The Oslerian legacy in the Southern states

Abstract

In the pages of The Southern Medical Journal, in 1919, William Osler’s colleague Lewellys Barker published a piece entitled “Osler and the South.” Using glowing terms but with startling inaccuracy, Barker described Osler’s relationship with the South and Southerners. Essentially, the brief communication was a happy birthday letter. If Osler had any thoughts on the Civil War, Reconstruction, or the Southern agrarian mindset, he never wrote them down, and a paucity of published information is available to support Barker’s comments. Even though William Osler lived in Baltimore when he worked at Johns Hopkins, he was never particularly fond of that city. He rarely traveled further south. When Osler departed Baltimore for the Regius Professorship in England in 1905, H. L. Mencken eventually published an exquisitely written and fond remembrance of Osler. On several occasions when Osler did venture south, he left a momentous literary or academic footprint. He gave his famous address, “The Fevers of the South,” at the American Medical Association meeting in Atlanta in 1896. From this oratory comes the iconic and oft-quoted line: “Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.” On another excursion, he and two colleagues traveled to the Dismal Swamp, in Old Comfort Point, Virginia. Osler’s fascination with Thomas Moore’s poem “The Lake of the Dismal Swamp” inspired the outing. During their lunch break, Osler composed a whimsical tale, intended for his son Revere, about the swamp. Osler wrote the story on blank pages in the back of a copy of The Anatomy of Melancholy. That particular volume came to rest in a library in Christ Church and, when discovered, the “added contents” were quite a philological mystery until a letter, written by T. B. Futcher, describing the visit to the swamp, illuminated the activities of that outing. Despite Osler’s limited travels in the South, he left an Oslerian legacy there.

Living up to the expectations of the renowned Emory University cardiologist J. Willis Hurst, MD, was a challenge. Hurst, an inveterate writer and devoted historian of medicine, was fond of suggesting writing topics, encompassing a wide range of subjects and representing more articles than could possibly be written. For reasons that have long ago dimmed, one day in the hospital in the late 1990s, Dr. Hurst and I were discussing Sir William Osler when he mentioned to me that posterity needed to know more about Osler’s trip to Georgia. Hurst’s recollection was that Osler had come to Georgia for a meeting and then traveled to Americus, Georgia, by a special coach.

THE AMERICAN MEDICAL ASSOCIATION MEETING IN ATLANTA

In May 1896, the American Medical Association (AMA) held its 47th annual meeting in Atlanta, Georgia. Cushing duly recorded Osler’s attendance,¹ as did the local paper, The Atlanta Constitution. On May 1, 1896, Osler was in Philadelphia at the Association of Physicians meeting. Traveling with Henry M. Hurd, MD, a psychiatrist and the hospital superintendent at Johns Hopkins, they arrived in Atlanta on May 3 or 4. Hurd was president of the Academy of Medicine, whose meeting preceded but occurred in tandem with the AMA meeting. Several other medical organizations were present at the meeting, and Cushing reported that Osler delivered opening remarks said to be “given extemporaneously, in a charming and effective manner.”¹ These remarks were apparently “completely lost” in the subsequently published abstract of the Proceedings, Cushing lamented. As for the AMA meeting, the newspaper reported that “Atlanta with flowing speeches of welcome and a Georgia barbecue greeted and entertained for three days a thousand or more physicians.”¹ On May 6, Osler unleashed his famous address, “The Study of the Fevers of the South,” to wide acclaim. From this oratory comes the oft-quoted line: “Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.”²

The Atlanta Constitution, on May 7, recognized the AMA meeting, and Osler, with one full page of coverage (Figure 1). The most newsworthy topic involved the perennial problem of Dr. W. D. Atkinson, secretary of the AMA, whose administrative powers seemed to be waning: “Election of a younger man to the position” seemed likely. Osler gently favored that this physician move on from that position.³ Another issue of interest was Senate Bill 1552, which addressed rising antivivisectionist sentiment. Osler voiced a strong stand against this bill, as did the medical profession in general, and he feared that progress in medical research would encounter severe constraints. In five paragraphs under the subheading, “Dr. Osler’s Splendid Paper,” an innominate journalist wrote: “Dr. Osler dealt with fevers of all kinds in a technical way, but in an unusually lucid manner. … The paper was applauded frequently and when Dr. Osler was finished he was the recipient of the heartiest congratulations.”⁴ A century later, Oslerian Charles Bryan from the University of South Carolina commemorated this admirable oration in his 1996 Kass Lecture at the Infectious Diseases Society of America convention in New Orleans, noting that “in his address, Osler showed his appreciation of the history, epidemiology, management, and prevention of infectious diseases.”⁵

Figure 1.

