William Osler.

Aequanimitas : with other addresses to medical students, nurses and practitioners of medicine online

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showing Mahala how to soothe his sufferings and to allay
his pains. Woman, " the link among the days," and so
trained in a bitter school, has, in successive generations,
played the part of Mahala to the little Enoch, of Elaine
to the wounded Lancelot. It seems a far cry from the
plain of Mesopotamia and the lists of Camelot to the Johns
Hopkins Hospital, but the spirit which makes this scene

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DOCTOR AND NURSE

possible is the same, tempered through the ages, by the
benign influence of Christianity. Among the ancients,
many had risen to the idea of forgiveness of enemies, of
patience under wrong doing, and even of the brotherhood
of man ; but the spirit of Love only received its incarna-
tion with the ever memorable reply to the ever memor-
able question, Who is my neighbour ? — a reply which has
changed the attitude of the world. Nowhere in ancient
history, sacred or profane, do we find pictures of devoted
heroism in women such as dot the annals of the Catholic
Church, or such as can be paralleled in our own century.
Tender maternal affection, touching filial piety were
there; but the spirit abroad was that of Deborah not
Rizpah, of Jael not Dorcas.

In the gradual division of labour, by which civilization
has emerged from barbarism, the doctor and the nurse
have been evolved, as useful accessories in the incessant
warfare in which man is engaged. The history of the
race is a grim record of passions and ambitions, of weak-
nesses and vanities, a record, too often, of barbaric in-
humanity, and even to-day, when philosophers would
have us believe his thoughts had widened, he is ready as
of old to shut the gates of mercy, and to let loose the dogs
of war. It was in one of these attacks of race-mania that
your profession, until then unsettled and ill-defined,
took, under Florence Nightingale — ever blessed be her
name — its modern position.

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

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race, fall by the way, and need a shelter in which to
recruit or to 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 ? Here, we learn to scan gently
our brother man, judging not, asking no questions, but
meting out to all alike a hospitality worthy of the Hotel
Dieu, and deeming ourselves honoured in being allowed
to act as its dispensers. Here, too, are daily before our
eyes the problems which have ever perplexed the human
mind; problems not presented in the dead abstract of
books, but in the living concrete of some poor fellow in
his last round, fighting a brave fight, but sadly weighted,
and going to his account " unhouselTd, disappointed,
unanel'd, no reckoning made." As we whisper to each
other over his bed that the battle is decided and Euthanasia
alone remains, have I not heard in reply to that muttered
proverb, so often on the lips of the physician, " the fathers
have eaten sour grapes," your answer, in clear accents —
the comforting words of the prayer of Stephen ?

But our work would be much restricted were it not
for man's outside adversary — Nature, the great Moloch,
which exacts a frightful tax of human blood, spar-
ing neither young nor old ; taking the child from the
cradle, the mother from her babe, and the father from
the family. Is it strange that man, unable to dis-
sociate a personal element from such work, has incarnated
an evil principle — the devil ? If we have now so far
outgrown this idea as to hesitate to suggest, in seasons of
epidemic peril, that " it is for our sins we suffer " — when
we know the drainage is bad ; if we no longer mock the
heart prostrate in the grief of loss with the words " whom

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the Lord loveth He chasteneth " — when we know the milk
should have been sterilized— if , I say, we have, in a measure,
become emancipated from such teachings, we have not
yet risen to a true conception of Nature. Cruel, in the
sense of being inexorable, she may be called, but we can
no more upbraid her great laws than we can the leaser
laws of the state, which are a terror only to evildoers.
The pity is that we do not know them all ; in our ignor-
ance we err daily, and pay a blood penalty. Fortunately
it is now a great and growing function of the medical pro-
fusion to search out the laws about epidemics, and these
outside enemies of man, and to teach to you, the public —
dull, stupid pupils you are, too, as a rule — the ways of
Nature, that you may walk therein and prosper.

It would be interesting, Members of the Graduating
Class, to cast your horosoopes. To do so collectively
you would not like ; to do so individually — I dare not ;
but it is safe to predict certain things of you, as a whole.
You will be better women for the life which you have led
here. But what I mean by " better women " is that the
eyes of your souls have been opened, the range of your
sympathies has been widened, and your characters have
been moulded by the events in which you have been
participators during the past two years.

