aequanimitas

AEQUANIMITAS Sir William Osler, Valedictory speech, 1889

Thou must be like a promontory of the sea, against which, though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted.

Marcus Aurelius.

I say: Fear not! Life still Leaves human effort scope. But, since life teems with ill, Nurse no extravagant hope: Because thou must not dream, thou need'st not then despair

Matthew Arnold, Empedocles on Etna.

AEQUANIMITAS

TO many the frost of custom has made even these imposing annual ceremonies cold and lifeless. To you, at least of those present, they should have the solemnity of an ordinance—called as you are this day to a high dignity and to so weighty an office and charge. You have chosen your Genius, have passed beneath the Throne of Necessity, and with the voices of the fatal sisters still in your ears, will soon enter the plain of Forgetfulness and drink of the waters of its river. Ere you are driven all manner of ways, like the souls in the tale of Er the Pamphylian,2 it is my duty to say a few words of encouragement and to bid you, in the name of the Faculty, God-speed on your journey.

I could have the heart to spare you, poor, careworn survivors of a hard struggle, so "lean and pale and leaden-eyed with study;" and my tender mercy constrains me to consider but two of the score of elements which may make or mar your lives—which may contribute to your success, or help you in the days of failure.

In the first place, in the physician or surgeon no quality takes rank with imperturbability, and I propose for a few minutes to direct your attention to this essential bodily virtue. Perhaps I may be able to give those of you, in whom it has not developed during the critical scenes of the past month, a hint or two of its importance, possibly a suggestion for its attainment. Imperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, immobility, impassiveness, or, to use an old and expressive word, phlegm. It is the quality which is most appreciated by the laity though often misunderstood by them; and the physician who has the misfortune to be without it, who betrays indecision and worry, and who shows that he is flustered and flurried in ordinary emergencies, loses rapidly the confidence of his patients.

In full development, as we see it in some of our older colleagues, it has the nature of a divine gift, a blessing to the possessor, a comfort to all who come in contact with him. You should know it well, for there have been before you for years several striking illustrations, whose example has, I trust, made a deep impression. As imperturbability is largely a bodily endowment, I regret to say that there are those amongst you, who, owing to congenital defects, may never be able to acquire it. Education, however, will do much; and with practice and experience the majority of you may expect to attain to a fair measure. The first essential is to have your nerves well in hand. Even under the most serious circumstances, the physician or surgeon who allows "his outward action to demonstrate the native act and figure of his heart in complement extern," who shows in his face the slightest alteration, expressive of anxiety or fear, has not his medullary centres under the highest control, and is liable to disaster at any moment. I have spoken of this to you on many occasions, and have urged you to educate your nerve centres so that not the slightest dilator or contractor influence shall pass to the vessels of your face under any professional trial. Far be it from me to urge you, ere Time has carved with his hours those fair brows, to quench on all occasions the blushes of ingenuous shame, but in dealing with your patients emergencies demanding these should certainly not arise, and at other times an inscrutable face may prove a fortune. In a true and perfect form, imperturbability is indissolubly associated with wide experience and an intimate knowledge of the varied aspects of disease. With such advantages he is so equipped that no eventuality can disturb the mental equilibrium of the physician; the possibilities are always manifest, and the course of action clear. From its very nature this precious quality is liable to be misinterpreted, and the general accusation of hardness, so often brought against the profession, has here its foundation. Now a certain measure of insensibility is not only an advantage, but a positive necessity in the exercise of a calm judgment, and in carrying out delicate operations. Keen sensibility is doubtless a virtue of high order, when it does not interfere with steadiness of hand or coolness of nerve; but for the practitioner in his working-day world, a callousness which thinks only of the good to be effected, and goes ahead regardless of smaller considerations, is the preferable quality.

