Anton Chekhov (1860-1904). Russian playwright and short story writer, considered one of the greatest dramatists of modern time. Among his many famous short stories is The Bet, about a man who bets a million dollars he can live in solitude for many years. Plays include: The Sea Gull (1896); Uncle Vanya (1899); The Three Sisters (1901); The Cherry Orchard (1904).

Robin Cook (b. 1939). American author famous for medical thrillers, usually centering on some vile group of doctors or medical entrepreneurs. His most famous novel is Coma, also made into a movie. Cook was a Boston ophthalmologist before giving up practice for full time writing.

Michael Crichton (b. 1942). A 1969 graduate of Harvard Medical School, Crichton never practiced medicine. Popular fiction writer whose first novel, Andromeda Strain (1969) was made into a film (1971). Also wrote Five Patients (1970), The Terminal Man (1974), The Great Train Robbery (1975), Congo (1980), Sphere (1987), Jurassic Park (1991) and Rising Sun (1992).

Archibald Joseph Cronin (1896-1981). Scottish novelist and physician, a prolific writer of best selling novels depicting the medical profession. Several of his novels were made into movies, including The Stars Look Down (1935; film 1939), The Citadel (1937; film 1938), and The Keys of the Kingdom (1941; film 1944).

Arthur Conan Doyle (1859-1930). Doyle received his medical degree from the University of Edinburgh. Because his private practice was very slow he took up writing, and created British private detective Sherlock Holmes. Doyle named his detective after famed American physician Oliver Wendell Holmes, but modeled the fictional character's deductive reasoning powers after his Edinburgh professor, Dr. Joseph Bell (1837-1911). Doyle also wrote poems, historical novels and short stories.

W. Somerset Maugham (1874-1965). Trained as a physician at St. Thomas's Hospital in London but, like Michael Crichton, he never practiced medicine. Maugham wrote over 60 books, including Of Human Bondage (1915), Moon and Sixpence (1919), and The Summing Up (1938).

Michael Palmer (b. 1942). Graduated from Case Western Reserve University School of Medicine and trained as an internist at Boston City Hospital and Mass. General Hospital. Like Robin Cook, Palmer writes popular novels with medical themes, including: Natural Causes, a 1994 best seller; Silent Treatment (1995); and Critical Judgment (1996). His novels have been translated into two dozen languages.

Walker Percy (1916-1990). Graduate of Columbia University medical school. He practiced for a year before contracting tuberculosis. While recuperating he began to write, and never went back to medicine. His first novel, The Moviegoer (1961), won the National book award. Percy is also well known for novel The Thanatos Syndrome (1987).

William Carlos Williams (1883-1963). American poet, essayist and short story writer. Williams was a practicing pediatrician, and delivered more than 3000 babies in a working class, ethnically mixed neighborhood of Rutherford, N.J. Williams posthumously won the Pulitzer Prize for his two-volume work Paterson. His poetry emphasizes everyday life and speech. Williams also wrote 50 short stories, the best of which is considered The White Mule (1937). Many of the short stories deal with his life as a doctor.

Contemporary physician-writers of non-fiction books and stories aimed at the general public

(Listed in alphabetical order, with at least one of their books)

Coles, Robert. The Mind's Fate. A Psychiatrist Looks at His Profession. Thirty Years of Writings (Little, Brown & Co., Boston, 1995). Harvard child psychiatrist and Pulitzer-prize winning author of many works on children, including the 5-volume Children of Crisis, The Special Lives of Children and the Moral Life of Children.

Conger, Beach. Bag Balm and Duct Tape. Tales of a Vermont Doctor (Little Brown & Co., Boston, 1988). Dr. Conger's tales run the gamut from healthy hypochondriacs to the patient with terminal cancer.

Gray, Seymour. Beyond the Veil. The Adventures of an American Doctor in Saudi Arabia (Harper & Row, New York, 1983). Dr. Gray's account reveals something most doctors intuitively understand: culture and customs may differ, but patients' needs and problems are pretty much the same everywhere.

Hellerstein, David. Battles of Life and Death (Houghton Mifflin Co., Boston, 1986). Experiences of a sensitive and insightful doctor-in-training. Hellerstein (b. 1953; a psychiatrist) has also written A Family of Doctors.

Kean BH, with Tracy Dahlby. One Doctor's Adventures Among the Famous and Infamous from the Jungles of Panama to a Park Avenue Practice (Ballantine Books, New York, 1990). Absorbing autobiography of a colorful medical career, which began with internship in Panama. Dr. Kean practiced from a Park Avenue address, but his expertise in parasitology led him to treat patients all over the world, including the Shah of Iran.