Newspaper coverage of the American Medical Association convention in Atlanta, May 1896, with a full page devoted to the event.

Quite popular was a barbecue held for the AMA participants. The newspaper devoted almost a whole column to the feast under the title “Doctors Feast at a ’Cue. Given an Old Fashioned Georgia Spread: At Lithia Springs—Two Thousand People Gathered Around the Tables Yesterday Afternoon.” The article commented, “The largest barbecue ever given on Georgia soil was that at Lithia Springs yesterday. … Everything that goes to make the Georgia barbecue the greatest feast of epicurean taste was there. Lithia water flowed freely and other beverages of a more exhilarating type abounded.”⁶ In his history of the AMA, Morris Fishbein observed that the “Atlanta convention was especially notable for the quality of the entertainment, which included a Georgia barbecue.”⁷

The article also quoted John Temple Graves, a newspaper editor and politician, who had delivered a stirring talk: “Atlanta is proud beyond expression of her brilliant galaxy of physicians. We support 200 doctors in this happy town, maintain them in the most lavish splendor and the most indolent leisure. There is nothing here for them to do. In the elixir of this incomparable air and under the blue of these cloudless skies there is never an ailment that an old woman’s nostrums wouldn’t cure.”⁷ Possibly Graves also worked for the Atlanta Chamber of Commerce.

DID OSLER GO TO AMERICUS, GEORGIA?

Whether, as Dr. Hurst queried, Osler traveled to Americus, Georgia, is a question to consider. Americus is about 140 miles southwest of Atlanta, and in 1896 it would have been easily accessible by at least three railroads, including a popular and privately owned lavish railroad that catered to well-heeled vacationers. Visitors to Americus would have stayed in The Windsor Hotel, a Victorian edifice built in 1892. Americus was a winter resort destination frequently marketed to Northerners. Americus had a legitimate medical community presence, but no evidence is available to suggest that Osler knew any physicians there. In terms of the time frame, Osler could have departed Atlanta by train on or about May 10 and arrived in Americus in about 4 hours. A letter he penned at 1 West Franklin Street suggests that he returned to Baltimore at least by May 20.⁸ His letter does not mention the recent trip to Georgia. By July, he had made his way to the New England coast near Boston and sent a letter to Dr. Thayer, noting that “this is a fine spot, plenty of fresh air & the bathing is splendid.”⁹ Again, he refrained from epistolary recognition of his Georgia sojourn.

In that era, the Americus Times-Recorder was published every day but Monday. Although Osler’s visit would likely have received mention in the local paper, perusal of editions printed in the middle weeks of May 1896 revealed no reference to Osler. The Americus newspaper did offer one paragraph on May 6 regarding the AMA meeting in Atlanta.¹⁰ Referrals like this one to local citizens and their febrile illnesses were commonplace:

Mr. S. M. Bolton has been quite ill with fever for several days at his home on Prince Street, though his condition is by no means serious. There is very little sickness of this nature here, however. The one remaining case of scarlet fever in the city, the child of Joe Covington, is reported convalescent, and the hope and belief is expressed that the disease has been finally stamped out in Americus.¹¹

Had Osler gone to Americus, he would have encountered no shortage of fevers to challenge his diagnostic acumen. No proof currently is available, however, that he journeyed to Americus. Scrutiny of the chapter “Various Visitors” in a book about Americus was bereft of Osler’s name but included many lesser lights. Most of those guests apparently stayed at The Windsor,¹² but the hotel has no extant guest logs from that era.

