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Introduction
William Osler (1849-1919), one of the founders of medicine at Johns Hopkins, wrote The Principles and Practice of Medicine, arguably the first, great modern textbook of medicine, and certainly one of the most influential textbooks of medicine ever written. The first edition came out in 1892. "Osler did not keep his first copy of Principles and Practice. He took it to Philadelphia and gave it to the woman who had refused to marry him while he was writing it. He threw it in her lap, the story goes, saying either 'Take the damned thing' or 'Here's the dirty thing.' Then he may have added, 'Now what are you going to do with the man?'" (1)
Principles and Practice was well-received and influential worldwide; it went through sixteen editions in its fifty-five years in print. (2) "The clear, concise, attractive presentation and the many citations from history and the classics gave it a unique place among scientific books with an essentially literary flavor." (3) "With a few exceptions, his accounts of the natural history of disease still make sense, in some instances are considered classic. In 1892 the endocrine system had not been understood, the body's immune system was still a mystery, viruses could not be identified, principles of nutrition and genetics were largely unknown, and x-rays, electrocardiographs, and scores of other diagnostic devices had not yet been developed. But exploration produced intelligible maps long before aerial surveying; the Jaguar owner cherishes model-T Fords; and a practitioner who reads Osler from 1892 learns a lot about the etiology and extremes of diseases which the coming of antibiotics and other remedies have effectively conquered, if only, perhaps, for the time being." (1)
In 1902, a humorous "examination paper" based on some of the literary, historical and biographical references in the 4th edition of Principles and Practice was published in St. Thomas's Hospital Gazette (4). A reprinted version in 1902 (5) had five questions added (possibly by Osler). "The 52 questions cover some 40 different diseases or syndromes. Smallpox and gout both appear three times, and pneumonia, aneurysm, tuberculosis, appendicitis, and hydrocephalus occur twice… The identity of patients plays a part in Osler's style, and, taken as a collection, the individuals sound like the character list of a stage play: The Appleton-Swain family, the hydrocephalic Cardinal, Chancellor Ferrier of McGill, the celebrated Master McGrath, the lame Mephibosheth, Napoleon Bonaparte, Renforth the oarsman, Dean Swift, and Colonel Townshend. Others come in by description: the terror-inspiring hungry diabetic, the Pullman car conductor from Chicago, the toad-like caricature of humanity, the living skeleton, and the Western physician…" (6)