Abstract
On a Sunday afternoon in July 1910 McEwan Hall, Edinburgh University's magnificent auditorium, was overflowing with visitors and students who had come to see and hear the man who had recently (1908) excited their hopes and interest during his campaign as a non-party candidate for the essentially ceremonial Lord Rectorship of the University. Politics had defeated his quest but not tarnished his image. The same could be said for William Osler's fellow candidate, the Rt Hon Winston Churchill (1864–1975), Liberal cabinet minister.
Osler (1849–1919), now at the pinnacle of his career as Regius Professor of Medicine at Oxford, previously held professorships at McGill, Pennsylvania, and Johns Hopkins but had always felt a special affinity for Edinburgh, averring ‘I tell you frankly that I would rather hold a chair in Edinburgh than in any school in the English-speaking world’. This was particularly meaningful in 1900 when he happily occupied the chair at Hopkins. It was at this time that he received a call from Edinburgh and, after much soul searching and dissatisfaction with the testimonial system required, finally offered himself as a candidate but quickly withdrew in the face of strong local pressure in Baltimore and concern over the effects of the rigorous Edinburgh winters on his health.
Osler's secular sermon at McEwan Hall, Man's Redemption of Man, was his Presidential Address at the Annual Meeting of the National Association for the Prevention of Consumption and Other Forms of Tuberculosis. The Address was also part a Memorial Service for Robert Koch (1843–1910), renowned bacteriologist and Nobel Laureate, who had died recently.
Some of the material for Osler's Edinburgh address was taken from a lecture that he gave earlier in the year to the class of Professor George Gilbert Murray (1866–1957), Regius Professor of Greek at Oxford. Murray noted ‘Every year I organize a course of Greek lectures outside the general course – Greek Medicine, Greek Astronomy, Greek Mathematics and the like, in which I invite specialists to come and lecture. Osler was always interested in this course and helped me more than once’. Murray's fellow Regius, William Osler, addressed the class on ‘The Lessons of Greek Medicine’ on 27 May 1910. The lecture was never published and Harvey Cushing (1869–1939) suggests that this was because Osler used parts of it in Man's Redemption of Man (first published in book form in 1910) but this is by no means certain as Osler was in the habit of recycling much of his historical material.
Taking his text from two verses from Isaiah, Osler began his lay sermon by noting: To man there has been published a triple gospel – of his soul, of his goods, of his body. Growing with his growth, preached and professed in a hundred different ways in various ages of the world, these gospels represent the unceasing purpose of his widening thoughts.
Of the first two gospels and without diminishing their importance, he says little and it is the third for which he reserves his rhetoric, introducing his topic by affirming: The third gospel, the gospel of his body, which brings man into relation with nature – a true evangelion, the glad tidings of a conquest besides which all others sink into insignificance – is the final conquest of nature, out of which has come man's redemption of man, the subject of which I am desirous of directing your attention.
This redemption of man, Osler emphasizes, is through the conquest of nature beginning with the triumph of Greek thought and the evolution of the scientific spirit. Osler's philhellenism, a movement that grew in popularity among the classicists of the late 19th century, transcended mere intellectual attraction and he appears to have become a spiritual Hellene. He frequently quoted Sir Henry Maine who asserted: ‘To one small people … it was given to create the principle of progress. That people was the Greek. Except the blind force of Nature nothing moves in the world which is not Greek in its origin’. Osler's ineluctable attraction to Greek philosophy and medicine is manifest throughout his works and he was subsumed by the Greek epic repeatedly referring to ‘the glory that was Greece, and the grandeur that was Rome’. He wrote poignantly: Let us come out of the murky night of the East, heavy with phantoms, into the bright daylight of the West, into the company of [Greek] men whose thoughts made our thoughts, and whose ways made our ways – men who first dared look on nature with the clear eyes of the mind.
