For God and Progress: Notes On Training the Medical Mind

William Osler, teaching at the bedside.

Understanding changing perceptions of “great works”— what books are included in a canon at a given moment in history, why certain works make the cut while others fall to the wayside, and tracking down the individuals responsible for these decisions—is a hobby of mine. I have written about it many times on the Scholar’s Stage. This week I came across an interesting example of cannon formation in action. William Osler was one of the founding physicians of John Hopkins Medicine, creator of the hospital residency system, inventor of much of the hands-on medical pedagogy still used in medical schools today, and one of the most famous doctors of his day. On the final page of Aequanimitas, a collection of Osler’s lectures and orations published in 1904, is a list of books that Osler believes should be on every medical student’s bookshelf. He suggests that while in medical school young doctors-to-be should spend the last 30 minutes of their night reading from this chosen library. 

 This is the list: 

1. The Old and New Testaments 
2. Shakespeare 
3. Montaigne 
4. Plutarch’s Lives 
5. Marcus Aurelius 
6. Epictetus 
7. Religio Medici 
8. Don Quixote 
9. Emerson 
10. Oliver Wendell Holmes—Breakfast Table series. [1] 

 It is difficult to imagine such a list pushed on medical students by any dean today! I fear starting with Osler’s bedside library might give you the wrong impression of Osler’s priorities; this is, after all, taken from the last page of Osler’s book. Osler was practical minded: he had these words stenciled in in every one of his medical textbooks at John Hopkins:

The knowledge which a man can use is the only real knowledge, the only knowledge which has life and growth in it and converts itself into practical power. The rest hangs like dust about the brain or dries like rain drops off the stones.[2]

To find this “real knowledge” Osler instructed students to “Divide your attentions equally between books and men.“[3] “To study the phenomena of disease without books is to sail an uncharted sea,” Osler argued, but “to study books without patients is not to go to sea at all.”[4] Thus Osler’s pioneering pedagogy, which brought medical students into hospitals as they learned. But Osler’s injunction to study men went beyond medical patients:

The strength of a student of men is to travel—to study men, their habits, character, mode of life, their behavior under varied conditions, their vices, virtues, and peculiarities. Begin with a careful observation of your fellow students and of your teachers; then, every patient you see is a lesson in much more than the malady from which he suffers. Mix as much as you possibly can with the outside world, and learn its ways. Cultivated systematically, the student societies, the students’ union, the gymnasium, and the outside social circle will enable you to conquer the diffidence so apt to go with bookishness and which may prove a very serious drawback in after-life. I cannot too strongly impress upon the earnest and attentive men among you the necessity of overcoming this unfortunate failing in your student days.[5]

The “books” Osler urged his students to study were not limited to his bedside library. He gave long lectures on the urgency of keeping up with advances in science and medicine that would occur during a doctor’s life.[6] Of these sciences, Osler believed biology the most critical:

Biology touches the problems of life at every point, and may claim, as no other science, completeness of view and a comprehensiveness which pertains to it alone. To all whose daily work lies in her manifestations the value of a deep insight into her relations cannot be overestimated. The study of biology trains the mind in accurate methods of observation and correct methods of reasoning, and gives to a man clearer points of view, and an attitude of mind more serviceable in the working-day-world than that given by other sciences, or even by the humanities. Year by year it is to be hoped that young men will obtain in this Institute a fundamental knowledge of the laws of life.

To the physician particularly a scientific discipline is an incalculable gift, which leavens his whole life, giving exact-ness to habits of thought and tempering the mind with that judicious faculty of distrust which can alone, amid the uncertainties of practice, make him wise unto salvation. For perdition inevitably awaits the mind of the practitioner who has never had the full inoculation with the leaven, who has never grasped clearly the relations of science to his art, and who knows nothing, and perhaps cares less, for the limitations of either.[7]

I excerpt Osler at such length only to show that he was not some fancy fart bitter over the low number of STEM students enrolling in his seminar on the poetics of gender in 1970s Chicano literature. This was a man who valued practical knowledge above all, a man who was enamored with science and its possibilities—and a man who wanted all of his medical students to read Shakespeare and Emerson. 

