The Student Life (Sir William Osler)

Background: “The Student Life. A Farewell Address to Canadian and
American Medical Students” was published in several locations
in 1905, including the Canada Lancet (vol. 39, pages 121-138,
1905-06). It was reprinted in Aequanimitas (2nd edition, 1906)
and in Christopher Morley’s Modern Essays (New York,
Harcourt, Horace & Co., 1921).

EXCEPT IT be a lover, no one is more interesting as an object of study
than a student. Shakespeare might have made him a fourth in his
immortal group. The lunatic with his fixed idea, the poet with his fine
frenzy, the lover with his frantic idolatry, and the student aflame with
the desire for knowledge are of “imagination all compact.” To an
absorbing passion, a wholesouled devotion, must be joined an
enduring energy, if the student is to become a devotee of the grey-eyed
goddess to whose law his services are bound. Like the quest of
the Holy Grail, the quest of Minerva is not for all. For the one, the
pure life; for the other, what Milton calls “a strong propensity of
nature.” Here again the student often resembles the poet-he is born,
not made. While the resultant of two moulding forces, the accidental,
external conditions, and the hidden germinal energies, which produce
in each one of us national, family, and individual traits, the true
student possesses in some measure a divine spark which sets at
naught their laws. Like the Snark, he defies defInition, but there are
three unmistakable signs by which you may recognize the genuine
article from a Boojuman-an absorbing desire to know the truth, an
unswerving stead fastness in its pursuit, and an open, honest heart,
free from suspicion, guile, and jealousy.

At the outset do not be worried about 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 but 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-all. What is the student but a lover courting
a fickle mistress who ever eludes his grasp? In this very elusiveness is
brought out his second great characteristic-steadfastness of
purpose. Unless from the start the limitations incident to our frail
human faculties are frankly accepted, nothing but disappointment
awaits you. The truth is the best you can get with your best endeavour,
the best that the best men accept-with this you must learn to be
satisfied, retaining at the same time with due humility an earnest
desire for an ever larger portion. Only by keeping the mind plastic
and receptive does the student escape perdition. It is not, as Charles
Lamb remarks, that some people do not know what to do with truth
when it is offered to them, but the tragic fate is to reach, after years of
patient search, a condition of mind-blindness in which the truth is
not recognized, though it stares you in the face. This can never happen
to a man who has followed step by step the growth of a truth, and who
knows the painful phases of its evolution. It is one of the great
tragedies of life that every truth has to struggle to acceptance against
I honest but mind-blind students. Harvey knew his contemporaries
well, and for twelve successive years demonstrated the circulation of
the blood before daring to publish the facts on which the truth was
based.* Only steadfastness of purpose and humility enable the student
to shift his position to meet the new conditions in which new truths
are born, or old ones modified beyond recognition.

And, thirdly, the honest heart will keep him in touch with his
fellow students, and furnish that sense of comradeship without which
he travels an arid waste alone. I say advisedly an honest heart-the
honest head is prone to be cold and stern, given to judgment, not
mercy, and not always able to entertain that true charity which, while
it thinketh no evil, is anxious to put the best possible interpretation
upon the motives of a fellow worker. It will foster, too, an attitude of
generous, friendly rivalry untinged by the green peril, jealousy, that is
the best preventive of the growth of a bastard scientific spirit, loving
seclusion and working in a lock-and-key laboratory, as timorous of
light as is a thief.

You have all become brothers in a great society, not apprentices,
since that implies a master, and nothing should be further from the
attitude of the teacher than much that is meant in that word, used
though it be in another sense, particularly by our French brethren in
a most delightful way, signifying a bond of intellectual filiation.
A fraternal attitude is not easy to cultivate the chasm between the
chair and the bench is difficult to bridge. Two things have helped to
put up a cantilever across the gulf. The successful teacher is no longer
on a height, pumping knowledge at high pressure into passive
receptacles. The new methods have changed all this. He is no longer
Sir Oracle, perhaps unconsciously by his very manner antagonizing
minds to whose level he cannot possibly descend, but he is a senior
student anxious to help his juniors. When a simple, earnest spirit
animates a college, there is no appreciable interval between the
teacher and the taught-both are in the same class, the one a little
more advanced than the other. So animated, the student feels that he
has joined a family whose honour is his honour, whose welfare is his
own, and whose interests should be his first consideration.

The hardest conviction to get into the mind of a beginner is that
the education upon which he is engaged is not a college course, not a
medical course, but a life course, for which the work of a few years
under teachers is but a preparation. Whether you will falter and fail in
the race or whether you will be faithful to the end depends on the
training before the start, and on your staying powers, points upon
which I need not enlarge. You can all become good students, a few
may become great students, and now and again one of you will be
found who does easily and well what others cannot do at all, or very
badly, which is John Ferriar’s excellent definition of a genius.