Cultivate, then, gentlemen, such a judicious measure of obtuseness as will enable you to meet the exigencies of practice with firmness and courage, without, at the same time, hardening "the human heart by which we live." In the second place, there is a mental equivalent to this bodily endowment, which is as important in our pilgrimage as imperturbability. Let me recall to your minds an incident related of that best of men and wisest of rulers, Antoninus Pius, who, as he lay dying, in his home at Loriam in Etruria, summed up the philosophy of life in the watchword, Aequanimitas. As for him, about to pass flammantia moenia mundi (the flaming rampart of the world), so for you, fresh from Clotho’s spindle, a calm equanimity is the desirable attitude. How difficult to attain, yet how necessary, in success as in failure! Natural temperament has much to do with its development, but a clear knowledge of our relation to our fellow-creatures and to the work of life is also indispensable. One of the first essentials in securing a good-natured equanimity is not to expect too much of the people amongst whom you dwell. "Knowledge comes, but wisdom lingers," and in matters medical the ordinary citizen of to-day has not one whit more sense than the old Romans, whom Lucian scourged for a credulity which made them fall easy victims to the quacks of the time, such as the notorious Alexander, whose exploits make one wish that his advent had been delayed some eighteen centuries. Deal gently then with this deliciously credulous old human nature in which we work, and restrain your indignation, when you find your pet parson has triturates of the 1000th potentiality in his waistcoat pocket, or you discover accidentally a case of Warner’s Safe Cure in the bedroom of your best patient. It must needs be that offences of this kind come, expect them, and do not be vexed.

Curious, odd compounds are these fellow-creatures, at whose mercy you will be full of fads and eccentricities, of whims and fancies; but the more closely we study their little foibles of one sort and another in the inner life which we see, the more surely is the conviction borne in upon us of the likeness of their weaknesses to our own. The similarity would be intolerable, if a happy egotism did not often render us forgetful of it. Hence the need of an infinite patience and of an ever-tender charity toward these fellow-creatures; have they not to exercise the same toward us?

A distressing feature in the life which you are about to enter, a feature which will press hardly upon the finer spirits among you and ruffle their equanimity, is the uncertainty which pertains not alone to our science and arts but to the very hopes and fears which make us men. In seeking absolute truth we aim at the unattainable, and must be content with finding broken portions. You remember in the Egyptian story, how Typhon with his conspirators dealt with good Osiris; how they took the virgin Truth, hewed her lovely form into a thousand pieces, and scattered them to the four winds; and, as Milton says, "from that time ever since, the sad friends of truth, such as durst appear, imitating the careful search that Isis made for the mangled body of Osiris, went up and down gathering up limb by limb still as they could find them; We have not yet found them all,"1 but each one of us may pick up a fragment, perhaps two, and in moments when mortality weighs less heavily upon the spirit, we can, as in a vision, see the form divine, just as a great Naturalist, an Owen or a Leidy, can reconstruct an ideal creature from a fossil fragment; Areopagitica.

It has been said that in prosperity our equanimity is chiefly exercised in enabling us to bear with composure the misfortunes of our neighbours. Now, while nothing disturbs our mental placidity more sadly than straightened means, and the lack of those things after which the Gentiles seek, I would warn you against the trials of the day soon to come to some of you—the day of large and successful practice. Engrossed late and soon in professional cares, getting and spending, you may so lay waste your powers that you may find, too late, with hearts given away, that there is no place in your habit-stricken souls for those gentler influences which make life worth living.

It is sad to think that, for some of you, there is in store disappointment, perhaps failure. You cannot hope, of course, to escape from the cares and anxieties incident to professional life. Stand up bravely, even against the worst. Your very hopes may have passed on out of sight, as did all that was near and dear to the Patriarch at the Jabbok ford, and, like him, you may be left to struggle in the night alone. Well for you, if you wrestle on, for in persistency lies victory, and with the morning may come the wished-for blessing. But not always; there is a struggle with defeat which some of you will have to bear, and it will be well for you in that day to have cultivated a cheerful equanimity. Remember, too, that sometimes "from our desolation only does the better life begin" Even with disaster ahead and ruin imminent, it is better to face them with a smile, and with the head erect, than to crouch at their approach. And, if the fight is for principle and justice, even when failure seems certain, where many have failed before, cling to your ideal, and, like Childe Roland before the dark tower, set the slug-horn to your lips, blow the challenge, and calmly await the conflict.

