Re-exploration of Oslerian legacy of Osler’s address “Old Humanities and New Science”

Introduction

On 16 May, 1919, Sir William Osler, “the Founding Father of Modern Medicine and Medical Education”, delivered an important speech at Oxford University titled “The Old Humanities and the New Science”. This was his presidential address to the Classical Association of Oxford, and his last public speech not long before his death. During his life, Osler caught every opportunity to preach medical humanism. In important occasions, speeches and works throughout his life, Osler advocated restoring the humanistic tradition of medicine in order to overcome problems brought to medical practice and doctor’s career by the lack of humanistic and historical insight. For his untranscendability in medical sciences and humanities, Osler was honored with the ultimate accolade of “the last maitre de penser for a noble-minded general medicine” [1].

Osler successively held professorships at McGill University, the University of Pennsylvania, and Oxford University, exercising a global influence on the development of medicine and medical education [2]. Osler supported the revival of classical humanities in education, advocating the wide and miscellaneous reading and collecting of books concerning humanities. He recommended a list of Bedside Library for Medical Students, including the works by Shakespeare, Don Quixote, Oliver Wendell Holmes, Emerson, Marcus Aurelius, Plutarch and Montaigne. He initiated the “Book and Journal Club” at the Medical and Chirurgical Faculty of Maryland, where not only medical scientific knowledge and medical history, but also patient stories, medical humanities and life wisdom were shared.

In order to commemorate Osler’s medical achievements and inheritance in humanism, Osler Societies have been established in various countries where Osler worked. The Osler Society in McGill University was founded in 1921, the Osler Club of London in 1928 and the American Osler Society in 1970. These societies and clubs dedicate themselves to the commemoration and perpetuation of the intellectual resourcefulness and the ethical example of Osler [3]. While Osler never worked in China, his influence in China’s residency training program and the growth of Chinese medical professionals should not be underestimated. In memorial of his influence, Chinese Physician Charter Association founded the Osler Research Society and elected the academician Lang Jinghe as president in 2019 at the centenary of Osler’s death as well as his delivery of “The Old Humanities and the New Science”.

Chinese Osler Research Association aims at inheriting Oslerian legacy in medical humanities and medical philosophy, and strengthening international communication between Osler’s Societies from all over the world. In 2019, William Osler: A Life (1925) by Harvey Cushing, one of Osler’s students and the “Father of Modern Neurosurgery”, was translated into Chinese. It brings to light Osler’s stories to the medical students from Narrative and Humanities Workshop, Southern Medical University, as well as to medical practitioners from various Narrative Sharing Centers established by more than 30 high-level hospitals across the country. This includes Shunde Hospital, the First Affiliated Hospital of Xi’an Jiao Tong University, Baiqiuen 1st Hospital of Jilin University, Norman Bethune Hospital, and Nanfang Hospital. In June 2023, the Chinese version of William Osler: A Life in Medicine (1999) by Michael Bliss, an award-winning historian of modern medicine, was published in China, a prominent work of which was edited by Lang Jinghe and co-translated by the author as well as the key members of the society.

As an orator, Osler’s addresses were sagacious, classics-quoting and thought-provoking, inspiring “thousands to strive for the best in the way of promoting health and happiness among peoples everywhere” [4]. In this light, the thrust of this essay is to commemorate Oslerian legacy by interpreting and illuminating the Oslerian humanism in his addresses and writings. This essay is of great significance for two reasons: on one hand, the year 2019 marks the centenary of “The Old Humanities and the New Science”, the last major address by Osler; on the other hand, current medical students are “increasingly unfamiliar with the Oslerian legacy” [5]. This essay serves as a medium to reintroduce Osler and his legacy to the medical trainees and practitioners through clarifying the immortality of Oslerian tradition in the emerging and evolving of both western and Chinese narrative medicine.

Osler’s multiple identities as a classicist

Osler was a man wide in his scopes of learning and multiple in his identities as classicist, whose faith lies in literature, library, Greco-Roman culture, and the practice of medicine [6]. He was not only a clinician, diagnostician, professor, lecturer and medical educator, but also an essayist, historian, biographer, bibliographer, and humanist. If we revise what Lord Byron once says that “I hate an author who is all author”, we may safely assume that “we hate a doctor who is all doctor”. Osler was never all doctor, and he could never have fallen to a genius of his stature to be all any one identity [7]. His diverse identities made him a true Renaissance man.

