Osler's Pupil, Henry W. Ochsner, MD (1877–1902): His Life, Lineage, and Death

INTRODUCTION

In pocket-sized “memorandum books,” Sir William Osler kept notes from readings and lectures and drafted ideas for lectures and memoranda (1). On a loose piece of paper tucked inside one of his memorandum books is a pencilled jotting written by Osler and titled “Death (Poor Ochsner).” The jotting (Fig. 1) reads,

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Figure 1.

Penciled jotting, “Death (Poor Ochsner),” written by William Osler immediately after Dr. Henry W. Ochsner's death from typhoid on November 25, 1902 at the Johns Hopkins Hospital. (1; used with permission)

The oppressive stillness of the chamber in which he lay dying was made more oppressive by the soft but hurried & [unreadable] just audible respiration. I sat holding the poor chap's hand & beside me were my two assistants & at the foot of the bed an angel in white, one of the two who had shared the fight with us. For three weeks we had worked in hope but in vain. The [blank] was in the room and we silently waited the end with sad hearts & brimming eyes. The young life full of life and promise & only just equipped for the race was dear to us by the association in work of four years, & the thought that those to whom the dear man was vital, were far away intensified the tragedy of the moment. A strange half frightened look at times [or, At times a strange half frightened look] lightened the quiet apathy of the countenance, which … Far from his home, far from the loved one who has watched with pride his career at…

In this jotting, Osler describes the 1902 deathbed scene of Henry W. Ochsner, MD (Fig. 2), a first-year resident physician (referred to as “interne” at the time) at the Johns Hopkins Hospital. It suggests that Osler was deeply moved by Ochsner's death, which was due to typhoid, a disease Osler hated and about which he was an expert. Indeed, Ochsner's death is cited in multiple editions of Osler's Principles and Practice of Medicine (6th–11th editions; 2–7), each of which declares that Ochsner contracted the disease from a patient. Osler also laments Ochsner's death in a 1904 speech (8a) and in his 1905 essay, “A Student Life” (9), yet little is known about Ochsner. This article describes the life, lineage, and death of Osler's pupil, Henry W. Ochsner.

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Figure 2.

Photograph of Dr. Henry W. Ochsner, taken in 1902. (From the Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, MD; used with permission)

HENRY W. OCHSNER'S LINEAGE

Henry W. Ochsner was born on March 31, 1877, in Waumandee, Buffalo County, Wisconsin (10). He was the youngest of six children of Johannis (John) and Louisa Ochsner (11a). Johannis and Louisa Ochsner were pioneers who emigrated from Switzerland, settled in the Waumandee area in southwestern Wisconsin, and eventually operated a prosperous flour mill (12) on the Waumandee River in the Waumandee Valley. The valley, not far from the Mississippi River (into which the Waumandee River flows), consists of rich farmland and rolling hills covered with forest. Although the Ochsner flour mill is not in operation today, its primary structure still stands.

Henry W. Ochsner's father, Johannis Ochsner, had 10 siblings (11a). One brother of Johannis, Konrad, also a pioneer settler of Waumandee, became prominent, in part, because of his knowledge and skills in treating human and animal illness and injuries despite never having received formal training in allopathic or veterinary medicine (11b,12). Konrad invented “Ochsner's solution,” a topical disinfectant that is still prescribed today by practitioners in Waumandee and the adjacent region (12). Another brother of Johannis, Heinrich, was the father of Albert J. Ochsner, MD, the innovative and famous Chicago surgeon (11a). Hence, Henry W. Ochsner and Albert J. Ochsner were first cousins.

Notably, Dr. Albert J. Ochsner was the mentor of Alton Ochsner, MD, the founder of the Ochsner Clinic in New Orleans, Louisiana (13,14). Albert, who regarded Alton as a cousin, was largely responsible for guiding Alton through his medical training. Indeed, the stories of Dr. Albert J. Ochsner and Dr. Alton Ochsner are incomplete without describing this mentor-protege relationship (13). According to Alton Ochsner's son, John L. Ochsner, MD (currently surgery physician emeritus of the Ochsner Clinic), Albert J. Ochsner and Alton Ochsner's father “were very close. It was because of their friendship that dad [Alton] came under A.J. Ochsner's tutelage. A.J. had one son who did not go into medicine and hence he was very close to my dad, and referred to him as his nephew, …” when, in fact, they were distant cousins (Ochsner JL, personal communication, May 2004).