Practically there should be for each of you a busy, useful,
and happy life ; more you cannot expect ; a greater bles-
sing the world cannot bestow. Busy you will certainly
be, as the demand is great, both in private and public,
for women with your training. Useful your lives must be,
as you will care for those who cannot care for themselves,
and who need about them, in the day of tribulation, gentle

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hands and tender hearts. And happy lives shall be yours,
because busy and useful ; having been initiated into the
great secret — that happiness lies in the absorption in
some vocation which satisfies the soul ; that we have here
to add what we can to, not to get what we can from, life.
And, finally, remember what we are — useful super-
numeraries in the battle, simply stage accessories in the
drama, playing minor, but essential, parts at the exits and
entrances, or picking up, here and there, a strutter, who
may have tripped upon the stage. You have been much
by the dark river — so near to us all — and have seen so
many embark, that the dread of the old boatman has
almost disappeared, and

When the Angel of the darker Drink

At last shall find you by the river brink,

And offering his cup, invite your soul

Forth to your lips to quaff— you shall not shrink:

your passport shall be the blessing of Him in whose foot-
steps you have trodden, unto whose sick you have minis-
tered, and for whose children you have oared.



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A University consists, and has ever consisted, in demand and
supply, in wants which it alone can satisfy and which it does satisfy,
in the communication of knowledge, and the relation and bond
which exists between the teacher and the taught. Its constituting,
animating principle is this moral attraction of one class of persons
to another ; which is prior in its nature, nay commonly in its history,
to any other tie whatever ; so that, where this is wanting, a Uni-
versity is alive only in name, and has lost its true essenoe, whatever
be the advantages, whether of position or of affluence, with which
the civil power or private benefactors contrive to encircle it.

John Hinby Nbwman.

It would seem, Adeimantus, that the direction in which education
starts a man will determine his future life.

Plato. Republic, iv. — Jowett's Translation.



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TEACHER AND STUDENT 1



TRULY it may be said to-day that in the methods of
teaching medicine the old order changeth, giving
place to new, and to this revolution let me briefly refer,
since it has an immediate bearing on the main point I wish
to make in the first portion oi my address. The medical
schools of the country have been either independent, Uni-
versity, or State Institutions. The first class, by far the
most numerous, have in title University affiliations, but
are actually devoid of organic union with seats of learning.
Necessary as these bodies have been in the past, it is a
cause for sinoere congratulation that the number is steadily
diminishing. Admirable in certain respects— adorned too
in many instances by the names of men who bore the bur-
den and heat of the day of small things, and have passed to
their rest amid our honoured dead— the truth must be
acknowledged that the lamentable state of medical
education in this country twenty years ago was the direct
result of the inherent viciousnees of a system they fostered.
Something in the scheme gradually deadened in the pro-
fessors all sense of the responsibility until they professed
to teach (mark the word), in less than two years, one of

1 University of Minnetota, 1892.
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the most difficult arts in the world to acquire. Fellow
teachers in medicine, believe me that when fifty or sixty
years hence some historian traces the development of the
profession in this country, he will dwell on the notable
achievements, on the great discoveries, and on the un-
wearied devotion of its members, but he will pass judg-
ment — yes, severe judgment — on the absence of the sense
of responsibility which permitted a criminal laxity in
medical education unknown before in our annals. But
an awakening has come, and there is sounding the knell
of doom for the medical college, responsible neither to the
public nor the profession:

The schools with close university connexions have been
the most progressive and thorough in this country. The
revolution referred to began some twenty years ago with
the appearance of the President of a well-known University
at a meeting of its medical faculty with a peremptory com-
mand to set their house in order. 1 Universities which
teach only the Liberal Aits remain to-day, as in the middle
ages, Schota minores, lacking the technical faculties which
make the Schol® majores.- The advantages of this most
natural union are manifold and reciprocal. The profes-
sors in a University medical school have not that inde-
pendence of which I have spoken, but are under an
influence which tends constantly to keep them at a high
level : they are urged by emulation with the other faculties
to improve the standard of work, and so are given a
strong stimulus to further development.

To anyone who has watched the growth of the new

» See Holmes on President Eliot in Life and Letters of 0. W.
Helmet, 1806, ii. 187* 188, 190.

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ideas in education it is evident that the most solid advances
in methods of teaching, the improved equipment, clinical
and laboratory, and the kindlier spirit oi generous rivalry —
which has replaced the former debased method of counting
heads as a test of merit — all these advantages have come
from a tightening of the bonds between the medical school
and the University.

And lastly there are the State schools, of which this
college is one of the few examples. It has been a char-
acteristic of American Institutions to foster private
industries and to permit private corporations to meet any
demands on the part of the public. This idea carried to
extreme allowed the unrestricted manufacture— note the
term— of doctors, quite regardless of the qualifications
usually thought necessary in civilized communities — of
physicians who may never have been inside a hospital
ward, and who had, after graduation, to learn medicine
somewhat in the fashion of the Chinese doctors who re-
cognized the course of the arteries of the body, by noting
just where the blood spurted when the acupuncture needle
was inserted. So far as I know, State authorities have
never interfered with any legally instituted medical school,
however poorly equipped for its work, however lax the
qualifications for license. Not only has this policy of
non-intervention been carried to excess, but in many
States a few physicians in any town could get a charter
for a school without giving guarantees that laboratory or
clinical facilities would be available. This anomalous
condition is rapidly changing, owing partly to a revival
of loyalty to higher ideals within the medical profession,
and partly to a growing appreciation in the public of the

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TEACHER AND STUDENT

value of physicians thoroughly educated in modern
methods. A practical acknowledgment of this is found
in the recognition in three States at least of medicine as
one of the technical branches to be taught in the University
supported by the people at large.

