Osler and my father

William Osler was the most celebrated English-speaking physician of his day, and still excites interest though he died over 80 years ago and there can be few still living who were his patients or knew him professionally. Murray Wrong, my father, was both a family friend and a patient, and preserved his letters, which provide a personal glimpse of Osler during his last years at Oxford and also a glimpse of medical and academic practice of the time against the horrors of the First World War. The friendship began in Toronto, where Murray's father George was professor of history and Osler joined the Wrongs during summer vacations.^1,2

At the age of 15 in 1904, Murray had scarlet fever—in retrospect probably rheumatic fever, for it left him with aortic regurgitation sufficiently gross to cause a 'water-hammer' pulse which moved his chair with each heart-beat. In his teens and twenties he had several attacks of debilitating illness which were described as rheumatic fever and lasted for weeks. One of Murray's attacks occurred at the end of his first year in the University of Toronto, when he was aged 19 and on a bicycle trip in England with a college friend. Osler in Oxford was consulted, and regarded Murray's heart disease seriously, writing to him in Toronto in August 1910:

'I hate to bother you with an unsolicited letter of advice, but you will understand my motives. You have a crippled engine that will last you for years with ordinary care, but you must treat it as a sensible engineer would—keep to the 10 knots an hour. I am afraid that dancing, tennis, hill climbing put more strain on it than is justifiable. You must take counsel with Dr Murray Wrong. After all there is plenty in life apart from the muscles. Your daily cross must be to keep your heart action within safe limits.'

In the same year the historian A L Smith, Master of Balliol College in Oxford, embarked on a lecture tour of North American universities, accompanied by two of his seven daughters. The party was enthusiastically received by George Wrong and his family in Toronto, and several of George's children were attracted to the possibility of further studies in Oxford, particularly Murray who later that year took his Toronto degree and enrolled as a Balliol undergraduate, staying initially with the Osler family in Oxford. Osler wrote again to Murray on 1 July 1913, when Murray was probably resident in Balliol:

'.. Hearty congratulations on your First—well deserved+well earned.

Keep on an even keel—+no top sails, +your engine (it should be ship) will carry you far...'

Murray took his Oxford final examinations in only two years, probably shortening this period from the usual three years because of the time he had already spent studying history in Toronto. In 1914 he was appointed Beit fellow in colonial history at Magdalen College in Oxford. At about this time he determined to marry Rosalind, the sixth daughter of A L Smith. Mary Smith, the formidable wife of the Balliol Master, clearly had reservations about the marriage of her daughter to a young Canadian academic with serious heart disease. Inevitably Osler was consulted. The situation became even more difficult when in March 1915 Murray, staying with family friends in Herefordshire, had a further attack of 'rheumatic fever' lasting several weeks. Osler visited him there, and in May conveyed his anxieties in a letter to George in Toronto:

'If the heart has not within three months returned to the status quo they will have to part as marriage with the heart in the present state is out of the question. It may come back, but it must come down to 10 knots rate. I will get Mrs Smith to postpone a decision until his return from Canada. It is a very distressing business...'

Osler wrote to Murray on 21 June:

'I saw Mrs Smith last eve and discussed the situation. She has consented to let matters rest for three months, by which time your heart will have made up its mind (muscle) whether or not it could stand matrimony. You have improved rapidly. Save every beat for the next month, then move about quietly for a couple of weeks, before sailing. I will see the President of Magdalen.'

Murray convalesced with his family in Canada and returned to England with his mother Sophia after the summer; there seems to have been little danger from submarines in sailing across the Atlantic at this early stage in the 1914–18 war. Several others of the Wrong family were already in England: Murray's elder sister Marga was studying in Oxford, and his brothers Harold and Hume and first-cousin Gerald Blake had volunteered for the army and were training with their regiments in camp, Harold with the Lancashire Fusiliers in Conway, Hume and Gerald with the Oxford and Bucks Light Infantry in Bicester.

Sophia Wrong wrote from Oxford to George in Toronto on 15 October 1915:

'On Tuesday morning M and I saw Sir W.O. and though he found the heart much better he would give no opinion about marriage, obviously not wishing to take the responsibility. He told us to go to Sir James MacKenzie in London, a great heart specialist, and get an independent opinion, he, Sir W, not holding any communication with him before. Murray wrote and got an appointment for yesterday at noon. We had a most satisfactory visit. Sir J.M. said he could certainly marry, that the heart had healed well, that leading an academic life he might look forward to many years of usefulness. He was a nice cordial Scotchman, and was most cheery and encouraging in every way... I can't tell you with what light hearts we came away from our interview, and we felt it was well worth the £3.3.0 we had to pay...

We saw no trace of the zeppelin raid when we were in town... We heard that the damage had been somewhere in the Strand...'