Henry W. Ochsner had five siblings (four brothers and one sister). A brother, Rudolph, was also a physician (11a).

HENRY W. OCHSNER'S EDUCATION

Many details regarding Henry W. Ochsner's life and education can be derived from original newspaper articles from the era. For example, the June 5, 1890 issue of the Buffalo County Journal (Wisconsin) reports, “The following pupils …were awarded common school diplomas.” Listed among the recipients was Henry Ochsner, age 13 (15). In 1894, Henry Ochsner graduated from the Alma (Buffalo County, Wisconsin) High School (16). The September 13, 1894 issue of the Buffalo County Journal reports, “Henry Ochsner left Monday for Madison, where he enters the state university. Henry is a bright, intelligent, young man and we predict a successful career for him” (17).

Ochsner's transcripts from the University of Wisconsin show that he completed course work in biology, chemistry, physics, bacteriology, psychology, histology, astronomy, botany, comparative psychology, and physiology. He also studied German, ethics, Shakespeare, gymnastics, rhetoric, French, and military drill. In all, Ochsner took 50 courses at the University of Wisconsin. On a scale of 0 to 100, his grades ranged from 81 to 98, with an overall average of 92 (18). Ochsner's thesis is titled “A Study of the Lung of Necturus Maculatus” (19). W. S. Miller, MD, Assistant Professor of Vertebrate Anatomy, was Ochsner's thesis advisor (10). Necturus maculatus is an aquatic salamander found in rivers and streams in Wisconsin. Ochsner's thesis includes his detailed drawings of microscopic cross-sections of lung tissue from the animal.

Ochsner's academic success at the University of Wisconsin did not go unnoticed. In Ochsner's senior yearbook it is written, “No ordinary man was he” (11c). The June 23, 1898 edition of the Buffalo County Journal reports, “Among those who graduated from the University of Wisconsin and received the bachelor's degree, was Henry W. Ochsner, son of John Ochsner, of this place. His many friends congratulate him on his success” (20).

During 1898, Ochsner applied for admission to the Johns Hopkins University School of Medicine. In his application, Ochsner described his education, training, and practical experience at the University of Wisconsin and stated that he could “read French and German and speak and write German also.” He also wrote, “Can I not make up my Latin during the summer and next year? …. Please let me know immediately if my application for admission is successful” (10).

Several individuals wrote letters of recommendation on behalf of Ochsner. In a June 16, 1898 letter, Dr. Miller writes, “I am sure he will prove as good a Medical Student as he has Science Student here” (21).

In a June 16, 1898 letter, E.A. Birge, MD, Professor of Zoology at the University of Wisconsin, describes Ochsner's undergraduate work as consisting “to a large degree of laboratory work” and “successful to an unusual degree.” As a senior, Ochsner worked as an assistant in the vertebrate anatomy laboratory. Dr. Birge writes, “I commend him cordially to the authorities of the Johns Hopkins Medical School” (22).

Henry W. Ochsner's application to Johns Hopkins was successful. On his application, an unknown author has written, “Can enter. Condition in Latin. In general excellent preparation” (10). A letter written by Ochsner (on his father's stationery, the top of which reads, “Waumandee Roller Mills, John Ochsner, Prop.”) to William H. Welch, MD, of Johns Hopkins, dated June 25, 1898, reads,

I have just gotten home after graduating at Madison and find your letter here. I am glad to hear that I can enter with a condition in Latin. I am sorry to say that I have never had any Latin whatever, and as it is absolutely necessary for me to stay at home this summer and work on the farm and in the mill you can readily see that I won't be able to do much at my Latin. I expect, therefore, to be at Johns Hopkins next fall, ready to do my work (23).