But it is a secondary matter, after all, whether a school
is under State or University control, whether the endow-
ments are great or small, the equipments palatial or
humble ; the fate of an institution rests not on these ;
the inherent, vital element, which transcends all material
interests, which may give to a school glory and renown
in their absence, and lacking which, all the " pride, pomp
and circumstance 9 ' are vain— this vitalizing element, I
say, lies in the men who work in its halls, and in the ideals
which they cherish and teach. There is a passage in one
of John Henry Newman's Historical Sketches which ex-
presses this feeling in terse and beautiful language: "I
say then, that the personal influence of the teacher is
able in some sort to dispense with an academical system,
but that system cannot in any way dispense with personal
influence. With influence there is life, without it there
is none ; if influence is deprived of its due position, it will
not by those means be got rid of, it will only break out
irregularly, dangerously. An academical system without
the personal influence of teachers upon pupils, is an Arctic
winter ; it will create an ice-bound, petrified, cast-iron
University, and nothing else."

Naturally from this standpoint the selection of teachers
is the function of highest importance in the Regents of
a University. Owing to local conditions the choice of men
for certain of the chairs is restricted to residents in the



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TEACHER AND STUDENT

University town, as the salaries in most schools of this
country have to be supplemented by outside work. But
in all departments this principle should be acknowledged
and acted upon by trustees and faculties, and supported
by public opinion— that the very best men available
should receive appointments. It is gratifying to note the
broad liberality displayed by American colleges in welcom-
ing from all parts teachers who may have shown any
special fitness, emulating in this respect the liberality of
the Athenians, in whose porticoes and lecture halls the
stranger was greeted as a citizen and judged by his mental
gifts alone. Not the least by any means of the object
lessons taught by a great University is that literature
and science know no country, and, as has been well said,
acknowledge " no sovereignty but that of the mind, and
no nobility but that of genius. 9 ' But it is difficult in this
matter to guide public opinion, and the Regents have
often to combat a provincialism which is as fatal to the
highest development of a University as is the shibboleth
of a sectarian institution.

II

To paraphrase the words of Matthew Arnold, the
function of the teacher is to teach and to propagate the
best that is known and taught in the world. To teach
the current knowledge of the subject he professes—sifting,
analyzing, assorting, laying down principles. To pro-
pagate : i.e., to multiply, facts on which to base principles
—experimenting, searching, testing. The best that is
known and taught in the world— nothing less can satisfy
a teaoher worthy of the name, and upon us of the medical

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TEACHER AND STUDENT

faculties lies a bounden duty in this respect, since our Art,
co-ordinate with human suffering, is cosmopolitan.

There are two aspects in which we may view the teacher
— as a worker and instructor in science, and as practitioner
and professor of the art; and these correspond to the
natural division of the faculty into the medical school
proper and the hospital.

In this eminently practical country the teacher of
science has not yet received full recognition, owing in
part to the great expense connected with his work, and
in part to carelessness or ignorance in the public as to
the real strength of a nation. To equip and main-
tain separate Laboratories in Anatomy, Physiology,
Chemistry (physiological and pharmacological), Patho-
logy and Hygiene, and to employ skilled teachers, who
shall spend all their time in study and instruction,
require a capital not to-day at the command of any medical
school in the land. There are fortunate ones with two or
three departments well organized, not one with all. In
contrast, Bavaria, a kingdom of the German Empire,
with an area less than this State, and a population of five
and a half millions, supports in its three University towns
flourishing medical schools with extensive laboratories,
many of which are presided over by men of world-wide
reputation, the steps of whose doors are worn in many
cases by students who have crossed the Atlantic ; seeking
the wisdom of methods and the virtue of inspiration not
easily accessible at home. But there were professors in
Bavarian medical schools before Marquette and Joliet
had launched their canoes on the great stream which the
intrepid La Salle had discovered, before Da Lhut met

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Father Hennepin below the falls of St. Anthony; and
justice compels us to acknowledge that while winning an
empire from the back-woods the people of this land had
more urgent needs than laboratories of research. All
has now changed. In this State, for example, the phe-
nomenal growth of which has repeated the growth of
the nation, the wilderness has been made to blossom as
the rose, and the evidences of wealth and prosperity on
every side almost constrain one to break out into the now
old song, " Happy is that people that is in such a case."