Dr. Hurst’s question about Osler traveling to Americus may have an answer in certain clues. Osler’s trip involved a train and a resort. The barbecue at Lithia Springs, about 15 miles west of Atlanta, necessitated a train ride (Figure 2). Lithia Springs did feature spas at its resorts, and the therapeutic water naturally carried a touch of lithium. The train that conveyed over 2000 people to the barbecue was

Figure 2.

(a) Advertisements for the Lithia Springs spas and the Sweetwater Hotel, site of the AMA barbecue. (b) The narrow-gauge railroad Osler would have taken to the barbecue.

made up of two sections of about eight coaches each, and every coach was packed. From the depot in Lithia Springs, it was a half-mile walk to the springs, near the Sweetwater Park Hotel. Lofty descriptions of the affair hinted that Georgia invented the ’cue, the tables were spread in the beautiful grove around the spring, which, since the days when the Indian tribes resorted to it to drink its healing waters. … It was a memorable barbecue even in the native state of the ’cue.⁶

Perhaps Dr. Hurst conflated these two destinations in his mind, and he may have read about the AMA barbecue in Lithia Springs but somehow recalled that as Americus. Dr. Hurst was a stickler for evidence and repeatedly warned his housestaff about not drawing more of a diagnostic conclusion than the data would support. Dr. Hurst would probably have pointed out that no hard data were available that Osler went to the ’cue, yet the gregarious Osler most likely would have attended the barbecue outing.

OSLER AND THE SOUTH

Osler promulgated a universal brotherhood of physicians that transcended political and geographical borders. Nonetheless, for Osler, the South, as a piece of the global pie, seems to have captured a lesser slice of the orb. If some take exception that Osler never considered himself a Southerner, others would note that Osler identified as British and was never an American citizen. Slivers of Southern recognition did exist, however. The iconic lecture alluded to above, “The Study of the Fevers of the South,” was inspired by a practitioner in Alabama. Cushing wrote that the paper was “a by-product of which had been the discovery of the Alabama Student.”¹ In that essay, Osler penned:

When looking over the literature of malarial fevers in the South, chance threw in my way Fenner’s Southern Medical Reports, vols. i and ii, which were issued in 1849–50 and 1850–51. Among many articles of interest, I was particularly impressed with two by Dr. John Y. Bassett, of Huntsville, Alabama, in whom I seemed to recognize a “likeness to the wise below”, a “kindred with the great of old.”¹³

Osler simply did not travel that much to the Deep South. Some might note that as a resident of Maryland, he lived in the South. As a border state, Maryland had mixed proclivities during the Civil War. Osler never expressed much of a viewpoint on the political issues of slavery and the Civil War. He did “give clinical rules of diagnosis which should guide practitioners above Mason & Dixon’s Line, emphasizing that in these regions an intermittent fever which resists quinine is not of malarial origin, nor is continued fever due to malarial infection, even though for variability of symptoms the aestivo-autumnal infection takes precedence even of typhoid fever.”¹ This quote from Osler provides sage advice to more Northern practitioners about when to abandon the diagnosis of aestivo-autumnal malaria (Plasmodium falciparum, a type of malaria that tended to afflict in the late summer and early fall), which was less common in the North, and consider other etiologies for a patient’s fever.

A whimsical excursion with robust literary overtones took Osler to Old Point Comfort, Virginia. Traveling with his younger medical colleagues T. B. Futcher and H. B. Jacobs in April 1900, he took a trip to the Dismal Swamp, featured in Tom Moore’s poem, “The Lake of the Dismal Swamp” (Figure 3). Futcher observed in a letter that Osler “had always been fascinated” by this poem.¹ Getting to the mystical lake was quite an ordeal that took most of the morning. Futcher noted further that “on our way back, and while we were eating our frugal lunch, the Chief wrote a most imaginative account of our experiences for Revere on the blank pages in the back of Burton’s Anatomy of Melancholy which he had brought along with him.” Despite Futcher and Jacobs’ encouragement, Osler never published “this amusing tale.” That copy of Burton’s work found its way into the collection at Christ Church and was later repatriated to the Osler Library. The “added contents” had been quite a philological mystery.¹

Figure 3.