Osler had made remarkable accomplishments in pathological research during his early medical career, and deserved to be “the greatest diagnosticians ever to wield a stethoscope” [8]. Besides his encyclopedic knowledge of pathology and illness, Osler has great literary breadth and historical inheritance. He believed that doctors should study not only the scientific knowledge and technology relating to contemporary medical achievements, but most importantly, the history of medicine. Osler deemed that “infecting ordinary people with ancient humanistic spirit and great minds’ thoughts in the history of medicine was the greatest single gift that humanities education could give to mankind” [9].

As the first chief physician at Johns Hopkins Hospital, Osler led the young hospital to develop rapidly to become an outstanding institution of medical education in the United State. He actively reformed clinical teaching system and promoted standardization of medical education and hospital management. At the end of the 19th century, Osler initiated the “full-time sleep-in residency system” in Johns Hopkins Hospital, which highlighted bedside skill training. His advocation of moving medical education to the wards is still applicable in present day. Over the next century, this system has been popularized all over the world, and its rationality and feasibility have been repeatedly tested. In order to form a more intimate relationship among all the subjects in the context of healthcare, Osler advocated that doctors use more daily language for bedside care.

Osler was inclined to use life-world language instead of science-world language to state his medical and humanistic philosophy in speeches and writings. The widely read 1892 treatise The Principles and Practices of Medicine, which sprinkles with allusions to Greco-Roman mythology and classical literature, has guided many medical students and succeeding generations to grow up into excellent doctors during the last century, such as Harvey Cushing, William Sydney Thayer, John Farquhar Fulton, Leonard Wood, just to name a few. The important differences between the book and other medical textbooks lie in Osler’s masterly use of Linacrean literary language instead of the rigid and obscure scientific jargon. In this treatise, Osler praised the humanistic doctors in history, including Linacre and Sydenham.

In addition, Osler was also active in classical literature, philosophy and science of librarianship. He praised Thomas Carlyle, a well-known philosopher of the Victorian era for his viewpoints that “[t]he true university of these days is a collection of books”. He boosted the construction of university libraries and served as the board member of the library in universities he once stayed. Osler encouraged medical students to read classical medical literature and conduct in-depth research; he exhorted that, in order to become great doctors with creativity and attainability, medical practitioners need to learn about medical history and shall get inspired by spiritual sources from classic medical books.

In addition to the abovementioned identities, Osler played the role as mentor and model to younger generation of physicians as well as his students in his lifetime, and continued to influence after his death. Osler was inclined to interact with his students. He often hosted informal club and encouraged students to share their mutual reading experience as well as their stories about professional growth at his own home on Saturday evenings. Thus, his house at 13 Norham Gardens in Oxford had been called the “open arm”, which offered shelters to young medical students who had not grown to an independent doctor. Osler even gave keys of his house and personal library to his students, for example, the “lucky latch-keyers” [10] and “two heirs of the Oslerian legacy” Harvey Cushing and Wilder Penfield [11]. The two mentees visited frequently as though they were Osler’s two dear sons.

Cushing bequeathed his collections to The Medical Library of Yale University, which had been considered as “a lasting tribute to the mentorship and example that Osler had on Cushing” [12]. His keen biographical abilities were grown out of his mentor’s excellent narrative competence. He wrote the biography Life of Sir William Osler in 1925 and won the Pulitzer Prize in the following year, making Cushing one of the few doctors who gained this honor in history. Harvey Cushing’s Oslerian legacy lied not only in his collection of historical items and his narrative competence, but also in his subsequent seconding of Osler’s medical education philosophy by criticizing the practices of the Flexnerian reform. Although Flexner himself hadn’t intended to undermine the importance of medical humanities, the inexorable development of medical science and technology made the medical educators and clinicians embraced the latter side of medicine overwhelmingly. With the misreading of his report, the narrative and humanities side of medicine had vanished into thin air. Osler and his heirs tried their best to conserve the essential side of medical education and clinical practice.

