Sir William Osler and the Schorstein Memorial lectures at the London Hospital

Abstract

The formal named lecture has an iconic position in British medical life, but it is less valued now than in the past. The Schorstein memorial lecture series at the London Hospital illustrates the evolving role of such lectures and their significance in medical practice, science and history, and the evolving concepts of medicine in society. The founding concept underlying the Schorstein lectures was an ideal of education, strongly supported by William Osler and other influential figures. The influence of the series of annual lectures and their subsequent publication among the wider medical community was immense. However, the formal named lecture as an educational experience is now less highly regarded. Nonetheless, with a changed focus, as has been applied recently to the Schorstein lecture series, such events can continue to play a role in contemporary medical life.

Keywords

Barts and London School of Medicine diabetes mellitus London Hospital medical benefactions medical education Named lectures Sir William Osler

On 15 October 1909, William Osler (1849–1919), Regius Professor of Medicine in the University of Oxford since 1905 and Professorial Student (Fellow) of Christ Church, gave the inaugural Schorstein Memorial Lecture at the London Hospital.¹ Osler’s lecture had been preceded by publication of part of Dr Schorstein’s 1894 MD thesis, ‘Abscess of the Brain in Association with Pulmonary Disease’, in the Lancet on 18 September 1909, the historical component being ommitted.² As the first lecturer, Osler lauded the memory of Gustave Schorstein’s service to the profession and ‘to the great charity, the London Hospital’, that was ‘to be commemorated in this most appropriate way’. He noted, also, that he was himself ‘a representative of Dr Schorstein’s old university’. In his lecture, Osler, displaying his wide reading, considered the history of syphilis and the role of syphilitic aortitis as a common cause of aortic aneurysm distinct from atherosclerotic aneurysm, stressing the importance of the recent discovery of the causal spirochaete. He noted that atherosclerotic aortic aneurysm was curiously uncommon in women. The London Hospital pathologist, Dr HM Turnbull, displayed specimens, slides and papers to illustrate the topic. The lecture, afterwards much referenced, was published in the British Medical Journal a few weeks later.¹

The occasion was doubly important to the London hospital, since it coincided with the formal opening of new laboratories for Physics, Chemistry and Physiology at the London Hospital Medical College,³ funded by an anonymous gift of £20,000 (equivalent to more than £2,000,000 at a 2020 valuation), now recognised as that of Sir Alfred Yarrow, a ship builder born in the East End of London.⁴ Osler gave a second address to celebrate the opening of these laboratories, immediately preceding the Schorstein lecture,³ in which he pointed out the comparative neglect of laboratory studies in British medical schools, and the failure of ‘that mysterious body, the University of London’, to establish a higher, MD degree based on research attainment. In his biography of Osler, Cushing notes that Lord Haldane would address these shortcomings in his forthcoming inquiry into university education in London.⁵ However, the organisational problems of the loose constituent colleges of the University of London have been resolved only since radical changes in the NHS and the fusion of London teaching hospitals, their medical schools and other colleges in the period 1992–2013.⁶

Establishing the lectureship

The eponymous Schorstein lectureship at the London Hospital Medical College followed a letter of appeal published in the Lancet on 2 March 1907.⁷ The letter set out the intention, in tribute to the memory of Dr Schorstein, to endow at the London Hospital ‘an advanced course of lectures in clinical medicine which, it has long been recognised, is one of the greatest needs of the medical school’ … ‘along the lines of the endowed lectureships of the Royal College of Physicians, such as the Goulstonian’. The letter also stated that ‘election to the lectureship is to be regarded as a professional distinction’. Subscriptions ‘large or small’ were invited but no list of either donors or amounts given was to be published, ‘in accordance with Dr Schorstein’s wish’. Nonetheless, a list of the 120 subscribers retained in the Archive of the Royal London Hospital,⁸ shows that sums large and small were indeed given, totalling £1010 (a sum equivalent to approximately £120,000 at a 2020 valuation).⁹ Arrangements were made for the choice of Lecturer to be decided by a triumvirate consisting of the Regius Professor of Medicine at Oxford University, the President of the Royal College of Physicians, and a representative of the London Hospital Medical College Board – now Barts and the London School of Medicine and Dentistry, Queen Mary University of London. The Schorstein lecture series has continued annually as an important event in the Medical School’s curriculum, with inevitable interruptions during the two calamitous world wars of the 20th century. A separate Schorstein Research Fellowship at Oxford University, endowed in Dr Schorstein’s Will, also continues. The persons driving the establishment of this memorial lecture are described below.

