Medical Resources

Book Review: "A Way of Life"

Sir William Osler's "A Way of Life"
Editors: Shigeaki Hinohara, M.D., and Hisae Niki, M.A.
Duke University Press 2001 (378 pp)
Reviewer: Margaret O'Leary, MD, FAAEM

What a rare and timely book this is! It provides a glimpse into the inner thought processes of Sir William Osler (1849-1919) during his long and distinguished career as a physician clinician and professor at McGill University, the University of Pennsylvania, the Johns Hopkins University, and finally, as the Regius Chair in Medicine at Oxford University. Osler wrote 1,158 medical publications, and 182 literary papers and essays in his lifetime, including his famous medical text, The Principles and Practice of Medicine. Osler, born in Ontario, Canada, was the youngest son of Reverend Featherstone Lake Osler and Ellen Free's eight children. Osler first determined to be a clergyman, but later abandoned the idea to become a physician. The interweaving in his life of religion and science are exemplified in the titles of the twenty essays presented in the book, e.g., "A Way of Life," "Aequanimitas," "The Leaven of Science," "Chauvinism in Medicine," and "Man's Redemption of Man."

Osler's essays vividly describe the nineteenth and early twentieth centuries of medicine, which he helped shape--a world that has powerfully shaped our own world as emergency physicians working the dawn of the 21st century. The addresses provide powerful insights as to how the world of medicine became what it is today. Yesterday's solutions are today's problems. An understanding of our Oslerian past can help us untangle meaning in the present and set direction for the future.

Osler, of course, at least early in his life, would have frowned on analyzing the past to give meaning to our present and future lives. Osler described medicine as "A Way of Life," admonishing physicians to practice living for the day only, "life in day-tight compartments," (referring to the watertight compartments in ships). "Our main business" he said, "is not to see what lies dimly at a distance, but to do what lies clearly at hand," a quote from Carlyle. Osler went on: "The load of tomorrow, added to that of yesterday, carried today makes the strongest falter. Shut off the future as tightly as the past. No dreams, no visions, no delicious fantasies, no castles in the air.Let the limit of your horizon be a twenty-four hour circle." By shutting close the "great fore and aft bulkheads of the ship," Osler believed that physicians could stave off the terrible mental distress, anxiety and waste of energy that come from thinking about the past and future. "The quiet life in day-tight compartments will help you to bear your own and others' burdens with a light heart," he said.

In "Chauvinism in Medicine," Osler decries the medical profession that is "not free of the failings of smugness, various forms of provincialism, and chauvinism." To avoid narrowness, physicians need the "culture" given by a liberal education as well as medical learning. He cautions physicians to ignore both gossip and overblown praise, to be charitable to fellow practitioners, and to actively pursue good relations, especially with potential rivals. Osler even has something to say about the business side of the profession: "In no single relation of life does the physicians show a more illiberal spirit than in the treatment of himself. I do not refer so much to careless habits of living, to lack of routine in work, or to failure to pay due attention to the business side of the profession-sins which so easily beset him-but I would speak of his failure to realize first, the need of a lifelong progressive personal training, and secondly, the danger lest in the stress of practice he sacrifice that most precious of all possessions, his mental independence."

Osler's writings abound in references to classical, historical, literary, theological, and medical literature, making reading treacherous for readers who have not been exposed to a classical education, which includes most of us. Dr. Hinohara and Ms. Niki, editors of the tome, solved the problem by providing numerous rich annotations, which define words and clarify phrases. The annotated Oslerian works came about in a remarkable way: Dr. Hinohara in 1941 worked as a hospital physician at St. Luke's International Hospital (Tokyo, Japan), which immediately after World War II was requisitioned by the Supreme Commander for the Allied Forces as one of their army general hospitals. As Dr. Hinohara stood witnessing the hand-over ceremony, the head of this army general hospital, Dr. Warner Bowers, presented him with a copy of Osler's Aequanimitas with Other Address to Medical Students, Nurses, and Practitioners of Medicine. Hinohara translated the lectures into Japanese and, in the course of the translation, annotated all the words and phrases that were unfamiliar to the Japanese public, which widely purchased and read the book. The essays were then translated back into English along with the annotations, and published in 2001 by Duke University Press.

Osler's addresses can be a balm to the frazzled mind, depicting a simpler era when our "medical guild" was proud of its noble ancestry, remarkable solidarity, progressive nature, and singular beneficence-solving the eternal problems of human suffering. But lurking nearby these prideful words are Osler's quiet, but prescient words: "We form almost a monopoly or trust in this business" (p 232). A close reading of Sir William Osler's essays provides anchor for emergency physicians who need mooring in our intemperate times. On a scale of 1 to 5, this book rates 5 stars.