Osler's “A Way of Life” and Other Addresses, with Commentary and Annotations, Sir William Osler.

What more can be said about Sir William Osler? He is, for all intents and purposes, already canonized by the medical profession as its most current saint and the epitome of the ideal physician for the twentieth century. His life has been well chronicled, researched, and reviewed by others, notably in Harvey Cushing's biography of Osler published in 1925 [1], and, disregarding the centenary of his birth, he is still the topic of current literature as can be seen by recent citations in MEDLINE. Despite the passages of time and the myriad changes that have affected medicine, Osler retains his strength as a spokesperson for medicine. In an age of advancing technology applied to the diagnosis and treatment of disease, physicians can still point to one physician who articulates the values of the profession even in the face of daunting and difficult decisions regarding ethical choices. Although Osler is important for his role in stating the values of the profession, why then another volume? In a note to the reader, the compilers of this most-recent work state that Osler's addresses and essays were already published in various editions in 1985, 1961, 1951, 1913, and 1905, when Osler himself published some of his essays. What then is the reason for this new volume? The compilers of this volume demonstrate their deep and abiding respect for Osler's point of view and his breadth of knowledge by selecting twenty of his nonmedical literary addresses and essays. Shigeaki Hinohara, M.D., chairman of the Board of St. Luke's International Hospital in Tokyo, “is an indefatigable, peripatetic, international medical ambassador and renowned Oslerian” (p. xii) as introduced in the foreword by John P. McGovern, M.D., founder of the American Osler Society and adjunct professor of history and philosophy of medicine, Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. Like many physicians in the United States, Dr. Hinohara was introduced to Osler by receiving as a gift Osler's volume of essays, Aequanimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine. Influenced by the gift and by Osler's writing, Dr. Hinohara vowed to translate the essays into Japanese, so students in his native country could come to appreciate Osler's perspective on medicine and professional life. In the process of translating the essays with Hisae Niki, an acquaintance from St. Luke's Hospital School of Nursing and a Shakespeare scholar, the annotations became important parts of understanding Osler for a different culture. What Hinohara and Niki have done that is unique in the Osler canon is provide a thorough editing of all Osler's references in these selected addresses and essays, which amounts to well over 800 annotations. Each of the twenty essays now includes annotations that offer definitions of words unfamiliar to today's students (Osler's principal audience was students) and the general public (p. xix), as well as explanations for each of the many references to “classical, historical, literary, theological and medical (especially the names of Osler's contemporaries)” sources (p. xix). In addition to the annotations, the compilers offer general commentary in introducing each address or essay. They place the piece in the context of why it was written and to whom Osler was speaking, and they provide a general summary of what Osler tries to convey in his writing. The need for this unique work says much about Osler and us. Osler's addresses and essays certainly reflect the man and his education, namely, his ability to reference a huge breadth of knowledge. Dr. Hinohara explains that “In his lectures relating to medicine, Osler referred frequently to the literary and philosophical passages of ancient and contemporary authors, philosophers, and educators. But he lived in an age when people wrote allusively, making extensive references to literature and the Bible without citing chapter and verse, because all readers, sharing a common classical education, were expected to recognize the sources. Graceful allusion to those texts was the mark of a learned and distinguished writer” (p. xvi). The point here is that Osler's education is reflected in his thoughts and in his writing. Granted, Osler paraphrases or twists the references either by desire or by accident, but there is no denying that Osler brings many literary and other cultural allusions to his writing. To do Osler justice, to make him understood, and to share an appreciation of Osler's thoughts so Japanese medical students could also learn to appreciate him and Osler's words about their profession, Hinohara and Niki have supplied the meaning of his references, which in turn says something about our age and our lack of classical education. The range of the essays here is striking. The volume opens with two key pieces: “A Way of Life” and “Aequanimitas.” In “A Way of Life,” Osler addressed Yale students in 1913. He is forceful in telling students how to live their professional lives. He urges them to stay focused on the present day by removing all thoughts of the past or future. “To die daily, after the manner of St. Paul, ensures the resurrection of a new man, who makes each day the epitome of life” (p. 9); or “Shut off the future as tightly as the past. No dreams, no visions, no delicious fantasies, no castles in the air, with which, as the old song so truly says, ‘hearts are broken, heads are turned’” (pp. 9–10). Note the references to St. Paul's first letter to Corinthians and Robert Browning's “In a Balcony.” In “Aequanimitas,” Osler addressed the 1889 graduating class of the University of Pennsylvania Medical School, just prior to leaving for Baltimore to establish the Johns Hopkins School of Medicine. He “urges the graduates to develop imperturbability and equanimity” (p. 19): imperturbability is necessary for physicians to maintain their self-control so as to aid their patients confidently from their scientific knowledge and the ways to apply it in individual cases, and equanimity is necessary for physicians to maintain presence of mind by being patient and persistent in working with patients and others. The compilers also include Osler's essay on “Books and Men,” the 1901 dedication address delivered at the Boston Medical Library. The essay is full of aphorisms important to the classical images that link physicians to books: “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all”; “There should be in connection with every library a corps of instructors in the art of reading, who would, as a labour of love, teach the young idea how to read”; “For the general practitioner a well-used library is one of the few correctives of the premature senility which is so apt to take him”; and “It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it” (pp. 220–1). The theme of Osler's remarks centers on classifying professional men in their relation to books: teachers, practitioners, and bibliomaniacs. For all of them, a library is indispensable, and Osler credits the latter for building libraries so as to preserve and protect what the past can teach us. Overall, this volume serves as the reference point it is meant to be: to answer the questions about Osler's meaning in the context of his writing and for the audiences he meant to serve. Other collections of his essays are important, but, for those who wish to appreciate the fullness of Osler's thoughts and save themselves the hard research, this volume is indispensable, too. And where else would most users seek it, except in a library.