OSLER TRANSMITTED-A STUDY IN HUMANISM* by ALFRED WHITE FRANKLIN THE PLAN of my oration is to consider three questions, by whom is Osler transmitted, by what means and to what end? And because Osler is praised as a humanist, we shall need to examine that chameleon word, on our way to the finish that crowns the work-the moral. My title, Osler transmitted, well understood by Oslerolators, comes from Osler's classification of authors as Creators, Transmuters and Transmitters when opening the Bodley Shakespeare Exhibition in Oxford on 24 April 1916. He instanced Shakespeare as the world's greatest creator, Francis Bacon as the first of the modem transmuters, and Robert Burton as the last of the great transmitters. 'At the command of Prospero', he began, 'the authors . would arrange themselves in three groups', the transmitters (of learning) 'swarming black over Port Meadow and the soft, low-lying Cumnor hills', the creators fitting perhaps on to Harvard President Eliot's seven-foot book shelf. 'The melting-pot of the transmuters has changed the world . .. [they] have given to man his world dominion.' Osler put them into his Bibliotheca Prima in his Library Catalogue, 'the essential literature grouped about the men of the first rank, arranged in chronological order'. These transmuters have forged from the designs ofthe creators the tools of thought and action, from antiquity through the intellectual highlands of seventeenth-century England where dwelt Bacon, Harvey, Willis, Sydenham, Boyle, and on as far as nineteenth-century Rontgen. Twentieth-century wonders have since added more than a handful of fresh transmuters. OSLER TRANSMITmS Osler was a transmitter. He first transmitted himself to the medical profession of the world through 7he Principals and Practice of Medicine, published in 1892 and for the next twenty-five years the standard student textbook in English and in the many foreign tongues of its translations. He transmitted himself, too, through his pupils in the four universities, McGill, Pennsylvania, Johns Hopkins and Oxford, men and women who helped transform medical practice and education. His own thoughts on medical education still ferment, witness the recent book called Wm. Osler the Continuing Education, containing fourteen of his addresses on this subject, each treated to a modem commentary by a different Oslerian. Behind this publication and the foundation of the American Osler Society, both in 1969, fifty years after Osler's death, stands the figure of Wilburt C. Davison, Rhodes Scholar, Osler's friend from 1913-1919, Hopkins graduate, 6migr6 to Duke and its Oslerian inspirer. For those who knew not Osler, the word comes from the two volumes of Harvey * The Second Osler Oration delivered before The Royal College of Physicians of London on 8 July 1971. 99 A. White Franklin Cushing's biography, which must remain the chief literary source for transmitting Osler. This it certainly was that inspired two idle youths at Saint Bartholomew's Hospital Medical College in 1928 to found The Osler Club of London, with the twin objects of encouraging the study of the history of medicine among medical students and of keeping green the memory of Sir William Osler. But Harvey Cushing, transmitter-in-chief, biographied in his turn by John Fulton, needs a whole oration to himself. The Osler Club of London owes most to Walter Bett, co-founder, seven years Foreign Secretary and eleven years Secretary. A sensitive idealist, talented above most in tongue and pen, Bett founded and refounded our Club, providing a century of successful meetings in a single decade. He served the Club generously and with distinction. Unbridled enthusiasm under Oslerian inspiration was shown by Louis Carlyle Lyon, an Ealing general practitioner, who seemed to believe that no doctor was a whole man who was not a member of The Osler Club. In the world of the pre-war gathering storm the Club sank into slumber, a sleeping beauty awaiting Prince Charming who duly arrived in 1947 in the form of Carlyle Lyon. Among his many gifts to the Club, and his enthuiasm was not the least of these, is the complete set of editions of Osler's textbook. These are housed in the Wellcome-Osler Room in the WeUcome Institute of the History of Medicine and the Wellcome transmitting of Osler makes a separate story. Over the water in far-away San Francisco another enthusiast, Dr. Esther Rosencrantz, busied herself with amassing Osleriana. Books, papers, notes, pictures, things by Osler, about Osler, about the Osler entourage, the annotators of Osler, everything that touched Osler found a place, and now this collection rests in the Library of the University of California, San Francisco, in the care of Dr. John de C. B. Saunders, Regents Professor of the History of Medicine. The Osler collections at San Francisco and Osler's own at McGill are places for Oslerian study. And what of the Royal College of Physicians of London? Osler did not develop a special relationship with this College in his lifetime and he discouraged a move in 1915 to support him for President, partly because he lived in Oxford and he thought the President should live in London. 