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Sir William Osler:Still Relevant Today?

By Joseph Vander Veer, MD, Co-Chair,
GSRMC/PCH Bioethics Committee

 

   My father was a great admirer of Sir William Osler.Dad's recent death gave me an opportunity to reassess some of Sir William's writings, including his textbook and some of his addresses to medical students.  Since I don't hear him referred to much anymore, and when I do, his name is often mispronounced (it has a long O), it may be timely to review his contributions to medicine.

 

   When published in 1892, The Principles and Practice of Medicine made Osler’s reputation.  It was well received, went through 16 editions and 84 printings, was translated into German, French, Spanish, and Chinese and sold over 300,000 copies:it earned him a considerable income over his lifetime.  I have a first printing and a fourth edition in my library and, being surgically minded, looked up two diseases I see commonly-- diverticulitis and appendicitis-- in the index of the 1901 edition to see how Osler dealt with them. The former, diverticulitis, was not even listed.  Appendicitis, however,was superbly described, including its diagnosis and (quite modern) treatment.  Osler was a contemporary of Reginald Fitz and Charles McBurney, who respectively described the pathology of the disease and the incision we now use most commonly.  Appendicitis is still our most common abdominal surgical emergency condition; but diverticulitis is close behind.  A century ago it must not of been very problematic. ( I guess they had more bulk or less refined sugar in their diets than we do!)Up to date in some respects, outmoded in others, Osler's textbook is still eminently readable for its superb style.

 

   Osler read French, German, Latin and Greek.Regarding the latter, he was an accomplished scholar, and after his first move to Oxford, he was president of the British Classical Association.  His addresses are peppered with classical and Biblical allusions, most of which I suspect today's medical students would not recognize.  Indeed,for today’s sound-bite habituated reader, the text of many of his orations may be hard going.  Yet the messages in his addresses are timeless.  Over my career I particularly valued three of them, for his counsel is as applicable today as then.

 

   In “Aequanimitas”,an 1889 address to the medical students at the University of Pennsylvania (where Osler was Professor for five years), he extolled the virtue of equanimity.  To him it meant “coolness and presence of mind under all circumstances… clearness of judgment in moments of grave peril.  ”It’s indispensable in the field of surgery, but of great merit for any physician nowadays, buffeted about as we are by regulatory agencies, lawyers and the public.  It allows us, like Jonah (1:5) or St. Paul (Acts 27) to be calm within, while the storms of life rage without.

 

   In“The Master-Word in Medicine,” an address to Toronto medical students in 1903, Osler tells us the recipe for success in medicine.He discloses   it using a splendid rhetorical device, keeping the reader in suspense, making us anxious to know the answer:  It is the open sesame to every portal, the great equalizer in the world, the true philosopher's stone which transmits all the base metal of humanity into gold.  The stupid man among you it will make bright, the bright man brilliant, and the brilliant student steady.  With the magic word in your heart, all things are possible and without at all study is vanity and vexation……

   When the answer comes, it's simple, but still not a letdown.  For as every successful doctor knows, “…. the Master Word is work, a little one as I have said, but fraught with momentous sequences if you can but write it on the tables of your heart and bind it upon your forehead.

 

   In “A Way of Life,” an address to Yale students in 1913, given toward the end of his life, Osler tells another secret of his success.  In doing so he conjures up the image of the great ocean liner that has many water-tight compartments which can, with a flip of an electric switch, be shut out of the future, concentrating on this day's work.  As a surgeon, it resonates with me: when one enters the operating room for a difficult case, happy is he who can shut out the past and future giving undivided attention to the task at hand.

 

   Why was William Osler great, and why is he relevant today?.  First, he was a great role model, particularly for students and residents with whom he often established lifelong friendships.  Second, he not only led by example, he also is immortalized his ideals for future generations in his addresses (above) and aphorisms ( see Bean, W., Sir William Osler Aphorisms, CC Thomas, 1951.

 

   Third, he seemed to grasp intuitively the secret of success, principles that have been articulated only recently as managers began to analyze and describe them.This is dealt with nicely in one of the best books I've read about Osler,published last year by Oxford U. Press. Inspirations from a Great Physician. The author, Charles S. Bryan (Professor of medicine at South Carolina) examines Osler's life in the light of current principles.Through it you'll learn much about “The Chief” and why he was so revered and respected.  A commemorative issue of JAMA (1969 :210:2213 –2271) is also worth reading, revealing his multi-faceted, protean nature.

 

Osler was once asked if he had any personal ideals.  He gave three, which even today are refreshing and relevant:

 

1)One, to do the days work well and notbother about tomorrow;

 

2)To act the Golden rule as far as in me lay,toward my professional brothern and toward the patients committed to my care;

 

3)To cultivate such a measure of equanimity as would enable me to bear success with humility, the affection of my friends without pride, and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man.

 

HARD TO BEAT FOR ANYONE ANYTIME.

 

….Vital Signs; Summer, 1989.