1984, at age 79, she willed the chair to the Medical Archives, to be displayed in the Precursors Study library, and her will took effect at her death in 1997 (24, 25).

Osler's desk (at which he wrote The Principles and Practice of Medicine) had originally been given to Dr. Julius Friedenwald (1866–1941), distinguished University of Maryland gastroenterologist, who bequeathed it to Johns Hopkins. In 2005 this companion office chair was reunited with Osler's desk in the Osler Textbook Room beneath the dome at the Johns Hopkins Hospital—a centennial journey that Henry M. Thomas III believes should be used to “solidify the memory of a remarkable man who embodied the hospital and the medical school” (20, 24–26).

JAMES W. CAREY THOMAS (1833–1897)

James W. Carey Thomas (the grandfather of “Hal”) was a graduate of Haverford College, Pennsylvania, and the University of Maryland School of Medicine. He was a member of the first board of trustees of the Johns Hopkins University and Bryn Mawr College and served on the medical board of the Johns Hopkins Hospital. James was a consulting physician to the Johns Hopkins Hospital, lecturer in hygiene at the Woman's Medical College of Baltimore, and president of the Clinical Society of Maryland (7, 12, 27). Writing to Henry M. Thomas Sr., Osler lamented:

I wish you had said something of your father & all the good work that he did. We do not half realize (& I know it has never been sufficiently acknowledged)—what spade work he did in those early days (28).

In an address to the medical and chirurgical faculty of Maryland, Osler echoed these sentiments, declaring “that it is the sign of a dry age when the great men of the past are held in light esteem” (29).

In 1896 Osler presided over the annual meeting of the medical and chirurgical faculty, during which reports were given of the advances in sanitation in the state of Maryland; efforts to acquire a pure milk supply for Baltimore; a new nurses' directory; the appointment of a new librarian, etc. Osler was the driving force behind many of these activities and with characteristic modesty chose to stay in the background. This did not escape the notice of James Carey Thomas, who exuberated:

Dear Dr. Osler,—

I feel that I must tell you how beautifully you obliterated yourself in the exercises of last evening. Every thing we saw & heard was due to you—your influence & personal effort — & yet nobody was permitted to say so. May I be allowed to take this quiet method of throwing up my hat & shouting, Osler! Osler! long live Osler!!

Yours truly,

J. W. Carey Thomas (30)

Osler saw James Thomas during his last illness, advising that he would do better with less frequent hypodermics (presumably morphine). With equally outspoken candor, the vexed patient complained of his renowned consultant: “There is not a general practitioner on the fringes of Baltimore who would not know better than to interfere with what gives me so much relief” (7).

MARTHA CAREY THOMAS (1857–1935)

James' daughter, Martha Carey Thomas (the sister of Henry M. Thomas Sr.), graduated from Cornell in 1877 and attended Johns Hopkins University but was not permitted to pursue a graduate degree. Carey (Figure 4), as she preferred to be called, then did graduate work at Leipzig, but after 3 years of study was denied a degree because of her gender. Moving to the University of Zurich, she earned a PhD summa cum laude in linguistics (1882)—the first woman and first foreigner to achieve this. Carey was a founder of the Bryn Mawr School for girls and became the first female dean of an American college when she was elected dean and chair of English at the newly established Bryn Mawr College for women, later serving as its second president (31, 32). Carey Thomas became the model for Helen Thornton, dean of Fernhurst College, in Gertrude Stein's early novella, Fernhurst (1904), a fictionalized account of a romantic triangle (33–35).

Figure 4.

Martha Carey Thomas, PhD. Photo from Wikimedia Commons.

Carey Thomas was a major force in the establishment of the Johns Hopkins School of Medicine. The hospital had opened in 1889, but the medical school was delayed until 1893 because of a lack of funds resulting from the failure of the Baltimore and Ohio Railroad, whose stock comprised almost half of its endowment. It was not until the Women's Fund Committee led by Mary Garrett and Carey Thomas (supported by her father) initially offered $100,000 and later an additional donation (for a total of almost $355,000) to meet the required $500,000 endowment fund (36) that the school began operation in 1893 (37). The money was offered with the strict stipulations that women were to be admitted on equal terms with men and that the prerequisites for admission would be a bachelor's degree and a knowledge of German and French. Hopkins was reluctant to accept these terms and Thomas, speaking less euphemistically, branded the action of the trustees as fighting “in the dark with treachery and false reasons. Trustees, doctors, professors … became involved in a tangle of hatred, malice, detraction that beggars description” (36, 38, 39).