Klass, Perri. A Not Entirely Benign Procedure. Four Years as a Medical Student (G. P. Putnam's Sons, New York, 1987). Dr. Klass, a practicing Boston pediatrician, has written several other books, including two novels.

Klawans, Harold L. Newton's Madness. Further Tales of Clinical Neurology (Harper & Row, New York, 1990). Dr. Klawans is a professor of neurology and pharmacology in Chicago. His first book in this genre was Toscanini's Fumble and Other Tales of Clinical Neurology.

Konner, Melvin. Becoming a Doctor: A Journey of Initiation in Medical School. There are many medical-school-journal books, but Dr. Konner's is one of the best.

Kra, Siegfried. The Three Legged Stallion and Other Tales from a Doctor's Notebook (W.W. Norton Company, New York, 1989). Twelve medical stories by a cardiologist.

Marion, Robert. The Intern Blues (William Morrow and Co., New York, 1989). A year in the mid-1980s spent caring for sick children.

Martin, Lawrence. "Pickwickian" and Other Stories of Intensive Care. Medical and Ethical Issues in the ICU (Lakeside Press, Cleveland, 1991). A collection of stories, several published in magazines, about patients cared for in a medical intensive care unit.

Mullan, Fitzhugh. Vital Signs. A Young Doctor's Struggle with Cancer (Farrar Straus Giroux, New York, 1975). Dr. Mullan recounts his battle with almost-fatal cancer. Although written in the mid-1970s, anyone undergoing seemingly impersonal, high-tech care in the 1990s will appreciate this book.

Nolen, William A. A Surgeon's Book of Hope (Coward, McCann & Geoghegan, New York, 1980). Author of best selling books The Making of a Surgeon and Surgeon Under the Knife, here Dr. Nolen tells the true stories of patients who were at one point considered hopeless and survived.

Nuland, Sherwin. Nuland, a Yale surgeon, has written widely on medical history, including The Origins of Anesthesia (Gryphon Editions, 1983) and Doctors: The Biography of Medicine (Alfred Knopf, New York, 1988). Nuland also wrote How We Die, a 1994 best seller about death and dying.

Reynolds, Richard C. and Stone, John, editors. On Doctoring. Stories, Poems, Essays. Simon & Schuster, New York, 1991. A collection that includes several first-person accounts of doctors, including selections from Somerset Maugham, William Carlos Williams, Richard Selzer and Robert Coles.

Sacks, Oliver. The Man Who Mistook His Wife For a Hat and Other Clinical Tales (Summit Books, New York, 1985). Neurology patients and their problems make for some of the most interesting tales. This book was on the New York Times best seller list. Dr. Sacks is also author of Awakenings (Doubleday, 1973; made into a popular 1990 movie by the same name, starring Robin Williams and Robert de Niro), and more recently An Anthropologist on Mars (1995).

Selzer, Richard. Confessions of a Knife (Simon and Schuster, New York, 1979). Essays by another best selling surgeon-author. Dr. Selzer has written many other medicine-related works for a general audience, including an autobiography (Down from Troy, published 1992) reviewed on the front page of the New York Times Book Review.

Siegel, Bernie S. Love, Medicine & Miracles. Lessons Learned About Self-Healing from a Surgeon's Experience with Exceptional Patients (Harper & Row, New York, 1986). Siegel's emphasis is on the link between mind and body, literally overcoming major illness through will, faith and conviction, as opposed to surgery and drugs.

Thomas, Lewis. American Essayist, past president of. Memorial Sloan Kettering Hospital. Wrote Lives of a Cell (won National Book Award), The Medusa and the Snail, and Late Night Thoughts on Listening to Mahler's Ninth Symphony.

Weissmann, Gerald. Democracy and DNA (Hill & Wang, New York, 1996), a passionate argument against nontraditional remedies that are based on nothing more than irrational and mystical beliefs. Weissmann, director of rheumatology at New York, has also written many essays, collected into several books, including The Woods Hole Cantata (1985), They All Laughed at Christopher Columbus (1987), and The Witch Doctor with Two Heads (1990).

Two Notable Medical Essays

There are many good essays by doctors and about medicine (see On Doctoring, under Contemporary physician writers [Dr. Reynolds]). Two of the most notable essays are considered masterpieces: Aequanimitas, by Sir William Osler (1849-1919) and The Care of the Patient, by Francis Weld Peabody (1881-1927). Written generations ago, these essays are remarkable for their wisdom and timeless relevance.

