William Osler's Influence on the Career of Tinsley Randolph Harrison.

ABSTRACT: In 1957, I was graduated from what was then the Medical College of Alabama, a division of the University of Alabama. It was a privilege and honor to be on Dr. Harrison's service on two occasions during my last 2 years of medical school. He was the most influential role model during my student years and has remained so throughout my professional life. I have always benefitted from his writings, his profound philosophical approach to medicine, and his numerous aphorisms. Only in later years have I come to know of the tremendous influence of William Osler on Tinsley Harrison through his father, William Groce Harrison. Unfortunately, Tinsley Harrison never knew Sir William Osler because he died the year Tinsley Harrison began his second year of medical school at Johns Hopkins. This connection is interesting from many standpoints. For instance, Osler advised Groce Harrison to make Tinsley a "teacher of medicine" when Tinsley was only 3 years old. Through the advice of his father, Tinsley followed the Osl erian tradition throughout his life. This paper presents several similarities between Osler and Harrison.

WILLIAM OSLER (1849-1919) influenced the lives of many physicians, some directly such as John McCrae and others indirectly such as Tinsley Randolph Harrison (Figs 1 and 2). Since the lives of Osler and Harrison barely overlapped, Osler's influence was manifested through an intermediary, William Groce Harrison, Tinsley Harrison's s father. Groce Harrison served to modify the life of Tinsley in the Oslerian tradition and ideals beginning in Tinsley's infancy. An overview of the life of Tinsley Harrison is necessary so that the pervasive influence of Osler on his medical career can be frilly elucidated. I will conclude with some remarkable similarities of the careers of William Osler and Tinsley Harrison.

As a student at the Medical College of Alabama in Birmingham in the late 1950s, I had the privilege of being on Tinsley Harrison's service on two occasions during my third and fourth years. He was easily the favorite mentor of my class. I learned much from this illustrious physician, since he was a fabulous teacher who had an ever-increasing fount of knowledge that he was eager to share with students and house staff. From Harrison I first learned of William Osler. He encouraged students to keep a copy of Aequanimitas at our bedside and to read it as often as we could. I have diligently followed this advice and have always learned something new from re-reading this poignant series of essays.

Tinsley Harrison was born March 18, 1900, in Talledega, Alabama, a city about 60 miles east of Birmingham. He was the firstborn child of Louise and Groce Harrison. Groce Harrison was a sixth generation physician who practiced with his father in Talledega. Tinsley finished high school in Birmingham and went to the Marion Institute in Marion, Alabama, for a year of "seasoning" before entering the sophomore class at the University of Michigan in 1916. He was an outstanding student and was allowed to pursue graduate school in combination with his fourth year of college. After considering a career in law, he decided to enter medicine at the behest of his father. Therefore, Tinsley's final year of college was also his first year of medical school, which he entered at the unusual age of 18. After his freshman year at the University of Michigan School of Medicine, his father, who had been influenced by William Osler many years earlier, insisted that Tinsley complete his medical education at Johns Hopkins. Groce Harr ison was convinced that this was the only medical school for his son. Tinsley entered the sophomore class at Johns Hopkins in 1919, the same year that Osler died. During his medical school career, he was constantly aware that Groce Harrison virtually worshiped Osler as the supreme physician and the embodiment of all he wanted Tinsley to become. In fact, according to James A. Pittman, Jr., MD, (oral communication, March, 1994), growing up in the Harrison household, young Tinsley was 4 years old before he could distinguish between God, Jesus Christ, and Dr. Osler. So from childhood on, especially during his medical years of training, Osler served as Tinsley's model of the perfect physician. He worked under inspired guidance of William Osler, not only during the years of medical school, but also for the remainder of his life. He completed medical school in 1922 and spent 2 years at Peter Bent Brigham before returning for a third year of internal medicine training at Johns Hopkins. In 1925, Canby Robinson offered Tinsley the chief residency in internal medicine at the newly reopened Vanderbilt University School of Medicine in Nashville, Tennessee. Robinson had been the interim Chair of Medicine at Johns Hopkins during the years that Tinsley was there as a student. Tinsley finished his residency and served on the faculty of Vanderbilt for 16 years. During this time, he published 107 papers and two editions of The Failure of the Circulation in 1935 and 1938. He left Vanderbilt in 1941 to accept the Chair of Medicine at the new Bowman Gray School of Medicine in Winston-Salem, North Carolina. After 3 years, he moved to Dallas to head the Department of Medicine at the new Southwestern Medical School and briefly served as Dean. In 1950, he returned to his roots when he was called to Birmingham to be the Chair of Medicine at the Medical College of Alabama. Significantly, that same year, he published the first edition of Principles of Internal Medicine. Other honors that came to Tinsley Harrison included the presidency of th e American Society of Clinical Investigation in 1939, and he was founder and first president of the Southern Society of Clinical Investigation in 1946. In 1948, he was elected President of the American Heart Association and also became a founding member of the Council of the National Heart Institute. Later, he received the Kober medal, one of the highest honors that can come to an internist.

