The Wisdom of Sir William Osier
Marvin J. Stone, MD
William Osier (1849-1919) was generally regarded as
the greatest and most respected physician of his time.
He is still considered by many in these terms. Others
have questioned the relevance of Osler's teachings in
recent years. This paper describes Osler's lifo and gives
his philosophy and views in his own words. An out-
standing clinician who emphasized bedside teaching
and observation, he possessed extraordinary charm
that inspired many disciples. As Professor of Medicine
at 4 institutions in 3 countries, he exerted a profound
influence on medical education. He was a prolific writer
and his textbook became the most papular and wide-
ltionlheWilliam
year 1994 marked the 75th anniversary of Sir
Osler's death. Osier occupies a umque posi-
in the hmtory of medicine. He was generally
acknowledged as the greatest and best-loved physician
of has time. 1-4 Many of Osler's writings 5-13have msptred
and been cherished by medical students and physicians
throughout the world. His close personal relationship
w]th students and colleagues has been amply docu-
mented. 14-17 Commemorative issues of several journals
have appeared in his honor, J8-2° a number of b~bliogra-
phles of Ins writings have been pubhshed, 21-24 and his
ltkeness has been preserved on many portraits, busts, and
medals. 25 The Osier Society of McGdl Unwerslty was
founded m 1921, the Osier Club of London m 1928, and
the American Osier Society in 1970. 26,27 Recently, an
organizaUon honoring Osler's memory was estabhshed
m Japan. In May 1994, a joint meeting of the American
Osier Society and the Osier Club of London was held
m the Umted Kingdom
What are the reasons for the enormous and enduring
influence of this man? I wdl try to address this quesUon
in 2 ways: fist, by providing a brief description of his
hfe; and second, by letting Osier speak for himself.
In 1889 Osier gave the valedictory address to grad-
uates m medicme at The University of Pennsylvania. His
speech became the title essay m the book, Aequammt-
tas wtth Other Addresses to Medwal Students, Nurses
and Practztloners of Medwme, 5 which has been revered
by generaUons of medical students and phys]clans.
Equammlty has been defined as evenness of mind or
calmness. Synonyms include composure and self-pos-
session.
"In the physician or surgeon no quahty takes rank
with lmperturbablhty-28
"One of the fist essentials in secunng a good-natured
equanlrmty is not to expect too much of the people
amongst whom you dwell. ''29
From the Departments of Internal Medicine and Oncology and the
Charles A Sammons Cancer Center, Baylor University Medical Cen-
let, Dallas, Texas Manuscnpt rec)eved and accepted October 6,
1994
Address for repr)nts MarvmJ Stone, MD, Baylor Unlvers)t',/Med-
ical Center, 3500 Gaston Avenue, Dallas, Texas 75246
HISTORICAL STUDIES/THE WISDOM OF SIR WILLIAM OSLER 269
ly read treatise on medicine in the wodd. He also was
a medical historian, a classical scholar, and an avid
bibliophile. He emphasized the value of hard work and
ongoing education. His compassion and concern for
patients and colleagues reflected his personality. Osler's
wisdom is as relevant now as in his era. It is likely that
he would be in the forefront of medical science if he
were alive today. Osier blended the art and s~ience of
medicine perhaps better than anyone else and remains
a valuable role model for students and physicians more
than 75 years after his death.