William Osler was the pre-eminent physician of his era. Born in Ontario, he took his medical training at McGill University, then migrated to the U.S. where he occupied chairs of medicine at the University of Pennsylvania and the new Johns Hopkins Hospital. At Hopkins he developed the department of medicine. Osler's final academic venue was Regius Professor of Medicine at Oxford University in England, where he was knighted.

In his writing and teaching Osler displayed not only diagnostic excellence but a compassionate approach to medicine. He was also a superb anatomic pathologist who, like other great clinicians of the era, performed autopsies on his patients. And he was prolific, authoring over 700 papers on diagnosis, patient care and medical education.

Among his greatest works was the comprehensive textbook Principles and Practice of Medicine, a classic of which he was sole author. Principles went through 16 editions between 1891 and 1947 (he wrote each new edition up until his death).

A two-volume biography by Harvard neurosurgeon Harvey Cushing (1869-1939), Life of Sir William Osler, won the 1926 Pulitzer Prize. About Osler, Sherwin Nuland writes: "He was the greatest clinical teacher of his day...the fact that English began gradually to replace German as the international language of medicine was due more to his writing and speeches than to the works of any other man." (Doctors: The Biography of Medicine; Alfred Knopf, New York, 1988.)

Aequanimitas is the valedictory speech Osler gave to the 1889 graduating medical class at the University of Pennsylvania, just before he left to join Johns Hopkins Hospital. As Osler explained in his short speech, Aequanimitas means a calm equanimity, and was the dying word of one ancient Roman, Antoninus Pius. Below are three brief excerpts; the "farewell" was Osler's, for in the same speech he announced his imminent move to Baltimore.

. . .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 expressive word, phelgm. 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.

. . .Cultivate, then gentleman, 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."

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

* * *

The Care of the Patient was one of a series of talks delivered to the students of Harvard Medical school by Francis Peabody, a physician at Boston City Hospital. Although not of Osler's stature (no one was), Peabody was an eminent and well-respected physician. His essay was published as the lead article in The Journal of the American Medical Association, March 19, 1927 (Vol 88, No. 12). Consider these snippets, and remember that they were written in the 1920s! The last sentence is one of the most widely quoted in the vast literature of medicine.

. . . The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine or, to put it more bluntly, they are too "scientific" and do not know how to take care of patients.

. . . When a patient enters a hospital, one of the first things that commonly happens to him is that he loses his personal identity. He is generally referred to, not as Henry Jones, but as "that case of mitral stenosis in the second bed on the left." There are plenty of reasons why this is so, and the point is, in itself, relatively unimportant; but the struggle is that it leads, more or less directly, to the patient being treated as a case of mitral stenosis, and not as a sick man.

. . . The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.

Other Quotable Quotes

Joseph Bell (1837-1911), in a lecture to medical students at the University of Edinburgh. (Doyle patterned Sherlock Holmes's investigative methods after Dr. Bell).

"The precise and intelligent recognition and appreciation of minor differences is the real essential factor in all successful medical diagnosis... Eyes and ears which can see and hear, memory to record at once and to recall at pleasure the impressions of the senses, and an imagination capable of weaving a theory or piecing together a broken chain or unraveling a tangled clue, such are the implements of his trade to a successful diagnostician."

Ambrose Bierce (1842-1914). Definitions from The Devil's Dictionary

"BELLADONNA, n. In Italian a beautiful lady; in English a deadly poison. A striking example of the essential identity of the two tongues.

DENTIST, n. A prestidigitator who, putting metal into your mouth, pulls coins out of your pocket.

DIAGNOSIS, n. A physician's forecast of disease by the patient's pulse and purse.

GOUT, n. A physician's name for the rheumatism of a rich patient.

MIND, n. A mysterious form of matter secreted by the brain. Its chief activity consists in the endeavor to ascertain its own nature, the futility of the attempt being due to the fact that it has nothing but itself to know itself with.

PHYSICIAN, n. One upon whom we set our hopes when ill and our dogs when well."

Anton Chekhov (1860-1904)

"Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too." Ivanov, Act I.

Sir Arthur Conan Doyle (1859-1930)

"It is an old maxim of mine that when you have excluded the impossible, whatever remains, however improbable, must be the truth". The Adventures of Sherlock Holmes, "The Adventure of the Beryl Coronet"

Thomas Edison (1847-1931)

"Genius is one per cent inspiration and ninety-nine percent perspiration." Aphorism

Hippocrates (460-370 BC), from Aphorisms

"Life is short, and the Art long; the occasion fleeting; experience fallacious; and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals co-operate."

