William Osler: saint in a “White man’s dominion”

I read with great interest the article by Persaud et al that suggests that Sir William Osler harboured racist views (1).

The part that intrigued me most was the line where I learnt about the Medical Students Society of McGill University having recommended that we stop using Osler eponyms and rename locations named after him, because of the belief that Osler was racist and sexist.

Whether this is true or not, and whether Osler should be viewed through the lens of contemporary thought, is indeed relevant. But thus far, eponyms which have been renamed, have been those for physicians with a Nazi past. This is perfectly justified. Even if it were true that Osler was racist, it seems a bit much to equate Osler with such physicians.

How would the students react to the term "Hansen's disease"? Hansen once injected leprous material beneath the conjunctiva of a woman in a shameful experiment - which he continued to justify as acceptable in the name of science (2). What do we do with other uncomfortable facts such as our current knowledge that Henry Ford, the motoring pioneer, was an anti-Semite? Or that many American forefathers who wrote in their constitution that 'all men are created equal' - and yet had slaves.
While I welcome the fact that the students are willing to question dogma, I find this specific opinion of theirs rather disconcerting and indeed, perplexing.

REFERENCES
1. Persaud N, Butts H, Berger P. William Osler: saint in a “White man’s dominion”. CMAJ November 09, 2020 192 (45) E1414-E1416; DOI: https://doi.org/10.1503/cmaj.201567

2. Lanska DJ. Armauer Hansen: The Controversy Surrounding his Unethical Human-to-Human Leprosy Transmission Experiment
https://worldneurologyonline.com/article/armauer-hansen-the-controversy-... [ Last accessed 19-12-20 ]

We are pleased that our article about Osler’s racist misconduct has helped some of our colleagues reassess Osler’s position in modern medicine, and to reflect on racism more broadly.[1] While the names of Abraham Flexner, Woodrow Wilson and James Watson are being dropped by medical and educational institutions,[2,3] some of our esteemed colleagues refused to reconsider Osler and instead rehashed tired defenses that we cited and discussed.

In attempts to cancel out Osler’s racist statements, some colleagues quoted from racist speeches that we did not have room to describe. While it is tempting to impute anti-racist sentiments into Osler’s comment about medicine rising above differences in “race, nationality, colour, and creed”, Osler was referencing the “the Anglo-Saxon race” across the Empire from Australia to Canada in a speech titled “British medicine in Greater Britain”.[4] In the same speech, he mocks British colleagues in India (that he calls “Vishnu-land”) because calls for more investments are even being made by “native chiefs!”. Immediately after the carefully plucked quote about “race” and “creed” are a series of white supremacist lines about “the great race so dominant on the earth to-day”.

In an homage to his mentor, Rudolf Virchow, Osler does indeed reference Galatians 3:28 that reads: “There is neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus”. [5] This verse has different interpretations, but Osler clarifies in the very next sentence he is referring to “national lines” and two sentences later that he is talking about that fact that Virchow is “not of this country, not of our blood” because Virchow was from Germany and not the United States. There is nothing in the speech about redressing the crime of mass enslavement or addressing racism, and to the contrary Osler relays his delight at giving Virchow “four choice examples of skulls of British Columbian Indians” that were used in a study comparing skulls across races.