(Am J Cardiol 1995;75:269-276)
Sixteen years later Osier stud, "I have had three per-
sonal 1deals. One, to do the day's work well and not to
bother about tomorrow... The second ideal has been to
act the Golden Rule, as far as m me lay, towards my pro-
fesslonal brethren and towards the patients committed to
my care. And the third has been to cultivate such a mea-
sure of equanimity as would enable me to bear success
with humlhty, 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. ''3°
William Osier was born in Bond Head near Toronto
m 1849. 31,32 His mother lived past the age of 100 years;
his father was an Anghcan clergyman. William attend-
ed private school where he met Reverend W. A. John-
son, who introduced him to biology and the microscope
This interest m m~croscopy was to become one of the
dominant features of h~s career. He enrolled in Trinity
College at Toronto and originally planned to follow his
father into the clergy. After being influenced by a physi-
cian, Dr. James Bovell, Osier switched to medicine. 33
He transferred to McGill for his final 2 years of medical
school. There he came in contact with the famous clin-
ician and teacher, R. Palmer Howard. Johnson, Bovell,
and Howard were the 3 teachers to whom Osier later
dedicated his textbook. He recewed his MD degree m
1872 and then traveled to England and Continental
Europe. Osler's experience abroad made him a propo-
nent of postgraduate travel. His trip was the fist of what
later became known as "bram-dustmg excursions." He
spent a year in Burdon-Sanderson's laboratory m Eng-
land, during which time he became one of the first to
recogmze the platelet as the third formed element in the
blood and documented the importance of platelets in
thrombus formation. 34 He also visited Germany and
came m brief contact with the great Rudolph Virchow.
On returning to Canada, he worked briefly as a general
practitioner A few months later, he was invited to join
the medical faculty at McGII1.
His views on travel are exemplified by the followmg
statements: "The all-important matter is to get a breadth
of view as early as possible, and this is dlflicult without
travel. ''35
"To walk the wards of Guy's or St. Bartholomew's,
to see the work at the St. Louis and at the Salp&n~re,
to put in a few quiet months of study at one of the Ger-
man university towns will store the young man's mind
with priceless treasures. I assume that he has a mind. I
am not heedless of the truth of the sharp taunt-- How
much the fool that hath been sent to Rome, Exceeds the
fool that hath been kept at home. ''36
"At any rate, whether he goes abroad or not, let him
early escape from the besetting sin of the young physi-
cian, Chauvmtsm, that intolerant attitude of mind, which
brooks no regard for anything outside his own circle and
his own school. ''36
Dunng his 10 years on the McGlll faculty
(1874--1884), Osier rose to the rank of professor He was
recognized as an outstanding clinician and stimulating
teacher. He also served as pathologist to a smallpox hos-
pital, had a small private practice, and pubhshed many
papers dealing with various chnical, pathologic, and vet-
erinary subjects. Dunng this decade, Osier orgamzed
medical clubs and achieved unusual popularity engen-
dered by his exemplary conduct and generosity.
Osier performed nearly 1,000 autopsies; this experi-
ence, combined with his knowledge of microscopy, made
him well grounded in morbid anatomy and contributed
much to his understanding of the natural history of dis-
ease and importance of chnlcopathologlc correla-
tion. 37,38
FIGURE 1. William Osier in 1905. From a photograph by
William Nolman, Montreal. Reproducedfrom A b b o t t ME, ed.
Sir William Osier Memorial Number. Appreciations and Remi-
niscences. Bulletin No. IX of the International Associationof
Medical Museums. Privately printed at 836 University St., Mon-
treal, Canada; 1926:320. 4
270 THE AMERICAN JOURNAL OF CARDIOLOGY~ VOL 75
A f t e r 4 years at the University of Pennsylvania as
Professor of Chnical Medicine, Osier became Chief of
Medicine at the new Johns Hopkins Hospital and med-
ical school where he remamed from 1889 to 1905 (Fig-
ure 1).
Dr. Robert B. Bean, the father of Dr. William B.
Bean, was a student of Osler's at The Johns Hopkins
between 1903 and 1905. The younger Dr Bean, a
renowned Oslerlan Scholar, complied numerous epi-
grams of Osier from Ins father's notes. 39,40 Many of
Osler's clinical aphorisms collected by Dr. Bean and oth-
ers still nng true:
"Medicine is learned by the bedside and not in the
clas sroom."41
"In taking histories follow each line of thought; ask
no leading questions; never suggest. Give the patient's
own words m the complaint. • " - ,42
"Record what you have seen; make a note at the time;
do not walt -43
"Half of us are blind, few of us feel, and we are all
deaf."4z
"Pneumoma is the captam of the men of death and
tuberculosis is the handmaid. ''45
"A patient with a written list of symptoms--neuras-
thenia. ''46
"Adhesions are the refuge of the diagnosUcally des-
titute -47
"There is no disease more conducive to clinical
humility than aneurysm of the aorta. ''48
"One swallow does not make a summer, but one
tophus makes gout and one crescent malaria. ''48
"Angina pectorls may be precipitated by: muscular
exertion, violent mental states, stomach upsets, or cold
weather. ''45
"A physician who treats himself has a fool for a
patient. ''49
"The chief function of the consultant is to make a
rectal examination that you have omitted. ''5°
"Advice Is sought to confirm a position already tak-
en."51
Osier was instrumental m estabhshmg The Johns
Hopkins as the outstandmg restitution of medical edu-
cation m the United States. 52-55 He helped start the new
school and was 1 of 4 doctors commemorated in the
famous Sargent portrait. 56 He introduced the clinical
clerkship and created the template of graded responsi-
bility among students and house officers that survwes to
the present. 54,55 He stressed the importance of medical
history and wrote many inspirational essays.