Signatories of the Letter of Appeal

The six signatories⁷ of the Letter of Appeal in the Lancet were all associated, in different ways, with Dr Schorstein. Osler’s association probably derived from his Fellowship, at ‘The House’ in Oxford, Schorstein’s old College, and his recognition of Schorstein’s clinical reputation. Their different backgrounds demonstrate the remarkable social mobility in professional London society at the beginning of the 20th century.

Sir Samuel Montagu (1832–1911) founded the Samuel Montagu Merchant Bank in 1853. He was born in Liverpool to a Jewish watchmaker and educated in a Mechanics Institute High School in Liverpool. The Bank was initially based on Australian gold transactions. A pious Orthodox Jew, he supported the Federation of Synagogues in East London, gave philanthropic support for the housing and education of Jewish people in Whitechapel, and was an early Zionist. He was Liberal MP for Whitechapel 1887–1890, the area in which the London Hospital is situated. He was created Baronet in 1894 and raised to the peerage as Baron Swaythling, in Southampton, in 1907. Swaythling is associated with table tennis since the Swaythling Cup, the major trophy of the men’s game was given by Samuel Montagu’s wife, whose son, Ivor Montagu, was the first president of the international table tennis federation. The game is said to have been first formalised at their home in Swaythling, Southampton.

Sir Lewis McIver MP (1846–1920) was Schorstein’s brother-in-law. His wife, Charlotte Rosalind, was the daughter of Nathaniel Montefiore and Emma Goldsmid, therefore related to the Rothschild and Montefiore families.

CH Dorking†: Cecil Henry Boutflower MA (1863–1942), Bishop of Dorking from 1905-1909, born to a clerical family and educated at Uppingham, was a contemporary and close friend of Schorstein at Christ Church, Oxford. After Schorstein’s death, he was appointed Bishop of Tokyo before returning to England as Bishop of Southampton in 1921.

Sir Stephen Mackenzie MD FRCP (1844–1909), Physician to the London Hospital, was educated at Christ’s Hospital and the London Hospital Medical College. His father was a General Practitioner in Leytonstone, Essex. His brother, Sir Morell Mackenzie (1837–1892), the innovative laryngologist, also on the staff of the London Hospital, was famously involved in the controversy concerning diagnosis of the laryngeal cancer affecting Frederick III, Crown Prince of Germany.

Sir William Osler MD FRCP, Canadian by birth, Regius Professor of Medicine at the University of Oxford (1905–1919), knighted in 1911, had Oxonian links with Schorstein and may have been aware that he had been considered a candidate for the Regius Chair. At this time, Osler was himself the best-known physician in the English-speaking world, by virtue of his teaching, clinical skills, his book Principles and Practice of Medicine, his published essays and addresses, his previous prestigious appointments in Canada and the USA, and his remarkable bibliophilia.

Dr Percy Kidd MD FRCP (1851–1942) was educated at Uppingham, Balliol College Oxford, and the Medical College of St Bartholomew’s Hospital. As a Radcliffe Travelling Fellow of Oxford University, he studied for a year at Strasbourg and Vienna. He was appointed to the Brompton Hospital (1881) and to the London Hospital (1899) and practised as a Chest Physician specialising in tuberculosis. Like Dr Schorstein, he was an important teacher at the London Hospital Medical College serving as Demonstrator in Anatomy (1891–1894) and then Lecturer in Physiology (1895–1898) and Medicine (1898–1908).

Gustave Isidore Schorstein MA MD FRCP DPH

Dr Schorstein, Physician to the London Hospital and to the Brompton Hospital for Consumption, died on 16 November 1906, aged 43 years, only a few months after his election to the Staff as Full Physician.¹⁰ He died in diabetic coma, a disorder then untreatable aside from dietary management, until the discovery of insulin in 1921 by the Toronto team of Banting, Best, Collip and Macleod. In 1923, the Nobel prize for Medicine or Physiology was awarded jointly to Banting and Macleod, who shared their prize money with their two co-researchers, both unrecognized by the Nobel committee.¹¹ JJR Macleod, a graduate of Aberdeen, had been a Lecturer in Biochemistry at the London Hospital Medical College before moving to Western Reserve University in Cleveland, Ohio in 1903, and then to the Chair of Physiology at the University of Toronto in 1918. Before the era of insulin therapy, beds were set aside at the London for patients dying with type 1 diabetes but, even before insulin became commercially available, it was soon produced in-house.¹²