Another heir and mentee was Wilder Penfield. His Oslerian legacy could be best shown in his proclamation that “[i]f ever I summon before me my highest ideals of men and medicine, I find them sprung from the spirit of Osler” [11]. As Wilder’s leg was broken during his days with Osler, Osler had “a leg to stand on” and “his ego ideal” [11]. He expresses his desire to emulate Osler, saying that “[i]f I were not so dumb, I should have the nerve to hope and dream I might follow in his footsteps” [11, 13]. As Wilder’s tutor, Osler is formatively influential to his growth as a world-renowned neurosurgeon, neuropathologist and neuroscientist.

Therefore, we may safely assume that Osler was never all doctor and he could never have fallen to a genius of his stature to be all any one identity [7]. His diverse identities integrated with each other so seamlessly that his literary, philosophical and historic talents were all heightened spectacularly by “his reflections on medicine and on the nature of a doctor’s calling [14]”, just as one of the Big Four, W. H. Welch, says, “No small part of Osler’s broadly liberal culture came from studies in medical history, biography and bibliography, which almost inevitably led far afield into die realms of classical and general literature and of social, political and philosophical history [15].”

Integration of humanities and sciences in Osler’s addresses

“The Old Humanities and the New Science” was Osler’s presidential address to Oxford Classical Association. The Association was founded in 1903 partly in the hope of defending the preeminence of the classics in education and public life. The election of a physician to its presidency shows its clarion calls for the revival of humanities in science, especially in medicine at that time as Osler is a physician who “devotes himself to his special science” of medicine, whilst keeping “nevertheless a broad basis of interest in letters of all kinds” [16].

From the address, Osler, who appreciated “the wisdom and comfort to be derived from sound persons and solid books” [4, 17] through the close contact with great people and exceptional minds of the past, integrated wisdom of medical humanist precursors such as Aristotle, Hippocrates, Thomas Linacre, John Caius and Francois Rabelais. Although he did not develop a detailed and direct theory on medical humanities, ethics or philosophy in the address, one may unfailingly extrapolate basic principles that serve medical practitioners [17].

Osler redefined and refined the scope of Hippocratic character of medicine [18]. Osler is hailed as the Canadian Hippocrates and his 1919 address is acclaimed as a paean to the Hippocratic maxim; that is, “[w]here there is love of humanity (philanthropia), there also is love of the art (philotechnia)”. However, in Osler’s address one more dimension is added as he concluded by highlighting the values of philosophia (the head), philotechnia (the hand), and philanthropia (the heart) [19]. In fact, Osler spared no efforts in explicating this humanistic idea by quoting the dialogue from Plato’s Symposium in several occasions. In the dialogue, Socrates asked Phaedrus:

All right, tell me this. Suppose someone came to your friend Eryximachus or his father Acumenus (who is also a physician) and said: “I know treatments to raise or lower (whichever I prefer) the temperature of people’s bodies; If I decide to, I can make them vomit or make their bowels move, and all sorts of things. On basis of this knowledge, I claim to be a physician; and I claim to be able to make others physicians as well by imparting it to them.” What do you think they would say when they heard that? [20]

Phaedrus answered:

What could they say? They would ask him if he also knew to whom he should apply such treatments, when, and to what extent. [20]

By reproducing Socrates’ hypothesis and echoing Phaedrus’ sagacious response to Socrates’ question, on the one hand, Osler clarifies that Eryximachus as the character in this dialogue has been regarded as “the representative of unlimited technicism” [21] – such a doctor is not a good doctor, but only as a medical technician, or a medical craftsman; on the other hand, Osler emphasizes that “the good physician treats the disease; the great physician treats the patient who has the disease” [22]. It is important to know who and when the doctor is treating; it is dehumanizing to simplify a patient to a certain disease. Osler’s words unequivocally echoed “Hippocratic commitments on whole patient care”; that is, “[i]t is much more important to know what type of patient has disease than what sort of disease the patient has [23].”

