Aequanimitas

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Aequanimitas
Aequanimitas cover.jpg
Aequanimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine, 1914.
Author Sir William Osler
LanguageEnglish
Publisher
  • P. Blakiston's Son & Co. (Philadelphia)
  • H. K. Lewis (London)
Publication date
1st 1889

Aequanimitas was one of Sir William Osler's most famous essays, delivered to new doctors in 1889 as his farewell address at the Pennsylvania School of Medicine, prior to his transfer to Johns Hopkins. It was published in the same year and in 1904 appeared in his collection of essays titled Aequanimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine. A second edition was produced in 1906, and a third in 1932. In the essay, Osler advocates two qualities "imperturbability" and "equanimity", which he defined as "coolness and presence of all circumstances". [1]

Contents

Between 1932 and 1953, Eli Lilly & Company distributed more than 150,000 copies of the third edition to medical graduates.

Through the years Osler's ideal of "Aequanimitas" has been analysed by various academics. Daniel Sokol, medical ethics and law expert, reasons in the British Medical Journal in 2007, that whatever interpretation is made of Aequanimitas, it "tackles head-on a timeless question: what makes a good doctor?". [2] [3]

Publication

The essay

Aequanimitas was an essay by Sir William Osler, delivered to new doctors on 1 May 1889 as his farewell address at the Pennsylvania School of Medicine. [2] [4] It was published in the same year. [1]

Aequanimitas refers to staying calm and composed. [3] [5] In the essay, Osler advocates two qualities "imperturbability" and "equanimity", which he defined as "coolness and presence of mind under all circumstances". [1]

1904 and 1906

In 1904, Aequanimitas was published by H. K. Lewis in Aequanimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine, a collection of his essays. [1] A second edition was produced in 1906 by P. Blakiston's Son & Co. in Philadelphia, [6] and H.K. Lewis in London. [7]

Eli Lilly & Company

Following Osler's death, an expanded version of the book appeared as a third edition in 1932. [8] [9] It omits the essays "A Way of life", "A man's redemption of man" and "The old humanities and new science", and became more widely available than the previous editions. [2]

Between 1932 and 1953, Eli Lilly & Company distributed more than 150,000 copies of the third edition to medical graduates. [8] [10] These volumes were not all the same. [8] There were at least seven different publications in English and one in each of Spanish and Portuguese. [8] There were variations in the type of paper, book size, title page, information on the spine, and printing information. [8] There were also differences in the congratulatory letters from Eli Lilly, placed in each book. [8]

Interpretation

Through the years Osler's ideal of "Aequanimitas" has been criticised on the grounds that it excludes empathy, sympathy, or emotional resonance with patients. [2] One of the strongest critiques was presented by Gerald Weissmann in his book The Woods Hole Cantata (1985). [11] It had been published the previous year in Hospital Practice, as an essay entitled "Against Aequanimitas". [12] Weissmann's assessment of Osler led him to conclude that Osler's advice held "the public tone of the academic snob". [12] After reciting Osler's description of "imperturbability", Weissmann held the opinion that "the Oslerian view is not only devoid of passion, but [also] of joy". [12]

Osler however, did not that day in 1889 intend to give the graduating medical students comprehensive advice about how to practice medicine. [13] His involvement was a relatively small part of a busy commencement programme, in which the principal honoree was the retiring professor of surgery, David Hayes Agnew ("Agnew day"). [2] [13] Charles S. Bryan later explains that Osler deliberately confined his remarks to two of the qualities the students would need in practice. Osler emphasized the need to balance "head" and "heart". [14] In his interpretation the balance varies according to the nature of the task at hand and Aequanimitas is best understood as emotions appropriate to the circumstances rather than as indifference as suggested by the critiques. [14]

Daniel Sokol, medical ethics and law expert, reasons in the British Medical Journal in 2007, that whatever interpretation is made of Aequanimitas, it "tackles head-on a timeless question: what makes a good doctor?". [2] [3]

Legacy

Japan's prime minister's physician, Shigeaki Hinohara, was given a copy of Aequanimitas in the early days of the United States Military Occupation of Japan after the Second World War. Hinohara subsequently translated the title address and paraphrased the rest. In 1948, he published a book entitled The Life of Dr. Osler—Pioneer of American Medicine. [15]

The term aequanimitas has become a motto. [16] At Johns Hopkins, it appears on ties and scarves worn by the housestaff, [16] and was mentioned in the television programme House . [16]

A similar concept to aequanimitas was addressed by Steve Jobs at Stanford University in 2005. [17] Daniel Goleman's notion of emotional intelligence has been described as a modern variation of aequanimitas. [17]

Related Research Articles

<span class="mw-page-title-main">William Osler</span> Canadian physician and co-founder of Johns Hopkins Hospital (1849–1919)

Sir William Osler, 1st Baronet, was a Canadian physician and one of the "Big Four" founding professors of Johns Hopkins Hospital. Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training. He has frequently been described as the Father of Modern Medicine and one of the "greatest diagnosticians ever to wield a stethoscope". In addition to being a physician he was a bibliophile, historian, author, and renowned practical joker. He was passionate about medical libraries and medical history, having founded the History of Medicine Society, at the Royal Society of Medicine, London. He was also instrumental in founding the Medical Library Association of Great Britain and Ireland, and the Association of Medical Librarians along with three other people, including Margaret Charlton, the medical librarian of his alma mater, McGill University. He left his own large history of medicine library to McGill, where it became the Osler Library.