Schorstein (Figure 1) was educated at the City of London School and Christ Church, Oxford where he was a Junior Student from 1881. His father, Lazarus Schorstein, a financial editor, originally from Austria, moved the family from Gustave’s birthplace in Neuilly, Paris to Paddington, London when Gustave was seven years old. At Christ Church, Gustave studied Classics, gaining a first in Honour Moderations, and graduating in 1885 in Literae Humaniores. He remained at Christ Church for a further 18 months as Tutor while studying anatomy and physiology, before entering the London Hospital Medical College and graduating MB BCh (Oxon) in 1889. At the London, he was House Physician to Dr J Hughlings Jackson, whose publications he listed in an obituary appreciation, before further junior appointments at the Royal London Ophthalmic Hospital, and the Hospital for Sick Children. He was successful in the MRCP (London) examination in 1891 and became FRCP in 1897. In 1894, he was awarded an Oxford MD degree. He was briefly Assistant Physician to the Hospital for Diseases of the Chest. He was appointed Assistant Physician to the London Hospital in 1894 and Full Physician in 1905 and rapidly developed a flourishing private practice.

Figure 1.

G.I. Schorstein, Physician 1894–1906.

At the London, he served as Demonstrator in Anatomy, and was a much-admired lecturer in the Medical School, teaching Public Health, Medicine, and Pathology. His obituarist⁸ noted that his clinical lectures ‘were most popular and his literary abilities made them models of what lectures should be – clearly thought out, logical and beautifully expressed, so that the most thoughtless could not help but learn’. It was also noted that ‘he wrote little or nothing for publication, concentrating his attention on his hospital teaching’. Indeed, an internet search reveals only a talk he gave to the East Surrey District Branch of the BMA on ‘The treatment of gastric ulcer’ on 10 May 1900¹³ and another on hereditary factors in pulmonary tuberculosis.¹⁴ There is a detailed report in the Lancet on the neurological features of a child with pontine glioma,¹⁵ doubtless demonstrating the clinical skills learned from Hughlings-Jackson (who requested his name to be hyphenated at the London Hospital).¹⁶ Schorstein was described as ‘well-prepared for the difficult career as a consulting physician, with wide knowledge and a courteous manner that enhanced the value of his native abilities’. His empathy with children was especially admired. His funeral at the West London Synagogue was attended by Sir William Osler, his friend the Bishop of Dorking and various colleagues from the London and the Brompton Hospitals. In his biography of Osler, Cushing¹⁷ recalls that Schorstein was one of those considered in 1905, in competition with Osler, as a potential candidate for the Regius Chair at Oxford, a considerable tribute to his skill, erudition and reputation.

Schorstein’s wide interests included Judaic studies. Israel Abrahams (1858–1925), a Jewish scholar who succeeded Solomon Schechter (1847–1915) as Reader in Talmudic and Rabbinic Literature at the Cambridge University, met with Schorstein during a visit to Cairo to inspect the recently discovered collection of ancient Hebrew manuscript fragments stored in the Genizah, a room traditionally reserved for discarded sacred documents bearing the name of God, at the historic Ben Ezra synagogue.¹⁸ In a letter to his wife, Abrahams¹⁸ describes a convivial dinner on 17 March 1898 with Schorstein at Shepheard’s Hotel, Cairo.

It was sunset and the rich yellow of the sandstone out of which the Pyramids are built was topped by a golden brow crest cast by the lingering sunshine. It was the very edge of the desert. At the foot of the Pyramids vegetation ceases entirely, and while on the outside all is green, on the other all has that marvellous colour which, once seen, will haunt one for ever … that brings one to an ecstasy of wonder and happiness.

The Schorstein Lectures: The named lecture in medical education then and now

The Schorstein Memorial lectures (Table 1) have usually been given in conjunction with an annual symposium that attracts large numbers of medical students and graduates. The initial lecturers were recognised leaders of the profession, speaking on their specialty interests, almost always focussing on clinical experience, sometimes with pathological illustrations. The second lecturer, Sir Robert Hutchison, physician to the London Hospital and Great Ormond Street Hospital, took idiopathic infantile pyloric stenosis as his subject.¹⁹ Hutchison, acclaimed as a brilliant teacher, was the author of ‘Clinical Methods’ (1893), a practical handbook of clinical skills, now in its 25th edition, that continues to be used by modern medical students across the world. Some lecturers addressed particular problems in medical science. For example, Sir James Mackenzie, Lecturer in Cardiology at the London Hospital, fresh from his remarkable individual research as a GP in Burnley, gave two lectures on auricular (atrial) fibrillation²⁰ and Sir Henry Head, neurologist at the London Hospital, lectured on syphilis of the central nervous system, a major contemporary problem. These early lectures were published in the British Medical Journal or the Lancet; many continue to be quoted as source references. For example, Professor Otto Foerster of Breslau’s research on the dermatomal cutaneous innervation patterns in man remains a fundamental source reference.²¹ After the Second World War, fundamental scientific subjects became more prominent (Table 2), but topics of more general interest in the context of the NHS were also addressed, e.g. Professor KW Cross on Ethics of Investigating the newborn; Sir John Ellis on Medical Education in London; Professor Clifford Wilson on the University in Medicine; Dr MacDonald Critchley on historical aspects of cerebral localisation; and Sir Russell Brain on the neurological tradition at the London.²²