Therefore, based on the above analysis, we may find that Eryximachus represents the doctor who lacks medical humanities. However, this is only a hypothesis made by Socrates in his dialogue with his follower for the purpose of illuminating his own judgment on a good doctor. Osler believes that in ancient Greece, doctors undeniably would not lack humanistic and ethic competencies, as they were always surrounded by philosophers and intellectuals.

Following the Hippocratic tradition, Osler illuminates that science and reason pertain to the values of the ‘head’, and this ‘head’ must control the ‘hand’, whether in the performing of surgery or the prescribing of medications. However, without a firm connection to the ‘heart’ values of compassion, congeniality, charity, empathy and other humane sensibilities, a doctor’s ‘head’ and ‘hand’ would not satisfy the profession’s highest ideals. Thus, the wisdom required by doctors comprises the ability to balance the competing values of the three dimensions [24].

Osler still lived in the peak era of “experimental medicine”, during which the value of “patient centered” and “service first” was gradually transformed into the value of “technology oriented” and “technological imperative”. In order to reorient medicine towards people, Osler emphasizes that education of science and humanities must be mutually reinforcing, and points out that humanities are the “hormone” of science as well as that of medicine. In this speech, Osler told his audience of classical scholars:

You secrete materials which do for society at large what the thyroid gland does for the individual. The humanities are the hormones […] the humanities bring the student into contact with the minds who gave us the philosophies, the models of our literature, the ideals of democratic freedom, the fine and technical arts, the fundamentals of science, the basis of our law […] into contact with the dead who never die, with those immortal lives ‘not of now, nor of yesterday, but who always are’ [19].

Without hormone, body will fall into dementia; without humanities, social development would stagnate and lose dynamic force. In other words, the humanities provide driving force for scientific development, medical education and clinic practice.

“Twin berries on one stem, grievous damage has been done to both in regarding the Humanities and Science in any other light than complemental [25].” According to Osler, medical and nursing science education can only impart the cookie-cutter knowledge and skill to students, but cannot help them acquire the wisdom of how to interact with individual patients in clinical context. In other words, medical education that only focuses on the impersonal disease and ignores the whole-person patient will fall into the abyss of scientism and technicism. Therefore, Osler advocates that “a physician needs a clear mind and a kind heart; his work is arduous and complex, requiring the exercise of the very highest faculties of the mind, while constantly appealing to the emotions and higher feelings [26].”

Osler believed that the only way to cultivate the doctor’s kind heart was literature reading. Osler advised that medical students spend half an hour daily in reading and discussing literary works created by Leo Tolstoy, Marcus Aurelius, Plutarch, Shakespeare and Montaigne and other classic works by physician writers such as Celsus, Linacre and Pare and feeling the power of human nature and morality. Osler listed the “must read” in his Bedside Library for Medical Students, which was also consistent with Osler’s Linacrean medical humanistic spirit. Osler often reminded students that “nothing will sustain you more potently than the power to recognize the true poetry of life” [27].

Osler indicated that “the extraordinary development of modern science may be her undoing. Specialism, now a necessity, has fragmented the specialties themselves in a way that makes the outlook hazardous [28].” In fact, the direct consequence of fragmenting the specialties was that the humanistic elements in the medical curriculum was persistently squeezed and eventually disappears from the scientific education system. In other words, scientific development lays disproportionate stress on “the love of skill” and leaves “the love of humanities” far behind. The technicians lose sense of proportion in a maze of constant divided specialties.

Everywhere men are in small coteries intensely absorbing in skills and knowledge within a very limited scope. Applying themselves early to research, young people “get into backwaters far from the main stream”. Without the whole vision of the world, “they quickly become hypercritical”. The smaller the field they are in, “the greater the tendency to be megalocephaly” [29], which responds to Isaac Newton’s far-sighted warning that men build too many walls without sufficient bridges. Just as Snow deemed that it was the literary group that shouldered most of the responsibility for the gulf between the polar groups of scientists and literary scholars, nowadays, the specialism sciences only function as walls instead of bridges and the tasks of building bridges fall upon the universal humanities.