Why? 

Here is the passage where Osler introduces the necessity of liberal learning:

The medical man, perhaps more than any other man, needs that higher education of which Plato speaks,—” that education in virtue from youth upwards, which enables a man eagerly to pursue the ideal perfection.” It is not for all, nor can all attain to it, but there is comfort and help in the pursuit, even though the end is never reached.

…Like a good many other things, it comes in a better and more enduring form if not too consciously sought. The all-important thing is to get a relish for the good company of the race in a daily intercourse with some of the great minds of all ages. Now, in the spring-time of life, pick your intimates among them, and begin a systematic cultivation of their works. Many of you will need a strong leaven to raise you above the dough in which it will be your lot to labour. Uncongenial surroundings, an ever-present dissonance between the aspirations within and the actualities without, the oppressive discords of human society, the bitter tragedies of life, besides the bidden springs of which we sit in sad despair—all these tend to foster in some natures a cynicism quite foreign to our vocation, and to which this inner education offers the best antidote. Personal contact with men of high purpose and character will help a man to make a start—to have the desire, at least, but in its fulness this culture—for that word best expresses it—has to be wrought out by each lesson that you will enjoy.

The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.

To you, as the trusted family counsellor, the father will come with his anxieties, the mother with her hidden grief, the daughter with her trials, and the son with his follies. Fully one-third of the work you do will be entered in other books than yours. Courage and cheerfulness will not only carry you over the rough places of life, but will enable you to bring comfort and help to the weak-hearted and will console you in the sad hours when, like Uncle Toby, you have ” to whistle that you may not weep.” [8]

Osler’s sentimentality is offered without apology. Words like his sound saccharine to the cynics of our century, but they were par for course at the turn of the last. No decade of American history was as effusively earnest as the 1890s; it was a time where men thought in moralisms and even vain intellectuals chased after homely, middle-class ideals. Like Osler, its leading figures were fervent devotees of both God and Progress. Osler saw his profession as the embodiment of both of these absolutes. No irony, no self-deprecation, no titters and tutters about doctors and their follies are to be heard from him! Hear him discourse to the nurses of the nation on the rightness of their chosen career:

Practically there should be for each of you a busy, useful, and happy life; more you cannot expect; a greater blessing 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 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.[9]

Imagine this sort of declaration coming from the lips of a professor of medicine today:How strange it would sound! In our day, those who quest for transcendence do not go to med-school (much less nursing). For the American millennial, med-school is instead a portal to bourgeois respectability (and personal misery). But Osler is all in on transcendence. He unironically describes the path of medicine as the path of Christ. Nurses and doctors have consecrated themselves as hands of the Lord and heralds of the future. Theirs is to comfort the afflicted, succor the needy, and heal the sick. Osler put the matter bluntly in an address to medical students in Minneapolis:

My message is chiefly to you, Students of Medicine, since with the ideals entertained now your future is indissolubly bound. The choice lies open, the paths are plain before you. Always seek your own interests, make of a high and sacred calling a sordid business, regard your fellow creatures as so many tools of trade, and, if your heart’s desire is for riches, they may be yours; but you will have bartered away the birthright of a noble heritage, traduced the physician’s well-deserved title of the Friend of Man, and falsified the best traditions of an ancient and honourable Guild.[10]

 Osler was no patsy. That he felt this admonition necessary is evidence of an acute awareness that not all doctors were as committed to the life of righteousness as he. This returns us the full circle, back to Osler’s bedside library. 