In the hurry and bustle of a business world, which is the life of
this continent, it is not easy to train first-class students. Under present
conditions it is hard to get the needful seclusion, on which account it
is that our educational market is so full of wayside fruit. I have always
been much impressed by the advice of St. Chrysostom: “Depart from
the highway and transplant thyself in some enclosed ground, for it is
hard for a tree which-stands…by the wayside to keep her fruit till it be ripe.”
The dilettante is abroad in the land, the man who is always
venturing on tasks for which he is imperfectly equipped, a habit of
mind fostered by the multiplicity of subjects of the curriculum; and
while many things are studied, few are studied thoroughly. Men will
not take time to get to the heart of a matter. After all, concentration is
the price the modern student pays for success. Thoroughness is the
most difficult habit to acquire, but it is the pearl of great price, worth
all the worry and trouble of the search. The dilettante lives an easy,
butterfly life, knowing nothing of the toil and labour with which the
treasures of knowledge are dug out of the past, or wrung by patient
research in the laboratories. Take, for example, the early history of this
country-how easy for the student of the one type to get a smattering,
even a fairly full acquaintance. with the events of the French and
Spanish settlements. Put an original document before him, and it
might as well be Arabic. What we need is the other type, the man who
knows the records, who, with a broad outlook and drilled in what may
be called the embryology of history, has yet a powerful vision for the
minutiae of life. It is these kitchen and backstair men who are to be
encouraged, the men who know the subject in hand in all possible
relationships. Concentration has its drawbacks. It is possible. to
become so absorbed in the problem of the “enclitic o~:’ or the
structure of the flagella of the Trichomonas, or of the toes of the
prehistoric horse, that the student loses the sense of proportion in his
work, and even wastes a lifetime in researches which are valueless
because not in touch with current knowledge. You remember poor
Casaubon, in Middlemarch, whose painful scholarship was lost on this
account. The best preventive to this is to get denationalized early. The
true student is a citizen of the world, the allegiance of whose soul, at
any rate, is too precious to be restricted to a single country. The great
minds, the great works transcend all limitations of time, of language,
and of race, and the scholar can never feel initiated into the company
of the elect until he can approach all of life’s problems from the
cosmopolitan standpoint. I care not in what subject he may work, the
full knowledge cannot be reached without drawing on supplies from
lands other than his own-French, English, German, American,
Japanese, Russian, Italian-there must be no discrimination by the
loyal student, who should willingly draw from any and every source
with an open mind and a stern resolve to render unto all their dues.
I care not on what stream of knowledge he may embark, follow up its
course, and the rivulets that feed it flow from many lands. If the work
is to be effective he must keep in touch with scholars in other
countries. How often has it happened that years of precious time have
been given to a problem already solved or shown to be insoluble,
because of the ignorance of what had been done elsewhere. And it is
not only book knowledge and journal knowledge, but a knowledge of
men that is needed. The student will, if possible, see the men in other
lands. Travel not only widens the vision and gives certainties in place
of vague surmises, but the personal contact with foreign workers
enables him to appreciate better the failings or successes in his own
line of work, perhaps to look with more charitable eyes on the work
of some brother whose limitations and opportunities have been more
restricted than his own. Or, in contact with a mastermind, he may
take fire, and the glow of the enthusiasm may be the inspiration of his
life. Concentration must then be associated with large views on the
relation of the problem, and a knowledge of its status elsewhere;
otherwise it may land him in the slough of a specialism so narrow that
is has depth and no breadth, or he may be led to make what he
believes to be important discoveries, but which have long been
current coin in other lands. It is sad to think that the day of the great
polymathic student is at an end; that we may, perhaps, never again see
a Scaliger, a Haller, or a Humboldt-men who took the whole field of
knowledge for their domain and viewed it as from a pinnacle. And yet
a great specializing generalist may arise, who can tell? Some
twentieth-century Aristotle may be now tugging at his bottle, as little
dreaming as are his parents or his friends of a conquest of the mind,
beside which the wonderful victories of the Stagirite will look pale.
The value of a really great student to the country is equal to half a
dozen grain elevators or a new transcontinental railway. He is a
commodity singularly fickle and variable, and not to be grown to
order. So far as his advent is concerned there is no telling when or
where he may arise. The conditions seem to be present even under the
most unlikely externals. Some of the greatest students this country
has produced have come from small villages and country places. It is
impossible to predict from a study of the environment, which a
“strong propensity of nature,” to quote Milton’s phrase again, will
easily bend or break.

The student must be allowed full freedom in his work,
undisturbed by the utilitarian spirit of the Philistine, who cries, Cui
bono? and distrusts pure science. The present remarkable position in
applied science and in industrial trades of all sorts has been made
possible by men who did pioneer work in chemistry, in physics,
in biology, and in physiology, without a thought in their researches of
any practical application. The members of this higher group of
productive students are rarely understood by the common spirits,
who appreciate as little their unselfish devotion as their unworldly
neglect of the practical side of the problems.