The “condition in Latin” was not an obstacle for Ochsner; his performance as a medical student at Johns Hopkins was exemplary. In fact, he graduated first in his class (24–26). The June 19, 1902 edition of the Buffalo County Journal reports that Ochsner “won the first prize” for the “highest average of all men in the class, …[and was awarded] a year's practice as interne” at the Johns Hopkins Hospital. The article also states,

… it is no surprise to those who best know him, that he should excel,…for we are used to see Henry always in the lead and have no doubt that he will occupy the same position, on entering upon his chosen profession. Our people and especially Henry's old school mates, feel proud of his success …. We send greetings to Dr. Ochsner, from old Waumandee (26).

During the summer of 1902 (after graduating from the Johns Hopkins University School of Medicine and before beginning his internship at the Johns Hopkins Hospital), Ochsner returned to Waumandee to vacation. The June 26, 1902 edition of the Buffalo County Journal comments, “A.G. [Adolph] Ochsner, who has been to Chicago for medical treatment returned home … accompanied by his brother the doctor, who will spend a two months' vacation here” (27).

During August 1902, Henry Ochsner returned to Baltimore. The August 28, 1902 edition of the Buffalo County Journal reports, “John Ochsner [and] Dr. Henry Ochsner… will visit at Cleveland, Ohio, and … will then return to Baltimore, where he holds the position of interne in the Johns Hopkins Hospital” (28). Ochsner began his internship at the Johns Hopkins Hospital on September 1, 1902 (25).

HENRY W. OCHSNER'S ILLNESS AND DEATH DUE TO TYPHOID

From 1900 to 1904, William Osler conducted his “Study of the Act of Dying,” in which nurses, resident physicians, and medical students recorded on data collection cards deathbed observations (e.g., physical discomforts) of 486 dying patients at the Johns Hopkins Hospital (29). For 188 patients, the cause of death was recorded on the cards (30). Eight patients died of typhoid. During the first month of his internship (September 1902), Dr. Henry W. Ochsner completed cards for 3 dying patients, including one for a man who died of typhoid on September 17, 1902 (patient #449 of Osler's study) (Fig. 3). The patient, a 31-year-old German immigrant, had been ill for 20 days before his death. Notably, typhoid was endemic in Baltimore during this era, especially among immigrants who lived in parts of the city with inadequate sewerage and contaminated water supplies. At the time, most cases of typhoid in Baltimore occurred during the period from July through October (31).

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Figure 3.

Actual data collection card completed by Dr. Henry W. Ochsner for William Osler's “Study of the Act of Dying.” (Patient name and medical record number have been masked.) This patient (patient #449 of Osler's study) died of typhoid on September 17, 1902. (29; used with permission)

During late October 1902, Ochsner himself became ill with typhoid. In his biography of Osler, Harvey Cushing, MD, writes,

Tuberculosis was bad enough—but typhoid—how [Osler] hated it! Until it disappeared there were to be plenty of sacrifices on the part of those endeavouring to check its ravages. Those were days when the wards were full of it, nurses, house staff, and students all being more or less exposed to chance infection despite the utmost care … (8a).

In fact, Ochsner may have contracted the disease specifically from the aforementioned patient. Persons who ingest Salmonella enterica serotype typhi bacteria remain free of symptoms for 3 to 60 days (average, 7–14 days). After this asymptomatic period, fevers, malaise, anorexia, headache, myalgia, dry cough, and other symptoms develop (32). Hence, the onset of Ochsner's illness is consistent with his exposure to the aforementioned patient with typhoid and the natural history of the disease.

Indeed, Osler explicitly attributed Ochsner's illness to patient contact. The sixth edition (1905) of Osler's Principles and Practice of Medicine, the first edition of the book published after Ochsner's death, reads,

Even with special precautions and an unusually large proportion of nurses to patients, we have not been able to avoid “house” infection [due to typhoid] at the Johns Hopkins Hospital. T. B. Futcher has analyzed the 31 cases contracted in the hospital among our first 1,500 cases; physicians, 5 among a total of 288* …” (2).