In ‘preaching’ (as he perhaps wryly expressed it) to this capacity audience of 2500, Osler soon drew upon his fundamental identity as physician and historian to illustrate man's conquest of nature by examples of scientific and medical achievements. With much enthusiasm he spoke of the inventions of Copernicus, Kepler and Galileo, and how the growth of the experimental method, so lacking in Greek science, allowed for the rise of modern physical and biological sciences and of how chemistry and physics have enabled the control of natural elements. He told how Charles Darwin (1809–82) had so influenced human thought that man no longer looked with regret to Paradise Lost but rather to a future Paradise Regained. But the greatest glory in man's redemption he placed with the triumph of medical science, recalling that wondrous day in the amphitheatre of the Massachusetts General Hospital in October 1846 when ‘a new Prometheus gave a gift as rich as that of fire, the greatest single gift ever given to suffering humanity’ – the introduction of anaesthesia and the death of pain: Today we take for granted the silence of the operating room, but to reach this Elysium we had to travel the slow road of laborious research; which gave us first the chemical agents; and then brave hearts had to risk reputation, and even life itself in experiments, the issue of which was for long doubtful.
The growth of sanitary science is extolled and in particular the great work of Lord Lister (1827–1912) in aseptic surgery and wound healing. Osler exalts the science of preventive medicine and the control of typhus, typhoid, smallpox, yellow fever and cholera. It is here that the gentle preacher momentarily takes on the voice of the sometimes wrathful God of the Old Testament (with an overtone of humour!) as he issues his well-known challenge to the sceptics of vaccination: I would like to issue a Mount Carmel-like challenge to any ten unvaccinated priests of Baal. I will take ten selected vaccinated persons, and help in the next severe epidemic, with ten selected unvaccinated persons (if available!). I should choose three members of Parliament, three anti-vaccination doctors, if they could be found, and four anti-vaccination propagandists. And I will make this promise – neither to jeer nor jibe when they catch the disease, but to look after them as brothers; and for the three or four who are certain to die I will try to arrange funerals with all the pomp and ceremony of an anti-vaccination demonstration.
In closing, Osler returns to the central theme of the meeting, the struggle against tuberculosis, noting the great achievements in identifying its aetiology and the reduction in mortality that followed the improvement in sanitation but lamenting that it kills more people than any other disease with over 10 percent of all deaths attributable to it. He calls for renewed effort saying: A plain proposition is before the people. We know the disease – how it is caused, how it is spread, how it should be prevented, how in suitable cases it may be cured. How to make this knowledge effective is the prime reason of this conference. It is a campaign for the public; past history shows that it is a campaign of hope. The measures for stamping out seem simple on paper, present difficulties interwoven with the fabric of society, but they are not insuperable and are gradually disappearing.
Cushing with considerable perspicacity said ‘One cannot escape the feeling that Osler's greatest professional service was that of a propagandist of public health measures’.
It was not until 1943 that Selman Waksman (1888–1973) isolated streptomycin, the first of the chemotherapeutic agents that revolutionized the fight against tuberculosis. Unhappily the disease is again resurgent with the emergence of multi-drug-resistant tuberculosis (MDR-TB).
Osler's lecture was one of four given that afternoon, all in part a memorial service to Robert Koch, the centenary of whose death we mark this year. Koch was a giant of 19th century medicine, a founder (with Louis Pasteur [1822–95]) of modern microbiology whose discoveries include the anthrax bacillus (bacillus anthracis) as the cause of the disease, the tubercle bacillus (mycobacterium tuberculosis), tuberculin and the renowned ‘Koch's postulates’ to determine the pathogenic nature of a given organism. Independently in 1854 he also discovered the cholera bacillus (vibrio cholerae Pacini) being unaware of the earlier discovery of the organism by Filippo Pacini (1812–83) whose work went unrecognised.
In his consideration on man's physical redemption of man, Osler concludes with a message of hope tempered by a note of despair concerning current circumstances: The outlook for the world as represented by Mary and John and Jennie and Tom has never been so hopeful. There is no place for despondency or despair. As for the dour dyspeptics in mind and morals who sit idly croaking like ravens – let them come into the arena, let them wrestle for their flesh and blood against the principalities and powers represented by bad air and worse houses, by drink and diseases, by needless pain, and by the loss annually to the state of thousands of valuable lives – let them fight for the day when a man's life shall be more precious than gold. Now, alas! the cheapness of life is every day's tragedy.
After 100 years, Osler's message remains pertinent and the grand quest goes forward.