He saw in these books a tool to instill within his students both the character traits and guiding ideals needed for a life in medicine. These traits include the “cheerfulness and courage” endorsed in the passage above, but also equanimity (for moments of pressure and crisis), wisdom (for the grieving patient), optimism (in the face of death and dying), and charity (an absolutely necessary trait, Osler argues, for peace of mind in a profession afflicted with large egos and petty jealousies). He also writes that

Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace, of the ordinary man, of the plain, toilworn woman, with their loves and their joys, their sorrows and their griefs. The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients.[11]

Behind Osler’s broad conception of a doctor’s role was an equally broad conception of the education a doctor needed to perform it. The metaphor Osler favored is the leaven in the bread-dough. He believed that studying great works of literature and philosophy will lead inborn virtues to bloom large and quick—or at least, larger and quicker than they otherwise would if left unleavened. A doctor who has internalized these works was not guaranteed to live a better life, but on balance such a doctor was more likely to choose right when the “best traditions of an ancient and honorable guild” were arrayed against the allures of lucre, envy, and prestige.

Thusfar I have emphasized the contrast between Osler’s view of the medical man and the narrower confines of the modern medical school. But his vision of a liberal education also stands in contrast to the manner in which most great works are approached by specialists in literature, poetry, rhetoric, and history today. Few professors would turn to Plutarch or Cervantes for “courage and cheerfulness.” Among the tempted few, fewer still are those who would proclaim their inspiration loudly. The modern academic mode is analytic and detached. What they teach is doomed to “hang like dust about the brain or dry like rain drops off the stones.”

 But it may be misleading to contrast Osler only with the present day. The truth is that his attitude towards the great works was itself a rather new development in anglophone thought. Let us contrast Osler’s recommended reading with a list composed by a different doctor some fifty years earlier. John Brown, once the most eminent doctor of Edinburgh, gives this advice on the training of young doctors-to-be:

But it may be asked, how are the brains to be strengthened, the sense quickened, the genius awakened, the affections raised — the whole man turned to the best account for the cure of his fellow-men? How are you, when physics and physiology are increasing so marvellously, and when the burden of knowledge, the quantity of transferable information, of registered facts, of current names—and such names!—is so infinite: how are you to enable a student to take all in, bear up under all, and use it as not abusing it, or being abused by it?

You must invigorate the containing and sustaining mind, you must strengthen him from within, as well as fill him from without; you must discipline, nourish, edify, relieve, and refresh his entire nature; and how? We have no time to go at large into this, but we will indicate what we mean: encourage languages, especially French and German, at the early part of their studies; encourage not merely the book knowledge, but the personal pursuit of natural history, of field botany, of geology, of zoology; give the young, fresh, unforgetting eye, exercise and free scope upon the infinite diversity and combination of natural colours, forms, substances, surfaces, weights, and sizes—everything, in a word, that will educate their eye or ear, their touch, taste, and smell, their sense of muscular resistance; encourage them by prizes, to make skeletons, preparations, and collections of any natural objects; and, above all, try and get hold of their affections, and make them put their hearts into their work.

Let there be no excess in the number of classes and frequency of lectures. Let them be drilled in composition; by this we mean the writing and spelling of correct plain English (a matter not of every-day occurrence, and not on the increase)—let them be directed to the best books of the old masters in medicine, and examined in them,—let them be encouraged in the use of a wholesome and manly literature. We do not mean popular or even modern literature—such as Emerson, Bulwer, or Alison, or the trash of inferior periodicals or novels—fashion, vanity, and the spirit of the age, will attract them readily enough to all these; we refer to the treasures of our elder and better authors. If our young medical student would take our advice, and for an hour or two twice a week take up a volume of Shakspere, Cervantes, Milton, Dryden, Pope, Cowper, Montaigne, Addison, Defoe, Goldsmith, Fielding, Scott, Charles Lamb, Macaulay, Jeffrey, Sydney Smith, Helps, Thackeray, etc., not to mention authors on deeper and more sacred subjects — they would have happier and healthier minds, and make none the worse doctors.