The Star’s coverage of Persaud et al.1 states the paper has been “rigorously fact-checked.” This claim is false. One glaringly anachronistic statement is "[Osler] was an active member of the American Medical Association when -- after a contentious debate -- it rejected membership applications from qualified racialized physicians."1 The cited reference shows this US debate occurred in 1870 (NB, Osler was still a medical student in Canada).
Historians collect available and relevant data on a topic, determine what seems credible, analyze this in the context of its totality, and then develop a narrative that best fits the data. Focusing on a few outlying observations is improper technique. The authors fail to contextualize or address presentism, the uncritical evaluation of ideas or events through a lens of present-day values.
The authors’ lack of understanding of medical biographies promotes unwarranted sensationalism. As explained by Barron Lerner: “For decades, physicians wrote much of the history of medicine, often ‘great man’ histories that celebrated their colleagues' accomplishments as part of a celebratory historical narrative. Beginning in the 1970s, social historians challenged this type of scholarship, arguing that it was Whiggish, omitted the flaws of the medical profession, left patients out of the story, and ignored issues of gender, race, and class.”2 The authors focus on Harvey Cushing changing a word in a quote. His book was published in 1925 at the height of medical hagiography. Cushing regularly omitted unflattering materials.
Michael Bliss, a meticulous social historian, spent several years reviewing essentially all of Osler’s writings and other relevant historical data. If his Osler biography3 documented and then “downplayed” a couple of racist statements and characterized them as offhand remarks, his judgement was likely fair and sound. Bliss never shied away from criticism in his biographies, as evidenced by his rather scathing assessments of Frederick Banting4 and his partner Charles Best.5 The preface to his Osler biography states that he planned to do some “icon bashing” and that the only “warts” he discovered were on Osler’s hands (i.e., from dissecting tuberculous bodies without gloves). If Michael Bliss, who wrote “Try as I might, I could not find a cause to justify the death of Osler’s reputation,”3 did not see racism, it is presumptuous and arrogant for three non-medical historians with rudimentary knowledge of Osler to conclude he was by cherry-picking a few statements that do not otherwise fit into an overwhelming pattern of admirable behavior and contributions. While fighting racism is important, a statement about statues of “once-revered individuals who participated in racist crimes” being used in the same sentence as “Osler” is unwarranted and unjust. While scurrilous charges based upon weak historical evidence make headlines, such a tactic is an inappropriate way to promote a just cause!

Persaud et al. urge us to rethink our high regard for Osler in light of his objectionable attitudes toward non-white races and cultures. Instead of idolizing Osler and other white men, we would do better to redirect our sense of who best exemplifies professional virtue to physicians of color who overcame the racism of their times to succeed professionally. This particular brand of iconoclasm has now become a common public ritual, as demands to remove Confederate statues have moved on to attacks on the American founders and on British heroes such as Churchill and Nelson. What these men exemplified, we are told, is racism and white supremacy. If not down the memory hole with them, at least let us see them clearly as the deplorable creatures they were, unworthy of the pedestals we have put them upon.

There is no doubt that white male heroes of the Anglosphere in the late Nineteenth and early Twentieth centuries held many attitudes we now rightly find objectionable. It would be odd if they did not, as white racial and Western cultural superiority were unquestioned presumptions in the elite culture of the time. Persaud et al. and others seek to bring our present heightened sensitivity to racism to our cultural inheritance, bringing figures like Osler to the bar of contemporary standards for antiracist virtue and finding them wanting. This project is not wholly misguided. The important figures of our history need to be seen in light of their faults as well as of their accomplishments. And unsung physicians who struggled against the racism of their times should be recognized.

Yet, while it is well to point out that Osler was a man of his time, it is something else to demand that our recognition of his greatness be withdrawn. An important aspect of professional identity is an awareness of history and especially of those professional forbears who reflect the ideals we aspire to in the present. Osler was a physician of towering accomplishment in medical science, in medical education and in medical humanism. He has inspired generations of internists by his dedication to science, his compassion for his patients and his care for his students. That he was a man of his time in regard to race is regrettable but not a reason to banish him from the pantheon—or to banish virtually every other major figure of that time in our history. Race was certainly a blind spot for Western elites of the recent past; what our own blind spots are will no doubt be revealed to posterity. To demand pristine moral purity on the issue of race as a condition for the favorable recognition of great accomplishment is a curiously myopic demand—a failure to acknowledge that there may, or in fact that there will, be motes in our own eyes as we go about our moral lives. Persaud and his colleagues should consider that perhaps particular moral failures are not disqualifying for heroism—or for inclusion in the professional guild. We should all be thankful for that.