Tinsley Harrison died in 1978, and the editors of the Principles of Internal Medicine added this memorial to the preface of the ninth edition:

From time to time, a personality scintillates across the medical firmament who dazzles all beholders. Tinsley Harrison was such a person, a delightful, vivacious passionate physician. He stimulated everyone with whom he came in contact and he placed an indelible stamp on the medical events of his day. [1]

Currently, the Harrison Research Building on the campus of the University of Alabama in Birmingham School of Medicine stands as a lasting tribute to this great physician.

Anyone who has read Osler's essay An Alabama Student is familiar with the fondness and esteem that Osler held for rural physicians, particularly those who saw the need for additional medical instruction. [2] A letter written to Groce Harrison by William Osler from Oxford in 1910 addresses him as "Dear Alabama Student." Groce Harrison was not the "Alabama Student." The real Alabama Student was John Y. Bassett who practiced in Huntsville, Alabama. A copy of this letter was obtained from John Bondurant Harrison, MD, Tinsley Harrison's son, who practices medicine today in Huntsville, Alabama.

Groce Harrison was born in 1871 and was educated at Alabama A&M, later to be renamed Auburn University He received his MD degree from the University of Nashville, but feeling inadequately trained, he went to Baltimore and received a second MD from the Baltimore Medical College in 1893. During this year in Baltimore, he visited the relatively new Johns Hopkins Medical School and there met William Osler. He was fascinated with Osler, and this began a lifelong relationship, with Osler serving as Groce Harrison's most trusted and revered mentor. He frequently made rounds with Osler, and an enduring mutual friendship developed. In 1893, he returned to Talledega and practiced with his father. Several years later, in 1903, Groce Harrison was offered the Chair of Medicine at a new medical school planned for Mobile. He wanted to spend some time with Osler to refresh his medical knowledge, as well as to seek Osler's opinion regarding this new undertaking. After Groce Harrison wrote Osler requesting a visit, he received the reply, "Come when it suits you. When you arrive, come direct to my home 1 Franklin Street." [3] With this invitation, Groce Harrison took the train to Baltimore and promptly went to Osler's home. He was met at the door, and once his identity was confirmed, Osler handed him a card addressed to the medical library. On the back of the card, Osler had written, "This will introduce my rural friend who needs a brain dusting. For God's sake, help him if you can." [3] Osler was known for recommending a quinquennial brain dusting for physicians who were out of touch with an academic medical center. Soon after Groce Harrison's arrival in Baltimore, Osler invited him to dinner with the following invitation: "I want you to come here and eat dinner with me tomorrow night. No one here except Mrs. Osler and us boys. I am going to look for you promptly at 7:00 P.M. and leave at 8:00 P.M." [3] Groce Harrison went to dinner and was met by Osler who asked him to treat Grace Revere Osler's whooping cough. Osler said, "It is giving her a lot discomfort. Please write a prescription for whooping cough because I don't know anything about it and I am sure the average doctor in Baltimore does not know how to treat it. But here you are from somewhere out in the sticks and you ought to know what to do." [3] Apparently, Groce Harrison did know what to do. He wrote his favorite prescription for whooping cough, which resulted in much improvement in Mrs. Osler's condition. Needless to say, Dr. Osler was impressed and grateful. After dinner, Groce Harrison was offered an unexpected opportunity to go to Washington with Osler for a consultation with Senator Mark Hanna, who was ill. Osler offered such an outstanding invitation that Groce Harrison could hardly refuse, so they went to Washington on the 8:15 PM train. Harrison met Senator Hanna, and Osler introduced him as a visiting consultant. This trip was the highlight of the Baltimore visit with Osler, which lasted 10 weeks from January through March 1903.