Engraving of “The Lake of the Dismal Swamp” by James Smillie, based on a painting by John Gadsby Chapman.

In April 1905, Osler was “in the south for consultation—in Columbus, Georgia, in Savannah, in Richmond.”¹ Cushing identified no source for this attribution. In his paper on “Osler’s Practice,” George Harrell mentioned this same trip. He obtained the information from Osler’s “Day Book,” which was a daily office log of patients.¹⁴ Epistles from Osler to L. F. Barker on April 5 and 10, 1905,^15,16 and to F. J. Shepherd on April 10, 1905,¹⁷ made no mention of this journey South.

Osler did miss a prime opportunity to travel to Columbia, South Carolina, for the June 4, 1890, wedding of Caroline Hampton and William S. Halsted, at Trinity Episcopal Church (Figure 4). At the time, Osler was traversing Europe. William Welch was the best man, so the assumption would be that Osler would have attended the wedding had they not been abroad. Imber, in his biography of Halsted, reported that Osler “was not particularly enamored of Baltimore, but it was of little importance since he spent most of his time working.”¹⁸

Figure 4.

Trinity Episcopal Church in Columbia, South Carolina, where William Halsted married Caroline Hampton June 4, 1890.

Lewellys Barker, a professor of clinical medicine at Johns Hopkins, published a short and curious piece titled “Osler and the South” in July 1919, feting Osler’s birthday. Barker noted: “In this impulse to honor Dr. Osler, Southern physicians delight to share.” Acknowledging Osler’s long tenure in Maryland, he extrapolated that “the South regards him peculiarly as its own” and augmented this claim with the dubious observation that “his patients were largely from the South and the Southwest.”¹⁹ He noted that Osler influenced a large number of medical students and residents who migrated to Hopkins like disciples and then spread the Oslerian gospel in the South when they returned to their hometowns. With startling reach, Barker concluded: “Osler had a peculiar understanding of the minds of the people of the South, and that Southerners generally have felt that they could share with him a kind of intimacy that they could not experience with other leaders.”¹⁹

The remarkable hospitality of the Oslers received special mention: “What greater praise in this regard could be given the Oslers than to admit that their genius for hospitality is worthy of the best traditions of the South?”¹⁹ Little in Osler’s published canon provides evidence for Barker’s sappy Southern sentiments, although the Oslers’ penchant for hospitality certainly ranks with the finest of this Southern custom. Barker’s comments should be viewed with skepticism and were perhaps written hastily but with sincere intention.

If Osler held an opinion on the Civil War, Reconstruction, or the Southern agrarian mindset, he did not leave a written record. Osler more likely shared sentiments voiced by the fiery Sage of Baltimore, H. L. Mencken, with whom he was acquainted, but decorum and sensibility likely hindered Osler from openly embracing Mencken’s inflammatory rhetoric. As a humanist, Osler took care of patients regardless of color or religion and avoided sociopolitical entanglements as best he could. The notable exception was his high-profile skirmishes with the political leaders of Baltimore, in which he chided them for their lack of attention to public health infrastructure. As Bliss observed: “Nor did he have much to say generally about the great racial divide in America and Baltimore.”²⁰ Catching Osler in an anti-Semitic statement was also a lost cause.

Mencken, as his work The Sahara of the Bozart attests, was no fan of the South either. As news leaked that Osler was leaving Baltimore for England, Mencken offered six eloquent paragraphs in which he lamented the departure. He published these thoughts in the “Interesting People” section of American Magazine 4 years following Osler’s departure:

Say of one of them that he used to sit under Osler at the John Hopkins, and you are giving him high praise. Say of him, going further, that he promises, some day, to be worthy of his master, and you are at the limit of lawful eulogy. … Dr. Osler was solving problems that the textbooks put down as insoluble; he was ridding the art of medicine of cobwebs and barnacles; he was sending our parties of enthusiastic young men to explore the medical Farthest North and Darkest Africa. He observed things that no one else noticed, and he drew conclusions that violated the league rules.²¹

Perusal of the Bibliotheca Osleriana²² for Southern literary connections was minimally fruitful. Entries 1434 and 1446 to 1456 were devoted to Dr. Crawford W. Long, of Jefferson, Georgia, and the question surrounding who discovered anesthesia. John Y. Bassett, of An Alabama Student fame, garnered several entries (entry 3576, no. 166, p. 319, Correspondence; and entry 6748, Osler’s book, An Alabama Student, p. 578).