At the bottom of the page adjacent to the asterisk (*) is written, “Only three of these [physicians] were in attendance on typhoid cases. Two of the five died.—(Oppenheimer and Ochsner)” (2). This section (i.e., that which mentions the deaths of Ochsner and Oppenheimer) remains unchanged in the 7th through the 11th (published in 1930) editions of the Principles and Practice of Medicine (3–7). “Oppenheimer” refers to Arthur R. Oppenheimer, a resident physician at the Johns Hopkins Hospital, who died in 1895 (33).

Ochsner was ill for 3 weeks, and then his condition acutely worsened (see Osler's “Death [Poor Ochsner],” Fig. 1). In patients who have been ill for more than 2 weeks, serious complications may develop, including gastrointestinal bleeding, intestinal perforation, encephalopathy, and death (32). A minute item of a meeting of the Board of Trustees of the Johns Hopkins Hospital held November 11, 1902 notes “The temporary appointment of Dr. C.K. Winne, to act as Assistant Resident Physician, during the illness and disability of Dr. Ochsner,…” (34).

The November 20, 1902 edition of the Buffalo County Journal reports,

The many friends of Dr. H.W. Ochsner will be grieved to learn that he is ill with typhoid fever, at the John's [sic] Hopkins Hospital, in Baltimore. His cousin Dr. Edward Ochsner, of Chicago, is at his bedside and we most sincerely hope that the skill of eminent physicians and trained nurses may succeed in restoring the health of this promising, young man (35).

Edward Ochsner, MD, was Dr. Albert J. Ochsner's brother (11a).

On the same day (November 20, 1902), William Osler was in New York City seeing a patient in consultation (36). On news of Ochsner's worsening condition, Osler returned immediately to Baltimore. In a letter dated November 21, 1902 to C.N.B. Camac, MD, Osler writes, “I was in New York yesterday, only for two hours, a hurried consultation. Sorry I could not see you. I had to come back at once, as poor Ochsner, one of my internes, is desperately ill with typhoid” (37).

“After three more anxious days,” Henry W. Ochsner died on November 25, 1902 (8a). Osler was holding Ochsner's hand when he died (37), and after Ochsner's death, Osler, “deeply…moved,” jotted “Death (Poor Ochsner)” and placed the jotting in his pocket memorandum book (8a). On the same day, Osler wrote a letter of condolences to Ochsner's father, Johannis (John):

Allow me to express my most heartfelt sorrow at the death of your son. He had made himself much beloved by all of us, and his zeal & ability were of such a high order that few of our young men seemed to have before them a more promising career. It is inexpressibly sad to think that his life should have been cut short at the outset of his work.

With sincere sympathies, Faithfully yours, William Osler (38).

Ochsner's death certificate was completed by Thomas McCrae, MD, Osler's chief resident and later coeditor and coauthor of the Principles and Practice of Medicine (39). News of Ochsner's death reached Waumandee and was met with an outpouring of grief. The November 27, 1902 edition of the Buffalo County Journal laments,

When the universe was created and the planets and other heavenly bodies were evolved from chaos and again when the earth, our temporary abode was populated with beings animate, nature laid down certain laws of evolution, growth and decay. To these laws all creation must submit. Nothing can escape them, not even nature's most highly developed creation, man. Aye, it appears that this high stage of development, is even conducive to hastening the end and that not only the aged, the weak and infirm but the young, the active, the vigorous are taken away before their time. Death, the grim reaper, is no respecter of persons. The cooing infant, in his mother's lap, the young man with a bright future before him, the aged and infirm, whose course is run, must alike bow to his mandate and abide by his summons….