In 1904, Groce Harrison once again sought Osler's advice. Dr. Harrison had contracted pneumonia on two occasions making house calls in inclement weather and sought advice on what Osler thought he should do regarding his future in medicine. Osler's advice was "Get into a subspecialty that does not involve exposure to all kinds of weather Go abroad and get a years' training and train those boys to be teachers of medicine." [3] Groce Harrison followed Osler's advice and did go to Vienna for a years' training. He returned as an ear, eye, nose, and throat specialist and moved his practice to Birmingham. The final advice to train Tinsley to be a teacher of medicine was most significant, and this undoubtedly shaped Tinsley's future. Literally, from that day on, at age 3 years, Tinsley Harrison was destined to become a teacher of medicine, and his father saw that this prediction and advice from Osler became a reality. So Osler's advice was extremely helpful to Groce Harrison, but it was life-forming for Tinsley. He w ent on to be a great physician by following in the footsteps of William Osler.

There are a remarkable number of similarities between the careers of Osler and Tinsley Harrison. Both were somewhat peripatetic and served at four different medical schools. Osler ultimately returned to his ancestral roots in England, and Harrison returned to his roots in Alabama. They both produced an outstanding textbook of medicine. Osler was sole author of Principles and Practice of Medicine, which was published in 1892 and ultimately went through 16 editions. Harrison edited Principles of Internal Medicine, the first edition appearing in 1950, with 15 subsequent editions. Both physicians loved bedside teaching and were fantastic teachers of medicine. William Osler delighted in his Saturday morning clinic, and Tinsley Harrison regularly participated in a Saturday morning medicine/surgery clinic. Anyone who was there has lasting memories of this outstanding clinical teacher at his best before a large audience. Sadly, both Osler and Harrison lost a son in a World War. Revere Osler died of shrapnel injuries with Harvey Cushing in attendance in 1917, and "Woody" Harrison, Tinsley's firstborn son, was lost at sea as a navy pilot at the age of 20 in World War II. Both Harrison and Osler faced destructive fires. The Baltimore city fire in 1904 literally stopped at the door of Osler's home on Franklin Street. Later, a disastrous fire struck his home at 13 Norham Gardens in Oxford, and his books were saved only by the quick action of Osler and Revere. Harrison suffered a disastrous fire when moving from North Carolina to Texas in 1944. The family was moving in two vans and one of the vans caught fire and was completely consumed, resulting in the loss of the entire manuscript of the third edition of the Failure of the Circulation, which was never published.

So William Osler, the ideal mentor and teacher of medicine, designed vicariously through Groce Harrison the career of Tinsley Harrison. Had Osler lived, I am sure he would have been extremely proud of Tinsley Harrison, who always persevered in the Oslerian tradition and manifested all of the Osler ideals as well as anyone who has ever followed Osler. Because there was Osler, there was the embodiment of Osler in Tinsley Harrison, who through his father came to be as Oslerian as possible throughout his entire life. Upon his death, the world was saddened as it was when Osler died. Certainly, there will never be another William Osler, and in my opinion there will never be another Tinsley Harrison.

References

(1.) Isselbacher KJ, Adams RD, Braunwald E, et al: Harrison's Principles of Internal Medicine. New York, McGraw-Hill Inc, 9th Ed, 1980, dedication page

(2.) Osler W: An Alabama Student. London, Oxford University Press, 1908

(3.) Harrison G: Memoirs. Manuscript collection 8. Located at: Reynolds History of Medicine Library, University of Alabama at Birmingham School of Medicine