The sage advice of a legendary doctor

Sir William Osler May 11 1957

The sage advice of a legendary doctor

Sir William Osler May 11 1957

The sage advice of a legendary doctor

Sir William Osler

For no other reason than that they are full of a shimmering wisdom rarely met today, Maclean’s herewith presents a diverse sampling from the writings of one of the most extraordinary Canadians who ever lived. Their author is, of course, himself immortal. He is Sir William Osier, remembered by all students and practitioners of medicine as a teacher, remembered by others as a great name. But it is as a writer—not only on medical subjects but on everything touching human thought and behavior and the eternal mysteries of living and dying—that Osier may have left his highest monument.


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William Osier was the greatest physician of his day.

As a writer and thinker he may

His greatest love, next to people, was the written word: books on medicine, any good book— he felt alive in them the mind of the author and the hand of the craftsman. Before he died, he wrote: “I like to think of my books in an alcove of a fireproof library in some institution that I love; at the back of the alcove an open fireplace and a few easy chairs, and on the mantelpiece an urn with my ashes, through which my astral self could peek at the books I have loved, and enjoy the delight with which kindred souls still in the flesh would handle them.” He began his medical career at McGill University and, in answer to his own wishes, his collection is installed there in the Osier Library. Behind his portrait on a bronze plaque, and surround^ ed by books, are also his ashes.

If Osier, recognized as the leading physician of his time, had not devoted his life to medicine, he might have won a comparable place as a writer and philosopher. The writings he produced as a doctor and teacher, usually while pressed for time, and always for some particular practical occasion, have often the universal quality of literature. Since his death in 1919 they have been read, re-read and quoted. He lived in a verbose period; but while nearly all the outpourings of that day have fallen into oblivion, his unpretentious essays and talks have kept the imperishable freshness of classics.



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a legendary

have been even greater.

Witness these words — as arresting

today as in his own lifetime

I have a message that may be helpful ... It is the oldest and the freshest, the simplest and the most useful, so simple indeed it is that some of you may turn away disappointed . . . I wish to point out a path in which the wayfaring man, though a fool, cannot err; not a system to be worked out painfully only to be discarded, not a formal scheme, simply a habit as easy— or as hard!—to adopt as any other habit, good or bad.

It is the practice of living for the day only, and for the day’s work, Life in day-tight compartments . . .

The workers in Christ’s vineyard were hired by the day; only for this day are we to ask for our daily bread, and we are expressly bidden to take no thought for the morrow. To the modern world these commands have an oriental savor, counsels of perfection akin to certain of the Beatitudes, stimuli to aspiration, not to action. I am prepared on the contrary to urge the literal acceptance of the advice ... in the modernist spirit, as a way of life, a habit, a strong enchantment, at once against the mysticism of the East and the pessimism that too easily besets us.


Shut out the yesterdays, which have lighted fools the way to dusty death, and have no concern for you personally, that is, consciously. They are there, all right, working daily in us, but so are our livers and stomachs. And the past, in its unconscious action on our lives, should bother us as little as they do ... To die daily, after the manner of St. Paul, ensures the resurrection of a new man, who makes each day the epitome of a life.


The load of tomorrow, added to that of yesterday, carried today makes the strongest falter. Shut off the future as tightly as the past. No dreams, no visions, no delicious fantasies, no castles in the air, with which, as the old song so truly says, “Hearts are broken, heads are turned.”

The future is today—there is no tomorrow!

The day of a man’s salvation is now—the life of the present, of today, lived earnestly, intently, without a forward-looking thought, is the only insurance for the future. Let the limit of your horizon be a twenty-four-hour circle . . . Look heavenward if you wish, but never to the horizon—that way danger lies. Truth is not there, happiness is not there, certainty is not there; but the falsehoods, the frauds, the quackeries, the ignes fatui which have deceived each generation—all beckon from the horizon, and lure the men not content to look for the truth and happiness that tumble out at their feet.


What are the morning sensations?—for they control the day. Some of us are congenitally unhappy during the early hours; but the young man who feels on awakening that life is a burden or a bore has been neglecting his machine . . . Or he has been too much with Lady Nicotine, or fooling with Bacchus, or, worst of all, with the younger Aphrodite—all “messengers of strong prevailment in unhardened youth.” To have a sweet outlook on life you must have a clean body . . . The one cannot be sweet and clean without the other, and you must realize, with Rabbi ben Ezra, the great truth that flesh and soul are mutually helpful . . . With a fresh sweet body you can start aright without those feelings of inertia that so often, as Goethe says, make the morning’s lazy leisure usher in a useless day.