But in the enormous development of material interests
there is danger lest we miss altogether the secret of a
nation's life, the true test of which is to be found in its
intellectual and moral standards. There is no more potent
antidote to the corroding influence of mammon than the
presence in a community of a body of men devoted to
science, living for investigation and caring nothing for
the lust of the eyes and the pride of life. We forget that
the measure of the value of a nation to the world is neither
the bushel nor the barrel, but mind ; and that wheat and
pork, though useful and necessary, are but dross in com-
parison with those intellectual products which alone are
imper shable. The kindly fruits of the earth are easily
grown ; the finer fruits of the mind are of slower develop-
ment, and require prolonged culture.

Each one of the scientific branches to which I have
referred has been so specialized that even to teach it
takes more time than can be given by a single Professor,
while the laboratory classes also demand skilled assistance.
The aim of a school should be to have these depart-
ments in the charge of men who have, first, enthusiasm

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that deep love oi a subject, that desire to teach and extend
it without which all instruction becomes cold and lifeless ;
secondly, a full personal knowledge of the branch taught ;
not a second-hand information derived from books, but
the living experience derived from experimental and
practical work in the best laboratories. This type of
instructor is fortunately not rare in American schools.
The well-grounded students who have pursued their
studies in England and on the Continent have added depth
and breadth to our professional scholarship, and their
critical faculties have been sharpened to discern what is
best in the world of medicine. It is particularly in these
branches that we need teachers of wide learning, whose
standards of work are the highest known, and whose
methods are those of the masters in Israel. Thirdly, men
are required who have a sense of obligation, that feeling
which impels a teacher to be also a contributor, and to add
to the stores from which he so freely draws. And precisely
here is the necessity to know the best that is taught in
this branch, the world over. The investigator, to be suc-
cessful, must start abreast of the knowledge of the day,
and he differs from the teacher, who, living in the present,
expounds only what is current, in that his thoughts must
be in the future, and his ways and work in advance of the
day in which he lives. Thus, unless a bacteriologist has
studied methods thoroughly, and is familiar with the ex-
traordinarily complex flora associated with healthy and
diseased conditions, and keeps in touch with every labor-
atory of research at home and abroad, he will in attempting
original work, find himself exploring ground already well-
known, and will probably burden an already over-laden

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literature with faulty and crude observations. To avoid
mistakes, he must know what is going on in the laboratories
of England, France and Germany, as well as in those of his
own country, and he must receive and read six or ten
journals devoted to the subject. The same need for wide
and accurate study holds good in all branches.

Thoroughly equipped laboratories, in charge of men,
thoroughly equipped as teachers and investigators, is the
most pressing want to-day in the medical schools of this
country.

The teacher as a professor and practitioner of his art
is more favoured than his brother, of whom I have been
speaking ; he is more common, too, and less interesting ;
though in the eyes of " the fool multitude who choose by
show" more important. And from the standpoint of
medicine as an art for the prevention and cure of disease,
the man who translates the hieroglyphics of science into
the plain language of healing is certainly the more useful.
He is more favoured inasmuch as the laboratory in
which he works, the hospital, is a necessity in every centre
of population. The same obligation rests on him to
know and to teach the best that is known and taught
in the world — on the surgeon the obligation to know
thoroughly the scientific principles on which his art is
based, to be a master in the technique of his handicraft,
ever studying, modifying, improving ;— on the physician,
the obligation to study the natural history of diseases
and the means for their prevention, to know the true
value of regimen, diet and drugs in their treatment, ever
testing, devising, thinking ;— and upon both, to teach
to their students habits of reliance, and to be to them

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examples of gentleness, forbearance and courtesy in dealing
with their suffering brethren.

I would fain dwell upon many other points in the rela-
tion of the hospital to the medical school — on the necessity
of ample, full and prolonged clinical instruction, and on
the importance of bringing the student and the patient
into close contact, not through the cloudy knowledge of
the amphitheatre, but by means of the accurate, critical
knowledge of the wards ; on the propriety of encouraging
the younger men as instructors and helpers in ward work ;
and on the duty of hospital physicians and surgeons to
contribute to the advance of their art — but I pass on with
an allusion to a very delicate matter in college faculties.

From one who, like themselves, has passed la crise
de quarante arts, the seniors present will pardon a few plain
remarks upon the disadvantages to a school of having too
many men of mature, not to say riper, years. Insensibly,
in the fifth and sixth decades, there begins to creep over
most of us a change, noted physically among other ways
the silvering of the hair and that lessening of elasticity,
which impels a man to open rather than to vault a five-
barred gate. It comes to all sooner or later ; to some it is
only too painfully evident, to others it comes unconsciously,
with no pace perceived. And with most of us this physical
change has its mental equivalent, not necessarily accom-



Online LibraryWilliam OslerAequanimitas : with other addresses to medical students, nurses and practitioners of medicine → online text (page 2 of 26)