If they, by good fortune—for the tide has set in strong against the lifer humaniores—have come off with some Greek or Latin, we would supplicate for an ode of Horace, a couple of pages of Cicero or of Pliny once a month, and a page of Xenophon. French and German should be mastered either before or during the first years of study. They will never afterwards be acquired so easily or so thoroughly, and the want of them may be bitterly felt when too late.[12]

There are several points of interest here. Notice first that with the exception of Cervantes and Montaigne, the writers were all British. They are poets, essayists, and novelists all, artists of the English language. Not included are philosophers or political theorists who wrote in English (like John Locke or Thomas Hobbes). Ancient authors are included almost as a philological exercise; they are to be read in their original tongue, and only a few pages a day. While these readings are described as “wholesome and manly” the main reason given for studying them is not to leaven moral virtues (like Osler’s “courage and cheerfulness”) but to produce “happier and healthier minds.” Brown’s educational program is not designed to shape the soul so much as it is “strengthen the brain” and “quicken the sense”—the nineteenth century gloss for what we today might call “critical thinking.” 

Brown’s conception was closer to the nineteenth century norm. In England and America both, an education is “great books” meant reading through the greatest poets and prose-writers of the English language. If a book like Dante’s Inferno, a staple of 20th century great books collections, was taught in university, it was to students of Italian. Thus even in 1907 Arnold Bennett would write up a list of two hundred great works without including a single work in translation.[13] The study of these writers were often justified in fairly utilitarian terms: Thomas Jefferson advised his nephew to read “Milton’s Paradise Lost, Shakspeare, Ossian, Pope’s and Swift’s works” not for their insight but “in order to form your style in your own language.”[14] This is why Brown connects his list of wholesome, manly writers to “the writing and spelling of correct plain English”—one read the great poets, novelists, and essayists of the past to become a better wordsmith.

Running parallel to the study of English language was an education in classics, meaning literature of Greece and Rome. But here too, study was more philological than philosophical. The crowning jewels of the nineteenth century education were Horace and Cicero.[15] Neither makes Osler’s list, and neither is given much space in the twentieth century great works curricula. I do not read Latin, but my secondhand understanding is that as stylists Horace and Cicero tower over their fellow Romans. Both served as the inspiration for some of the greatest poems and orations of the English language. However, (from firsthand experience this time) neither author’s wordplay translates especially well into English; I have not yet found a translation of Horace or Cicero that I would describe as beautiful. I suspect that those who cannot read Latin will never enjoy these two writers the way the great minds of the nineteenth century did. 

At the dawn of the twentieth century these two distinct educational traditions—the “masters” of the English language and the “classics” of Greece and Rome begin to merge. Osler’s reading list is a data point in this transition, but also an example of why this transition occurred. Osler was a pioneer of the new university system. These were universities as we know them today: houses of learning divvied up into distinct (and multiplying!) academic apartments staffed by professors who are expected to engage in research as a professional pursuit. Skill in ancient Greek was of little use to students in these departments, and the mandatory study of Greek and Latin was slowly eliminated from admissions tests.[16]

Yet the growing specialization of academic fields was not without its problems.[17] Many worried that learning would grow too fractured, intellectual life too fragmented. Others feared that an education system that simply churned out technicians would endanger democracy and the liberty. One solution to these problems was that endorsed by Osler: the close reading of a new canon of “classic” texts.

 I sometimes think of this as the transition from Horace to Homer. Homer was read avidly over the eighteenth and nineteenth centuries, but it is difficult to find him in any of the educational lists or syllabi written over these centuries. Homer’s Greek was archaic even in classical times, and his length did not make him an ideal vessel for language study. But when the study of the classics transitioned to the study of classics in translation, this was no longer a barrier. In this new environment, a gripping narrative work like The Iliad had an advantage over Horace’s lyrics. Homer became a staple of the new syllabi, and Horace was reduced down to an optional afterthought.[18] 

