Osler's service: a view of the charts.

It has been asserted that William Osler (1849-1919) shaped the Medical Clinic of the Johns Hopkins Hospital 'to become a pre-eminent facility, first in patient care and later in medical education'. Osler's impact on medical education in the United States is beyond dispute, but few, if any, data support the assertion that patients at the Johns Hopkins Hospital fared better than those at similar hospitals during the late 19th century. Patient records were scanty and were seldom, if ever, signed by Osler or other senior professors. The numerous publications that arose from Osler's service suggest the data were derived not from the hospital charts, but rather from a parallel system of data collection designed mainly for research. Issues raised by this review of the charts on Osler's service reverberate in American medicine.