<span class="mw-page-title-main">Phlegm</span> Mucus produced by the respiratory system (excluding the nasal passages)

Phlegm is mucus produced by the respiratory system, excluding that produced by the throat nasal passages. It often refers to respiratory mucus expelled by coughing, otherwise known as sputum. Phlegm, and mucus as a whole, is in essence a water-based gel consisting of glycoproteins, immunoglobulins, lipids and other substances. Its composition varies depending on climate, genetics, and state of the immune system. Its color can vary from transparent to pale or dark yellow and green, from light to dark brown, and even to dark grey depending on the constituents. The body naturally produces about 1 quart of phlegm every day to capture and clear substances in the air and bacteria from the nose and throat.

<span class="mw-page-title-main">Michael Bliss</span> Canadian historian (1941–2017)

John William Michael Bliss (1941–2017) was a Canadian historian and author. Though his early works focused on business and political history, he also wrote biographies of physicians Frederick Banting, William Osler and Harvey Cushing. Bliss was a frequent commentator on political events and issues. He was an Officer of the Order of Canada.

<span class="mw-page-title-main">Charles Singer</span> British historian

Charles Joseph Singer was a British historian of science, technology, and medicine. He served as medical officer in the British Army.

<span class="mw-page-title-main">Royal Society of Medicine</span> Learned society devoted to medical science in the United Kingdom

The Royal Society of Medicine (RSM) is a medical society based at 1 Wimpole Street, London, UK. It is a registered charity, with admission through membership.

<span class="mw-page-title-main">Clifford Allbutt</span> English physician

Sir Thomas Clifford Allbutt was an English physician best known for his role as president of the British Medical Association 1920, for inventing the clinical thermometer, and for supporting Sir William Osler in founding the History of Medicine Society.

Thomas McCrae was professor of Medicine at Jefferson Medical College, and student and later colleague of Sir William Osler. Often quoted in medical training for his remark "more is missed by not looking than not knowing". He was the brother of John McCrae, author of "In Flanders Fields".

<i>The Principles and Practice of Medicine</i> Medicine textbook

The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine is a medical textbook by Sir William Osler. It was first published in 1892 by D. Appleton & Company, while Osler was professor of Medicine at Johns Hopkins University. The book established Osler as the world's leading authority in the teaching of modern medicine.

<span class="mw-page-title-main">Zachary Cope</span>

Sir Vincent Zachary Cope MD MS FRCS was an English physician, surgeon, author, historian and poet perhaps best known for authoring the book Cope's Early Diagnosis of the Acute Abdomen from 1921 until 1971. The work remains a respected and standard text of general surgery, and new editions continue being published by editors long after his death, the most recent one being the 22nd edition, published in 2010. Cope also wrote widely on the history of medicine and of public dispensaries.

Charles Gordon Roland was a Canadian medical historian. Roland's publications and public lectures consisted of history and bibliography, medical communications, and medicine, particularly Canadian medical history in the 19th century, the influence of William Osler, and on military medicine. Many of his research materials related to Osler are held at the Osler Library of the History of Medicine at McGill University. His research interests focused on medical aspects of World War II, culminating in two books on the Warsaw Ghetto and on Canadian prisoners of war of the Japanese in the Far East.

<span class="mw-page-title-main">Osler Club of London</span> Medical society

The Osler Club of London, founded in 1928, is a medical society with the purpose of encouraging the study of history of medicine, particularly amongst medical students, and to keep "green the memory of Sir William Osler". Membership in the club is open to medical professionals, medical students, persons associated with the history of medicine and in allied sciences.

<span class="mw-page-title-main">Thomas John Murray</span>

Thomas John "Jock" Murray is a Canadian neurologist, medical historian and author.

<span class="mw-page-title-main">History of Medicine Society</span>

The History of Medicine Society (HoMS), at the Royal Society of Medicine (RSM), London, was founded by Sir William Osler in 1912, and later became one of the four founder medical societies of the British Society for the History of Medicine.

<span class="mw-page-title-main">Alfred White Franklin</span>

Alfred White Franklin FRCP was an English neonatologist and paediatrician who edited numerous books on child abuse, founded the British Association for the Study and Prevention of Child Abuse and Neglect, kept an interest in medical history and wrote on child matters. He was a prominent figure in the field of child abuse prevention.

<span class="mw-page-title-main">American Osler Society</span>

The American Osler Society is an organisation dedicated to the history of medicine and focuses on the "life, teachings, and ethical example of Sir William Osler". It works in co-operation with the Osler Library of the History of Medicine at McGill University and consists of a group of physicians, medical historians, and other related professions united by "the common purpose of keeping alive the memory of Sir William Osler".