Dunng his tenure at Hopkms, Osier acqutred an
mtematlonal reputation and became one of the most
respected chnlclans in the world (Figure 2).
"The practice of medicine is an art, based on sci-
ence."57
"Variability is the law of life, and as no two faces are
the same, so no two bodies are alike, and no two indi-
viduals react alike and behave ahke under the abnormal
conditions which we know as disease -58
"Start out with the conviction that absolute truth is
hard to reach in matters relating to our fellow creatures,
healthy or diseased, that slips m observation are
inevitable even with the best-trained faculties, that errors
FEB 1, 1995
in judgn tent must occur m the practice of an art which worked in a hospital as part of its machinery, as an essen-
consists largely in balancing probabilities. "'59 tml part of the work of the wards. In saying this, Heav-
"We the doctors, are so falhble, ever beset with the en forbid that I should obliquely disparage the good and
common and fatal facdity of reaching conclusions from faithful work of my colleagues elsewhere. But the
superficial observations, and constantly misled by the amphitheater clinic, the ward and dispensary classes, are
ease w~t h which our mmds fall into the ruts of one or but bastard substitutes for a system which makes the
two experiences. ''6° medical student hmaself help in the work of the hospi-
"The Art of Detachment, the Vtrtue of Method, and tal as part of Its human machinery. He does not see the
the Quahty of Thoroughness may make you students, m pneumoma case m the amphitheater from the benches,
the true sense of the word, successful practitioners, or but he follows it day by day, hour by hour; he has tus
even great investigators; but your characters may still Ume arranged so that he can follow it; he sees and stud-
lack that which can alone give permanence to powers-- ]es similar cases and the disease itself becomes his chief
the Grace of Humdtty-6] teacher, and he knows its phases and variations as depict-
In 1892, Osler pubhshed the first edition of his text- ed in the lwing, he learns under skdled direction when
book, The Princzples and Practtce of Medtcine, which to act and when to refrain, he learns insensibly pnncl-
became the leading treatise on general medicine in the pies of practice and he possibly escapes a "nickel-in-the-
world for the next 40 years. 62-69 He personally revised slot" attitude of mind which has been the curse of the
the book through 7 ediUons physician m the treatment of disease. And the same with
Two quotations appear m the front of the book: other branches of his art; he gets a first hand knowledge,
"Experience is fallacious and judgment difficult" Hip- which, if he has any sense, may make him wise unto the
pocrates salvation of his fellows. And all this has come about
"And I said of medicine, that this is an art which con- through the wise provision that the hospital was to be
siders the const]tuuon of the patient, and has prmclples part of the medical school, and it has become for the
of acUon and reasons in each case" Plato.
The enormous influence and popularity of the text-
book were evident from its sales and its translation into
French, German, Spamsh, and Chinese editions. It also
was indirectly responsible for the formation of the Rock-
efeller InsUtute for Medical Research. 65,67,69,70The text-
book emphasized euology, pathogenesls, and dmgnosis,
and reflected Osler's great clmical and morphologic
knowledge. It was said that Osier "succeeded in making
a sc]enufic treatise literature." However, he became
known as a therapeutic nihd]st. 65,71 On balance, one
should recall that not many effectwe medical treatments
existed m the latter part of the 19th century.