This transition to reading classics in translation also opened the door to writers like Dante, Molière, and Tolstoy, who did not fit any of the traditional language based categories. The canon soon grew beyond Great Britain and the ancient world. Famous British prose writers—like Addison, Lamb, and Johnson—were squeezed out of the curriculum to make room for these new additions. Further pressure on the masters of English prose came when philosophy and theology were folded into this new conception of the canon. As the new canon was defined by intellectual and moral categories instead of philological ones, the inclusion of philosophy made sense. The main cost was a severe reduction in the English poetry and prose students were expected to be familiar with. This is still true today: Augustine, Aquinas, Rousseau, and Kant are not exactly household names, but our intellectuals are expected to have a vague idea of what they wrote, even if they have not read their works themselves. No such expectations exist for Edmund Spencer, Henry Fielding, or Thomas de Quincy. 

Osler’s bedside library arrives at the beginning of the Horace-to-Homer transition. He does not include Homer or any long work of political philosophy in his list. Works like that do not meet the goals he has set out for the bedside library. His reading list is carefully tailored. it is meant for men who will embark on a career in medicine, not politics. They must be books that can be read thirty minutes at a time before bed. As he recommends this list to all his students, they must also be easy for philosophical or historical novices to pick up. His list largely follows these requirements. 

Two of Osler’s chosen authors were themselves doctors. None offer extended narratives or complex, belabored arguments (Don Quixote comes closest here, but even it is divided up into a dozen smaller narratives, not unlike a television serial). One of Osler’s students could pick up a meditation of Emerson’s one day, a life of Plutarch the next, then an essay of Montaigne’s the day following, and not suffer from confusion. These are works whose subdivisions can be read straight through or as standalone pieces. They are all very much concerned with practical ethics and practical spirituality. Most could be defined as character studies or wisdom literature; all were well known for their aphoristic acumen. 

 In addition to the Bible, Osler’s list of authors includes two Stoics, one other Roman, three Renaissance men, and two American transcendentalists. Another way to look at that: in Osler’s library we see the foundational ethics of Rome and Jerusalem, the Renaissance attempt to synthesize these pagan and Christian values into one organic whole, and the American update on this synthesis for the democratic age. The enlightenment and the middle ages are not represented, subsumed instead under the eras that follow them. 

There is a certain optimism in this progression. The Roman voices come from the empire at its height, not the Republic in decline; the Renaissance thinkers wrestle over and glory in the expanding frontiers of their age; the Americans speak for a nation brimming with energy and self-confidence. Foundations are followed by synthesis, a synthesis soon brightened and democratized. There are no voices here from human civilization’s descents into darkness. Osler’s library is the story of mankind climbing towards the light. 

Osler lived just before the lights went out. From this side of that black chasm, the defining egoist of Osler’s century was not Emerson but Nietzsche. To our ears, the voices of the transcendentalists are crowded out by the prophecies of Marx, the warnings of Dostoevsky, and the murky imaginaries of Melville and Conrad. Twentieth century compilers of great works would turn to these dark visionaries to make sense of their lived reality. They would champion the shattered order of Thucydides and the nightmarish disasters of the Greek tragedians over the sober reflections of Plutarch and the Stoics; they pulled Augustine and Dante out of the dark ages and set them as the equal of any artist of the Renaissance. Their canon was larger Osler’s bed-side library, but also grimmer. They lived with less confidence in God and Progress. 

 As to what ten books the doctors of today should read to complete their learning, I cannot say. I am no doctor. But I cannot help but think Osler is right: the physician is called to “exercise an influence of the strong upon the weak, of the righteous upon the wicked, and the wise upon the foolish,” and must prepare his or her soul to do so. Perhaps that requires a canon tinged darker than Osler’s little library. But perhaps not. Perhaps the pendulum has swung too far. Maybe what the doctors and nurses of our day need most is the brazen idealism of Osler himself. If so, Osler’s Aequanimitas would be a worthy first entry in the bedside library of our own doctors-to-be. 