Osler’s legacy to medical humanities and narrative medicine

As a pioneer and promoter of modern medical education, Osler contributed to the establishment of clinical education system, promotion of professionalism and cultivation of humanism more than the exploration of medical science. In his well-known speech, Osler keenly points out that the clinical practice is disadvantaged by three predicaments of modern medicine; that is, “the lack of historical insight, the rift between science and humanities, and the alienation of technology advancement and humanitarianism” [30]. Despite being highly praised by humanists such as British paleographer and literary critic Sir Frederic Kenyon and British historian and Erasmus scholar Percy Allen, Osler’s humanistic philosophy failed to be reasonably recognized and bolstered in the practice of medical education, partly due to the medical educators’ misreading of Osler’s contemporary – Abraham Flexner’s Report.

“Flexner Report”, published in 1910, was hailed as a milestone in the reform of medical education. The Flexner’s spirit embodied in the report concentrated on the scientific dimension of medicine. From then on, courses on humanities and arts in medical curricula had been replaced by courses on science and technology. Medical educators and clinical practitioners had turned medicine into a discipline, focusing and basing it exclusively on science. However, that may have been the partial misinterpretation of the “Flexner Report” by the scientolatrists.

In fact, although the main thrust of his report “was the strong advocacy of scientific rigor in the intellectual portion of medical training” [31], Flexner never planned to exclude humanities courses from the medical curriculum. On the contrary, he argued that if the sick people “are to reap the full benefit of recent progress in medicine, a more uniformly arduous and expensive medical education is demanded” [32], which referred to the education of humanities. He believed that doctors must be “an educated man” [33], and medical science education alone was insufficient to carry out medical practice.

Flexner advocated the trainees to develop “varied and enlarging cultural experience” so as to meet the “greatly modified ethical responsibility” and cope with the “more subtle elements” in medical practice that came with unprecedented scientific progress [33]. In his 1925 paper, Flexner also mentioned his disappointment with the overall scientization of medicine and embraced Osler’s notion of medical humanism, lamenting that doctors trained in “medical science education model” were “sadly deficient in the cultural and philosophical background” [34].

During the second half of 20th century, American medicine attuned to a course of extraordinary scientific advancement. However, the mistreatment of research subjects and the erosion of doctor-patient relationship in health care system that is increasingly unaffordable, complex, and impersonal suggest that such progress came at a price. In this context, Oslerian legacy is re-cherished in the field of medical education and clinical practice. The humanistic spirit in Osler’s speech was not well implemented in medical education at that time, but western medical education continued their exploration of solutions fictionally or realistically for the centenary predicaments under the guidance of Oslerian spirits.

Osler is admired by the men of letters such as Sinclair Lewis. Sinclair Lewis, the first American novelist awarded the Nobel Prize for Literature, infuses Osler’s humanistic ideas into his Pulitzer Prize-winning novel Arrowsmith (1925). The novel guided many young Americans to embrace medicine as their career in the 1930s and 1940s. Under the influence of Osler’s Bedside Library, Sinclair emphasizes in Arrowsmith that doctors should read three kinds of books during their lifetime – The Bible, Shakespeare and Gray’s Anatomy. The Bible in this context stands for books on philosophy and history and Shakespeare for books on literature, art and ethics whereas Gray’s Anatomy represents the books on medical science. In this way, Sinclair fully illustrates the significance of Osler’s literary and philosophical attainments in medical edification.

While Sinclair himself was not a doctor, he was born in a medical family. Arrowsmith expresses Osler’s anxiety about the false antithesis between humanities and science. As a medical student, the young protagonist Martin Arrowsmith struggles between two distinct medical concepts. One is the clinician-humanist concept which regards medicine as a healing art requiring emotional involvement. Its representative is the affable dean, Silva who is a “fit disciple of Osler” [35]. The other is the clinician-scientist concept which considers medicine only a science and research concern. Its representative is the mentor of the protagonist, the German bacteriologist Max Gottlieb. It seems that in the novel medical students can only make career choices between Silva’s medical humanism and Gottlieb’s scientism. In this way, Sinclair reinforces Osler’s call for the integration of humanities and science into one world through this novel.