"But know also, man has an mborn craving for med-
icine. Heroic dosing for several generalaons has gwen
his Ussues athtrst for drugs. The destre to take medicine .... ',~,~m'~' ,
is one feature which distinguishes man, the ammal, from
his fellow creatures. ''72
"Remember how much you do not know. Do not pour
strange medicines into your patients -73
"Do not rashly use every new product of which the
penpateUc siren smgs. Consider what surprising reac-
tions may occur m the laboratory from the careless mix-
mg of l mknown substances. Be as considerate of your
patient and yourself as you are of the test-tube. ''73
"The young physicmn starts hfe with twenty drugs
for each disease, and the old physician ends life with one
drug for twenty diseases. ''74
Osler's philosophy of medical education might be
best dlustrated by a passage from his farewell address
to The Johns Hopkins Hospital m 1905. 75
"By far the greatest work of the Johns Hopkins Hos-
pital has been the demonstraUon to the profession of the
Umted States and to the pubhc of this country of how
medical students should be instructed m thetr art. I place
it first because it was the most needed lesson, I place it
first because ~t has done the most good as a stimulating FIGURE 2. Osier at the bedside. Snaps.hobtaken by T. W.
example, and I place it first because never before m the Clarke. Reproduced from Cushing H. The Life of Sir William
history of this country have medical students hved and Osier, Volume 1. Oxford: Claren~donPress, 1925:552.1

HISTORICALSTUDIES/THEWISDOM OF SIR WILLIAM OSLER 271

senior students, as it should be, their college Moreover
they are not in it upon sufferance and admitted through
side-doors, but they are welcomed as important aids
without which the work could not be done efficiently
The whole question of the practical education of the
medical student is one in which the public is vitally inter-
ested. Sane, intelligent physicians and surgeons with cul-
ture, science, and art, are worth much in a community,
and they are worth paying for in rich endowments of our
medical schools and hospitals. Personally, there is noth-
ing in life in which I take greater pride than m my con-
nection with the organization of the medical clinic of the
Johns Hopkins Hospital and with the introduction of the
old-fashioned methods of practical mstruction I desire
no other epitaph--no hurry about it, I may say--than
the statement that I taught medical students m the wards,
as I regard this as by far the most useful and important
work I have been called upon to do."
Grace Revere Osler was the great granddaughter of
Paul Revere and the widow of Osler's friend, Doctor
Samuel W. Gross, the Philadelphia surgeon who helped
recruit Osier to the University of Pennsylvania. 76-79
Grace and William were mamed in May 1892, shortly
after publication of the first edition of the textbook They
had 2 children, Paul Revere who survived only briefly,
and in 1895, Edward Revere
When Osier was appointed Regius Professor of Med-
icine at Oxford, he was busy with professional activities
and testimonial diners. He departed for England in
advance of his family, leaving Grace to oversee the pack-
ing and shipping of their household goods and books.
She remarked, "Wilhe's motto may well be Aequanim-
ltas because he always files when things like this are
going on. ''77
Osier left Baltimore m 1905 to assume his new posi-
tion at Oxford where he lived the remainder of his life.8°,81
He thought that Oxford would offer a more relaxmg
atmosphere so that he could retire gradually, but he was
soon as busy as he had been m Baltimore. 31 The Osier
home at 13 Norham Gardens became known as the "Open
Arms" to students, colleagues, and friends. Osier con-
tmued to found medical organizations and journals. In
the pattern of Virchow, Osler vigorously supported pub-
lic health and sanitary measures He contmued clinical
teaching, collected books, published papers, and prac-
ticed medicine. 81-83He was kmghted in 1911.The tragedy
of his hfe occurred m 1917 when his son, Edward was
lolled m Flanders m World War I. Osler never recovered
from this loss, and m 1919, he developed pneumonia and
died on December 29th. 84 His last formal presentation
was the inaugural address as President of the British Clas-
sical Association 6 months before his death. 85
Lady Osler selected Doctor Harvey Cushmg to write
her husband's biography after reading Cushing's tribute
to Osler in January 1920. 86,87 It began: "in the first shock
of grief at the news of Sir William Osler's death it is dif-
ficult for anyone who felt close to hun to say what is in
his heart And the strange thing about this unusually gift-
ed and versatde man is that everyone fortunate enough
to have been brought in contact with him shares in this
feehng of devotion, for he gave of himself much to all
272 THE AMERICAN JOURNAL OF CARDIOLOGY® VOL 75
This was true of his patients as might be expected, and
he was sought far and wide not only because of his wide
knowledge of medicine and great wisdom, but because
of his generosity, sympathy and great personal charm. It
was true als(y--and this is more rare--of the members
of his profession, for whom, tugh or low, he showed a
spirit of brotherly helpfulness untlnctured by those pet-
ty jealousies which sometimes mar these relationships.