Everywhere now the medical student is welcomed as an honoured
member of the guild. There was a time, I confess, and it is within
memory of some of us, when, like Falstaff, he was given to “taverns
and sack and wine and metheglins, and to drinkings and swearings
and starings, pribbles and prabbles”; but all that has changed with the
curriculum, and the “Meds” now roar you as gently as the “Theologs.”
On account of the peculiar character of the subject-matter of your
studies, what I have said upon the general life and mental attitude of
the student applies with tenfold force to you. Man, with all his mental
and bodily anomalies and diseases-the machine in order, the
machine in disorder, and the business yours to put it to rights.
Through all the phases of its career this most complicated mechanism
of this wonderful world will be the subject of our study and of your
care-the naked, new-born infant, the artless child, the lad and the
lassie just aware of the tree of knowledge overhead, the strong man in
the pride of life, the woman with the benediction of maternity on her
brow, and the aged, peaceful in the contemplation of the past. Almost
everything has been renewed in the science and in the art of medicine,
but all through the long centuries there has been no variableness or
shadow of change in the essential features of the life which is our
contemplation and our care. The sick love-child of Israel’s sweet
singer, the plague-stricken hopes of the great Athenian statesman,
Elpenor bereft of his beloved Artemidora, and “Tully’s daughter
mourned so tenderly:’ are not of any age or any race-they are here
with us today, with the Hamlets, the Ophelias, and the Lears. 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. 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, toil-worn 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. The humorous side is really almost as frequently
turned towards him as the tragic. Lift up one hand to heaven and
thank your stars if they have given you the proper sense to enable you
to appreciate the inconceivably droll situations in which we catch our
fellow creatures. Unhappily, this is one of the free gifts of the gods,
unevenly distributed, not bestowed on all, or on all in equal portions.
In undue measure it is not without risk, and in any case in the doctor
is is better appreciated by the eye than expressed on the tongue.
Hilarity and good humour, a breezy cheerfulness, a nature “sloping
toward the southern side;’ as Lowell has it, help enormously both in
the study and in the practice of medicine. To many of a sombre and
sour disposition it is hard to maintain good spirits amid the trials and
tribulations of the day, and yet it is an unpardonable mistake to go
about among patients with a long face.

Divide your attentions equally between books and men. The
strength of the student of books is to sit still-two or three hours at a
stretch-eating the heart out of a subject with pencil and notebook in
hand, determined to master the details and intricacies, focussing all
your energies on its difficulties. Get accustomed to test all sorts of
book problems and statements for yourself, and take as little as
possible on trust. The Hunterian “Do not think, but try” attitude of
mind is the important one to cultivate. The question came up one
day, when discussing the grooves left on the nails after fever, how long
it took for the nail to grow out, from root to edge. A majority of the
class had no further interest; a few looked it up in books; two men
marked their nails at the root with nitrate of silver, and a few months
later had positive knowledge on the subject. They showed the proper
spirit. The little points that come up in your reading try to test for
yourselves. With one fundamental difficulty many of you will have to
contend from the outset-a lack of proper preparation for really hard
study. No one can have watched successive groups of young men pass
through the special schools without profoundly regretting the
haphazard, fragmentary character of their preliminary education. It
does seem too bad that we cannot have a student in his eighteenth
year sufficiently grounded in the humanities and in the sciences
preliminary to medicine-but this is an educational problem upon
which only a Milton or a Locke could discourse with profit.
With pertinacity you can overcome the preliminary defects and once
thoroughly interested, the work in books becomes a pastime. A serious
drawback in the student life is the self-consciousness, bred of too close
devotion to books. A man gets shy, “dysopic;’ as old Timothy Bright
calls it, and shuns the looks of men, and blushes like a girl.

The strength of a student of men is to travel-to study men, their
habits, character, mode of life, their behaviour 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. It is not easy for everyone to reach a happy medium, and the distinction
between a proper self-confidence and “cheek’ particularly
in junior students, is not always to be made. The latter is met with
chiefly among the student pilgrims who, in travelling down the
Delectable Mountains, have gone astray and have passed to the left
hand, where lieth the country of Conceit, the country in which you
remember the brisk lad Ignorance met Christian.

I wish we could encourage on this continent among our best
students the habit of wandering. I do not know that we are quite
prepared for it, as there is still great diversity in the curricula, even
among the leading schools, but it is undoubtedly a great advantage to
study under different teachers, as the mental horizon is widened and
the sympathies enlarged. The practice would do much to lessen that
narrow “I am of Paul and I am of Apollos” spirit which is hostile to
the best interests of the profession.

