The great stink of London: Sir Joseph Bazalgette and the cleansing of the Victorian capital

essays, pamphlets, and catalogues galore. And the 1930s and 1940s saw the claim that the world had had only three great men: Christ, Shakespeare, and Osler. Osler liked to say that man's life fell into three phases: achievement (ages 30 to 45), consolidation (45 to 60), and uselessness (after 60). His contention that many evils could be traced to the sexagenarians created a storm far worse than that evoked earlier by Anthony Trollope's novel The fixed period, where men retired to a Pacific island before euthanasia at 68. Certainly Osler's own life reflects these concepts. At 28 he was appointed to Montreal General Hospital, at 35 to the University of Pennsylvania, and at 39 to the foundation chair at Hopkins. At 56 he then followed his principles: "I am going to retire from active life; I am going to Oxford", accepting the Regius chair offered by A J Balfour, the Prime Minister. Yet which of Osler's clinical achievements produce the immortality? He made no original discoveries; his eponymous descriptions-Vaquez-Osler disease or Rendu-Weber-Osler disease-had already been documented. He was an inspired teacher, but so were some contemporaries, while his brilliance as an administrator was outshone by others, in particular the Flexners. He had some of the great and the good as patients-not only tycoons and the Prince of Wales but also Walt Whitman and Henry and William James but so did many of his colleagues, and a few of these must have shared Osler's characteristics: optimism, humour, and good cheer. And he was too grounded in gross pathology to absorb the shift towards laboratory studies occurring in clinical medicine by the end of his career. "We want a university professor who will conduct his medical work along laboratory lines", Osler's colleague Frederick Mall wrote in 1902, "and will not continue publishing cases." Nevertheless, as Bliss demonstrates in this well-crafted biography, Osler has one unique claim to immortality. His Principles andpractice ofmedicine may not have been the first textbook ofmedicine, but it was brilliant-the most comprehensive and readable, revised continually between successive editions, and achieving world-wide circulation. Many of Osler's other writings reflect contemporary pomposity and smugness, often gamished with other men's flowers (his Ingersoll Lecture at Harvard began with five quotations; in the first four paragraphs he quoted nine other authors; and he added eight pages of notes and further quotations). In the textbook, conversely, the language is direct, simple, and concise and even today there is often no better source for the natural history of a disease. As an influence not only on medical education of its time but of the future, then, Osler's work was unique. (Recently, moreover, the holistic medicine and the "good death" movements have rediscovered him as an icon for their causes.) As befits the author of The discovery ofinsulin and the biographer of Frederick Banting, Michael Bliss, a history professor at the University ofToronto, has covered the ground skilfully, extracting from a vast number ofdocuments the essence of an interesting life in interesting times. Less happily, as one has now come to expect even from university presses, there are the literals-"chaisson disease, typhitis, and obstretrics" (and surely a sub-editor should have told Bliss what "disinterest" really means). But Bliss's balanced account has done Osler proud, and nobody need attempt it again.