When the news of the death, of Dr. Henry W. Ochsner, was received here Tuesday, those of us who have watched his career and have been intimately associated with him, for almost a quarter of a century, were deeply grieved, the sorrow being akin to that caused by a personal loss. A bright career has been cut short, one whose talents, achievements, determination and honest application to his duties indicated that he was destined to become a leader in his chosen calling, has been taken away and we stand at his open grave deploring the great loss, sustained by those he had chosen to serve. For all these excellent qualities we esteemed him but what endeared him to us, more than anything else was his manliness, his true kindness of heart, his integrity and honesty of purpose and the modesty with which he bore all his triumphs and successes. To his friends he always remained “Henry,” plain and simple and we well recall an incident when he was addressed as doctor by one who had been a close friend to his mother, of his saying “Oh, call me Henry, I am the doctor to my patients but to my friends I am and shall remain, Henry.”… He never swerved from the path of duty and in its performance he gave up his life … His mother preceded him to the grave over a year ago. His remains will arrive here, to day and will be taken to his home in Waumandee for interment, at one o'clock tomorrow afternoon. To the bereaved family, we extend that sympathy, which words can not express (16).

The December 4, 1902 edition of the Buffalo County Journal reported that his brother, Rudolph Ochsner, MD, of Cleveland accompanied his remains to Waumandee (40).

Ochsner's funeral took place on November 28, 1902, and this too was reported in the Buffalo County Journal. With grief, the December 4, 1902 edition comments,

Sadly, sorrowfully their heads bowed in genuine grief, did the people of Waumandee, and other parts of the country assemble, at the home of their honored fellow citizen, John Ochsner, last Friday, to pay the last, sad tribute to the memory of one, who was destined to be crowned with success and whose name was to bring fame to his birthplace. On that day Waumandee's brightest son was laid to rest, amid the scenes of his happy childhood …

An address was delivered at the grave, by William Ulrich, of Fountain City, who paid the memory of the deceased a loving tribute. His remains were borne to their last resting place by those who had been intimately associated with him and by loving hands the casket, covered with floral offerings donated by kind friends, was lowered into the grave. The Columbia Maennerchor rendered touching songs, at the home and at the grave. Thus fittingly was one of the county's favorite sons, one of Wisconsin's brightest intellects laid to rest. May he sleep as peacefully, as he lived nobly and manfully. From the depths of our heart we say, Farewell, young friend, farewell (41).

Henry Ochsner's funeral was widely attended. The December 5, 1902 edition of The Mondovi Herald (Mondovi, Buffalo County, Wisconsin) reports, “It was the largest funeral ever held in this community. He was well known to the people of Buffalo county, … who deeply mourn his early death” (42). Ochsner was buried south of Waumandee in a small roadside cemetery adjacent to a farm. His gravestone is simple. Under an Ochsner family headstone is a small flat stone that reads, “Henry W. 1877–1902.” Ochsner's father, John Ochsner, in a “card of thanks” to the Waumandee community published in the December 4, 1902 edition of the Buffalo County Journal, writes,

“To all those who so kindly extended to us their sympathy, by word and deed, song and flowers, or presence at the last sad rites of our dear Henry, we wish to extend our sincere thanks” (43).

Life at the Johns Hopkins Hospital continued after Ochsner's death. C.H. Horst, a resident physician on the surgical service, was appointed to the medical service to fill the vacancy caused by Ochsner's death (44,45). However, colleagues at Johns Hopkins also mourned his death. The December 4, 1902 edition of the Buffalo County Journal reports,

At a meeting held at 9:30 o'clock Tuesday morning, on the twenty-fifth of November, 1902, in the Young Men's Christian Association room of the Johns Hopkins Medical School, presided over by Dr. Guy L. Hunner, the following resolutions were adopted:

WHEREAS, we have lost our beloved colleague, Henry William Ochsner, BE IT RESOLVED, that we, the University of Wisconsin Alumni Association of the Johns Hopkins Medical School and Hospital, do express to his family our heartfelt sympathy in their great bereavement … we have grown to love him for his purity of character …(46).

The Fourteenth Report of the Superintendent of the Johns Hopkins Hospital for the Year Ending January 31, 1903 notes,

I regret to announce that Dr. H.W. Ochsner, a Medical House Officer, who entered upon the discharge of his duties in September last, died at the Hospital of typhoid fever November 25, 1902. Dr. Ochsner graduated from the Medical Department of the Johns Hopkins University in June last at the head of the class. He had excellent natural powers of mind which had been disciplined by careful training, and gave promise of a successful and useful career. His rectitude of life, his conscientious devotion to duty, his keen interest in scientific work, and his many winning traits of character, endeared him to all who came in contact with him. His death was a severe loss to the Hospital and a personal grief to all of his associates here (25).

