Aequanimitas
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''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 The Perelman School of Medicine, commonly known as Penn Med, is the medical school of the University of Pennsylvania, a private research university in Philadelphia, Pennsylvania. Founded in 1765, the Perelman School of Medicine is the oldest medi ...
, prior to his transfer to
Johns Hopkins Johns Hopkins (May 19, 1795 – December 24, 1873) was an American merchant, investor, and philanthropist. Born on a plantation, he left his home to start a career at the age of 17, and settled in Baltimore, Maryland where he remained for most ...
. 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 mind under all circumstances". 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 ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'' in 2007, that whatever interpretation is made of ''Aequanimitas'', it "tackles head-on a timeless question: what makes a good doctor?".


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 The Perelman School of Medicine, commonly known as Penn Med, is the medical school of the University of Pennsylvania, a private research university in Philadelphia, Pennsylvania. Founded in 1765, the Perelman School of Medicine is the oldest medi ...
. It was published in the same year. Aequanimitas refers to staying calm and composed. In the essay, Osler advocates two qualities "imperturbability" and "equanimity", which he defined as "coolness and presence of mind under all circumstances".


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. A second edition was produced in 1906 by P. Blakiston's Son & Co. in Philadelphia, and H.K. Lewis in London.


Eli Lilly & Company

Following Osler's death, an expanded version of the book appeared as a third edition in 1932. 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. Between 1932 and 1953,
Eli Lilly & Company Eli Lilly and Company is an American pharmaceutical company headquartered in Indianapolis, Indiana, with offices in 18 countries. Its products are sold in approximately 125 countries. The company was founded in 1876 by, and named after, Colonel ...
distributed more than 150,000 copies of the third edition to medical graduates. These volumes were not all the same. There were at least seven different publications in English and one in each of Spanish and Portuguese. There were variations in the type of paper, book size, title page, information on the
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, and printing information. There were also differences in the congratulatory letters from Eli Lilly, placed in each book.


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. One of the strongest critiques was presented by Gerald Weissmann in his book ''The Woods Hole Cantata'' (1985). It had been published the previous year in ''Hospital Practice'', as an essay entitled "Against Aequanimitas". Weissmann's assessment of Osler led him to conclude that Osler's advice held "the public tone of the academic snob". After reciting Osler's description of "imperturbability", Weissmann held the opinion that "the Oslerian view is not only devoid of passion, but lsoof joy". Osler however, did not that day in 1889 intend to give the graduating medical students comprehensive advice about how to practice medicine. 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 David Hayes Agnew (November 24, 1818March 22, 1892) was an American surgery, surgeon. Biography Agnew was born on November 24, 1818, Nobleville, Pennsylvania (present-day Christiana, Pennsylvania, Christiana). His parents were Robert Agnew and ...
("Agnew day").
Charles S. Bryan Charles Stone Bryan (born 1942) 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 ...
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". 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. Daniel Sokol, medical ethics and law expert, reasons in the ''
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'' in 2007, that whatever interpretation is made of ''Aequanimitas'', it "tackles head-on a timeless question: what makes a good doctor?".


Legacy

Japan's prime minister's physician, Shigeaki Hinohara, was given a copy of ''Aequanimitas'' in the early days of the Occupation of Japan, 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''. The term ''aequanimitas'' has become a motto. At Johns Hopkins, it appears on ties and scarves worn by the housestaff, and was mentioned in the television programme ''House (TV series), House''. A similar concept to aequanimitas was addressed by Steve Jobs at Stanford University in 2005. Daniel Goleman's notion of emotional intelligence has been described as a modern variation of aequanimitas.


References


Further reading

* iarchive:aequanimitaswit04oslegoog/page/n9, ''Aequanimitas'' P. Blakiston's Son & Co (1910)


External links

* {{DEFAULTSORT:Aequanimitas History books about medicine Medical books History of medicine William Osler 1889 essays Canadian essay collections