Critical Woodcuts/William Osler
IN the house of letters there are many delightful mansions; but, according to my own taste and judgment, the first competent, comprehensive biography of a great contemporary is the most important and the most stimulating form of current literature. It presents what our society needs above everything else: an objective made visible, an ideal made contagious by realization. If wishing could do it, I would wish "The Life of Sir William Osler" into the hands of every man, woman and child who reads the six best-selling novels.
When one comes to think of it, there are excellent reasons for bringing the layman in at this point. The lay public often fears the lawyers, sometimes shuns the clergy, but, through thick and thin, it clings to the physicians. Year after year we laymen furnish them "laboratory material." We are intensely interested in the outcome of their experiments. In the long run from the cradle to the grave we are certain to have been many times in debt, and indebted, to them.
Furthermore, Dr. Osler, though a most resolute and devoted physician, was much else that interests the laity. In his earlier years he was a passionate student of the fundamental sciences, and as an Oxford professor he was a propagandist for scientific studies
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in the last refuge of the classics. He was a great teacher and a persuasive speaker on the regimen of the student and on the arts of instruction. He was a medical publicist and statesman with messages of the highest importance to mayors, town meetings and that miscellaneous rabble out of which that noble force known as Public Opinion proceeds. He was a bookman, an enamored bibliographer, a curator of the Bodleian, a director of the Oxford Press, a founder, patron and promoter of libraries in England, Canada and the United States. Besides all this, he was a beautiful and lovable character, completely possessing several great and simple virtues which drew men to him and held them.
As for the medical profession, I fancy not much inviting will be required to bring it to this sumptuous feast. The head of the Johns Hopkins Hospital, the author of "The Principles and Practice of Medicine" and "Æquanimitas," touched it at all points. Wherever he touched it, he glorified it. He loved every honest medical man from Galen, Hippocrates and Avicenna to his Alabama student, and if he had enjoyed the leisure of Methuselah he would have delivered an address or have erected a monument in honor of every one. Fearful of specialism, he loved the whole range of pathology, and in the laboratory or the clinic or in strategic counsels with his colleagues, he had a hand in the fighting against all the major plagues of mankind. The story of his life must appeal to his old comrades as Grant's "Memoirs" appealed to the veterans of the Civil War. Nor can one conceive of any intelligent and aspiring young physician, surgeon, nurse, trustee of a hospital, or any one earnestly concerned with public health or medical education and research who will not desire to own the book—no owner would lend it long enough to read it through—and repeatedly to make his way through its fourteen hundred inspiring and richly informative pages.
The author, whose name appears on the title-page without any professional identification or display of learned letters, has a record rather strikingly like that of Osler: nine years on the Johns Hopkins staff as associate surgeon, three years of the period with Osler in charge; professor of surgery at Harvard since 1911; in charge of a base hospital and consultant in France during the war, with a colonelcy in the Medical Corps of the U. S. A.; many foreign honors, membership in British and French medical associations, and enormous acquaintance with the history, bibliography and personnel of his profession.
Without using the first personal pronoun, Dr. Cushing keeps his eye on the object from first to last. He has made his imagination work to realize every step of Osler's career from the Canadian backwoods to the Regius professorship.
The prime question about a distinguished man is how he got his start. Introducing Osler in 1909 at a session of the London School of Tropical Medicine, the American Ambassador, Whitelaw Reid, presented the speaker as "a very excellent example of what the States could do with a Canadian when caught young." That was a fair ambassadorial crack, but Dr. Cushing's admirable opening chapters on the birth and upbringing of our physician do not justify it. The States were more indebted to Osler than Osler to the States. What the Johns Hopkins got when it called this Canadian was a physician who had supplemented his training in the best Edinburgh traditions by acquaintance with the latest developments on the Continent.
Osler was a good Canadian, a good American, a good Englishman, but of nationality he made little, and he was never an American citizen. His parents were English people out of Cornwall—the father a Saxon, the mother a "black Celt" who, in 1837, crossed the Atlantic to propagate the Gospel in the upper Canadian wilderness. William was born in 1849. You see the sturdy father, a Cambridge University man and a fine mathematical scholar, by the way, riding through the woods on horseback with the baptismal register in his saddlebags, hunting out his youngest parishioners, helping them spiritually into the world. You see the mother of nine children conducting a large Sunday school class and also a big sewing class twice a week, to second her husband's efforts for the civilization of the Canadian backwoods. She is an educated woman and writes charming, affectionate, humorous letters to her boys, when they are at school, which you may be sure they are, and under the best masters, men, English university graduates. This good woman lived to be three months more than a hundred years old. The family reckoned twenty members in the World War. It is English-Canadian, and it is magnificent. William Osler got his start from his parents: black hair and black eyes from his mother, and good blood, brains, character and indomitable energy from both.
