HUMANITIES | MEDICINE AND SOCIETY

William Osler: saint in a “White man’s dominion” n Cite as: CMAJ 2020 November 9;192:E1414-6. doi: 10.1503/cmaj.201567

lthough William Osler (1849– 1919) continues to be held up as an example physicians should follow,A medical students at his alma mater of McGill University have passed a motion in favour of dropping Osler eponyms.1,2 We examine Osler’s treat- ment of racialized people, and we con- trast his lionization with the meagre rec- ognition of his contemporaries who fought racism inside and outside the medical profession. Osler held authoritative positions in medicine around the turn of the twentieth century.3 He was the first physician-in- chief of Johns Hopkins Hospital, where he helped to expand the role of bedside teaching, and he was Regius Professor of Medicine at the University of Oxford. Osler wrote a widely read textbook, The Princi- ples and Practice of Medicine (1892). Many of his contemporaries have attested to his warmth and dedication; some even “wor- shipped” him.3 The centenary of his death was marked by multiple publications ­celebrating his life and contributions.1 A common theme was how much we can still learn from Osler today. Several med­ ical institutions in Canada, the United States and the United Kingdom are named after Osler. There is an Osler Club of London in the United Kingdom and an American Osler Society. Adulation for Osler at least partly arises from his humanism and “love of human- ity.”1 Yet it was Osler who wrote: “I cannot make up my mind about the Pan-America [Medical Congress]. I hate Latin Americans — but I do not like to desert my friends who are in it.”2 An intern recounted that, when she was embarrassed by her colleagues after six deaths from pneumonia on a “coloured” ward overnight, Osler attempted to support her by saying some- US National Library of Medicine thing to the effect that “the coloured, usu- ally both syphilitic and alcoholics, were the worst risk in pulmonary disease …”3 He also Alexander Thomas Augusta, courtesy of Oblate Sisters of Providence Archives, Baltimore, Md.

E1414 CMAJ | NOVEMBER 9, 2020 | VOLUME 192 | ISSUE 45 © 2020 Joule Inc. or its licensors HUMANITIES ​ 7 E1415 One of those physicians was AlexanderOne of those Thomas Augusta (1825–1890), who was a who was a Thomas Augusta (1825–1890), spread after the American Civil War. He wasCivil War. American after the spread Medical of the American an active member when — after a contentious Association applica- rejected membership debate — it racialized physicians. tions from qualified ISSUE 45 ISSUE |

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| Osler lived in a time of rampant racismtime of rampant lived in a Osler Brodel Max NOVEMBER 9, 2020 NOVEMBER | .nlm.nih.gov/spotlight/gf/catalog/nlm:nlmuid-101743406X27-img Drawing of Osler, “The Saint — John’s Hopkin’s Hospital.” Original Repository. Osler Library of the of Library Osler Repository. Original Hospital.” Hopkin’s John’s — Saint “The Osler, of Drawing URL.History of Medicine, McGill University, Montréal, Que. William Osler Photo Collection. 12787. http://digital.library.mcgill.ca/osler/. Free text. Image no.: CUS_046–007B_P. Available: https://profiles and he wrote copiously, but not about not about copiously, but and he wrote Osler volumes written about ­racism. The the experi- tended to erase have, similarly, though people, even ences of racialized medicine on “coloured” Osler practised as segregation laws wards in Baltimore

7 5 CMAJ The The 5,6 winning Under a pseudo­ 3 He also brought “four 4 Bliss includes the anecdote about 3 Others have acknowledged that Others have acknowledged that 3 These behaviours have been down- some of Osler’s actions were problematic but have tempered this by, for example, explaining that his “prejudices, like those distance a at operated people, many of and for the most part evaporated on face- to-face contact” and that “Osler was as much of a racist as the next Edwardian.” played in a number of descriptions of played in a number of descriptions of Osler. Cushing modified a transcription of Osler’s letter that included “I hate Latin Americans,” replacing the word “hate” to deciding before for,” care “don’t with Prize–­ Pulitzer his of out this leave biography, which spanned two volumes and more than a thousand pages. biography of Osler by Michael Bliss biography of Osler by Michael Bliss describes the comment about “Latin Americans” as something Osler once “off- handedly remarked,” although it was writ- ten in a letter, and Bliss explains that “he could not have had much contact with them.” deaths in a “coloured” ward as an exam- ple of Osler supporting women in medi- cine.