Never believe what a patient may tell you to the detri-
ment of another physician--even though you may fear
it is true, was one of his sayings to students. He was pre-
emmently the physician to physicians ~md their families,
and would go out of his way unsolicited and unspanng-
ly to help them when he learned that they were 111or m
distress of any kind."
Harvey Cushing was a me&cal immortal in his own
right. 86,88 The father of neurosurgery, he was the man
about whom Osier said, "[he] had opened the book of
surgery in a new place." They had been long-time friends
and next-door neighbors m Baltimore Cushing was one
of Edward Revere Osler's physicians after he was
wounded in World War 1 89 When Osler's wife asked
Cushing to write the biography, he accepted, but planned
to spend only a year. It took 5 years Notably, Cushing
omitted himself from the book Cushmg's Ltfe of Osier
won the Pulitzer Prize in 1926 1
A prolific writer, Osler had approximately 1,500
items in his bibliography. 24 His first publication dealt
with the microscope.9°His important origmal observa-
tions on blood platelets were made in 1873 when he was
24 years old. Nearly one third of his scientific papers
dealt with cardiovascular disease, particularly infective
endocarditis. 91.92 He described hereditary hemorrhagic
telangiectasia (Osler-Weber-Rendu disease) 93 and wrote
an excellent clinical description of polycythemia vera
(Osler-Vaquez disease). 94 Osler's clinical mvestigatlve
and research background provided him with an insight-
ful perspective:
"By the historical method alone can many problems
in medicine be approached profitably. ''95
"The philosophies of one age have become the absur-
dities of the next, and the foohshness of yesterday has
become the wisdom of tomorrow. ''96
'q'he greater the ignorance the greater the dogma-
tism. ''97
"In science the credit goes to the man who convmces
the world, not to the man to whom the idea first occurs' ,98
"Should your assistant make an important observa-
tion, let him pubhsh it. Through your students and your
disciples will come your greatest honor ,,9
"Men will not take tune to get to the heart of a mat-
ter After all, concentration is the price the modem stu-
dent pays for success. Thoroughness is the most difficult
habit to acquire, but it is the pearl of great price, worth
all the worry and trouble of the search. The dilettante hves
an easy, butterfly life, knowmg nothmg of the toll and labor
with which the treasures of knowledge are dug out of the
past, or wrung by patient research m the laboratories. ''1°°
Osler's delightful sense of humor, practical approach
to the job at hand, and insplnng advice to students are
exemplified by the following quotations:
FEB 1, 1995
 "A cheerful man at the breakfast table is a great
annoyance to his grouchy neighbor. ''i°l
"Look wise, say nothing and grunt Speech was giv-
en to conceal thought. ''1°2
"Things cannot always go your way. Learn to accept
m silence the minor aggravations, cultivate the gift of tac-
ittmuty 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 complamts ,,103
"Practically there should be for each of you a busy,
useful, and happy life; more you cannot expect; a greater
blessing the world cannot bestow. ''1°4
"Throw away, in the first place, all ambition beyond
that of domg the day's work well. ''1°5
"Now the way of life that I preach is a habit to be
acquired gradually by long and steady repetition It is
the practice of livmg for the day only, and for the day's
work. Ltfe tn day-ttght compartments ,,106
"To know just what has to be done, then to do it,
comprises the whole philosophy of practical life -107
"To many of a somber and sour disposition it is hard
to mmntaan good spirits amid the trials and tribulations
of the day, and yet it is an unpardonable mistake to go
about among patients with a long face. ''1°8
"Nothing will sustain you more potently than the
power to recognize in your humdrum routine, as perhaps
it may be thought, the true poetry of life--the poetry of
the commonplace, of the ordinary man, of the plain toll-
worn woman, with their loves and their joys, their sor-
rows and their griefs. ''1°9
"We are here to add what we can to, not get what we
can from, hfe. ''1°4
"Nothing in life is more wonderful than faith--the
one great moving force which we can neither weigh m
the balance nor test in the crucible. ''u°
"Faith in the gods or in the samts cures one, faith m
little pills another, hypnotic suggestion a third, faith m
a plato common doctor a fourth. ''m
Osier continually emphasized the importance of bed-
side teaching and clinical laboratory microscopy, the
ongoing necessity to read throughout one's career, and
the acknowledgment of contributions of previous physi-
cians. He was always in direct contact with students, and
often hosted informal meetings with them on Saturday
evenings in his home. Many were given keys to his front
door so that they could take advantage of his outstand-
ing library and were known as the "Latch Keyers."