Oliver Wendell Holmes (1809-1894), from Medical Essays

"Throw out opium, which the Creator himself seems to prescribe, for we often see the scarlet poppy growing in the cornfields, as if it were foreseen that wherever there is hunger to be fed there must also be pain to be soothed; throw out a few specifics which our art did not discover, and is hardly needed to apply; throw out wine, which is a food, and the vapors, which produce the miracle of anesthesia, and I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes."

Moses ben Maimon (Maimonides, 1135-1204) from Mishneh Torah, "Hilchoth De'oth" Chapter IV, No. 1 (translated by Dr. Fred Rosner in Annals of Internal Medicine 1965;62:372).

"It is obligatory upon man to avoid things which are detrimental to the body and acclimatize himself to things which heal and fortify it. These are as follows: A person should never eat except when he is hungry nor drink unless he is thirsty. He should not postpone his eliminations for even a single moment; rather, every time that micturition or defecation become necessary, he should respond thereto immediately."

W. Somerset Maugham (1874-1965), The Summing Up

"I do not know a better training for a writer than to spend some years in the medical profession. . .the doctor. . . sees [human nature] bare. Reticences can generally be undermined; very often there are none. Fear for the most part will shatter every defence; even vanity is unnerved by it."

Clifton K. Meador (from A Little Book of Doctors' Rules, Hanley & Belfus, Philadelphia, 1992)

"Patients who are receiving money for disability rarely get well. After the first year they never get well even if the money is less than they could earn working."

"If you add a drug, try to remove one."

Sir William Osler (1849-1919), from various addresses:

"Take the sum of human achievement in action, in science, in art, in literature subtract the work of the men above forty, and while we should miss great treasures, even priceless treasures, we would practically be where we are today. . .The effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty."

"Superfluity of lecturing leads to ischial bursitis."

"There are only two sorts of doctors: those who practise with their brains, and those who practise with their tongues."

"Medicine is the only world-wide profession, following everywhere the same methods, actuated by the same ambitions, and pursing the same ends."

"To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all."

George Bernard Shaw (1856-1950)

"Life is a disease; and the only difference between one man and another is the stage of the disease at which he lives." Back to Methuselah, Pt. II, "Gospel of the Brothers Barnabas"

"When men die of disease they are said to die from natural causes. When they recover (and they mostly do) the doctor gets the credit of curing them." The Doctor's Dilemma, "Preface on Doctors"

"Medical science is as yet very imperfectly differentiated from common curemongering witchcraft." The Doctor's Dilemma, "Preface on Doctors"

William Shakespeare (1564-1616)

"He will be the physician that should be the patient."

Troilus and Cressida

"The patient dies while the physician sleeps."

The Rape of Lucrece

"What wound did ever heal but by degrees?"

Othello

"Kill the physician and the fee bestow

Upon the foul disease."

King Lear

MAJOR MEDICAL BOOKS OF HISTORICAL IMPORTANCE

We frequently see in print lists of books that "changed the world." They invariably include the Bible, Nicolas Copernicus's epochal De Revolutionibus Orbium Coelestium (1543; on circulation of the planets), Isaac Newton's Principia (1687; about gravitation), and Charles Darwin's The Origin of Species (1859; theory of evolution). I'll confine my list to books that are medically relevant. Criteria are: single-author text written for the medical profession and of established historical importance, with first edition published before 1940. List includes title, author, country of origin, year pubished and a short comment. All books authored in a foreign language, except those by Galen and Vesalius, are available in English translation. (Yes, this list is incomplete and subjective, but it has to start somewhere; any recommendations will be welcomed.)

Ars Magna and Ars Parva, Galen (Greece, 2nd century B.C.) Galen, considered the founder of experimental physiology, was the most prolific of ancient writers. These two encyclopedic textbooks (on "therapeutics" and "practice," respectively), set the standard for medical teaching for centuries.

De Humani Corporis Fabrica (The Fabric of the Human Body), Andreus Vesalius (who was from Belgium, but taught and wrote in Italy; work is from 1543). This is the first accurate, illustrated anatomy book; it challenged the Aristotelian idea that the heart is the seat of life, arguing instead that it is the brain. De Humani also corrected much of Galen's inaccurate anatomy.