There is much that I would like to say on the question of work,
but I can spare only a few moments for a word or two. Who will
venture to settle upon so simple a matter as the best time for work?
One will tell us there is no best time; all are equally good; and truly,
all times are the same to a man whose soul is absorbed in some great
problem. The other day I asked Edward Martin, the well-known
story-writer, what time he found best for work. “Not in the evening,
and never between meals!” was his answer, which may appeal to some
of my hearers. One works best at night; another, in the morning; a
majority of the students of the past favour the latter. Erasmus, the
great exemplar, says, “Never work at night; it dulls the brain and hurts
the health.” One day, going with George Ross through Bedlam,
Dr. Savage, at that time the physician in charge, remarked upon two
great groups of patients-those who were depressed in the morning
and those who were cheerful, and he suggested that the spirits rose
and fell with the bodily temperature-those with very low morning
temperatures were depressed, and vice versa. This, I believe, expresses
a truth which may explain the extraordinary difference in the habits
of students in this matter of the time at which the best work can be
done. Outside of the asylum there are also the two great types, the
student-lark who loves to see the sun rise, who comes to breakfast
with a cheerful morning face, never so “fit” as at 6 a. m. We all know
the type. What a contrast to the student-owl with his saturnine
morning face, thoroughly unhappy, cheated by the wretched breakfast
bell of the two best hours of the day for sleep, no appetite, and
permeated with an unspeakable hostility to his vis-a.-vis, whose
morning garrulity and good humour are equally offensive. Only
gradually, as the day wears on and his temperature rises, does he
become endurable to himself and to others. But see him really awake
at 10 p.m. while our blithe lark is in hopeless coma over his books,
from which it is hard to rouse him sufficiently to get his boots off for
bed, our lean owl-friend, Saturn no longer in the ascendant, with
bright eyes and cheery face, is ready for four hours of anything you
wish: deep study, or
Heart-affluence in discursive talk,
and by 2 a. m. he will undertake to unsphere the spirit of Plato
In neither a virtue, in neither a fault we must recognize these two
types of students, differently constituted, owing possibly- though I
have but little evidence for the belief-to thermal peculiarities.

II

In the days of probation the student’s life may be lived by each
one of you in its fullness and in its joys, but the difficulties arise in the
break which follows departure from college and the entrance upon
new duties. Much will now depend on the attitude of mind which has
been encouraged. If the work has been for your degree, if the diploma
has been its sole aim and object, you will rejoice in a freedom from
exacting and possibly unpleasant studies, and with your books you
will throwaway all thoughts of further systematic work. On the other
hand, with good habits of observation you may have got deep enough
into the subject to feel that there is still much to be learned, and if you
have had ground into you the lesson that the collegiate period is only
the beginning of the student life, there is a hope that you may enter
upon the useful career of the student-practitioner. Five years, at least,
of trial await the man after parting from his teachers, and entering
upon an independent course-years upon which his future depends,
and from which his horoscope may be cast with certainty. It is all the
same whether he settles in a country village or goes on with hospital
and laboratory work; whether he takes a prolonged trip abroad; or
whether he settles down in practice with a father or a friend-these
five waiting years fix his fate so far as the student life is concerned.
Without any strong natural propensity to study, he may feel such a
relief after graduation that the effort to take to books is beyond his
mental strength, and a weekly journal with an occasional textbook
furnish pabulum enough, at least to keep his mind hibernating. But ten
years later he is dead mentally, past any possible hope of galvanizing
into life as a student, fit to do a routine practice, often a capable,
resourceful man, but without any deep convictions, and probably
more interested in stocks or in horses than in diagnosis or therapeutics.
But this is not always the fate of the student who finishes his work on
Commencement Day. There are men full of zeal in practice who give
good service to their fellow creatures, who have not the capacity or
the energy to keep up with the times. While they have lost interest in
science, they are loyal members of the profession, and appreciate their
responsibilities as such. That fateful first lustrum ruins some of our
most likely material. Nothing is more trying to the soldier than
inaction, to mark time while the battle is raging all about him; and
waiting for practice is a serious strain under which many yield. In the
cities it is not so hard to keep up: there is work in the dispensaries and
colleges, and the stimulus of the medical societies; but in smaller
towns and in the country it takes a strong man to live through the
years of waiting without some deterioration. I wish the custom of
taking junior men as partners and assistants would grow on this
continent. It has become a necessity, and no man in large general
practice can do his work efficiently without skilled help. How
incalculably better for the seniors, how beneficial to the patients, how
helpful in every way if each one of you, for the first five or ten years,
was associated with an older practitioner, doing his night work, his
laboratory work, his chores of all sorts. You would, in this way, escape
the chilling and killing isolation of the early years, and amid congenial
surroundings you could, in time, develop into that flower of our
calling-the cultivated general practitioner. May this be the destiny of
a large majority of you! Have no higher ambition! You cannot reach
any better position in a community; the family doctor is the man
behind the gun, who does our effective work. That his life is hard and
exacting; that he is underpaid and overworked; that he has but little
time for study and less for recreation-these are the blows that may
give finer temper to his steel, and bring out the nobler elements in his
character. What lot or portion has the general practitioner in the
student life? Not, perhaps, the fruitful heritage of Judah or Benjamin
but he may make of it the goodly portion of Ephraim. A man with
powers of observation, well trained in the wards, and with the strong
natural propensity to which I have so often referred, may live the ideal
student life, and even reach the higher levels of scholarship. Adams, of
Banchory (a little Aberdeenshire village), was not only a good
practitioner and a skilful operator, but he was an excellent naturalist.
This is by no means an unusual or remarkable combination, but
Adams became, in addition, one of the great scholars of the
profession. He had a perfect passion for the classics, and amid a very
exacting practice found time to read “almost every Greek work which
has come down to us from antiquity, except the ecclesiastical writers.”
He translated the works of Paulus Aegineta, the works of Hippocrates,
and the works of Aretaeus, all of which are in the Sydenham Society’s
publications, monuments of the patient skill and erudition of a
Scottish village doctor, an incentive to everyone of us to make better
use of our precious time.

