We can imagine a conversation in a library – A.D. 2009 – between two assistants wearily sorting a pile of second hand books just sent in.
‘What are we to do with all this old rubbish by a man named Osler? He must have had very little to do to spoil so much paper. Where did he live anyway?’
‘Oh, I don’t know. Baltimore, I think. Any how they have a Hall there that bears his name.’
William Osler, 1909
Sir William Osler underestimated the influence he would have more than a hundred years after penning those words for the inauguration of Osler Hall. His oration was published in JAMA under the title “Old and New”.
His scientific discoveries and his method of teaching medicine at the bedside have lived on, and his words about being a physician still speak to doctors all over the world.
Thumbing through old books and reading online, I have found letters and speeches that could have been written specifically for doctors in my specialty, Primary Care, in 2011.
The other day my WordPress dashboard listed as one of the search terms that brought a visitor to A Country Doctor Writes “Holiday reflection by Sir William Osler”. That got me thinking: What would Sir William say to doctors like me today?
(Curiously, William Osler’s first published article, at age 20, is said to have been one with a Christmas theme, “Christmas and the Microscope”, in Hardwicke’s Science-Gossip.)
Perhaps Sir William Osler would write something like this today (every phrase in black is quoted from his writings):
Christmas greetings to you all.
I hope everything is going well with you, the silent workers of the ranks, in villages and country districts, in the slums of our large cities, in the mining camps and factory towns, in the homes of the rich and in the hovels of the poor. To you is given the hard task of illustrating with your lives the Hippocratic standards of Learning, of Sagacity, of Humanity, and of Probity:
Of learning, that you may apply in your practice the best that is known in our art, and that with the increase in your knowledge there may be an increase in that priceless endowment of sagacity, so that to all, everywhere, skilled succour may come in the hour of need. Of a humanity, that will show in your daily life tenderness and consideration to the weak, infinite pity to the suffering, and broad charity to all. Of a probity, that will make you under all circumstances true to yourselves, true to your high calling, and true to your fellow man.
Each generation has its own problems to face, looks at truth from a special focus and does not see quite the same as any other.
In 1908 at Oxford William James made a remark that clung. ‘We live forward, we understand backwards. The philosophers tell us that there is no present, no now – the fleeting moment was as we try to catch it.’
The past is always with us, never to be escaped; it alone is enduring; but, amidst the changes and chances which succeed one another so rapidly in this life, we are apt to live too much for the present and too much in the future. It is good to hark back to the olden days and gratefully to recall the men whose labours in the past have made the present possible.
Hippocrates had a splendid paragraph in ‘Ancient Medicine’ on the attitude of mind towards men of the past: “We ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well made, and not from chance.’
Like a living organism, truth grows. Much of history is a record of the mishaps of truths which have struggled to the birth, only to die or else to wither in premature decay. Or the germ may be dormant for centuries, awaiting the fullness of time.
Read the classics of medicine, and also The Old and New Testament, Shakespeare, Don Quixote, Emerson, Oliver Wendell Holmes. The average, non-reading doctor might play a good game of golf or of bridge, but professionally he is a lost soul.
The love, hope, fear and faith that make humanity, and the elemental passions of the human heart, remain unchanged, and the secret of inspiration in any literature is the capacity to touch the cord that vibrates in a sympathy that knows nor time nor place.
For the general practitioner a well-used library is one of the few correctives of the premature senility which is so apt to overtake him. It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it.
With half an hour’s reading in bed every night as a steady practice, the busiest man can get a fair education before the plasma sets in the periganglionic spaces of his grey cortex.
Be patient. It has been said that “in patience ye shall win your souls,” and what is this patience but an equanimity which enables you to rise superior to the trials of life?
Things cannot always go your way. Learn to accept in silence the minor aggravations, cultivate the gift of taciturnity and consume your own smoke with an extra draught of hard work, so that those about you may not be annoyed with the dust and soot of your complaint.
Respect the Psychical methods of cure. After all, faith is the great lever of life. Without it, man can do nothing. Faith is the aurum potabile, the touchstone of success in medicine. As Galen says, confidence and hope do more good than physic – “he cures most in whom most are confident.” While we doctors often overlook or are ignorant of our own faith-cures, we are just a wee bit too sensitive about those performed outside our ranks. In all ages the prayer of faith has healed the sick, and the mental attitude of the suppliant seems to be of more consequence than the powers to which the prayer is addressed. We physicians use this every day; without faith, we should be very badly off.
The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of influence.
In the words of Sir Thomas Browne, whose Religio Medici was the second book I ever bought:
“There is surely a piece of divinity in us, something that was before the elements, and owes no homage unto the sun.”
I hope this will reach you in time for Christmas. I think especially of you country doctors, members of the class ‘Hippocraticus Rusticus’.
Never has the outlook for the profession been brighter. Everywhere the physician is better trained and better equipped than he was fifty years ago. Disease is understood more thoroughly, studied more carefully and treated more skillfully. Diseases familiar to your fathers and grandfathers have disappeared, the death rate of others is falling to the vanishing point, and public health measures have lessened the sorrows and brightened the lives of millions.
The vagaries and whims, lay and medical, may neither have diminished in number nor lessened in their capacity to distress the faint-hearted who do not appreciate that to the end of time people must imagine vain things, but they are dwarfed by comparison with the colossal advances of the past century.
So vast and composite has the profession become that the real dangers and evils that threaten harmony among you are internal, not external. Yet, no other profession can boast of the same unbroken continuity of methods and ideals. We may indeed be justly proud of our apostolic succession.
Your profession in truth is a sort of guild or brotherhood, any member of which in any part of the world can find brethren whose language and methods and whose aims and ways are identical to his own.
I wish all of you the best for this Holiday.
1.) Aequanimitas, Sir William Osler, P. Blakiston’s Son & Co., 1904
2.) The Evolution of Modern Medicine, by Dr. William Osler, (Originally published 1913), Kaplan Classics of Medicine, 2009
3.) Sir William Osler By Harvey Cushing, Oxford University Press, 1925