Sir William speaks

The quotable Osler Mark E. Silverman, T. Jock Murray, Charles S. Bryan, editors Philadelphia: American College of Physicians; 2003 320 pp. $45.90 ISBN 1-930513-34-8

It would be tempting to start this review with a quotation — not just because the book under scrutiny, The Quotable Osler, is a collection of sayings by one of the most quoted physicians of the last century, but because a quotation at the beginning of a piece of writing gives a certain prestige to what follows, as if the person quoted were silently nodding in agreement with whatever the writer wants to say. “A quotation is the product of a great mind transcribed for posterity so that lesser minds may justify their own mediocre ideas.” Doesn't that sound like something Osler might have said?

Actually, he didn't say that. I just made it up. Doesn't sound nearly so impressive, does it? The sentence loses its classic ring when you discover it is not decades old; without Osler's imposing shadow behind it, it sounds hollow and pompous.

Perhaps this is why so many medical articles and presentations appeal to Osler for a word of support. Who is going to credit a junior resident when she says the diagnosis of a perforated appendix can be difficult? Yet who could dispute the great Osler when he says, “In many instances the diagnosis of perforated appendix presents great difficulties” (“Typhlitis and Appendicitis”)? The benefits of having Sir William Osler in one's corner are not restricted to house staff, either. What faculty member would hesitate to refer to Osler's assertion that “the professoriate as a class ... is wretchedly underpaid” (“After Twenty-five Years,” in Aequanimitas)?

Quoting Osler can make one appear extremely well-read and in possession of the sort of memory that allows certain despicable classmates to skip class all term and then ace the final exam. The beauty of this book of quotations is that one can find just the right sentence or passage without having to wade through an entire essay. The book is divided into nine sections on broad topics such as “personal qualities” and “faith, religion, melancholy, death,” and there is an alphabetical index at the back. (Sadly, there was no entry for “quotations,” leaving me to make one up on my own.)

The Quotable Osler should prove a boon to physicians everywhere who want to add a high-brow touch to grand rounds. Osler himself loved to quote from history and literature, making essays like the immortal Aequanimitas almost inaccessible to modern readers who lack either a classical education or a heavily annotated copy. Indeed, by selecting one's quote carefully, one can cite both Osler and William Wordsworth in the same breath. As the man himself put it, “The practitioner needs culture as well as learning” (“Chauvinism in Medicine,” in Aequanimitas).

As well as serving as a repository of Oslerian sound bites, this book provides an introduction to Osler for those who are only slightly acquainted with the man and his writings. A brief biographical overview at the beginning is illuminating yet concise. For those without the time or inclination to tackle his writings in their entirety, this book provides a taste of Osler's ideas about work, devotion to one's calling and the importance of careful clinical observation. Naturally, the full development of these ideas is limited by the inherent brevity of quotations, and some readers may decide to read the complete works to deepen their understanding of what is glimpsed in only a sentence or two.

A foreword by Charles Roland, professor emeritus of medical history at McMaster University, could serve as an introduction to those devotees who have added the noun “Osleriana” to the English language and whose enthusiasm sometimes borders on the fanatical. Roland dismisses critics of Osler as either “purveyors of seriously flawed logic” or “chiefly ... those who are uncomfortable beholding apparently seamless good sense, good humor, and good intentions, presented in good English.” For the Oslerian, however, this volume may be not unlike a compendium of favourite scripture verses, useful for teaching, rebuking, correcting and training in righteousness.

For others, such as myself, this book may be rather like a box of chocolates to be sampled at leisure. It was a pleasure to recognize favourite quotes and to be struck by the wisdom of some that were less familiar. The quotations on the subject of women were interesting, and led me to ponder again Osler's attitudes in this area, a continuing stumbling-block for me despite what seem to be the efforts of Oslerians to rehabilitate his sexist image.

The section that I found the least engaging was that on “disease, specific illnesses, lifestyle, drugs.” For example, “Syphilis is common in the community, and is no respecter of age, sex or station in life” (The Principles and Practice of Medicine). Doubtless, this is (or was) true, but does it really deserve to be preserved for posterity? On the other hand, some of the clinical descriptions are strikingly original and memorable, such as Osler's depiction of the neurasthenic presenting with a written list of symptoms. Perhaps a bit more restraint in this section would have highlighted the clinical descriptions most worthy of immortality.

As the editors themselves have said, they had an abundance of riches before them and their most difficult task was to know which ones to include and which to leave out. The Quotable Osler is a charming and even inspiring book, and an important addition to any medical library. “Carefully studied, from such books come subtle influences which give stability to character and help to give a man a sane outlook on the complex problems of life” (“Sir Thomas Browne,” in An Alabama Student).

Couldn't have said it better myself.

Lara Hazelton Psychiatrist Dalhousie University Halifax, NS