"The-tralnmg of the medical school gwes a man his
direction, points him the way, and furnishes him with a
chart, fairly incomplete, for the voyage, but nothing
more."ll2
"We expect too much of the student and we try to
teach him too much. Give him good methods and a prop-
er point of view, and all other things will be added as
his experience grows ,,H3
"No bubble is so mdescent or floats longer than that
blown by the successful teacher. ''114
"When a simple, earnest spirit animates a college,
there is no appreciable interval between the teacher and
the taught--both are m the same class, the one a little
more advanced than the other. ''uS
HISTORICALSTUDIES/THEWISDOM OF SIR WILLIAM OS!.ER 273
"The very best Instructor for students may have no
conception of the higher lmes of work in his branch, and
contrariwise, how many brilliant investigators have been
wretched teachers? ''u6
"It is astonishing with how little reading a doctor can
practice medicine, but it is not astonishing how badly he
may do it. ''u7
Osier cultivated a lifelong interest m the history of
medicine and the humanities, u8-121 He emphasized the
importance of the classics and of regular reading at bed-
time 122 He collected over 7,000 books, which Lady
Osler donated to McGlll University. 123,124 He humor-
ously wrote under a pseudonym, Egerton Yordck Davis,
sometimes cnticlzmg his own (i.e., Osier's) writ-
lngs.24,125-127 Perhaps one of the best examples of Osler's
literary style as well as his knowledge of medical history
comes from The Master-Word m Medtcme 128. "It seems
a bounden duty on such an occasion to be honest and
frank, so I propose to tell you the secret of life as I have
seen the game played, and as I have tried to play it
myself You remember in one of the Jungle Stones that
when Mowgh wished to be avenged on the villagers he
could only get the help of Hathi and his sons by send-
mg them the master-word. This I propose to gwe you m
the hope, yes, in the full assurance, that some of you at
least will lay hold upon it to your profit. Though a little
one, the master-word looms large m meaning. It is the
open sesame to every portal, the great equalizer in the
world, the true philosopher's stone, which transmutes all
the base metal of humanity into gold. The stupid man
among you it will make bright, the bright man bnlhant,
and the bnlhant student steady. With the magic word in
your heart all things are possible, and without it all study
is vanity and vexation. The miracles of life are with it;
the blmd see by touch, the deaf hear with eyes, the dumb
speak with fingers. To the youth it brings hope, to the
middle-aged confidence, to the aged repose. True balm
of hurt mmds, in its presence the heart of the sorrowful
is lightened and consoled. It is directly responsible for
all advances m medicine during the past twenty-five cen-
turies Laying hold upon it Hippocrates made observa-
tion and science the warp and woof of our art. Galen so
read its meaning that fifteen centuries stopped thinking,
and slept until awakened by the De Fabrwa of Vesal-
ius, which IS the very incarnation of the master-word.