MEETING OF THE AMERICAN OSLER SOCIETY IN ATLANTA, 1984 AND 2017

At the American Osler Society (AOS) Atlanta meeting in 1984, the venue was the Georgia World Congress Center. The gathering lasted 1 day: Friday, April 27. Dr. Shigeaki Hinohara, who did some of his training at nearby Emory University, gave the luncheon talk, “How Osler Came to Japan,” at the Omni International Hotel. Dr. Jeremiah Barondess delivered the presidential address at the Piedmont Driving Club on the topic of the friendship between William Osler and Harvey Cushing. No presentation dealt with any issue regarding the South, although a talk by William Bean focused on Osler’s Milwaukee connections. In 2017, 33 years later, the AOS met again in Atlanta, from April 9 to 12, this time on the Emory University campus. Fifty talks occurred, and Joe Vander Veer gave a highly personal and moving presidential address regarding a real-life encounter with Aequanimitas. Of the first 50 AOS meetings from 1971 through projected venues to 2020, the highest percentages ironically have been in the South (15 meetings, 30%) (Table 1).

Table 1.

Percentage of annual American Osler Society meetings held in various locations

U.S. region/country	Meetings (n)	%
South	15	30
Midwest	8	16
West	7	14
Canada	7	14
Mid-Atlantic	6	12
United Kingdom	3	6
New England	3	6
Southwest	2	4

An Oslerian legacy at Emory University is that Osler’s nephew (the son of his sister), Osler A. Abbott, MD, was a distinguished thoracic surgeon at Emory (Figure 5) and one of the founding members of the Emory Clinic. Osler Abbott performed the first intracardiac surgery in the South, a mitral valve stenosis repair, in 1951. Emory University honors Osler’s achievements: the medical school at Emory is divided into four student houses, of which the Osler House is one. In the lobby of one of the medical school administration buildings a history of medicine mosaic, with over 2 million tiles and 3000 colors, depicts Osler on panel 23 (Figure 6). Stewart E. Roberts, MD (1878–1941), Georgia’s first cardiologist, had a long and distinguished career at the Emory University School of Medicine and was known as “the Osler of the South”²³ (Figure 7).

Figure 5.

Osler A. Abbott, MD (June 6, 1912–November 3, 1976), a founding member of the Emory Clinic, who performed the first intracardiac surgery in the South in 1951, a mitral stenosis repair.

Figure 6.

Panel 23 of the Emory University History of Medicine mural depicting William Osler. In this 66-foot-long, 33-panel mural, 2.5 million tiles were used in the mosaic, done by Italian-born artist Sirio Tonelli.

Figure 7.

Biography of Stewart R. Roberts, MD, also known as “the Osler of the South,” written by his grandson, Charles Stewart Roberts, MD.

CONCLUSION

Why Osler traveled to the South so infrequently is a matter of speculation. One inescapable conclusion is that he did not have much need or desire to do so. His sphere was Canada, the Northeast USA, England, and Western Europe. Medical centers in the South at the time were of marginal distinction and likely not attractive to him as destinations. Osler favored Europe for medical meetings. Holidays with his family included traveling to the Northeastern cities, based on the heritage of his wife, Grace, and Canada, in view of his roots. Overall, a limited but anecdotally rich body of evidence ties Osler to the South.

ACKNOWLEDGMENTS

The author acknowledges the research and editorial assistance of Penny Merle Black, PhD, Candler Professor Emeritus, Emory University; Charles Bryan, MD, University of South Carolina; Michael Lubin, MD, Emory University; and Sally Wolff-King, PhD, Emory University.