Osler, initially unenthusiastic, ultimately urged the trustees to accept (37, 40). The stakes were high, the women inflexible, and a new era in American medicine began when the university, eager to begin the long-delayed medical school, acceded to the demands of the Women's Fund Committee. The new standards of a graduate-level medical school created alarm over whether any students would come or could meet the entrance requirements and led Osler in a jocular vein to comment to Dean William H. Welch: “Well, we are lucky to get in as professors, for I am sure that neither you nor I could ever get in as students” (40, 41).

There is no evidence that Osler had any direct contact with Carey, but there was certainly interaction with the Women's Fund Committee and in the affairs of Carey's sister Grace, who was divorced by her husband Tom Worthington in 1896. It was a convoluted affair, scandalous among Quakers, on the grounds of deprivation of connubial rights and with allegations of infidelity committed by Tom. Osler apparently became involved by observing to James Thomas that Tom suffered from “monomaniatic insanity on sexual questions,” a view disturbing to Carey who expostulated that Tom was “mad! mad as men have been from the beginning of time, mad about some other woman” (42).

Carey was a study in contrasts: a freethinker, a leader in the suffrage movement, a pioneer feminist and champion of women's educational rights, but flawed by racist and anti-Semitic views—a cognitive dissonance that was expressed in her actions at Bryn Mawr, which excluded blacks and limited the number of Jewish students (36, 43).

Carey Thomas' niece, Millicent Carey Thomas, PhD (1898–2001), in family tradition, became the acting dean of Bryn Mawr College and then president of Barnard College. Her husband, Russell McIntosh, was a pediatrician who taught at Columbia College of Physicians and Surgeons (44).

HELEN WHITALL THOMAS (1871–1956) AND HER HUSBAND, SIMON FLEXNER (1863–1946)

Carey's sister, Helen Whitall Thomas, a devoted feminist and graduate of Bryn Mawr College, married the celebrated Simon Flexner, physician, scientist, pathologist, and bacteriologist. Her new brother-in-law's ethnicity proved a bitter pill for Carey, who confessed: “It is a blow … but I shall have to make the best of it for Helen's sake, and at least he is very eminent and has the prize position in the country in pathology” (45).

Flexner's postgraduate studies included Johns Hopkins University, where he worked as William H. Welch's protégé and ultimately rose to professor of pathological anatomy. Osler's stimulus to the men advising John D. Rockefeller through his Principles and Practice of Medicine resulted in the creation of the Rockefeller Institute for Medical Research, first directed by Simon Flexner (46, 47). Osler maintained a friendly, supportive relationship with Flexner, whose help he acknowledged in the second to the fifth editions of the textbook. There was a sporadic correspondence, not without Osler's touches of humor, as when he wrote in 1899: “Welcome home! with, I hope, an undefiled liver, and a smooth colic mucosa. We were on the lookout for you in London” (48). Simon and his son, James Thomas Flexner, MD, coauthored the well-known biography William Henry Welch and the Heroic Age of American Medicine (1941) (49).

THE FAMILY OF RICHARD HENRY THOMAS SR. (1805–1860)

Richard Henry Thomas Sr., MD, the great-grandfather of “Hal,” completed his undergraduate and medical studies at the University of Pennsylvania and subsequently practiced in Baltimore, where he was professor of obstetrics and medical jurisprudence at the University of Maryland. Thomas traveled extensively in America and Europe as a minister of the Society of Friends (50). His brother, John C. Thomas, with whom he corresponded during his travels, was also a physician of Baltimore who, in surviving scraps of information, was said to be “greatly beloved by his patients” (51).

Richard Henry Thomas Jr., MD (1854–1904) (the uncle of Carey and the great-uncle of Hal), was a graduate of Haverford College and the University of Maryland and completed postgraduate study in Vienna. Thomas was instrumental in the founding of the Woman's Medical College of Baltimore (52), where he was professor of diseases of the nose, throat, and chest and later served as dean. He investigated the effect of climatic changes on the spread of diphtheria and at his leisure translated and wrote poetry (50, 53).