Control of the mind as a working machine, the adaptation of it in habit, so that its action becomes almost as automatic as walking, is the end of education—and yet how rarely reached! It can be accomplished with deliberation and repose, never with hurry and worry ... A few hours out of the sixteen will suffice, only let them be hours of daily dedication—in routine, in order and in system, and day by day you will gain in power over the mental mechanism, just as the child does over the spinal marrow in walking. continued on page 92

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No mind however dull can escape the brightness that comes from steady application . . . The failure to cultivate the power of peaceful concentration is the greatest single cause of mental breakdown.

Do not worry your brains about that bugbear Efficiency, which, sought consciously and with effort, is just one of those elusive qualities very apt to be missed . . . Four or five hours daily . . . and you will acquire a habit by which the one-talent man will earn a high interest, and by which the ten-talent man may at least save his capital.


Know the great souls that make up the moral radium of the world. You must be born of their spirit, initiated into their fraternity, whether of the spiritually minded followers of the Nazarene or of that larger company, elect from every nation, seen by St. John.

Begin the day with Christ and His prayer—you need no other. Creedless, with it you have religion: creed-stuffed, it will leaven any theological dough in which you stick. As the soul is dyed by the thoughts, let no day pass without contact with the best literature of the world. Learn to know your Bible, though not perhaps as your fathers did. In forming character and in shaping conduct, its touch has still its ancient power.

This is the talisman . . . To the eternally recurring question. What is Life? you answer, I do not think—I act it; the only philosophy that brings you into contact with its real values and enables you to grasp its hidden meaning.


Amid an eternal heritage of sorrow and suffering our work is laid, and this eternal note of sadness would be insupportable if the daily tragedies were not relieved by the spectacle of the heroism and devotion displayed by the actors.

Individually, man, the unit, the microcosm, is fast bound in chains of atavism, inheriting legacies of feeble will and strong desires, taints of blood and brain. What wonder, then, that many, sore let and hindered in running the race, fall by the way and need a shelter in which to recruit or die. a hospital, in which there shall be no harsh comments on conduct, but only, so far as is possible, love and peace and rest?

Medicine arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need and sickness. The instinct of self-preservation, the longing to relieve a loved one, and above all. the maternal passion—for such it is—gradually softened the hard race of man.


Books are tools, doctors are craftsmen, and so truly as one can measure the development of any particular handicraft by the variety and complexity of its tools, so we have no better means of judging the intelligence of a profession than by its general collection of books. A physician who does not use books and journals, who does not need a library, who does not read one or two of the best weeklies and monthlies, soon sinks to the level of the cross-counter

prescriber, and not alone in practice, but in those mercenary feelings and habits which characterize a trade.

It is hard for me to speak of the value of libraries in terms which would not seem exaggerated. Books have been my delight and from them I have

received incalculable benefits. To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.


The best teaching is that taught by the patient himself. The whole art of medicine is in observation, as the old motto goes, but to educate the eye to see, the ear to hear, and the finger to feel, takes time .


Variability is the law of life. As no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease. This is the fundamental difficulty in the education of the physician, and one which he may never grasp, or he takes it so tenderly that it hurts . . .

Who can tell of the uncertainties of medicine as an art? The science on which it is based is accurate and definite enough; the physics of a man’s circulation are the physics of the waterworks of the town in which he lives, but once out of gear, you cannot apply the same rules for the repair of one as of the other.

The sage advice of a legendary doctor continued from page 37

‘Learn to know the Bible ... its touch has still its ancient power’


Credulity in matters relating to disease remains a permanent fact in our history, uninfluenced by education. But let us not be too hard on human nature . . . Precious perquisite of the race, as it has been called, with all its dark and terrible record, credulity has perhaps the credit balance on its side in the consolation offered the pious souls of all ages and of all climes, who have let down anchors of faith into the vast sea of superstition. We drink it in with our mother's milk, and that is indeed an evenbalanced soul without some tincture. We must acknowledge its potency today as effective among the most civilized people. the people with whom education is the most widely spread, yet who absorb with wholesale credulity delusions as childish as any that have ever enslaved the mind of man.