Osler was deeply moved by Ochsner's death. The extent of his grief is illustrated by “Death (Poor Ochsner).” In addition, Osler lamented Ochsner's death for years to come. Osler not only mentioned Ochsner's death in multiple editions of his Principles and Practice of Medicine, he also referred to Ochsner's death in an October 5, 1904 speech given at the Johns Hopkins Hospital to an audience assembled to unveil a tablet in memory of Jesse Lazear, MD, of the Yellow Fever Commission. According to Cushing, Osler “spoke feelingly” and said,

… Milton's poem ‘Lycidas’… touches that chord in each one of us which responds to the personal loss of some young man to whom we had become attached. Those of us who have got on in years mourn many young fellows whom we have seen stricken by our sides. We have had in this hospital fortunately only a few such losses. We have lost on the medical side Meredith Reese, Oppenheim [sic] and Ochsner… (8a).

Osler also refers to Ochsner's death in his 1905 essay, “A Student Life,”

As I look back it seems now as if the best of us had died, that the brightest and the keenest had been taken and the more commonplace among us had been spared. An old mother, a devoted sister, a loving brother, in some cases a broken-hearted wife, still pay the tribute of tears for the untimely ending of their high hopes, and in loving remembrance I would mingle mine with theirs. What a loss to our profession have been the deaths of such true disciples as Zimmerman, of Toronto; of Jack Cline and of R. L. MacDonnell, of Montreal; of Fred Packard and of Kirkbride, of Philadelphia; of Livingood, of Lazear, of Oppenheimer, and of Ochsner [sic], in Baltimore—cut off with their leaves still in the green, to the inconsolable grief of their friends! (9)

Several factors might account for Osler's emotional response to Ochsner's death. First, Osler was an expert on typhoid. He had vast clinical experience with the disease. In fact, at times, nearly half of the medical beds at the Johns Hopkins Hospital were occupied with patients stricken with typhoid (31). Osler published more than 50 articles and many exhaustive book chapters on the topic (47). To Osler, the prevalence of typhoid in Baltimore was a source of aggravation and an indicator of inadequate sanitation. He viewed the disease as preventable through public health measures (e.g., proper sewerage, clean water, isolation of cases). As a result, Osler was a tireless advocate of such measures to control the disease and was a vocal and persistent critic of Baltimore public officials who failed to implement them (31). Frustrated by the prevalence of the disease, Osler exclaimed, “year by year we physicians sit at the bedsides of thousands upon thousands, chiefly of youths and maids, whose lives are offered up on the altars of Ignorance and Neglect” (48). In this context, the deaths of patients due to typhoid caused Osler “heart-searching dread” and “poignant grief” for families and friends of the deceased (49). To lose one of his own pupils to typhoid must have been especially painful for Osler.

A second factor in Osler's emotional response is that the deaths of loved ones and patients often moved him (8c,50,51). He described informing a patient of his or her impending death as the “hardest stone [a physician] can throw” (52). Osler's written and verbal tributes to lost patients, pupils, and colleagues, including Ochsner, reflect the impact that their deaths had on him. Finally, Osler was a compassionate and empathetic physician who instinctively addressed not only the physical needs of his patients but also their mental and spiritual needs (50,53). In light of these facts, Osler's response to Dr. Henry W. Ochsner's death is not surprising.

CONCLUSION

Dr. Henry W. Ochsner was a brilliant and talented son of successful Swiss pioneers who settled in Waumandee, Wisconsin. He was a member of a family that included medical luminaries. He was an outstanding pupil in high school, college, and medical school. He was a physician with enormous potential but was also a humble and beloved fellow citizen. He was a favorite pupil of Sir William Osler, who was deeply moved by his death. And he was a victim of typhoid, a disease that Osler hated.