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To read more of my notes on the history of great works and their canons, see: “A Few More Notes on the Dearth of Great Works,” “Do the Great Books Have a Place in the 21st Century?” “Longfellow and the Decline of American Poetry,” “A Non-Western Canon: What Would a List of Humanity’s Hundred Greatest Thinkers Look Like?,”  “On Adding Phrase to the Language.” To get updates on new posts published at the Scholar’s Stage, you can join the Scholar’s Stage mailing list, follow my twitter feed, or support my writing through Patreon. Your support makes this blog possible. ————————————————————————————-

 [1] William Osler, Aequanimitas, With Other Address to Medical Students, Nurses, and Practitioners of Medicine (Philadelphia: P. Blakiston’s Son & Company, 1904), 389.\

[2] ibid., 215.

[3] ibid., 220.

[4] William Osler, “The Student Life,” or. pub. 1921. Available at Quotidiana, Edited by Patrick Madden, 19 January 2007.

[5] ibid.

[6] cf. Osler, Aequanimitas, 278-280,

[7] ibid., 97.

[8] ibid., 383.

[9] ibid., 19.

[10] ibid., 42.

[11] ibid.

[12] John Brown, Horae Subsecivae, 7th ed. (Edinburgh: Edmonston and Douglas, 1871 [or. ed 1858]), 400.

[13] Arnold Bennet, Literary Taste, How to Form It: With Detailed Instructions For
 Collecting A Complete Library Of English Literature (Hodder: 1909), reprint edition, available at DJ McAdam’s personal website.

[14] Thomas Jefferson to Peter Carr, Paris, 19 August, 1785. Available at the Avalon project.

 [15] Mary Rosner, “Cicero in Nineteenth-Century England and America,”  Rhetorica 4, no. 2 (1986) 153–82; Lyon Rathbun, “The Ciceronian Rhetoric of John Quincy Adams,” Rhetorica 18, no. 2 (2000): 175–215; . “English Literature and the Latin Classics: Review of Horace and the Chief Poets of the Nineteenth Century,” Classical Weekly, vol 12, no 23 (21 April 1921); Stephan Harrison, “The Reception of Horace in the Nineteenth and Twentieth Centuries,” The Cambridge Companion to Horace (Cambridge: Cambridge University Press, 2007), 334-347.

[16] For late 19th century changes in university curricula, see Christopher Stay, Classics Transformed: Schools, Universities, and Society in England, 1830-1960 (Oxford: Clarendon Press, 1998); John Thelin, A History of American Higher Education, 3rd ed (Baltimore: John Hopkins University Press, 2019).

[17] Osler himself laments this in a passage that sounds eerily similar to today’s complaints:

The extraordinary development of modern science may be her undoing. Specialism, now a necessity, has fragmented the specialities themselves in a way that makes the outlook hazardous. The workers lose all sense of proportion in a maze of minutiae. Everywhere men are in small coteries intensely absorbed in subjects of deep interest, but of very limited scope. Chemistry, a century ago an appanage of the Chair of Medicine or even of Divinity, has now a dozen departments, each with its laboratory and literature, sometimes its own society. Applying themselves early to research, young men get into backwaters far from the main stream. They quickly lose the sense of proportion, become hypercritical, and the smaller the field, the greater the tendency to megalocephaly. The study for fourteen years of the variations in the colour scheme of the thirteen hundred species of tiger-beetles scattered over the earth may sterilize a man into a sticker of pins and a paster of labels; on the other hand, he may be a modern biologist whose interest is in the experimental modification of types, and in the mysterious insulation of hereditary characters from the environment.

Osler, Aequanimitas, 50. 

[18] Another factor which accounts for this change, which I do not have time to go into at length here, is the slow decline of oratory as a spring of glory and a source of entertainment, and the correspondingly small amount of attention educators gave to rhetoric and wordplay as time went on.