Over the next half century, the debates on the tension between science and humanity have continued unabated since Osler’s speech [36] and figures and events resonating with Osler’s humanistic ideas have arisen constantly. In 1946, a group of US scientists, including Albert Einstein and Robert Oppenheimer, together with opinion leaders such as Walter Lippman and the Federation of American Scientists, issued a booklet entitled One World or None, reminiscent of Osler’s warning that “there must be a very different civilization or there will be no civilization at all.” [37] A main thrust of this booklet inherits from Osler’s advocacy that science needs the humanities for guidance and, that “[t]he Old Humanities and the New Science should be complementary and mutually informing and reinforcing in avoidance of the self-destruction of the whole world” [38].

In 1959, the British scientist, novelist and critic C.P. Snow delivered a famous address entitled “Two Cultures”, bringing Osler’s theory back to the limelight. Snow condemned,

the intellectual life of the whole of western society [was] increasingly being split two polar groups […] at one pole we [had] the literary intellectuals […] at the other scientists, and as the most representative, the physical scientists. Between the two a gulf of mutual incomprehension – sometimes (particularly among the young) hostility and dislike, but most of all lack of understanding. [39]

It severely hindered the social development and personal progress. Snow primarily mentioned that the divorce of science and humanities lowers the education quality worldwide, which makes people who engaged in science and technology unable to read Charles Dickens’ works, while literary intellectuals barely knew anything about scientific knowledge. Both were nevertheless overweening and looked down upon each other. Similarly, in order to get out of this predicament, people should follow Osler’s suggestion, turning literature as a bridge between science and humanities so as to prevent the world from self-destroying [40].

In the mid-twentieth century, half a century after Osler’s humanistic philosophy was brought forward, Karl Jaspers, a German existentialist philosopher and educator, succeeds Osler’s legacy with his existential-humanistic approach to medicine. Jaspers believed that the triumph of science and the decline of humanities made doctors, who regarded themselves as scientists, see no patients but their disease. However, just as Osler regards patients as “fellow men” [41], Jaspers is fully aware of the intersubjective bonding between doctors and patients. He argued that disease is not only a physical sign, and that the “doctor is neither technician nor savior, but (human) being for (human) being” [42]. Thus, a real doctor should treat himself and patients as holistic subjects and assess the physical, emotional, psycho-cognitive, social and spiritual dimensions of the person that assumes multiple causes for the problems experienced by the patient, creating a kind of “existential communication” with patients [43].

George Harrell, winner of 1973 Abraham Flexner Award and founding dean of several medical schools, was also deeply influenced by Osler’s humanistic philosophy. Harrell wrote many essays in memory of Osler, such as “Osler’s Practice” (1973), “Osler as a Real Person” (1974) and “Osler’s Professorships and His Families” (1985), which expressed respect and admiration toward Osler. With the summons of Osler’s spirit, Harrell set up the first department of Medical Humanities in Pennsylvania University Medical College in 1967. In 1972, Harrell integrated literature curriculum into medical education, creating full-time literature teaching posts, and devoting himself to cultivating literary reading habits of medical students throughout their lives. Harrell deems that poetry, fictional and autobiographical works reflecting interpersonal ethics, social values and changes can help medical students better socialize and form their own philosophy and ethics before dealing with the first patient.

Guided by Osler’s spirit, Literature and Medicine were recognized as a discipline in the 1980s. In 1982, the academic journal Literature and Medicine as well as its academy was initiated. Joanne Trautmann Banks, the first full-time professor of literature at a medical college in the US, believes that using literary methods and texts, literary scholars teach medical students and physicians how to listen more fully to patients’ narratives of illness and better comprehend illness and treatment from patients’ points of view [44]. Trautmann’s view resonates again with Osler’s medical education philosophy that literature is essential rather than luxury in medical education. Thus, some medical schools believed that literary courses should be more firmly anchored in education for medical practice as reading literary works can evoke empathy and enhance sensitivity which the scientific dimensions of medicine lacks.

Osler’s idea in humanities also immensely influences the renowned bioethicist Edmund Pellegrino and Albert R. Jonsen since the 1970’s. Pellegrino “realized the mutual impoverishment of the humanities and medicine” more clearly than any other of his contemporary [45]. He argues that “medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities” [46]. He suggests “physicians who do not understand their own humanities can hardly heal the others” [47]. Like Aristotle and Osler, Pellegrino is convinced that medical humanities and virtues can be taught through the acknowledgements of unique patient’s narrative. In order to “define the scholarly standards and address issues core to the medical humanities” [45], Pellegrino founded the Journal of Medicine and Philosophy in 1976.

