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Letters to the Editor performance of autopsies by ‘‘visiting the Philadelphia General Hospital. Med Life. Why Did Osler Not physicians.’’ 3,4 1933;40:162–177. 4. Landis HRM. The pathological records of Perform Autopsies at According to Henry Ware Cattell, a the Blockley Hospital. In: Abbott M, ed. Sir Wil- pathologist at the University of Penn- liam Osler Memorial Number: Appreciations Johns Hopkins? sylvania and Blockley in the 1890s, and Reminiscences. Bulletin No. IX of the Inter- national Association of Medical Museums and the custom at Blockley, even though Journal of Technical Methods. 1926:234–239. To the Editor.—Lucey and Hutchins1 it was not strictly legal, had been to 5. Cattell HW. Postmortem Pathology: A Man- investigate whether Sir William Os- ual of Technic of Post-mortem Examination and permit postmortem examinations on the Interpretations to be Drawn Therefrom: A ler, who performed almost 1000 au- ‘‘all persons dying in charitable insti- Practical Treatise for Students and Practitioners. topsies during his career, performed tutions’’ and that ‘‘this custom pre- 3rd ed. Philadelphia, Pa: JB Lippincott Co; 1906: even a single autopsy while at Johns vailed . . . with practically no oppo- 5–6. Hopkins. Their article focuses on a sition, until lawsuits, arising out of The author has no relevant ﬁnancial in- patient with bilateral congenital cys- this custom, caused it to be discon- terest in the products or companies de- tic kidney disease and then quibbles tinued.’’ 5 Essentially, Blockley was scribed in this article. with Bliss’s biography as to whether the Wild West on the North Ameri- the autopsy was performed by Osler can autopsy frontier, and Osler and (ie, as the ‘‘prosector’’) or whether Os- his deputies succeeded in stretching ler merely assisted William Mac- the limits even there. In Reply.—As we noted in our article,1 Callum, a Hopkins pathologist. Al- In stark contrast, Hopkins was not Harvey Cushing wrote that Sir Wil- though it is admirable that the au- a charitable institution specializing in liam Osler gave up ‘‘without ques- thors were able to identify the case in indigent patients, and William Henry tion’’ autopsy work at Johns Hopkins question within the records of the au- Welch was not a pathologist who after assuming the position of profes- topsy service at the Johns Hopkins could be ignored. Welch was not only sor of medicine.2 We hypothesized Hospital and build a case for Osler the founding physician at Hopkins; that Dr Osler asked permission of Dr being at the autopsy table as an as- he was responsible for hiring Osler. It Welch to participate in the autopsy sistant, the article does not address seems inconceivable that Welch, at the we described. Dr Wright makes an the more interesting question of why time of Osler’s hiring, was not fully excellent point in detailing how Osler Osler never functioned as an inde- aware of these issues in Philadelphia. and Welch may have come to an un- pendent autopsy pathologist at Hop- Undoubtedly, Welch made it clear derstanding regarding postmortems that the autopsy room at Hopkins be- before Osler joined the hospital staff. kins. longed to Welch and that Osler Certainly, this would explain Dr Osler was recruited to Hopkins would be a welcome guest, but that Cushing’s comment, as Osler would from Philadelphia, where he was a he was not going to be doing autop- have agreed to not pursue autopsy professor of medicine at the Univer- sies on his own and duplicating his work if he wanted to work at Johns sity of Pennsylvania and a ‘‘visiting Philadelphia behaviors at Hopkins. Hopkins. physician’’ at Blockley Hospital, an Shortly after receiving notiﬁcation almshouse for treating indigent pa- Osler clearly played by ‘‘the rules’’ while he was in Baltimore, and this of Dr Wright’s letter, we received cor- tients. It was at Blockley that Osler respondence regarding the use of performed his 162 Philadelphia au- fact is reinforced by the article by Lu- cey and Hutchins.1 handwriting analysis to resolve topsies, and it is well documented whether or not Dr Osler wrote the that Osler and his residents played autopsy report from our article (J. S. very loosely with institutional autop- JAMES R. WRIGHT, JR, MD
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