His daughter, Henrietta Martha Thomas, MD (1879–1919), was a graduate of the Woman's Medical College of Baltimore (1904), where she served as corresponding secretary of the Medical Society of the Woman's Medical College and as a staff member of the Thomas Wilson Sanatorium for Children (Mount Wilson, Baltimore County). Thomas went to England in 1914 and associated herself with the Society for the Relief of Destitute Aliens and gave pacifist service in Austria and Germany during the Great War (54–56).

THE BUCKET OF MAX EINHORN (1862–1953)

The gift that Hal received from Lady Osler was a product of the fertile mind of Max Einhorn, a pioneering gastroenterologist (Figure 5). Born in Grodno, Russia (now Belarus), a city close to the frequently changing Lithuanian and Polish borders, he studied in Berlin, receiving his medical degree in 1884. Einhorn emigrated to the United States, where he practiced at the German Hospital (later Lenox Hill Hospital) in New York and became the first professor of gastroenterology at the New York Post-Graduate Medical School. A founder of the American Gastroenterological Association, he served as its third president (57–60).

Figure 5.

Max Einhorn, November 1915. Photo from Images from the History of Medicine, National Library of Medicine.

It is undetermined whether Osler and Einhorn ever met, but there is no question of their mutual esteem. In a 1903 address, Osler, decrying the intellectual stagnation of many practitioners and their absence from medical societies, ironically proclaimed: “Why should he go to the society and hear Dr. Jones on the gastric relations of neurasthenia when he can get it all so much better in the works of Einhorn or Ewald? [Carl Anton Ewald, 1845–1915, of Berlin, a pioneering German gastroenterologist]” (61).

In an era preceding routine endoscopy and radiography, the Einhorn string (thread) test was an innovative method of confirming and localizing upper gastrointestinal bleeding (62). The test was quite familiar to Osler, who in The Principles and Practice of Medicine (1912) wrote:

Einhorn has introduced an ingenious thread test. A perforated olive with a long white thread attached is swallowed and remains in the stomach for 10 or 12 hours. If an ulcer, gastric or duodenal, is present, there is a stain corresponding to the part of the thread that has lain in contact with the ulcer, and the position on the thread gives an idea of the distance of the ulcer from the cardia (63).

Einhorn modified the test by attaching a gold bucket (1.2 × 0.6 cm) to the end of the silk thread, allowing determination of the permeability of the pylorus and the examination of the duodenal contents in addition to localizing ulcerations along the path of the thread (64).

George Tiemann & Co., a medical instrument maker of New York, manufactured the bucket, which together with accessories (porcelain dish and cover, dropper, brush, and needle) was marketed in a small leather case as the Einhorn Duodenal Bucket Set (Figure 6). William Osler's instrument, acquired under unknown circumstances between approximately 1908 and 1919, appears pristine and unused.

Figure 6.

William Osler's Einhorn Duodenal Bucket Set.

Osler and McCrae's Modern Medicine (1914) further describes the origin of the bucket and its use:

Einhorn has invented a duodenal bucket, and Bassler [Anthony Bassler, MD, 1874–1959, professor of gastroenterology at the New York Polyclinic Medical School and Hospital] a somewhat similar “string” test, the object in each case to detect the presence of an ulcer and possibly its location by means of the blood stain, or brown-black discoloration on the string, from contact with the eroded surface of the ulcer. The bucket or shoe-button, or B. B. shot with string (No. 8 braided silk) attached and of known length, is swallowed in the evening and is removed in the early morning and examined for any stain on the string. The situation of the stain on the string, measured according to its distance from the incisor teeth, determines the site of the lesion (65).

A similar note was found as late as 1926 in the third and last edition of Modern Medicine (66).

Max Einhorn was a contributor to the two-volume festschrift dedicated to Sir William Osler on his 70th birthday. Although Osler knew of this outpouring of affection by his friends, he saw only partially printed dummy volumes, the actual ones not reaching Oxford until a few days before his death when he was too ill to peruse them (67, 68).

CONCLUSION

Osler's relationship to the extraordinary Thomas family is but one of many multigenerational friendships characteristic of him and so mutually enriching. The gift to Hal Thomas was symbolic of this relationship and of the ongoing humanistic spirit of William Osler that was shared by Lady Osler.

Acknowledgment

Thanks to Susan Longo for valued information.