Given the sacred hunger and proper preliminary training, the
student-practitioner requires at least three things with which to
stimulate and maintain his education, a notebook, a library, and a
quinquennial braindusting. I wish I had time to speak of the value of
note-taking. You can do nothing as a student in practice without it.
Carry a small notebook which will fit into your waistcoat pocket, and
never ask a new patient a question without notebook and pencil in
hand. After the examination of a pneumonia case two minutes will
suffice to record the essentials in the daily progress. Routine and
system when once made a habit, facilitate work, and the busier you are
the more time you will have to make observations after examining a
patient. Jot a comment at the end of the notes: “clear case;’ “ca
illustrating obscurity of symptoms;’ “error in diagnosis;’ etc. The
making of observations, may become the exercise of a jackdaw trick,
like the craze which so many of us have to collect articles of all sorts.
The study of the cases, the relation they bear to each other and to the
cases in literature-here comes in the difficulty. Begin early to make a
threefold category-clear cases, doubtful cases, mistakes. And learn to
play the game fair, no self-deception, no shrinking from the truth;
mercy and consideration for the other man, but none for yourself,
upon whom you have to keep an incessant watch. You remember
Lincoln’s famous mot about the impossibility of fooling all of the
people all the time. It does not hold good for the individual who can
fool himself to his heart’s content all of the time. If necessary, be cruel;
use the knife and the cautery to cure the intumescence and moral
necrosis which you will feel in the posterior parietal region, in Gall
and Spurzheim’s centre of self-esteem, where you will find a sore spot
after you have made a mistake in diagnosis. It is only by getting your
cases grouped in this way that you can make any real progress in your
post-collegiate education; only in this way can you gain wisdom with
experience. It is a common error to think that the more a doctor sees
the greater his experience and the more he knows. No one ever drew
a more skilful distinction than Cowper in his oft-quoted lines, which
I am never tired of repeating in a medical audience:

Knowledge and wisdom, far from being one,
Have oft-times no connexion. Knowledge dwells
In heads replete with thoughts of other men;
Wisdom in minds attentive to their own.
Knowledge is proud that he has learned so much;
Wisdom is humble that he knows no more.

What we call sense or wisdom is knowledge, ready for use, made
effective, and bears the same relation to knowledge itself that 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. One of the most delightful sayings
of antiquity is the remark of Heraclitus upon his predecessors-that
they had much knowledge but no sense-which indicates that the
noble old Ephesian had a keen appreciation of their difference; and
the distinction, too, is well drawn by Tennyson in the oft-quoted line:
Knowledge comes but wisdom lingers.

Of the three well-stocked rooms which it should be the ambition
of every young doctor to have in his house, the library, the laboratory,
and the nursery-books, balances, and bairns-as he may not achieve
all three, I would urge him to start at any rate with the books and the
balances. A good weekly and a good monthly journal to begin with,
and read them. Then, for a systematic course of study, supplement
your college textbooks with the larger systems-Allbutt or
Nothnagel – a system of surgery, and, as your practice increases, make
a habit of buying a few special monographs every year. Read with two
objects: first, to acquaint yourself with the current knowledge on the
subject and the steps by which it has been reached; and secondly, and
more important, read to understand and analyse your cases. To this
line of work we should direct the attention of the student before he
leaves the medical school, pointing in specific cases just where the best
articles are to be found, sending him to the Index Catalogue-that
marvellous storehouse, every page of which is interesting and the very
titles instructive. Early learn to appreciate the differences between the
descriptions of disease and the manifestations of that disease in an
individual-the difference between the composite portrait and one of
the component pictures. By exercise of a little judgment you can
collect at moderate cost a good working library. Try, in the waiting
years, to get a clear idea of the history of medicine. Read Foster’s
Lectures on the History of Physiology and Baas’s History of Medicine.
Get the “Masters of Medicine” Series, and subscribe to the Library and
Historical Journal.*