Jonsen published an important monograph entitled The New Medicine and the Old Ethics, which was a rephrasing of the title of Osler’s address. One essay of the book titled “Humanities Are the Hormones” served as an eloquent reaffirmation of Osler’s metaphor. In the chapter of “The Nobility of Medicine”, Jonsen describes the contributions of Osler and other knighted medical men of the health profession in the 19th Century. Jonsen appreciated Osler’s summarization that “[t]he old art cannot possibly be replaced by, but must be absorbed in, the new science” [48].

With the consistent influence of Osler’s legacy, one of the most vocal calls for humanities appeared in 1984. The General Professional Education of Physicians (GPEP) in the Twenty-First Century urged that pre-medical education emphasized the humanities and avoided premature scientific specialization [49]. The report claimed that medical students equipped with sufficient preservations in humanities would achieve students’ holistic education and sustainable development of their careers, and realize social harmony and progress as well as the development of civilization. This report is the most powerful voice of medical humanism in the six or seven decades after Osler’s speech and the strongest confrontation against medical scientism and technicism.

However, with the fervent preaching of the conception of evidence-based medicine in the late 1980s, all these aforementioned efforts became immensely emasculated. During the era of evidence-based medicine, the interpersonal narrative connectedness between doctors and patients [50] is constantly under threat. In order to restore the medicine’s essential characteristics of humanities and inter-subjectivity, a brand-new conception was urgently called upon which can practically and potently integrate humanities and sciences. Under this circumstance, “a narrative revolution” or “a narrative turn” occurred in western medical education. With the guidance of narrative theory, some western medical schools endeavored to prescribe humanities courses as a kind of thyroid hormone to human body for the purpose of curing the medical students’ syndrome of humanities deficiency. In this background, narrative medicine emerged as a transdisciplinary dialogue among theories like ethics, history, literature, sociology, psychology as well as philosophy, regarding narratology as its conceptual foundations.

The ideas of narrative medicine and illness narrative were advocated by many scholars such as Arthur Kleinman, but was established as a discipline by Rita Charon at the beginning of the 21st century. Based on deep reflection on Osler and his followers’ humanistic philosophy and her consideration of using “narrative” as the bridge between science and humanities, Rita Charon, authored a book entitled The Principles and Practice of Narrative Medicine (2016), a parody to Osler’s seminal book The Principles and Practice of Medicine (1892), which made him the public embodiment of both scientific and humane medicine a century ago. In this context, William Osler, a historical figure full of classical thoughts of medical humanities as well as budding ideas of narrative medicine has thus once again absorbed the attention of experts and researchers in the field of medical education and clinical practice.

Charon upgraded Osler’s humanistic philosophy about literature reading, patient’s history taking and humility showing, and made it adapt to the need of the new medical era. The new humanistic model no longer regards Oslerian legacy as “an irrelevant high-mindedness from a vanished era” [51], but a practical principle that can tangibly enhance the medical professionalism. The new model embraces more of the integration of vocational education with liberal education than the narrow vocationalism. With deep appreciation of the limits of technological rationality, narrative medicine helps health professionals to discern humane approaches. Thus, medical humanity education has gradually entered the era of narrative medicine in the 21st century.

In China, with the three publications of earliest articles pertaining to narrative medicine in 2011, the year has been designated as “the initiating year of Chinese narrative medicine”. After 12 years of development, researchers from Southern Medical University have constructed the theoretical framework and the practical mode of Chinese narrative medicine. Chinese narrative medicine has absorbed the nutrition both from the Chinese legacy of traditional medicine and life philosophy and from the western legacy of Oslerian humanities. Although it has evolved from the narrative medicine advocated by Rita Charon, Chinese narrative medicine has made further development through proposing a series of new terms such as six types of “narrative foreclosures”, four kinds of “narrative adjustment”, three sorts of “narrative mediation”, “narrative community” between doctors, nurses, patients and their family, and “narrative remedy”, just list a few [52].