Table 1.

Selected early Schorstein lectures (1909–1937).

1909 Sir William Osler	Syphilis and aortic aneurysm
1910 Sir Robert Hutchison	Congenital pyloric stenosis
1911 Sir James Mackenzie	Auricular fibrillation
1914 Sir Henry Head (two lectures)	Clinical aspects of syphilis of the nervous system in the light of the Wasserman reaction and treatment with Salvarsan
1920 Sir Archibald Garrod	Diagnosis of diseases of the pancreas
1923 Sir Gordon Holmes	Clinical features of cerebellar disease
1924 Prof Sir Arthur Keith	On the fate of the bulbus cordis in the human heart
1925 Sir Humphrey Rolleston	On lymphadenoma: Hodgkin’s lymphogranuloma
1927 Prof Knud Faber^a	Chronic gastritis and gastric ulcer
1929 Sir Arthur Hurst	Precursors of cancer of the stomach
1930 Sir Henry Souttar	Radium in surgery
1931 Prof AJ Hall	Chronic epidemic encephalitis
1932 Prof Otto Foerster^b	The dermatomes in man
1934 Dr E Farquhar Buzzard	John Hughlings-Jackson: his influence on Neurology
1935 Sir William Bulloch	Medical periodical literature
1936 Prof John A Ryle	Anorexia nervosa
1937 Prof Arthur Ellis	Malignant hypertension

Note: There were no lectures during the period of the First World War (1915–1919). The subjects addressed reflect new ideas about common medical problems at that time. It is notable that Bulloch was concerned at the proliferation of the medical literature, an issue at least partially resolved by the advent of the internet. This period, up to the Second World War was a time when medicine was rapidly developing into its contemporary specialized form.

Christiania (Oslo), Norway.

Breslau, at that time a German city.

Table 2.

Selected later Schorstein lectures (1950–1984) and three more recent topics (2017–2019).

1950 Sir Francis Walshe	Principles of clinical neurology
1952 Sir Samuel Bedson	25 years of progress in virus research
1953 Sir James Spence	The varieties of clinical experience
1956 Dr Donald Hunter	Dangerous occupations
1959 Sir Russell Brain	The neurological tradition at the London Hospital
1960 Sir Macfarlane Burnet	Organ transplantation
1961 Dr William Evans	Cardiology at the London Hospital
1962 Sir Charles Illingworth	Enigmas of breast cancer
1963 Dr Henry Wilson	Reflections on psychiatry
1964 Dr Macdonald Critchley	Cerebral localisation: contributions of FJ Gall
1965 Dr AE Clark-Kennedy	Edith Cavell: pioneer and patriot
1968 Sir John McMichael	The history of digitalis
1969 Dr A King	The failure to control venereal infection
1971 Prof Dorothy S Russell	Fads, fancies and facts
1973 Prof Clifford Wilson	The university in medicine
1977 Prof KW Cross	Ethics of investigating the newborn
1979 Sir John Ellis	Medical education in London
1980 Prof JZ Young	Human evolution and the pineal gland
1981 Prof JM Ledingham	The kidney in hypertension
1984 Prof Sir John Vane	Prostaglandins
2017 Nick Ross	We’ve had enough of experts! The increasing charm of quackery
2018 Martin McKeown	Medicine in the era of fake news
2019 Ms Timendra Harkness	Am I my data?

Note: During this period, following the establishment of the NHS and after the Second World War, the subject matter became wider, sometimes historical (Bedson, Brain, Critchley, Clark-Kennedy), and often related to the societal role and organisation of medical practice and education (Hunter, King, Wilson, Cross and Ellis). There were fewer major reviews of scientific medical subjects (Walshe, Burnet, Vane). The more recent topics, of general socio-medical interest, have not addressed medical science.

