William Osler, Again

There is an old saying that "art consists in concealing art" (ars est celare artem), ¹ meaning that when a historian or biographer is successful, readers do not notice the skill that went into the research and writing. This aphorism, I think, applies to Michael Bliss's perceptive, graceful, and intellectually rigorous biography of William Osler. It is a work that historians--notoriously wary of biography ² --can profit from, both for the historical themes integrated into it and for the craftsmanship with which it is written. Deft scholars such as Bliss may camouflage their craft, it is true; nonetheless, it is salutary to pay attention to how skillful historians do what they do. For it is only by considering history as writing as well as research that we can provide an adequate account of historical and biographical craftsmanship. Toward that end, the following comments are brief case studies of how to approach history and biography as writing. Specifically, I will examine Bliss's depiction of the nature of medical knowledge, his narrative strategy, and his identification of the climax to Osler's life.

1. Techne and Phronesis

One of the many virtues of William Osler: A Life in Medicine is the seamless way in which Bliss interweaves important themes from Victorian and Edwardian history into his account of Osler's life. Among the most important of these are the growth of the religion of health care, empire and medicine, war and medicine, medicine and university reform, the rise of full-time clinical professorships, and the tension between clinical and laboratory knowledge. In this section I will focus on Bliss's treatment of this last issue and on how it still reverberates today.

The conflict over full-time clinical professorships was the most fundamental and public disagreement in Osler's career. It was also one of the most complicated nineteenth-century medical conflicts, involving, as it did, such issues as ensuring adequate clinical material for teaching and research, establishing fair compensation for professors, and funding increasingly expensive hospitals and laboratories. Inseparable from these pragmatic issues were efforts to construct professional identities and demarcate scientific disciplines. Threaded throughout the conflict, although rarely made explicit, were perennial philosophical questions about the nature of medical knowledge(s).

Although tensions between the knowledge produced in the laboratory and that required for effective clinical action and teaching became public while Osler was at Johns Hopkins and later at Oxford, he felt them earlier--for example, during his travels to Europe in 1884 and 1889. In 1884 he observed how the funding, reputation, and perquisites of laboratory workers outstripped those of teachers and clinicians (pp. 125-26). ³ Then, in 1889, after another visit to Europe, he contrasted the German laboratory scientists pursuing "knowledge for its own sake" with English clinicians "dragged into the mill of practice" (p. 179).

Beneath the social and institutional conflicts that Osler observed, he sensed, I think, the tension between theoretical knowledge (techne/episteme) and the practical reasoning learned and exercised in the clinic (phronesis). The former aims for certainty, timelessness, and universality, whereas the latter is particular, local, and concrete. ⁴ The distinction between these two types of medical knowledge, their roles in medicine, and the respective social and cultural valuations placed upon them have long preoccupied philosophers as well as physicians. As with so much else, Plato and Aristotle first stated the issues. ⁵ Both depicted medicine as one of the principal exemplars of the tension, and both philosophers have remained central to the subsequent dialogue. ⁶

Although the history of techne and phronesis in medicine has not been studied thoroughly and systematically, their tension appears frequently in historical narratives. Steven Shapin, for example, demonstrates that the archmodernist Descartes, committed to the pursuit of certain, universal, and abstract knowledge (episteme/techne) in physiology as well as physics, recognized that clinical knowledge is phronesis--that...