William Osler left Toronto for Montreal in 1870 to attend medical school at McGill University. At that time McGill offered the best medical education in Canada, with up-to-date facilities and better hospital access. Intellectual rigor was also needed: McGill had high admission requirements, and the program consisted of four years of study instead of the usual two or three. Osler did not distinguish himself as a student, but managed to place third in the final examinations, with a special prize for his graduation thesis. He received the degree of Doctor of Medicine and Master of Surgery (MD, CM) at the age of 22, in 1871.

In 1872 Osler began postgraduate work Europe, studying in England, Germany and Austria. He had kept in touch with some McGill professors and colleagues, notably Dr. Palmer Howard, his mentor, who exerted a profound influence on Osler's life. Shortly after his return to Canada in 1874 he was offered the position of Lecturer in the Institutes of Medicine, which he accepted. He was promoted to professor after one year, and developed into an engaging lecturer and a favourite among students. This was a time of many reforms in medical education at McGill, and Osler was at least partly responsible for changes such as abolishing the thesis requirement for graduation, and an increased emphasis on laboratory work, demonstrations, and dissections.

Professors were not well-paid and Osler opened a private practice in order to make ends meet. His experience with smallpox was extensive enough that he was made physician to the smallpox ward of the Montreal General Hospital in 1874. In 1878 he was appointed attending physician at Montreal General, and soon became its first pathologist. Pathology had interested Osler since his student days and would become a specialty.

Osler published prodigiously during his time at Montreal General, producing case studies, analyses, and lectures on a variety of topics. In addition to his professional accomplishments Osler was remembered by friends, family and colleagues in Montreal for his joie de vivre and sense of fun. Egerton Yorrick Davis, Osler's notorious alter ego, who was prone to submitting descriptions of fictitious cases to medical journals, made his first appearance in the Montreal years.

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