As a schoolboy William was at or near the head of his class, he was the best athlete in school and he was a ringleader in mischief—with an inherited leaning toward the ministry. The decisive turn in his career was made at school in Weston, conducted on the Eton plan, including the top hats. Opposite page 33 you may see William Osler, aged sixteen, in his top hat, as head prefect. At Weston he became the favorite pupil of a master with a passion for collecting, labeling and microscopically examining every conceivable specimen of "natural history." The passion was contagious. William caught it, became an infatuated microscopist and soon was so deeply absorbed in fresh-water polyzoa that he neglected his letters to his family. The influence of the master was reinforced by the medical director of the school, James Bovell. In 1868 William bought his first edition of Sir Thomas Browne's works, and began his life-long collecting of the "Religio Medici." Theology waned and medicine waxed. He went to McGill, where he received the best medical education to be had in Canada, and graduated with a special prize for a thesis "greatly distinguished for originality and research."
Perhaps the most significant thing that Osler did immediately after he was graduated was not to get married. Marriage he postponed till his forty-third year, in accordance with his advice to young medical students, that they should put their affections "on ice." Instead of getting married he went abroad for two years and studied with the masters in Europe and England, including seventeen months with John Burton Sanderson, whom thirty-four years later he succeeded as Regius Professor of Medicine at Oxford. At the age of twenty-four he returned to McGill as Professor of the Institutes of Medicine, which position he held from 1874 to 1884. He was called to the Professorship of Clinical Medicine at the University of Pennsylvania in 1884 and remained there till 1889. Then he accepted his post at the Johns Hopkins, and held it, in spite of all temptations, till 1905, when Oxford called him. "Stick to your last" was a maxim that he preached and practised.
Dr. Cushing disclaims any attempt at a systematic "appraisal of his professional accomplishments." Osler's name is not identified with any of the great epoch-making discoveries of his period. He cannot be ranked with men like Virchow, Koch, Lister, and Pasteur. He was never, says Dr. Cushing, an "adept in bacteriological technique," and this defect in his training rather precluded his participating in the most important way in the main line of the scientific advance. In his farewell to his American colleagues he himself declared that he had had but two ambitions in his professions: first, to make of himself a good clinical physician, and, second, "to build up a great clinic on Teutonic lines, not on those previously followed here and in England, but on lines which have proved so successful on the Continent and which have placed the scientific medicine of Germany in the forefront of the world." His biographer, who makes some reference to his studies of a third element in the blood, "Osler's disease," etc., inclines to believe that his greatest services were performed as an inseminator of other minds and as a propagandist for public health, perhaps with special reference to his participation in the antituberculosis and antityphoid crusades. To this should be added the fact that the Rockefeller Foundation for Medical Research seems to have been directly inspired by the reading of his "Principles and Practice of Medicine."
Osler himself repeatedly denied that he had attained the objects of his ambition by any extraordinary faculty, and I don't think Dr. Cushing brings any extraordinary faculty to light. What one sees is a young fellow of energetic mind and body who at the age of sixteen or seventeen discovered what he wanted to do with his life and stuck by that with a most consummate doggedness. From his medical student days onward he was a hard, regular and systematic worker. "Work" he gave as the master-word of success in the profession. He had performed more than a thousand autopsies before he left McGill, and that was but an incident in his labors. In another of his addresses, he offered students three master keys: the Art of Detachment, the Virtue of Method and the Quality of Thoroughness. The Art of Detachment he explains as "the faculty of isolating yourselves from the pursuits and pleasures incident to youth." Perhaps he was jesting a little, but so far as the record shows he was master of the Art of Detachment. Till he went to Oxford and let himself out in his bibliographical passions and in society he seems to have sought all his pleasure in his work, in the hospital, in scientific publications, in association meetings, in professional dinners.
There is no indication that getting rich was one of his ambitions. His "Principles and Practice of Medicine," of which he presented the hundred thousandth copy to his son, made him so independent that when fire devastated Baltimore he could offer to turn his salary for a period of five years back fo the Johns Hopkins. Checks for a hundred dollars to needy students or struggling libraries slipped from him easily. But when he took to purchasing first editions, incunabula, and manuscripts, he appreciated a gift of £1,000 from a prosperous brother. Always he looked on medicine as "a calling, not a trade." He refused to become involved in a general practise; he wanted to keep his hands free for science and for clinical instruction.