With its inspiration Harvey gave an impulse to a larger
circulation than he wot of, an impulse which we feel to-
day. Hunter sounded all its heights and depths, and stands
out m our history as one of the great exemplars of its
virtue. With it Virchow smote the rock, and the waters
of progress gushed out; while In the hands of Pasteur it
proved a very tahsman to open to us a new heaven in
medicine and a new earth in surgery. Not only has it
been the touchstone of progress, but it is the measure of
success m everyday life. Not a man before you but is be-
holden to it for his position here, while he who address-
es you has that honor directly in consequence of having
had it graven on his heart when he was as you are to-
day. And the master-word is Work..."
Osler's love of books and classical literature equaled
his love of teaching 13,129
 "It is easier to buy books than to read them and eas-
ier to read them than to absorb them. ''I30
"With half an hour's reading m bed every night as a
steady practice, the busiest man can get a fatr education
before the plasma sets in the penganghonic spaces of
his grey cortex. ''13°
"To study the phenomena of disease without books
is to sail an uncharted sea, while to study books with-
out patients is not to go to sea at all. ''131
"But by the neglect of the study of the humanities,
which has been far too general, the profession loses a
very precious quality. ''132
"You secrete materials which do for society at large
what the thyroid gland does for the individual. The
Humamties are the hormones .... The humanities bring
the student into contact with the minds who gave us the
pinlosopines, the models of our literature, the ideals of
democratic freedom, the fine and technical arts, the fun-
damentals of science, the basis of our law...into contact
with the dead who never die, with those immortal lives
not of now, nor of yesterday, but who always were. ''133
Osler constantly remmded students of the human side
of patient care and the high ideals of the medical pro-
fession:
"Care more particularly for the indwldual patient than
for the special features of the disease -134
"Not that we all live up to the highest ideals, far from
it--we are only men. But we have ideals, which mean
much, and they are realizable, which means more. ''135
"To have striven, to have made an effort, to have been
true to certain ideals--this alone is worth the strug-
gle."136
What application does Osier have to the pres-
ent? 137-14° Is he obsolete in the late twentieth century?
Much has been written about the "Oslerian tradition"
and its decline or lack of relevance m today's
world.141-146 An "antl-Oslenan" attitude has been voiced
by some. 31 The focus on equanlrmty and detachment as
desirable qualities has been connected with a lack of
empathy in medical students and physicians 147 Osier
anticipated such a reaction:
"From its very nature this precious quahty (imper-
turbablhty) is hable to be misinterpreted, and the gen-
eral accusation of hardness, so often brought agmnst the
profession, has here its foundation. ''148
I maintain that Osler's teachings are as important now
as they were during his life. He was not just a kindly old
clirnclan who liked to teach and write. He recognized
the need to be critical of colleagues.149 He applied the
latest advances in medicine to the care of his patients--
whether it was the use of newly described stmns in Inter-
pretation of blood smears or urging the Board of The
Johns Hoplons Hospital to acqutre an x-ray machine
within a few months of Roentgen's first publication
announcing its discovery, l~ It seems likely Osier would
be squarely m the forefront of advances in medical sci-
ence if he were alive today. 138,151He also would contin-
ue to emphasize the value of bedside observation in diag-
nosis 152
"To wrest from nature the secrets winch have per-
plexed philosophers m all ages, to track to thetr sources
274 THE AMERICANJOURNAl OF CARDIOLOGY® VOI. 75
the causes of &sease, to correlate the vast stores of knowl-
edge, that they may be quickly available for the preven-
tion and cure of &sease--these are our ambitions. ''is3
Much evidence indicates that Osier remains acknowl-
edged as one of the greatest physicians who ever hved.
His precepts and teachings continue to be cited fre-
quently.65,121,138-140,146,151,15,:1--167His approach to patients
and recognition that medicine is an art as well as a sci-
ence are touchstones m teaching the ethics and ethos of
medicine. 155,165,166 His thesis that "humanities are the
hormones" may be more important now than in 1919, as
we cope with the moral and humanitarian dilemmas of
care associated with intense pressures to reduce cost and
define "cost-effectiveness."