De Motu Cordis, William Harvey (England, 1628). Some consider this work, published in Latin as Exercitatio Anatomica De Motu Cordis Et Sanguinis In Animalibus, historically the greatest of all medical books. In De Motu Harvey expounded on a discovery he made in 1616, that the blood of animals circulates; his text laid the foundation of medical physiology.

De Sedibus (On the Seats and Causes of Diseases), Giovanni Battista Morgagni (Italy, 1761). Morgagni was a pioneer of morbid anatomy whose classic work was based on over 600 dissections. According to Garrison's Introduction to the History of Medicine, this work constitutes the "true foundation of modern pathologic anatomy in that, for the first time, the records of postmortem findings are brought into correlation with clinical records on a grand scale."

Inventum Novum (New Invention to Detect by Percussion Hidden Diseases of the Chest), Leopold Auenbrugger (Austria, 1761). His book is the first record of the use of immediate percussion of the chest in diagnosis, and is based upon observations verified postmortem. Using one's hands for diagnosis in the mid-eighteenth century was revolutionary.

Diseases of Workers, Bernardino Ramazzini (Italy, 1713). The first comprehensive text on occupational medicine. Ramazzini included chapters on all the common professions (miners, chemists, potters, etc.), and was the first to call attention to stone-mason's and miner's phthisis (pneumoconiosis).

Treatise on the Diseases of the Chest, RTH Laennec, (France, 1818; London, 1821). Laennec, the inventor of the stethoscope (in 1816), also did autopsies, and made chest diseases his specialty. This is the first textbook of chest medicine.

Cellular Pathologie, Rudolph Virchow (Germany, 1858). This work established the foundation of cellular pathology. It "set in motion a new way of looking at the body as a 'cell-state in which every cell is a citizen,' disease being 'merely a conflict of citizens in this state, brought about by the action of external forces.'" (Garrison, 1922)

Anatomy, Descriptive and Surgical, by Henry Gray (England, 1858). First published in 1858 by J.W. Parker & Son. Famous for clarity, completeness and intelligibility, the work is still in print (as Gray's Anatomy). Gray was a Fellow of the Royal College of Surgeons.

Le Compression Barometrique, Paul Bert (France, 1878). Thousand-page textbook on causes of decompression sickness and other pressure-related problems.

The Principles and Practice of Medicine, William Osler (United States, 1892). The first modern textbook of medicine, Principles was continuously published until 1947 (Osler died in 1919).

The Interpretation of Dreams, Sigmund Freud (Austria, 1899). Freud was the founder of psychoanalysis. One of his seminal theories was that dreams are an unconscious representation of repressed desires, especially sexual desires. Prior to this work dreams were outside the scope of scientific enquiry.

An Introduction to the History of Medicine, Fielding H. Garrison, M.D. (United States; four editions 1913-1929, W.B. Saunders, Co., Philadelphia) The four editions of this text set the standard for encyclopedic reviews on medical history. Although there are many excellent medical history books, no other comprehensive text has emerged since Garrison's work.

Osler's Top Ten List

I came across this list in an old paperback edited by renowned Boston Cardiologist Paul Dudley White: Aequanimitas and Other Papers That Have Stood The Test of Time (W.W. Norton Company, New York, 1963). It contains the famed essay plus many other Osler speeches and essays, including the brief 'bedside library'. The date Osler promulgated this list is not given. Oliver Wendell Holmes was an American physician famous both for discovering that childbed fever is contagious (1843) and also for his essays, which Osler clearly admired.

* * *

Bedside Library for Medical Students

by William Osler, M.D.

A liberal education may be had at a very slight cost of time and money. Well filled though the day be with appointed tasks, to make the best possible use of your one or of your ten talents, rest not satisfied with this professional training, but try to get the education if not of a scholar, at least of a gentleman. Before going to sleep read for half an hour, and in the morning have a book open on your dressing table. You will be surprised to find how much can be accomplished in the course of a year. I have put down a list of ten books which you may make close friends. There are many others; studied carefully these will help in the inner education of which I speak.

Old and New Testament

Shakespeare

Montaigne

Plutarch's Lives

Marcus Aurelius

Epictetus

Religio Medici

Don Quixote

Emerson

Oliver Wendell Holmes Breakfast-Table Series

Three Modern Novels Recommended to House Officers (This is ridiculously presumptuous, I know, like recommending just three modern paintings, symphonies or movies. Still, these three post-WW II novels seem to strike a responsive chord among most young doctors who read them.)