- A History of William Osler’s “The Principles and Practice of Medicine.”
Samuel Johnson once observed that "there has rarely passed a life of which a judicious and faithful narrative would not be useful." Something similar could be said of great books, although single-author biographies of books remain relatively rare. In the present book, Richard Golden vindicates the value of the biographical approach with his scrupulously detailed, edition by edition, illumination of William Osler's monumental textbook, Principles and Practice of Medicine. Golden is a medical doctor, chairman of medical history at the Suffolk Academy of Medicine, New York, and curator of the Osler Library of the History of Medicine, McGill University, Montreal. An Osler scholar at the University of Toronto, Michael Bliss, assesses Golden as a person "whose bibliographic knowledge of Osler and Osleriana is probably unequalled by any other living person . . .." (p. x). Golden, in turn, characterizes Osler's textbook as ". . . a marvel of precision, [End Page 518] clarity, and up to date information based on a solid foundation of pathology. It was filled with literary and classical allusions and written with such style as to make it eminently readable and enjoyable" (p. 49). I am in full agreement with both of these opinions.
Born in Canada in 1849, Osler served on the university medical faculties of McGill, Pennsylvania, and Johns Hopkins before going to Oxford as Regius Professor of Medicine in 1905, where he remained until his death in 1919. His magnum opus was published in 1892, during his years at Johns Hopkins. The book went through sixteen editions over fifty-five years, sold an estimated 500,000 copies, was translated into six foreign languages, and, with his practice income, made Osler a wealthy man. Golden devotes a chapter to each of the book's sixteen editions. For each revision, he details the relevant additions, omissions, changes in format and authors, inscriptions, new scientific and conceptual changes, and interesting sidelights. Henceforth, no scholar or collector encountering a copy of Osler's book need have any doubt as to its unique qualities and precise place in the series.
In the following examples, Golden demonstrates that in addition to medical advances, Osler's serial revisions reflected social, cultural, and philosophical changes marking the dawn of medicine's Golden Age—the three decades from widespread acceptance of the germ theory to the advent of sulfa drugs and antibiotics. Oster's evolving clinical experience with pneumonia led him to see the disease as merciful when it ended a futile life quickly with relatively little pain, a harbinger of the disagreement in terminal care persisting today. Before life-and-death clinical ethics existed, his inherent humanity evoked an angry condemnation of certain contemporary practices involving human experiments in yellow fever as "simply criminal" (p. 70). A serendipitous reading of the book in 1897, as it revealed the prevailing abysmal state of medical knowledge and practices, came as a revelation to Frederick Gates of John D. Rockefeller's staff. His response contributed directly to the founding of the Rockefeller Institute of Medical Research in 1901 and indirectly to Abraham Flexner's 1910 report on Medical Education in the United States and Canada.
Golden rounds off his book with a set of helpful appendices, including an outline of editions and printings, the varying colophons, and Charles Bryan's compilation of the 2,314 personal names imbedded in the text of the first edition. The latter serve as quasi-citations to help offset the dearth of formal references (137) in the 1,050 pages of Osler's text. As Osler foresaw, his book's useful life ended, but his influence was far from limited to his lifetime. Through his life and his writings, over the years he became and remains medicine's premier ideal of the "compleat physician," learned, humane, at once open-minded and skeptical. His name is enlisted [End Page 519] frequently today, particularly concerning bedside teaching, the inordinate emphasis on economics, and the decline of medical humanism in medical practice...