A Response to the Commentaries

Harvey Cushing may have been discombobulated by having Lady Osler looking over his shoulder. I have the whole American Osler Society (and its critics!) looking over mine. Praise is always welcome to an author; criticism is always healthy. I am pleased that Osler is being equally well received by such prominent "Oslerians" as Earl Nation and such noted critics of the "Osler industry" as Philip Teigen. Joe Lella's slightly differing perspective on the book is understandable and interesting, but, in my view, not sustained by the evidence. Of course, my interpretation of Osler's life is anything but etched in stone, and it may well change as a result of sessions like this and as scholarship about Osler and his medical times evolves.

William Osler lived an epic and complex life, and in Osler I try very hard to convey both the epic quality of the life and the complexities of its meaning and context. Philip Teigen rightly emphasizes the multiplicity of themes that are drawn out, including a heavy emphasis on movements and journeys. There is also a sustained play or meditation upon the relationship between biography and medicine. The book begins with a comparison of the act of biography with the postmortem examination of cadavers; it ends with a history of the last specimen, Osler's brain. The last sentence of the book is meant to imply homage to notions of medicine and biography as both art and science. My emphasis on such parallels stems largely from a consciousness of coming to Osler as a professional historian and biographer, not a trained physician. While I would like to think that the strengths of the book are rooted in my historical and literary training (and perhaps more of the weaknesses stem from my lack of medical knowledge than critics have yet noticed, though I did work very hard to get the medicine right), one of the motifs is the suggestion, which I am certain Osler would have found congenial, that the biographer's and the physician's quests are neither humanistically nor epistemologically dissimilar. Indeed, there are several layers of meaning in my treatment of Osler's understanding of medical knowledge, his interest in history and biography, and the evolution of key currents of nineteenth-century thought.

The particular concerns underlying much of my interest in medical history might be more clearly understood by seeing Osler as a kind of hypotenuse in a trilogy, that was not written chronologically. The scene is set in Plague: A Story of Smallpox in Montreal. ¹ Then we have Osler. Finally, in a history of events in Toronto two years after Osler's death, the Canadian's faith in the potential of medicine to affect the human condition--offering a form of salvation, even resurrection--is spectacularly vindicated in The Discovery of Insulin. ² These books, most explicitly Osler, are studies in the rise of health care as a secular replacement for traditional religious faith in the supernatural. Joe Lella may think that I sell spirituality short, but other readers may find that my writing is drenched in sensitivity to spiritual issues. I was a child of medicine, but I grew up very close to the manse.

It happens that Lella and I disagree about the precise role of spirituality in William Osler's life. This disagreement is based on our reading of the biographical evidence, admittedly a bit murky because of Osler's reluctance directly to address the subject. The diagnosis is tricky, but all of the evidence that I can find about Osler suggests that he gradually turned his back on his parents' belief in personal salvation and immortality, transferring his need to believe and serve to the profession of medicine and the limited temporal salvation it can offer. His father was a priest of the Church of England; Osler became priest of the Church of Medicine...