16 Nov 2020

To the editor,

re Persaud N et al. William Osler: saint in a “White man’s dominion”

While we can accept much of what the authors wrote in their recent piece about Osler, we found the conclusion unsettling: "As statues of once-revered individuals who participated in racist crimes are being removed around the world, we should change Osler’s place in medical curricula ..."

This recommendation smacks of presentism, which with respect to Osler has become widespread.1 As are we all, he was an imperfect human being and held attitudes now considered offensive but then prevalent, though not universal, in his social class. In addition to the sins of racism and sexism, Osler was also ageist by our standards.2 We should, however, consider the totality of his life. He advocated repeatedly for humanism in medicine, respecting the profession’s roots, and improving medical education. This is when he is referred to, if ever, in current medical curricula. We also dispute that he committed “racist crimes” as implied by Persaud et al. In researching his magisterial biography of Osler, Bliss wanted to uncover his failings3 but told one of us (AMC), "Believe me, I looked everywhere, in every source I could find” but to his surprise found little.

One must identify and eradicate prejudice and discrimination
in medicine. For example, we applaud the initiative of the University of Toronto in highlighting the most egregious example of racism in modern times, the behaviour of Nazi doctors. (: https://medicine.utoronto.ca/news/cultivating-moral-courage accessed November 15, 2020)
We agree that Osler was a man of his times who held sexist, ageist, and some but not all of the common racist views of his day.4 He deserves criticism on these points, but it is simplistic to conflate this with his full legacy.

Yours sincerely,

A. Mark Clarfield MD FRCPC
Emeritus Professor of Geriatric Medicine, Ben-Gurion University of the Negev, Beer-sheva, Israel
Professor (adjunct), McGill University, Montreal,QC

David B. Hogan MD FRCPC
Professor, Cumming School of Medicine, University of Calgary, Calgary AB

I read with interest the recent humanities piece by Drs. Persaud et al. but have been left with confusion as to the authors’ intents. If the piece was intended to highlight or re-discover the contributions of those who have not yet received their due in the history of medicine, then the authors have my applause and appreciation. On the other hand, if the authors’ intent was to assassinate a person already long deceased, then I have to add a note of caution. Apparently, Dr. Osler may have said or thought some things that are embarrassingly unflattering to his character and certainly unkind to those to whom he referred. If so, I can only hope that no one ever wastes their time in the future writing about my career for surely someone somewhere will have a recollection of something I have said that I might regret at a later date (given the opportunity to recant or clarify – something Dr. Osler is unable to do at this point).

Sir Isaac Newton (no hallowed saint himself) once said that, “if I have seen further, it is by standing on the shoulders of giants.” ​It is well recognized that Dr. Osler was one such "giant" in that he embraced the concept that medicine and medical education should be based upon science; he was the recognized leader of this movement in the late 19th and early 20th century. However, we would do well to pull out our endocrinology textbooks and recall that giants, for all their vertical advantages, can have many weaknesses as well: severe scoliosis, osteoarthritis, cardiomegaly with heart failure, diabetes, increased rates of cancer, sleep apnea, hypertension, hypopituitarism etc. For a medical practitioner (or the authors this CMAJ humanities piece) to diagnose a host of hidden but serious problems ​but omit the co-existing gigantism in which it occurs is as medically confused as it is historically inappropriate to use a person’s failings and weaknesses as a pretext to declare that their widely-appreciated help wasn’t so helpful after all. Giants can have problems that need diagnosis and correcting. But we still need to stand upon their shoulders to see beyond the barriers that otherwise stand in our way. Discovering and celebrating the best qualities of all those who work for the betterment of medical practice is surely a more charitable and gracious way to inspire others to do likewise while still generally acknowledging that humanity (including each of us!) has a long way to go.