Every day do some reading or work apart from your profession.
I fully realize, no one more so, how absorbing is the profession of
medicine; how applicable to it is what Michelangelo says: “There are
sciences which demand the whole of a man, without leaving the least
portion of his spirit free for other distraction”; but you will be a better
man and not a worse practitioner for an avocation. I care not what it
may be; gardening or farming, literature or history or bibliography,
anyone of which will bring you into contact with books. (I wish that
time permitted me to speak of the other two rooms which are really
of equal importance with the library, but which are more difficult to
equip, though of co-ordinate value in the education of the head, the
heart, and the hand.) The third essential for the practitioner as a
student is the quinquennial brain-dusting, and this will often seem to
him the hardest task to carry out. Every fifth year, back to the hospital,
back to the laboratory, for renovation, rehabilitation, rejuvenation,
reintegration, resuscitation, etc. Do not forget to take the notebooks
with you, or the sheets, in three separate bundles, to work over. From
the very start begin to save for the trip. Deny yourself all luxuries for
it; shut up the room you meant for the nursery-have the definite
determination to get your education thoroughly well started; if you
are successful you may, perhaps, have enough saved at the end of three
years to spend six weeks in special study; or in five years you may
be able to spend six months. Hearken not to the voice of old
“Dr. Hayseed,” who tells you it will ruin your prospects, and that he
“never heard of such a thing” as a young man, not yet five years in
practice, taking three months’ holiday. To him it seems preposterous.
Watch him wince when you say it is a speculation in the only gold
mine in which the physician should invest -Grey Cortex! What about
the wife and babies, if you have them? Leave them! Heavy as are your
responsibilities to those nearest and dearest, they are outweighed by
the responsibilities to yourself, to the profession, and to the public. Like
Isaphaena, the story of whose husband-ardent, earnest soul, peace to
his ashes! -I have told in the little sketch of An Alabama Student, your
wife will be glad to bear her share in the sacrifice you make.

With good health and good habits the end of the second lustrum
should find you thoroughly established-all three rooms well
furnished, a good stable, a good garden, no mining stock, but a life
insurance, and, perhaps, a mortgage or two on neighbouring farms.
Year by year you have dealt honestly with yourself; you have put
faithfully the notes of each case into their proper places, and you will
be gratified to find that, though the doubtful cases, and mistakes still
make a rather formidable pile, it has grown relatively smaller. You
literally”own” the countryside, as the expression is. All the serious and
dubious cases come to you, and you have been so honest in the frank
acknowledgement of your own mistakes, and so charitable in the
contemplation of theirs, that neighbouring doctors, old and young,
are glad to seek your advice. The work, which has been very heavy, is
now lightened by a good assistant, one of your own students, who
becomes in a year or so your partner. This is not an overdrawn picture,
and it is one which may be seen in many places except, I am sorry to
say, in the particular as to the partner. This is the type of man we need
in the country districts and the smaller towns. He is not a whit too
good to look after the sick, not a whit too highly-educated-impossible!
And with an optimistic temperament and a good digestion he is
the very best product of our profession, and may do more to stop
quackery and humbuggery, inside and outside of the ranks, than
could a dozen prosecuting county attorneys. Nay, more! such a doctor
may be a daily benediction in the community-a strong, sensible,
whole-souled man, often living a life of great self-denial, and always
of tender sympathy, worried neither by the vagaries of the well nor by
the testy waywardness of the sick, and to him, if to any, may come
(even when he knows it not) the true spiritual blessing-that
“blessing which maketh rich and addeth no sorrow.”

The danger in such a man’s life comes with prosperity. He is safe
in the hard-working day, when he is climbing the hill, but once
success is reached, with it come the temptations to which many
succumb. Politics has been the ruin of many country doctors, and
often of the very best, of just such a good fellow as he of whom I have
been speaking. He is popular; he has a little money; and he, if
anybody, can save the seat for the party! When the committee leaves
you, take the offer under consideration, and if in the ten or twelve
years you have kept on intimate terms with those friends of your
student days, Montaigne and Plutarch, you will know what answer to
return. If you live in a large town, resist the temptation to open a
sanatorium. It is not the work for a general practitioner, and there are
risks that you may sacrifice your independence and much else besides.
And, thirdly, resist the temptation to move into a larger place. In a
good agricultural district, or in a small town, if you handle your
resources aright, taking good care of your education, of your habits,
and of your money, and devoting part of your energies to the support
of the societies, etc., you may reach a position in the community of
which any man may be proud. There are country practitioners among
my friends with whom I would rather change places than with any in
our ranks, men whose stability of character and devotion to duty
make one proud of the profession.