James Mackenzie was the most noted cardiologist in the English-speaking world,³ having written extensively on heart disease and introduced the polygraph, which recorded both arterial and venous pulses in the neck and was used in the diagnosis of cardiac arrhythmias.⁴ In 1913 he had moved from general practice in Burnley in Lancashire to take up a post as consultant physician at the London Hospital, with private consulting rooms in Bentinck Street in Westminster.

After such an opinion, Mrs Smith must have been persuaded that it was reasonable for her daughter and Murray to marry. The ceremony was held in Holywell church in December 1915.

The war took a devastating toll of family and friends. On the western front the British infantry opened the Somme offensive on 1 July 1916. Harold Wrong with much of his battalion was killed that day near Thiepval. Gerald Blake was killed on 23 July in front of the German trenches near the village of Pozieres; Hume was able to retrieve the watch and revolver from his body. Osler's son Revere, his only child, served with the 59th brigade of the British Field Artillery and in August 1917 sustained mortal shrapnel wounds when his battery on the Ypres salient sustained a direct hit from a German shell. The surgeon Harvey Cushing, who had been a junior colleague of Osler's at the Johns Hopkins, managed to reach Revere before he died; he recorded at the burial: '... a strange scene—the great-great-grandson of Paul Revere buried under a British flag, awaiting him a group of some 6–8 American Army medical officers...'¹

In April 1917 Murray left Oxford to take up the post of Vice-Principal of the Manchester College of Technology. A son, Charles, had been born two months earlier. In January 1918 Charles, just under one year old, became febrile and drowsy. After several days he was still feverish and seemed to have headaches and a stiff neck. His family doctor called in Hugh Ashby (1880–1952), a paediatrician at the Manchester Children's Hospital, and a lumbar puncture revealed meningitis. From subsequent records this seems to have been the common meningococcal infection. Rosalind wrote in her diary that it was hopeless. Osler in Oxford was kept informed and wrote to Murray:

'I am so distressed to hear of the baby's illness—but the symptoms, as given in your letter which the Master has just sent up, are not severe, +this is a type of meningitis from which recovery takes place in many cases. Ashby is an A.1. man in whom you can have every confidence. The tappings of the condition seem to be the most satisfactory measures. Keep up your courage...'.

The 1912 eighth edition of Osler's Principles and Practice of Medicine, then the most recent edition, described cerebrospinal fever as 'a disease recognized as almost invariably fatal.'

Osler wrote again on 29 January:

'... So glad for encouraging letter from you this morning. As I wrote, it is the only form of meningitis with a fair percentage of recoveries+I do trust that your little one may be one of these to come through all right. For the coma to have disappeared is very hopeful...'.

Charles's condition continued to cause anxiety and on 4 February, the day after his first birthday, Rosalind wrote that he was not expected to live through the day. Ten days later Charles was a lot better and was declared out of danger, but Rosalind went into labour three months prematurely and was delivered of a female infant who died almost immediately.

Osler continued to write supportive letters to Murray. Details of Charles's treatment, including the use of antiserum, are not clear from family letters, but he had five lumbar punctures in all, the last of these during a brief relapse of his illness in early March. His condition improved after each spinal tap, and the parents were convinced that Hugh Ashby had saved his life. Charles eventually recovered without complications of his meningitis, went on to follow a career teaching history, and now at the age of 86 lives comfortably in retirement in Canada.

Osler died in December 1919 of lung abscess and empyema which were complications of the pneumonia he contracted after an exhausting and bitterly cold two-day motor drive from Newcastle to Oxford, necessitated by a rail strike. His biographies mention that for many years he had experienced frequent severe chest infections suggesting an underlying bronchiectasis. To a friend he had earlier referred to 'enjoying one of my recurring attacks of bronchitis', and that he had 'carried the pneumococcus for a great many years', but his biographers do not mention him having the copious and continuous purulent sputum that is a feature of his own textbook's description of this disease. His post-mortem examination, performed in his home by his colleague Dr George Gibson, makes clear that he had a localized bronchiectasis with multiple abscesses in the right lower lobe and an overlying empyema;⁵ he did not have the bronchial carcinoma that some writers later suggested might have arisen from his smoking habit.

Murray and his growing family returned to Oxford in late 1919, when Murray took up a more senior fellowship in history at Magdalen. He wrote several books and became Junior Proctor to the university. In November 1927 he took to his bed because of increasing breathlessness and cardiac irregularity. His cardiac failure became worse and he died on 15 February 1928, aged 38.

In retrospect, Osler was more correct than James Mackenzie in his doubts about the wisdom of Murray's marriage. However, it seems likely that Murray and Rosalind would have married whatever medical advice they received—a consideration that Mackenzie may have recognized in the optimistic advice he gave.