<span class="mw-page-title-main">Charles S. Bryan</span> American physician

Charles Stone Bryan is an American retired infectious disease physician, researcher, author and Heyward Gibbes distinguished professor emeritus of internal medicine at the University of South Carolina School of Medicine (UofSC). His contributions to medicine have included working on a formula for administering the maximum possible dose of penicillin to people with kidney failure which would treat the infection and avoid penicillin toxicity, and treating and writing on HIV/AIDS. He is also a noted medical historian and an authority on the life of William Osler.

<span class="mw-page-title-main">Mark E. Silverman</span> American cardiologist

Mark Edwin Silverman MD MACP FACC, was an American cardiologist, medical historian, medical educator and author of more than 200 medical articles and a number of books, who founded the cardiology program at Piedmont Hospital in Atlanta, Georgia.

<span class="mw-page-title-main">Rolando Del Maestro</span> Italian-born Canadian neurosurgeon

Rolando Fausto Del Maestro is an Italian-born Canadian neurosurgeon, the William Feindel Professor Emeritus in neuro-oncology and director of the Neurosurgical Simulation Research Center at the Montreal Neurological Institute and Hospital, where he has been involved in simulating real brain surgery by creating virtual setting scenarios, founded upon the principles of flight simulation.

References

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  2. 1 2 3 4 5 6 Bryan, Charles S. (2020). "Aequanimitas". In Bryan, Charles S. (ed.). Sir William Osler; An Encyclopaedia. Novato, California: Norman Publishing in association with the American Osler Society. pp. 10–12. ISBN   978-0-930405-91-5.
  3. 1 2 3 Sokol, Daniel (17 November 2007). "Aequanimitas". British Medical Journal . 335 (7628): 1049.2–1049. doi:10.1136/bmj.39385.642315.FA. PMC   2078638 .
  4. Pratt, Joseph H. (1 July 1949). "Aequanimitas" . Archives of Internal Medicine. 84 (1): 86–92. doi:10.1001/archinte.1949.00230010096018. ISSN   0730-188X.
  5. Landge. "Aequanimitas". www.j-pcs.org. Retrieved 10 June 2019.
  6. Osler, William (1906). Aequanimitas. Philadelphia: P. Blakiston's Son & Co. p. vi.
  7. Osler, William (1914). Aequanimitas : with other addresses to medical students, nurses and practitioners of medicine. London: H. K. Lewis.
  8. 1 2 3 4 5 6 Kimbrough, R. C. (August 1995). "The good gift: a comparison of the Eli Lilly presentation copies of Aequanimitas". Journal of the South Carolina Medical Association (1975). 91 (8): 350–354. ISSN   0038-3139. PMID   7674636.
  9. Greenberg, Stephen J. (April 2017). "History Matters: Whither Sir William?". Journal of the Medical Library Association. 105 (2).
  10. Nation, Earl (2001). "Osler in Cushing and Bliss: Personal Notes of a Seasoned Oslerian". Bulletin of the History of Medicine . 75 (4): 756–759. ISSN   0007-5140. JSTOR   44446103.
  11. Bliss, Michael (2002). William Osler: A Life in Medicine. University of Toronto Press. p. 556. ISBN   0-8020-4349-6.
  12. 1 2 3 Bryan, Charles S. (2020). "Weissman, Gerald (b. 1930), Criticisms of William Osler". In Bryan, Charles S. (ed.). Sir William Osler; An Encyclopaedia. Novato, California: Norman Publishing in association with the American Osler Society. p. 825. ISBN   978-0-930405-91-5.
  13. 1 2 Kaiser, Larry R.; Morris, Jon B. (24 September 2020). "The University of Pennsylvania Medical School Commencement of 1889: Aequanimitas and the Agnew Clinic" . Annals of Surgery. 274 (6): 1115–1122. doi:10.1097/SLA.0000000000004302. ISSN   0003-4932. PMID   32976282. S2CID   221937391.
  14. 1 2 Bryan, Charles S (2006). ""Aequanimitas" Redux: William Osler on detached concern versus humanistic empathy" . Perspectives in Biology and Medicine. 49 (3): 384–392. doi:10.1353/pbm.2006.0038. ISSN   1529-8795. PMID   16960308. S2CID   9384307.
  15. Hinohara, Shigeaki (1 September 1972). "Osler's Peregrinations in Asia—A Report on an Unusual Event". American Journal of Diseases of Children. 124 (3): 344–346. doi:10.1001/archpedi.1972.02110150042006. ISSN   0002-922X.
  16. 1 2 3 Fisher, Kimberly A. "Aequanimitas". www.hopkinsmedicine.org. Archived from the original on 16 July 2021. Retrieved 10 June 2019.
  17. 1 2 Raheja, Dev (2019). "14. Aequanimitas: the best known strategy for safe care". Safer Hospital Care: Strategies for Continuous Quality Innovation (Second ed.). New York: Routledge, Taylor & Francis Group. pp. 147–158. ISBN   978-0-367-17848-2.

Further reading