It has been said that "in patience ye shall win your souls," and what is this patience but an equanimity which enables you to rise superior to the trials of life? Sowing as you shall do beside all waters, I can but wish that you may reap the promised blessing of quietness and of assurance forever, until

Within this life, Though lifted o'er its strife,

you may, in the growing winters, glean a little of that wisdom which is pure, peaceable, gentle, full of mercy and good fruits, without partiality and without hypocrisy.

The past is always with us, never to be escaped; it alone is enduring; but, amidst the changes and chances which succeed one another so rapidly in this life, we are apt to live too much for the present and too much in the future. On such an occasion as the present, when the Alma Mater is in festal array, when we joy in her growing prosperity, it is good to hark back to the olden days and gratefully to recall the men whose labours in the past have made the present possible.

The great possession of any University is its great names. It is not the "pride, pomp and circumstance" of an institution which bring honour, not its wealth, nor the number of its schools, not the students who throng its halls, but the men who have trodden in its service the thorny road through toil, even through hate, to the serene abode of Fame, climbing "like stars to their appointed height." These bring glory, and it should thrill the heart of every alumnus of this school, of every teacher in its faculty, as it does mine this day, reverently and thankfully to recall such names amongst its founders as Morgan, Shippen, and Rush, and such men amongst their successors as Wistar, Physick, Barton, and Wood.

Gentlemen of the Faculty—Noblesse oblige.

And the sad reality of the past teaches us to-day in the freshness of sorrow at the loss of friends and colleagues, "hid in death’s dateless night." We miss from our midst one of your best known instructors, by whose lessons you have profited, and whose example has stimulated many.

An earnest teacher, a faithful worker, a loyal son of this University, a good and kindly friend, Edward Bruen has left behind him, amid regrets at a career untimely closed, the memory of a well-spent life;

We mourn to-day, also, with our sister college, the grievous loss which she has sustained in the death of one of her most distinguished teachers, a man who bore with honour an honoured name, and who added lustre to the profession of this city. Such men as Samuel W. Gross can ill be spared. Let us be thankful for the example of a courage which could fight and win; and let us emulate the zeal, energy, and industry which characterized his career.

Personally I mourn the loss of a preceptor, dear to me as a father, the man from whom more than any other I received inspiration, and to whose example and precept .1 owe the position which enables me to address you today. There are those present who will feel it no exaggeration when I say that to have known Palmer Howard was, in the deepest and truest sense of the phrase, a liberal education—

Whatever way my days decline, I felt and feel, tho’ left alone, His being working in mine own, The footsteps of his life in mine.

While preaching to you a doctrine of equanimity, I am, myself, a castaway. Recking not my own rede, I illustrate the inconsistency which so readily besets us. One might have thought that in the premier school of America, in this Civitas Hippocratica, with associations so dear to a lover of his profession, with colleagues so distinguished, and with students so considerate, one might have thought, I say, that the Hercules Pillars of a man’s ambition had here been reached. But it has not been so ordained, and to-day I sever my connexion with this University. More than once, gentlemen, in a life rich in the priceless blessings of friends, I have been placed in positions in which no words could express the feelings of my heart, and so it is with me now. The keenest sentiments of gratitude well up from my innermost being at the thought of the kindliness and goodness which have followed me at every step during the past five years. A stranger—I cannot say an alien—among you, I have been made to feel at home— more you could not have done. Could I say more? Whatever the future may have in store of success or of trials, nothing can blot the memory of the happy days I have spent in this city, and nothing can quench the pride I shall always feel at having been associated, even for a time, with a Faculty so notable in the past, so distinguished in the present, as that from which I now part.

Gentlemen,—Farewell, and take with you into the struggle the watchword of the good old Roman — Aequanimitas.

1Valedictory Address, University of Pennsylvania, May 1, 1889

2‘The Republic, Book X.