Faith has always been an essential factor in the practice of medicine . . .

Literature is full of examples of remarkable cures through the influence of the imagination, which is only an active phase of faith . . . My experience has been that of the unconscious rather than the deliberate faith healer. Phenomenal, even what could be called miraculous, cures are not very uncommon. I.ike others, I have had cases any one of which, under suitable conditions, could have become worthy of a shrine or made the germ of a pilgrimage.

The associations count for much. Without any skill in these cases, or special methods, our results at the Johns Hopkins hospital were most gratifying. Faith in St. Johns Hopkins, as we used to call him, an atmosphere of optimism, and cheerful nurses, worked just the same sort of cures as Aesculapius did at Epidaurus.


Common sense in matters medical is rare, and is usually in inverse ratio to the degree of education.


Western civilization has been born of knowledge, of knowledge won by hard honest sweat of body and brain, but in many of the most important relations of life we have failed to make that knowledge effective.

What we call sense or wisdom is knowledge, ready for use. made effective,

and bears the same relation to knowledge itself as bread does to wheat. The full knowledge of the parts of a steam engine and the theory of its action may be possessed by a man who could not be trusted to pull the lever to its throttle. It is only by collecting data and using them that you can get sense.


Do not be worried by this big question—Truth. It is a very simple matter if each one of you starts with the desire to get as much as possible. No human being is constituted to know the truth, the whole truth, and nothing hut the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition. In this unsatisfied quest the attitude of mind, the desire, the thirst—a thirst that from the soul must rise!—the fervent longing, are the be-all and the end-ail.


What, after all, is education but a subtle, slowly affected change, due to the action upon us of the Externals . . .

of the beautiful and harmonious surroundings of nature and of art, and of the lives, good or ill, of our fellows — these alone educate us. these alone mold the developing minds.

This higher education so much needed today is not given in the school, is not to he bought in the market place, but it has to be wrought out in each one of us for himself; it is the silent influence of character on character and in no way more potently than in the contemplation of the lives of the great and the good in the past, in m/~w„V more than in the “touch divine of noble natures gone.'"


There is possible to each one of us a higher type of intellectual detachment, a sort of separation from the vegetative life of the workaday world—always too much with us—which may enable a man to gain a true knowledge of himself and of his relations to his fellows. Once attained, self-deception is impossible, and he may sec himself even as he is seen —not always as he would like to he seen —and his own deeds and the deeds of others stand out in their true light. In such an atmosphere pity for himself is so commingled with sympathy and love for others that there is no place ¡ell for criticism or for harsh judgment of his brother. But as Sir Thomas Browne —most liberal of men and most distin-

guished of general practitioners — so beautifully remarks: “These are Thoughts of things which Thoughts but tenderly touch,” and . . . the word of action is stronger than the word of speech.


The atmosphere is darkened by the murmurings of men and women over the nonessentials, the trifles that are inevitably incident to the hurly-burly of the day’s routine. Things cannot always go your way. Learn to accept in silence the minor aggravations, cultivate the gift of taciturnity and consume your own smoke with an extra draught of hard work, so that those about you may not be annoye’d with the dust and soot of your complaints.


We are here not to get all we can oat of life for ourselves, but to try to make the lives of others happier. This is the essence of that oft-repeated admonition of Christ, “He that findeth his life shall lose it: and he that loseth his life for my sake shall find it,” on which hard saying, if the children of this generation would only lay hold, there would be less misery and discontent in the world.


On the steppingstones of our dead selves we rise to higher things, and in the inner life the serene heights are reached only when we die unto those selfish habits and feelings which absorb so much of our lives. To each one of us at some time, I suppose, has come the blessed impulse to break away from all such ties and follow cherished ideals. Too often it is but a flash of youth, which darkens down with the growing years. Though the dream may never be realized, the impulse will not have been wholly in vain if it enables us to look with sympathy upon the more successful efforts of others.


The history of man is the story of a great martyrdom—plague, pestilence and famine, battle and murder, crimes unspeakable, tortures inconceivable, and the inhumanity of man to man has even outdone what appear to be atrocities in nature . . . Dwelling too exclusively on this aspect of life, who does not echo the wish of Euripides: “Not to be born is best, and next to die as soon as possible.”

