The Persisting Osler III: Selected Transactions of the American Osler Society, 1991-2000 (review)

Considering his enduring contributions, it would seem unnecessary to have to identify Sir William Osler, especially to health professionals—yet to discover the discouraging truth, you need only ask a few physician friends or medical students who the man was and why he remains important to medicine. Osler was a Canadian physician whose life spanned the turn of the twentieth century with academic appointments at the universities of McGill, Pennsylvania, Johns Hopkins, and Oxford. As a clinician-humanist he became an icon of the Compleat Physician during his lifetime, and has remained so since. The latest flurry of interest in Sir William was fueled by Michael Bliss's wonderful 1999 biography, a review of which led Philip Teigen to employ the term "Osler industry" in describing the clubs, societies, and innumerable words devoted to the man around the world. ¹ Despite its pejorative overtone, the term had a distinctively heuristic effect and will likely appear in future discussions of Osler's legacy.

The present contribution to Oslerian literature is the third in a series, and contains twenty-four papers presented at meetings of the American Osler Society in the years 1991-2000. The book is beautifully crafted on heavy paper and has an appropriate index. The subject matter is divided into personalia, writings, clinical topics, societies, and varia. As with most essay collections, the contents are too diverse and unconnected to be covered individually in a short review.

Despite all the words devoted to Osler since his death in 1919, large questions remain. Two examples are: Is there anything important left to discover about the man? and, Can Osler, from a century ago, speak meaningfully to the complex problems facing today's medicine? Regarding the first question, in the present book, after describing an exhaustive search for new sources for his biography, Bliss reports that the very day after publication of the American edition he came by what turned out to be the main series of letters from Osler to the wife of Harvey Cushing, the man who published Osler's Pulitzer Prize biography in 1925.

As for the second question, does Osler speak to medicine today? Simultaneously last February the medical journals Lancet and Annals of Internal Medicine published a "Charter" aimed at promulgating revised principles of medical ethics and professionalism. The document was promptly dubbed by some as a new Hippocratic Oath. The Charter's premise is that the profound changes in health care in recent years endanger the values of professionalism and are enabling the tail of medical economics to wag the dog of patient primacy. In the book under review, the section by Herbert Swick is entitled "A Calling, Not a Business: William Osler's Call for Professionalism." The essay embraces a half-dozen pithy and timely Oslerian quotations, including this one on the role of business in medicine: "As the practice of medicine is not a business and never can be one, the education of the heart—the moral side of man—must keep pace with the education of the head. Our fellow creatures cannot be dealt with as a man deals in corn and coal; 'the human heart by which we live' must control our professional relations" (p. 152).

Osler endures because he speaks eloquently to values at the heart of medical professionalism and to unchanging human fears of illness and death. Physicians must preserve and practice the best of their heritage if they hope to be seen as professionals in the eyes of their patients and society. Sadly, Osler now speaks to a relatively small audience through the societies and clubs bearing his name. All physicians owe gratitude to the editors and contributors of this series for their persistence in producing three volumes aimed at introducing...