The highest praise that he could find for one of his masters at McGill was to say that he resembled Thomas Arnold, of Rugby. The molding of the Arnoldian tradition is plainly visible in Osler. It is easy, furthermore, to trace in his writing the influence of Matthew Arnold as a powerful formative influence. Under a photograph of himself with his little son on his back he has written jocosely: "And on his shoulders, not a lamb, a kid"—which is the last line of Arnold's sonnet "The Good Shepherd with the Kid." He praises Locke for the "sweet reasonableness," which is Arnold's phrase for the master quality of Jesus. When he leaves the United States he applies to himself the lines of Arnold's Empedocles:
Sophisticated no truth,
Nursed no delusion,
Allowed no fear.
He is like Arnold in his love for the Bible and for the classical moralists, and like him in this: Externally gay, affable, full of quips and drolleries, eminently companionable as he was, one recognizes that the groundwork of his character was stoical. Self-mastery, the performance of duty, unmurmuring acceptance of destiny were lessons that he learned early and never forgot.
Shortly before he left this country—to return only for "week-ends," as his friends put it—he made what the newspaper men distorted into his most notorious public utterance: his remarks on the uselessness of men over forty, whence the verb "to Oslerize." As a matter of fact, Osler had not a particle of malice toward old men; he had always, on the contrary, a special fondness for them. Significantly, he praised the French lecturer's habit of constant reference to "my distinguished Master." His remarks about old men had come out of his humility and his quizzical kindness. What he had meant to suggest was that he himself was on the verge of "senility," and that consequently his colleagues would not lose much by his migration to Oxford. He was tenderly trying to temper the wind of his departure to his shorn lambs. He had long been an advocate, however, of a "quinquennial braindusting," and he believed in the "peripatetic" life as a preventative of premature old age. I think it is clear that his growth in the years of his English residence was rather social, historical, and literary than scientific.
He had to take his part as a medical officer in the war, but I find no evidence that his heart was in it. He simply bowed to the inevitable as silently as possible. The entire vast madness lay entirely outside his scheme and philosophy of life. The Stoics whom he loved, Marcus Aurelius and Epictetus, and his adored Sir Thomas Browne, had taught him early to denationalize himself, to think of the human race fraternally, and to cultivate charity toward all men. As a man of science, he knew that he must be a cosmopolitan: there are no national boundaries to the commonwealth of science. And so he went about with tight lips and a stricken heart visiting the hospitals and preparing himself to surrender all that makes life of much account to a man who has done his work. In the second volume Dr. Cushing gives us some captivating glimpses of Osler's notable wife and of his only son, an affectionate boy after his father's own heart, and with his own tastes, a pacific book lover and angler of Izaak Walton's school, soon to be employed in stopping German shrapnel with chest, abdomen and thigh.
Dr. Cushing's conception of his many-sided subject is broad and humane. He is reticent about Osler's intimate personal life during the first forty years, but one suspects that there was not much intimate personal life before his forty-third year. In his English period the sweetness and gentleness of his nature come more and more to the surface, through the rush of professional and social duties, all the way to his own deathbed, on which he jests and takes notes and reads the "Religio Medici." They tell him that he will get well, but he smiles and says to his nurse: "Ah, Sister, we know, don't we?" His chief regret is that he will not be able to see the post-mortem.
The great length of the narrative is partly due to a lax application of the principle of selection among abundant materials, and in so far as that is true it results in a lack of perspective. But the urgent fullness of the work is partly attributable also to Dr. Cushing's brimfulness of every sort of information relevant to the entire life-course of the subject. He knows, for example, for any year you please, the condition of the medical faculty at McGill, Pennsylvania, the Johns Hopkins, Harvard, London, Edinburgh, Paris, Berlin and Vienna. He seems to know who read the important papers at every meeting of every important medical association. He knows the steps in all the great discoveries: the germ theory of disease, the place of aniline dyes in the detection of the tubercle bacillus, the differentiation of fevers, the development of serum therapy and the conquest of malaria, diphtheria and typhoid, the discovery of the Roentgen ray, the exploitation of the ductless glands, etc. As a consequence, he has almost inevitably made the life of Osler also a history of the revolutionary progress of medical science during his time.
In justice to his performance of this immense "labor of love" one other point should be made. In his modest one-page preface he disclaims having attempted a "final portrait." He calls these records mémoires pour servir. They are extraordinarily substantial and purposeful mémoires. But, on the whole, that characterization of them is just, and more accurate than a description of the book as a brilliant biographical portrait. It is a marvelously thorough piece of spade work. Osler was an artesian well, and Dr. Cushing has dug up the well. All the materials are here and in order, and the huge gusto of a like-minded colleague will find every scrap of them precious.
It is an immense and wonderful book, and it should be made prescribed reading for all those grim, sadeyed conservative killjoys who go about denying "the dogma of progress."