Curiously enough, the student-practitioner may find studiousness
to be a stumbling-block in his career. A bookish man may never
succeed; deep-versed in books, he may not be able to use his
knowledge to practical effect; or, more likely, his failure is not because
he has studied books much, but because he has not studied men
more. He has never got over that shyness, that diffidence, against
which I have warned you. I have known instances in which this malady
was incurable; in others I have known a cure effected not by the
public, but by the man’s professional brethren, who, appreciating his
work, have insisted upon utilizing his mental treasures. It is very hard
to carry student habits into a large city practice; only zeal, a fiery
passion, keeps the flame alive, smothered as it is so apt to be by the
dust and ashes of the daily routine. A man may be a good student who
reads only the book of nature. Such a one* I remember in the early
days of my residence in Montreal-a man whose devotion to patients
and whose kindness and skill quickly brought him an enormous
practice. Reading in his carriage and by lamplight at Lucina’s bedside,
he was able to keep well informed; but he had an insatiable desire to
know the true inwardness of a disease, and it was in this way I came
into contact with him. Hard pushed day and night, yet he was never
too busy to spend a couple of hours with me searching for data which
had not been forthcoming during life, or helping to unravel the
mysteries of a new disease, such as pernicious anaemia.

III

The student-specialist has to walk warily, as with two advantages
there are two great dangers against which he has constantly to be on
guard. In the bewildering complexity of modern medicine it is a relief
to limit the work of a life to a comparatively narrow field which can
be thoroughly tilled. To many men there is a feeling of great
satisfaction in the mastery of a small department, particularly one in
which technical skill is required. How much we have benefited from
this concentration of effort in dermatology, laryngology, opthalmology,
and in gynecology! Then, as a rule, the specialist is a free man, with
leisure or, at any rate, with some leisure; not the slave of the public,
with the incessant demands upon him of the general practitioner. He
may live a more rational life, and has time to cultivate his mind, and
he is able to devote himself to public interests and to the welfare of his
professional brethren, on whose suffrages he so largely depends. How
much we are indebted in the larger cities to the disinterested labours
of this favoured class the records of our libraries and medical societies
bear witness. The dangers do not come to the strong man in a
speciality, but to the weak brother who seeks in it an easier field in
which specious garrulity and mechanical dexterity may take the place
of solid knowledge. All goes well when the man is larger than his
speciality and controls it, but when the speciality runs away with the
man there is disaster, and a topsy-turvy condition which, in every
branch, has done incalculable injury. Next to the danger from small
men is the serious risk of the loss of perspective in prolonged and
concentrated effort in a narrow field. Against this there is but one
safeguard-the cultivation of the sciences upon which the speciality
is based. The student-specialist may have a wide vision-no student
wider-if he gets away from the mechanical side of the art, and keeps
in touch with the physiology and pathology upon which his art
depends. More than any other of us, he needs the lessons of the
laboratory, and wide contact with men in other departments may
serve to correct the inevitable tendency to a narrow and perverted
vision, in which the life of the anthill is mistaken for the world at large.
Of the student-teacher every faculty affords examples in varying
degrees. It goes without saying that no man can teach successfully
who is not at the same time a student. Routine, killing routine, saps
the vitality of many who start with high aims, and who, for years,
strive with all their energies against the degeneration which it is so
prone to entail. In the smaller schools isolation, the absence of
congenial spirits working at the same subject, favours stagnation, and
after a few years the fires of early enthusiasm no longer glow in the
perfunctory lectures. In many teachers the ever-increasing demands
of practice leave less and less time for study, and a first-class man may
lose touch with his subject through no fault of his own, but through
an entanglement in outside affairs which he deeply regrets yet cannot
control. To his five natural senses the student-teacher must add two
more-the sense of responsibility and the sense of proportion. Most
of us start with a highly developed sense of the importance of the
work, and with a desire to live up to the responsibilities entrusted to
us. Punctuality, the class first, always and at all times; the best that a
man has in him, nothing less; the best the profession has on the
subject, nothing less; fresh energies and enthusiasm in dealing with
dry details; animated, unselfish devotion to all alike; tender
consideration for his assistants-these are some of the fruits of a keen
sense of responsibility in a good teacher. The sense of proportion is
not so easy to acquire, and much depends on the training and on the
natural disposition. There are men who never possess it; to others it
seems to come naturally. In the most careful ones it needs constant
cultivation -nothing over-much should be the motto of every teacher.
In my early days I came under the influence of an ideal student-teacher,
the late Palmer Howard, of Montreal. If you ask what manner
of man he was, read Matthew Arnold’s noble tribute to his father in
his well-known poem, Rugby Chapel. When young, Dr. Howard had
chosen a path-“path to a clear-purposed goal;’ and he pursued it
with unswerving devotion. With him the study and the teaching of
medicine were an absorbing passion, the ardour of which neither the
incessant and ever-increasing demands upon his time nor the growing
years could quench. When I first, as a senior student, came into
intimate contact with him in the summer of 1871, the problem of
tuberculosis was under discussion, stirred up by the epoch-making
work of Villemin and the radical views of Niemeyer. Every lung lesion
at the Montreal General Hospital had to be shown to him, and I got
my first-hand introduction to Laennec, to Graves, and to Stokes, and
became familiar with their works. No matter what the hour, and it
usually was after 10 p.m., I was welcome with my bag, and if Wilks
and Moxon, Virchow, or Rokitanski gave us no help, there were the
Transactions of the Pathological Society and the big Dictionnaire of
Dechambre. An ideal teacher because a student, ever alert to the new
problems, an indomitable energy enabled him in the midst of an
exacting practice to maintain an ardent enthusiasm, still to keep
bright the fires which he had lighted in his youth. Since those days I
have seen many teachers, and I have had many colleagues, but I have
never known one in whom was more happily combined a stern sense
of duty with the mental freshness of youth.