'It is awfully good of some of the Fellows to think of me', he wrote; and added 'I think the business would bore me to death'. He had, in fact, sent in his resignation from the College during the previous year because Comitia had reprimanded him instead of rallying to his defence when his name had been used, without his knowledge, for an advertise- ment, and he only withdrew his resignation unwillingly at the President's vehement request. His lack of warmth towards our College stemmed mainly from his disapproval of the examination system, in those days the College's main concern. Had not its very foundation been aimed at improving and maintaining the highest standard of recruit- ment and practice? As early as 1873 he deplored the time and money wasted by his Canadian countrymen, 'grinding' to pass English qualifying exams which were neither degrees nor honours, when they should have been attending hospital. Never- theless he took the L.R.C.P. in that year and the M.R.C.P. in 1878. In another five years, aged thirty-three, he was a Fellow, and as one of the youngest gave the 100 Osler Transmitted - A Study in Humanism Goulstonian Lectures (on 'Malignant Endocarditis') in 1885. In 1906 he devoted his Harveian Oration to 'The Growth of Truth' and, a characteristic gesture, the fee to the binding and putting-in-order of the College's Harvey documents. In 1910 he gave the Lumleian Lectures on 'Angina Pectoris', based on his own long case ex- perience, and but for the War would have given the Fitzpatrick Lectures. Whatever his feelings about College administration and College policy, he showed a warm.and practical friendship for the library by presents of books and by bequeath- ing a fine case-book of Theodore Turquet de Mayerne and Jenner's holograph record of the Gloucester Medical Society (1785-1793). Among the nineteen books presented were Fracastoro on syphilis (1530), Auenbrugger on percussion (1761) and, always a favourite of his, Beaumont on gastric juice (1833) with the account of observations on Alexis St. Martin's stomach exposed for physiological studies by a shotgun wound. THOMAS FORREST COUON Osler's posthumousplaceinthe College is due to a fellow Canadian, Thomas Forrest Cotton. Cotton was born in 1884 in Cowansville, Province of Quebec, the son of a practising doctor. Trained in Montreal he made a European postgraduate tour and in 1913 came to University College Hospital in London to work in cardiology with Thomas Lewis. Cotton had already studied among his Montreal patients the relation- ship between the electrocardiogram and the weight of the different chambers of the heart, and the fortunes of war allowed him a full ten years of research into and clinical experience of heart affections. In 1915 with Slade and Lewis he published a paper proving that skin capillaries are capable of contracting actively and he was the first to recognize clubbing of the fingers as a sign that infection had complicated acquired valvular disease (Heart, 1921-2, 9, 347). Cotton moved from University College Hospital in 1915 to the Mount Vernon Building of the new Medical Research Conmittee and later to the Sobraon Military Hospital, Colchester, with a brief spell from February 1918 establishing a depot in France for the treatment of heart cases on the exercise lines elaborated in Colchester. The War over, he joined as a part-time worker the Department of Clinical Research at University College Hospital that was established by the Rockefeller Foundation under Lewis and T. R. Eliott. He took his M.R.C.P. in 1920 and began to practise at 17 Upper Wimpole Street, the patients mostly handed on by Lewis when a private consultant was needed. In 1924 he was appointed physician at the National Heart Hospital which he served for twenty-five years and he spent the rest of his life as a consulting cardiologist, seeing patients until a month before his death on 25 July 1965 at the age of eighty years. His ashes lie next to Osler's in the Osler Library at McGill. A fuller account of Cotton's life and work has been published by The Osler Club of London. Cotton was a great doctor rather than a great cardiologist. His patients enjoyed seeing him as much as he enjoyed seeing them, and his ebullient personality radiated cheerfulness even when the prospect was a fatal outcome. One of his patients said 'As long as I know where Dr.