As during his medical life, Osler had many heart-touching stories to help patients as well as colleagues out of suffering and crisis through his narrative wisdom. They have been fully explored and exploited to elaborate the new terms and concepts coined during the establishing of Chinese narrative medicine. For instance, when explaining the term of “narrative intervention” and “narrative remedy”, the story about his creation of a letter from heaven in the name his newly-dead son to his bereaved wife was told, and when explaining the term of “narrative mediation” in resolution to a possible medical conflicts, the story about how Osler established narrative connectedness with the dead patient’s parents to show the warm scene of their son’s deathbed that successfully avoided future disputes was told to the medical staff during the course to enhance their narrative competence [50].

Narrative medicine advocates that medical practitioners establish life to life bonding with patients and its family by using life world languages and telling daily life stories which can give powers and hopes to both, which can be reflected in Osler’s stories. For instance, Osler’s teaching reveals that a sense of humor and narrative imagination can help doctors fight off stress and connect with patients. When talking with sick children, Osler proposed that doctors should forget their professional identity and establish an intimate narrative connectedness with them through flexible narrative identities, such as magician and goblin [6]. I hope that another long article will elaborate Osler’s inspirational stories contributing to the construction of Chinese narrative medicine.

Conclusions

Although many reports and efforts from Osler to the present championed education of humanities “over narrow vocationalism for persons planning careers in medicine” [49], humanities have not been the mainstream of medical education. This is due to the enormous impact made by rapid development of sciences and proliferation of new technologies and due to the immense difficulties for technicism and scientism in bringing their habitual thinking to a halt, so that the commitments are incomplete and insufficient in the progression and consequently the educational streamline still produce batches of doctors suffering from humanities deficiency syndrome. The “unhappy divorce” warned by Osler, “which should never have taken place” [6] takes place in evidence-based medicine era.

In the era of evidence-based medicine, industrialization, commodification and overspecialization of medicine have reached its climax, and the mechanical, impetuous and unreasonable lifestyle has become seriously harmful to people’s psychosomatic health. The focus of attention has changed from patients as human being to disease at the molecular or cellular level. The technical and dehumanized medicine has no past, has no cultural language and has no philosophy [1], in the context of which clinical practice absolutely relies on and focuses on biomedical knowledge, the symbol of science and technology. Evidence-based medicine which bases itself on systematic clinical trials, meta-analysis, cross-sectional studies and so on, witnesses the total anthropological loss and the “history of the patient” has been relentlessly replaced by the “history of the disease”.

In this context, rethinking the Oslerian tradition or Oslerian legacy is of great value, because if the medical educators and practitioners can understand better his philosophy, we could be better prepared to use and pass on (the word tradition, which originates from the Latin root “tradere” and means “to deliver”) his tradition and legacy to a greater value and to the society’s best interest. The author of this article is a registered member of Chinese Osler Research Society, who has started to do research in the field of Narrative Medicine since 2008 and is one of the first medical educators in China to advocate the cultivation of narrative competence of both the residency trainees and the medical students. Narrative Medicine: A Humanistic Reader, edited by the author, was published in 2019, the centenary of Osler’s “The Old Humanities and the New Science”. What we call upon in the book is the synthetic approach of bridging the two cultures, integrating narrative medicine as “new humanities” with “precision medicine” as a “new science”.

Narrative medicine, in this sense, is the updated version of “the old humanities” proposed by Osler a century ago and has gradually become the complementary educational tool to revolute the current dominance of evidence-based medical practice as its beneficial supplement on the way to an upgraded medical era of “precision medicine”. Narrative is not a simple return of linguistic and humanistic traditions before the nineteenth century, but a new concept and philosophy derived from the traditional and Oslerian legacy. Human being is bio-cultural subjects composed of stories. Narrative is an important media of human thinking, language communications, identity and factual construction, as well as emotional expression, which link closely with human health, clinical treatment and health care [50, 53]. As other four essays will serially explore the inheritance narrative medicine acquired from Oslerian tradition, this essay is mainly dedicated to commemorate Osler’s contributions and its legacy during the 100 years after “The Old Humanities and the New Science”, the final major address by Osler was delivered.