Patients are cared for indwidually; the doctor-patient
relationship is a one-on-one encounter. Whether in an
office, clinic, hospital, or--as we were recently remind-
ed during the ceremonies commemorating the 50th
anniversary of D-Day---on a battlefield, doctors take care
of patients one at a tune. A physician must obtain a Ins-
tory, elicit pertment positive and negative physical find-
rags, and order appropriate laboratory tests. ~67 He or she
must analyze these data m the context of an ever-expand-
ing galaxy of scientific knowledge. What is the dtagno-
szs? What constitutes the best treatment for this patient?
What can be done to return this individual to as close to
normal daily actwlties for him or her as possible? These
goals of accurate inductive reasoning are sought every
time a doctor sees a patient.
Medical knowledge advances faster than anyone can
keep up with, medicine and society encounter new chal-
lenges on a continuing basis, and medical school orga-
mzatlon and curricula become ever more complicated--
year by year, let alone decade to decade, or from one
century to another.
However, some things do not change--at least not
very much. In this era of ongoing debate on health care
reform and delwery, it is essential to keep in mind how
patients are cared for, how medical students are taught,
and how medical science advances through carefully
conducted research. In flats context, Osler's wisdom is
everlasting. Its universality and timeless relevance are
guideposts. Osler's emphasis on the importance of hard
work, close observation, ongoing education, and practi-
cal approach to the day's activities build the foundation
for effective application of scientific knowledge in diag-
nosis and treatment. His wit, humor, warmth, compas-
sion, and humane concern for patients and colleagues
are trmts we strive to emulate. His example and precepts
provide the core quahtles that define what it means to
be a physician. In the words of composer Stephen Sond-
helm, "the art of malong art is putting it together. ''16s
Osier said, "the old art cannot possibly be replaced by,
but must be absorbed in, the new science. ''169 He put the
art and science of medicine together as well as anyone
ever has. Osier remains a role model for us all.
kknowledgnlen~ I thank Jill Stone, Nancy Stone,
and Rob Stone for editorial assistance and support.
Pamela Shortmo provided expert help with manuscript
preparation.
FEB 1, 1995
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60. Osier W Teacher and student In Osier W, ed Aequanlmltas with Other
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61. Osier W Teacher and student In Osier W, ed Aequammttas with Other
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62 Osier W The Principles and Practice of Medicine New York Appleton,
1892 1-1079
63 Harvey AM McKusick VA Osler's Textbook Rewslted New York Apple-
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74. Bean RB, Bean WB, eds Sir William Osier Aphonsms from Hm Bedsrde Teach-
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44 705-710
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88. Thompson Eli Harvey Cushing Surgeon, Author, Artist New York Henry
Schuman, 1950 1-347
89. Cushing H From a Surgeon's Journal Boston Little, Brown, 1936 197-198
90 Osier W Ctmstmas and the microscope Hardwlcke's Science- Gossip An
Illustrated Medmm of Interchange and Gossip for Students and Lovers of Nature
1869,5 44
91. Fye WB, ed Wflham Osler's Collected Papers on the Cardrovascular System
Btmungham, AL Classics of Cardiology Llbrury, 1985 1-919
9"2. Prmtt RE) Wllham Osier and his Gulstoman lectures on malignant endocarth-
tls Mayo Chn Proc 1982,57 4-9
93. Osier W On multiple herexhtary telanglectases with recurring hemorrhages
Quart J Med 1907,1 53-58
94. Osier W Chronic cyanosm with polycythemia and enlarged spleen a new chn-
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York Blalaston, 1932 266
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109. Osler W The student hfe In Osier W. ed Aequammitas with Other Address-
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116 Osier W Teaching and tlunkmg In Osier W, ed Aequanlmitas with Other
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117. Osier W Books and men In Osier W, ed Aequanimltas with Other Address-
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124. The Osier Library Montreal MEG111,1979'1-64
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129 Bean WB The Fourth Annual Guthne Lecture Some phystoans and books
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130. Osier W The medical library m post-graduate work Br Med J 1909,2 925-928
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167. Hunter KM Doctors' Stones The Narrative Structure of Medacal Knowledge
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FEB 1, 1995