But as I speak, from out the memory of the past there rises before
me a shadowy group, a long line of students whom I have taught and
loved, and who have died prematurely-mentally, morally, or bodily.
To the successful we are willing and anxious to bring the tribute of
praise, but none so poor to give recognition to the failures. From one
cause or another, perhaps because when not absorbed in the present,
my thoughts are chiefly in the past, I have cherished the memory of
many young men whom I have loved and lost. Io victis: let us
sometimes sing of the vanquished. Let us sometimes think of those
who have fallen in the battle of life, who have striven and failed, who
have failed even without the strife. How many have I lost from the
student band by mental death, and from so many causes-some
stillborn from college, others dead within the first year of infantile
marasmus, while mental rickets, teething, tabes, and fits have carried
off many of the most promising minds! Due to improper feeding
within the first five fateful years, scurvy and rickets head the mental
mortality bills of students. To the teacher-nurse it is a sore
disappointment to find at the end of ten years so few minds with the
full stature, of which the early days gave promise. Still, so widespread
is mental death that we scarcely comment upon it in our friends. The
real tragedy is the moral death which, in different forms, overtakes so
many good fellows who fall away from the pure, honourable, and
righteous service of Minerva into the idolatry of Bacchus, ofVenus, or
of Circe. Against the background of the past these tragedies stand out,
lurid and dark, and as the names and faces of myoid boys recur (some
of them my special pride), I shudder to think of the blighted hopes
and wrecked lives, and I force my memory back to those happy days
when they were as you are now, joyous and free from care, and I think
of them on the benches, in the laboratories, and in the wards-and
there I leave them. Less painful to dwell upon, though associated with
a more poignant grief, is the fate of those whom physical death has
snatched away in the bud or blossom of the student life. These are
among the tender memories of the teacher’s life, of which he does not
often care to speak, feeling with Longfellow that the surest pledge of
their remembrance is “the silent homage of thoughts unspoken.” As I
look back it seems now as if the best of us had died, that the brightest
and the keenest had been taken and the more commonplace among
us had been spared. An old mother, a devoted sister, a loving brother,
in some cases a brokenhearted wife, still pay the tribute of tears for the
untimely ending of their high hopes, and in loving remembrance I
would mingle mine with theirs. What a loss to our profession have
been the deaths of such true disciples as Zimmerman, of Toronto; of
Jack Cline and of R. L. MacDonnell, of Montreal; of Fred Packard
and of Kirkbride, of Philadelphia; of Livingood, of Lazear, of
Oppenheimer, and of Oechsner, in Baltimore-cut off with their
leaves still in the green, to the inconsolable grief of their friends!
To each one of you the practice of medicine will be very much as
you make it-to one a worry, a care, a perpetual annoyance; to
another, a daily joy and a life of as much happiness and usefulness as
can well fall to the lot of man. In the student spirit you can best fulfIl
the high mission of our noble calling-in his humility, conscious of
weakness, while seeking strength; in his confidence, knowing the
power, while recognizing the limitations of his art, in his pride in the
glorious heritage from which the greatest gifts to man have been
derived; and in his sure and certain hope that the future holds for us
richer blessings than the past.

Discussion Questions:

1. Did any of Sir Osler’s statements resonate with you personally? Reflect on a
previous experience that may connect to this statement.

2. Sir Osler discusses the importance of developing practical skills as well as ‘bookishness’
and ‘book wisdom’. Are you satisfied with the balance of your own medical education?
What steps can you do to improve this balance if you are not satisfied?

3. Sir Osler emphasizes the importance of being a lifelong learner. He describes medical education
as a ‘life course’. What are some challenges that you may face as a lifelong learner?

4. Many qualities of a good physician are discussed in this piece. Of these, which do you feel is your best quality? Which quality would you like to improve on?

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