The choice of lecturers and their subject matter has followed changing priorities and concerns in medical practice. The most recent lecturers (2015–2019), well known for their media skills, rather than physicians, have addressed subjects relevant to public concern about the universal healthcare system that is the NHS, rather than matters of medical science (Table 2). This change suggests that the earlier format of named lectures is now less relevant in the face of competition from increasingly sub-specialised medical and surgical conferences. Review lectures are popular events at specialty meetings, directed at audiences already knowledgeable in a particular field of medical practice and usually later accessible on the internet. Older, revered named lectures, such as the Goulstonian, Croonian, Harveian and others, given at the Royal College of Physicians of London, are now less well-attended, and are rarely, if ever, published in major general journals, or as reprinted pamphlets, as they were in the past.

We live and work in an age in which many of the great problems of previous centuries appear, at first sight, to have been resolved, but there are always new problems in medicine, as the COVID-19 pandemic has illustrated. The emergence of neurodegenerative diseases and cancers in aging populations, painful and disabling musculoskeletal disorders, the social scandal of opiate and other addictions, the scourge of atherosclerotic vascular disease and diabetic complications, and the need for preventive strategies to deal with malaria and other tropical disorders are some of the contemporary problems that Osler, Schorstein and their colleagues would assuredly exhort us to consider more vigorously. These mentors of another age would also emphasize health disparities evident at home and across the globe. There is much still to be discussed, and the published formal lecture continues to offer an appropriate format.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Michael Swash

Author biography

Michael Swash is Emeritus Professor of Neurology at QMUL. He has wide interests in neurology, including muscle disease and motor neurone disease, as well as ethical and historical aspects of medical practice.

References

Osler

. The Schorstein lecture on syphilis and aneurysm. BMJ 1909; ii: 1509–1514.

Schorstein

. Abscess of the brain in association with pulmonary disease. Lancet 1909; 174: 843–852.

Cushing

. The life of Sir WIlliam Osle 1926; (Vol ii) Oxford: Oxford University Press at the Clarendon Press, pp. 190–191.

Clark-Kennedy

. The London: a study in the voluntary hospital system; vol 2 The second hundred years 1840–1948, London: Pitman Medical, 1963, p. 170.

Haldane

. Royal Commission on University Education in London, London: HM Stationery Office, 1913, pp. 1–218.

Rivett

. The development of the London Hospital System 1823–2013, 2nd ed. London: King’s Fund Historical Series No 4, 2013, pp. 382–421.

Montagu

McIver

Dorking

, et al. The late Dr Schorstein and medical education. BMJ 1907; i: 535.

https://bartshealth.nhs.uk/the-royal-london-hospital-museum-and-archives. RLHMC/A/4/4 (accessed 10 April 2020).

Obituary, GI Schorstein MA MD FRCP(London). BMJ 1906; i: 1524.

10.

www.measuringworth.com. (accessed 10 April 2020).

11.

Banting FG. Diabetes and insulin; Nobel lecture 1925 (1923 prize in Medicine or Physiology awarded to Frederick G Best and John Macleod), www.nobelprize.org/prizes/medicine/1923/banting/lecture/ (accessed 31 March 2020).

12.

Morris

. The London Hospital, London: Edward Arnold & Co., 1926, p. 208.

13.

Schorstein GI. The treatment of gastric ulcer. Unpublished address given to the East Surrey Branch of the BMA at the Greyhound Hotel, Croydon, Tuesday, 10 May 1900.

14.

Schorstein

. The influence of heredity on phthisis. Unpublished address given at the Thames Valley Branch of the BMA at Kingston-on-Thames. BMJ 1894; 2: 1273.

15.

Schorstein

Walton

. A case of glioma of the pons. Lancet 1906; 167: 1035–1037.

16.

Swash

. John Hughlings-Jackson: a sesquicentennial tribute. J Neurol Neurosurg Psychiatry 1986; 49: 981–985.

17.

Cushing

. The life of Sir William Osler 1926; (Vol i) Oxford: Oxford University Press at the Clarendon Press, p. 626.

18.

Abrahams

. The letters of Israel Abrahams from Egypt and Palestine 1898. Trans Miscellanies (Jewish Historical Society of England) 1970; 24: 1–23.

19.

Hutchison

. Schorstein lecture: congenital infantile pyloric stenosis. BMJ 1910; ii: 1021–1024.

20.

Mackenzie

. Schorstein lecture: auricular fibrillation. BMJ 1911; ii: 869–174.

21.

Foerster

. The dermatomes in man. Brain 1933; 56: 1–39.

22.

Brain

. The neurological tradition at the London Hospital, or The importance of being thirty. Lancet 1959; 274: 575–581.