Why Did Osler Not Perform Autopsies at Johns Hopkins In Reply by ProQuest


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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
                                                                                                  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.
                                            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,
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