- A newspa publicly. racist statements made on a 1914 speech summarizedper reporting under the on immigration Osler’s view “The White man’s dominion”: heading “a to do when us is what are we question with to swarmand brown men begin the yellow do not want [Chineseover … We can say we but the case is differ- and Japanese] people, are our fellow citi- ent with the Indians, who We ought, if wezens [of the British Empire]. in, you are wel- could, say to them: ‘Come safeguard our coun- come.’ But we have to be bound to say, ‘Wetry. Therefore, we shall if we could, but you are sorry, we would terms with Euro- cannot come in on equal country abound to make our peans.’ We are White man’s country.” nym, Osler wrote a fictional manuscript manuscript fictional a wrote Osler nym, about Indigenous people, which included this phrase among similar ones: “Every primitive tribe retains some vile animal habit not yet eliminated in the upward march of the race.” choice skulls” of Indigenous people from from people Indigenous of skulls” choice North America to Germany for Rudolf ­Virchow’s collection of human remains from around the world, according to a letter included in a biography by Harvey Cushing. Other articles about Osler do not mentionnot do Osler about articles Other these instances at all. HUMANITIES down. their grocery storewould be burned parents leftAlabamaoutofconcernsthat Abbott, whowasborninCanadaafterhis racism inbothCanadaandtheUS. Association. Augustaprominentlyfought D.C., branchoftheAmericanMedical refused membershipintheWashington, underpaid bythemilitaryandwas but hewasrepeatedlymistreatedand can soldierburiedinArlingtonCemetery, Civil War. He was the first African Ameri anatomy atHowardUniversityafterthe tenant Colonelandwentontoteach eventually promotedtotherankofLieu- sion intheUnionArmy.Augustawas ­Abraham Lincolntorequestacommis- period in Canada, Augusta wrote to his trainingandworkingforashort he relocatedtoToronto.Aftercompleting gain admittancetoaschoolintheUS,so eventually accepted that he would not earn fundsforhismedicaleducationbut barber. Augusta moved to California to with privatetutorswhileheworkedasa Maryland, tobeginstudyingmedicine the 1840shehadmovedtoBaltimore, Virginia, andsecretlylearnedtoread.By Augusta wasbornafreemaninNorfolk, E1416 Osler, startedhistraininginToronto. contemporary ofOsler’sandwho,like elections. ­Indigenous peopletovote in federal Franchise Act,whichallowedsome Jones helpedtousherinthe Electoral Toronto aroundthesametimeasOsler. Dr. PeterEdmundJones—trainedin — Dr.Oronhyatekha(BurningSky)and Lincoln laydying. uals invitedtostandvigilwhileAbraham He wasamongasmallnumberofindivid- surgeon andearnedseveraldistinctions. Army, andeventuallyservedasacivilian appointment asasurgeonintheUnion to the Secretary of War, requesting an Canadian. Abbott repeatedly wrote letters sions, Abbottwasalsodisadvantagedasa had greatdifficultyobtainingcommis- wanted to serve as surgeons in the army 1862. WhileAfricanAmericanpeoplewho the medicalboardofCanadaWestin ity CollegeinTorontoandwaslicensedby these physicians, andtherewasnoout- Augusta mentoredDr.AndersonRuffin Two licensedIndigenousphysicians Today, nohospitalsarenamed after 10 AbbottstudiedmedicineatTrin- 11,12 CMAJ 8,9 -

Long IslandUniversity, Brookville,NY Heather ButtsJDMPH Health Toronto,Ont. Medicine, St.Michael’sHospital, Unity Department ofFamilyandCommunity University ofTorontoFaculty Medicine; Family andCommunityMedicine, St. Michael’sHospital;Departmentof Centre forUrbanHealthSolutions, Nav PersaudMDMSc physicians, matternow. other Black, Indigenous and racialized ­Oronhyatekha andJones,aswell ­racism. ThelivesofAugusta,Abbott, extraordinary couragebyfighting tions despiteracism,andwhoshowed managed tomakeimportantcontribu- plishments ofracializedphysicianswho today, wecanacknowledgetheaccom- ate throughmedicalschoollecturehalls White menwhosenamesstillreverber- heap recognitiononOslerandother lighted here. Rather than continuing to albeit notthestatementswehavehigh- mainstay ofmedicalschoollectures, ing and after his life? Osler quotes are a and themanyothersheinfluenceddur- behaviours have onhis devoted trainees medicine. WhateffectdidOsler’sracist curricula andexplicitlyaddressracismin should changeOsler’splaceinmedical being removed around the world, we who participatedinracistcrimesare likes ofOsler. the historyofmedicinethatstars tutions and there is a dominant view of men stillheadprominentmedicalinsti- ship positions.Acenturylater,White been aprerequisiteforholdingleader- quiet acceptanceofracismmighthave treatment ofracializedphysicians,and American MedicalAssociationforfair indicate that Osler advocated at the elite. Thereisnothingintherecordsto White menwhomadeupthemedical have helpedOslerfitinamongthe time. ­racist behavioursweretypicalforhis be erasedbythenotionthatOsler’s temporaries whofoughtracismtendto works andeventhelivesofOsler’scon- many haveevenheardofthem?The the centenariesoftheirdeaths.How pouring ofpraiseinmedicaljournalson | NOVEMBER 9,2020 As statuesofonce-reveredindividuals 3 Suchracistbehavioursmight

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| ISSUE 45 12. Medicine, Toronto,Ont. Medicine, UniversityofTorontoFaculty Department ofFamilyandCommunity Philip BergerMD 11. 10. 4. References interests weredeclared. Ontario SPORSupportUnit.Noother competing adian InstitutesofHealthReseach andthe has receivedresearchfundingfrom theCan­ Community Medicine.Outsideofthis work,he sity ofTorontoDepartment Family and within UnityHealthToronto,andby theUniver- Community MedicineatSt.Michael’sHospital program, bytheDepartmentofFamilyand being supportedbytheCanadaResearchChairs Competing interests:NavPersaudreports making forthisarticle. was notinvolvedintheeditorialdecision- Nav PersaudisanassociateeditorforCMAJand This articlehasbeenpeerreviewed. 7. 2. 3. 1. 9. 8. 6. 5.

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