At a time when attention is being focused on Black Lives, People of Colour and Indigenous Peoples, it is very poignant that Persaud et al have exposed some buried truths about Sir William Osler,(1) a man regarded by some leaders of the medical community in Canada as the ‘Father of Modern Medicine’.(2)

Persaud et al merely hint at irony that I think needs some further elaboration. Sir William Osler has indeed had a hospital named after him and it is situated in Brampton, Ontario. This large bustling and busy hospital serves the surrounding community of majority visible minority patients in Brampton, also known as Brown-Town, Bramladesh and Singhville (3). In fact, the Census shows that in 2016, 73.31% (433,230 people) of Brampton’s population reported being a visible minority, ranked the fourth highest in number of visible minority populations in Canada; 60% were South Asian.(4) That’s a whole load of ‘coloured wards’ for doctors to see patients on!

Naming a health care building after a medical historical individual of prominence implies that you uphold the values that they portray. Indeed, many renowned medical individuals have been indicted into the Canadian Medical Hall of Fame (5). It is notable that of these 137 Laureates, only 3% are people of colour (and those four were all men); none were black or indigenous. How does that reflect on our system of medical accolade?

At a time when truth and reconciliation are paramount, it begs the question as to whether indeed other medically noteworthy names may be more apt and reflective of modern society’s values. And yet, sadly, there are few names noted in the haloed halls of medical history that accurately reflect BIPOC individuals’ contribution to our noble profession. We stand invisible, even in a city in which we are a majority.

In an era when cries of “Lock her up” can rile a crowd to frenzy, it is the duty of a responsible editor to ensure that declamatory comment is backed up by academic rigour. It is clear CMAJ failed this test today.1 It has compounded the error by encouraging the media to fan the flames so that the associated front page article of The Star claims that the journal is calling for an end to celebrating Osler.2 Neither the authors nor the editor acknowledged the debt that CMAJ has to Osler, who not only encouraged its foundation but frequently contributed articles when he was world-renowned and the journal not. The article is based on a non-sequitur. Osler never hindered Drs. Augusta, Abbott, Oronhyatekha nor Jones. Indeed, I believe that he would have supported the current interest in these doctors, just as societies named for Osler have supported research into their lives. All of these doctors are included in the Dictionary of Canadian Biography, easily available online. Drs Augusta and Abbott feature in a book to be published by the American College of Surgeons on the historical role of Black surgeons in American medicine. Dr. Michelle Hamilton presented to Western's Osler Club on her biography of Dr Oronhyatekha, published by Dundurn Press a few years ago.3 The authors used hearsay to condemn Osler. Mortality from pneumonia was higher in Black patients just as mortality from COVID-19 is today. Why did the authors not quote from Osler when he addressed the topic directly? Why did the editors not correct the intended, but false, impression that Drs Augusta, Abbott, Oronhyatekha and Jones are forgotten because we are obsessed with Osler?

“By his commission the physician is sent to the sick, and knowing in his calling neither Jew nor Gentile, bond or free, perhaps he alone rises superior to those differences which separate and make us dwell apart, too often oblivious to the common hopes and common frailties which should bind us together”4

“...the priestly character of the physician has vanished with the ages; still there is left with us a strong feeling, of brotherhood, a sense of unity, which the limitations of language, race and country have not been able to efface”4

“Distinctions of race, nationality, colour, and creed are unknown within the portals of the temple of Aesculapius. Dare we dream that this harmony and cohesion so rapidly developing in medicine, obliterating the strongest lines of division, knowing no tie of loyalty, but loyalty to truth – dare we hope, I say, that in the wider range of human affairs a similar solidarity may ultimately be reached?”5

If we have not achieved what Osler dared to hope for a century ago, we should look to ourselves before we sling mud at another.

Dear Authors (Persaud et al.)

We are in a country where there is free speech
This article, an opinion, is an expression of free speech.

I would agree that William Osler is no saint. None of us are perfect. He was a human being. He had flaws. He had strengths.