Mercifully, the tragedy of life, though seen, is not realized, it is so close that we lose all sense of its proportions. And better so: for, as George Eliot has said, “if we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow, or the squirrel’s heart beat, and we should die of that roar which lies on the other side of silence.”


Stand up bravely, even against the worst. Your very hopes may have passed on out of sight, as did all that was near and dear to the Patriarch (Jacob) at the Jabbok ford, and. like him. you may be left to struggle in the night alone. Well for you, if you wrestle on. for in persistency lies victory, and with the morning may come the wished-for blessing. But not always; there is a struggle with defeat which some of you will have to bear, and it will be well for you in that day to have cultivated a cheerful equanimity.

To have striven, to have made an effort, to have been true to certain ideals —this alone is worth the struggle.


Nothing in life is more glaring than the contrast between possibilities and actualities, between the ideal and the real. By the ordinary mortal, idealists are regarded as vague dreamers, striving after the impossible; but in the history of the world how often have they gradually molded to their will conditions the most adverse and hopeless! They alone furnish the Geist that finally animates the entire body and makes possible reforms and even resolutions. Imponderable, impalpable, more often part of the moral than of the intellectual equipment, are the subtle qualities so hard to define, \et so potent in everyday life, by which these fervent souls keep alive in us the reality of the ideal. Even in a lost cause, with aspirations utterly futile, they refuse to acknowledge defeat, and, still nursing an unconquerable hope, send up the prayer of faith in the face of a scofling world. Most characteristic of aspirations of this class is the petition of the Litany in which we pray that to the nations may be given “unity, peace and concord.”


We were foolish enough to think that where Christianity had failed Science might succeed, forgetting that the hopelessness of the failure of the Gospel lay not in the message, but in its interpretation. The promised peace was for the individual—the world was to have tribulations; and Christ expressly said: “Think not that I am come to send peace on earth; 1 came not to send peace, but a sword.”


To the scientific student there is much of interest in what Milton calls this business of death, which of all human things alone is a plain case and admits of no controversy . . . The popular belief that however careless a man may be while in health, at least on the “low, dark verge of life” he is appalled at the prospect of leaving these warm precincts to go he knows not where—this popular belief is erroneous. As a rule, man dies as he has lived, uninfluenced practically by the thought of a future life.

I have careful records of about five hundred deathbeds, studied particularly w'ith reference to the modes of death and the sensations of dying . . . Ninety suffered bodily pain or distress of one sort or another, eleven showed mental apprehension. two positive terror, one expressed a spiritual exaltation, one bitter remorse. I he great majority gave no sign one w'ay or the other; like their birth, their death was a sleep and a forgetting.


The scientific student should be willing to acknowledge the value of a belief in a hereafter as an asset in human life. In the presence of so many mysteries which have been unveiled, in the presence of so much yet unsolved, he cannot be dogmatic and deny the possibility of a future state . . . Science is organized knowledge, and knowledge is of things we see. Now' the things that are seen are temporal; of the things that are unseen science knows nothing, and has at present no means of knowing anything.

On the question of the immortality of the soul, the only people who ever had perfect satisfaction are the idealists, who walk by faith and not by sight . . . Not always the wise men after the flesh (except among the Greeks), more often lowly and obscure, women more often than .men, these Teresians have ever formed

the moral leaven of humanity. Narrow, prejudiced, often mistaken in worldly ways and methods, they alone have preserved in the past, and still keep for us today, the faith that looks through death . . . The serene faith of Socrates with the cup of hemlock at his lips, the heroic devotion of a St. Francis or a St. Teresa, but more often for each of us the beautiful life of some good woman ... do more to keep alive in us a belief in immortality than all the preaching in the land . . . Not by the lips, but by the life, are men influenced in their beliefs.


The remarkable development of the material side of existence may make us feel that Reason is King, with Science as the prime minister, but this is a most shortsighted view of the situation. Today as always the heart controls, not alone the beliefs, but the actions of men, in whose life the head counts for little, partly because so few people are capable of using their faculties, but more particularly because we are under the domination of the emotions, and our deeds are the

outcome of passion and prejudice, of sentiment and usage much more than of reason.


As perplexity of soul will be your lot and portion, accept the situation with good grace. The hopes and fears which make us men are inseparable, and this wine press of Doubt each of you must tread alone. It is a trouble from which no man may deliver his brother or make an agreement with another for him.