I don’t believe any person should be elevated above another human being – it does not matter whether they have a skill, have a particular appearance, possess great speaking skills, or if they are ‘racialized and possibly oppressed and have a story to tell’ - we are all human. To elevate another human being would create separation and disparity. To elevate a person based on race is, inherently, racist. To define someone based on their race is, inherently, racist.

I would agree that people have a story to tell. Both positive and negative contributions should stimulate critical thinking - “What can I learn from this person’s example?”

From the article: “As statues of once-revered individuals who participated in racist crimes are being removed around the world, we should change Osler’s place in medical curricula and explicitly address racism in medicine.”

I disagree with the author statement and logic. This author wants cancel a person from medical curricula. Upon review of their character as a whole, a person should be cancelled. Such a knee-jerk, emotional response has consequences. It’s so convenient to point fingers and pass judgement at a person, especially a dead one, and throw them out. They’re dead. You can’t dialogue with a dead person. It is equally easy to elevate a person from the past based on written documents. We have limited information to pass judgement. Erasing history will enable future generations to repeat the mistakes of our past.

Although people are tearing down statues around the world, should we follow suit blindly? Follow the trend? Act out of pure emotion and feeling?

Throughout this article, it is hard to get a sense of any grace and dignity. Grace and forgiveness to people regardless of whether that person has done right or wrong? Shall we continue canceling the dead? Under this flawed logic, we are all guilty and none of us should be here and we should all be cancelled.

Dr. Gregory Chan

Friends,

The subject of racism in medicine has come increasingly under the spotlight over the past few years, although the broader issue of inequality in healthcare has been studied for much longer. It is understandable – even desirable – that physicians from minority communities should be engaged in resolving such injustices, but a responsible rather than resentful approach is required. The insinuation that William Osler – modern medicine’s most beloved professional icon – was racist is remarkable, and a considered study of his life and writings will make this abundantly clear. Osler’s bibliography is brimming with both explicit and implicit remarks decrying divisiveness in all its forms and encouraging social harmony. His above quoted remark is just one of very many unambiguous statements encouraging professional tolerance and cohesion.

Persaud and colleagues seem to perceive that Osler himself did not live up to such ideals. “Not by the lips, but by the life,” they might well say with Osler, “are men influenced in their beliefs.” But all throughout his life, William Osler was a warm and approachable supporter of minority physicians whenever he came into contact with them. Walter Sydney Atkinson (1881-1978), Wu Lien-teh (1879-1960), and John Andrew Kenney Sr. (1874-1950), are good examples of “racialized physicians” who spoke highly of Osler’s influence and character. Additionally, Osler was particularly indiscriminate in praising good medical work, and included references to contributions from diverse backgrounds in his lectures on The Evolution of Modern Medicine (1921). In 1914, he specifically sought out the Kurdish physician Dr Sa’eed Khan with views to restoring the Hamadan tomb of the great Persian polymath Avicenna (c. 980-1037) – “one of the greatest names in the history of medicine” – a clear instance of Osler’s respect for medicine’s international heritage. Finally, Osler was strikingly liberal in his personal dealings with foreigners. Consider his observations regarding “the Musselman at prayer” during his 1911 visit to Egypt: “it seemed the very apotheosis of worship – so simple, so fitting in its attitude and with words so appropriate to human feelings.”

William Osler was not racist, and he cannot be held personally responsible – as Persaud and colleagues imply – for the normalisation of racial inequalities in medicine. The historical record is unequivocally clear concerning Osler’s most attractive quality – his unconditional love for others – and this is consistently brought out in the reminiscences of his former colleagues and by those wishing to revitalize his legacy in more recent times. Osler may indeed have made a few off-hand comments that we would disagree with if repeated today but these remarks did not define him as a person and should not be used to denigrate his character one hundred years after his death. Rather, he should be upheld as a powerful advocate for a profession free from racism.