For a decade, Jefferson's prophecy seemed likely to come true. Even Morse's son, Samuel F. B. Morse, inventor of the telegraph, became a Unitarian. Yet years of defending themselves against the conservatives had left a mark. To prove that they were not in fact Unitarian, the liberals had turned to the Scriptures, finding passage after passage to demonstrate that one could deny the Trinity and still remain a mainstream Christian. They had gotten so used to dissecting, parsing, and endlessly reinterpreting biblical phrases that they stopped doing anything else. The movement, which had been so spiritual for most of its existence, became coldly pseudoscientific, almost Scholastic.
The person who arrested this tendency, who shifted the emphasis back from the mind to the soul, was the poet and orator Ralph Waldo Emerson, perhaps the most famous Unitarian America has ever produced. Emerson was a Unitarian minister who had attended Harvard during the years of the pamphlet wars. Channing was his own minister.
Emerson became pastor of Boston's Second Church in 1829 but resigned three years later, finding it increasingly difficult to perform his duties with the sense of inspired enthusiasm that he felt the office required. He began a new career as a public lecturer and turned his considerable intellect to the question of what had caused him to quit his pastorate. He decided that “the blame for his failure as a minister lay not with himself but the institutions of organized religion, which he declared could no longer command respect.” Probing further, he discovered that it was the trend toward intellectualism and formality that was deadening the spirit and turning religion away from its purpose.
In 1838, he was invited to address the graduating class at the Harvard Divinity School and used the occasion to deliver a sermon decrying common church practice and putting forward his own views of the remedy, which came to be known as transcendentalism. Emerson's transcendentalism had nothing to do with India or meditation. Man's essence, he argued, was not formed simply through a series of sensory experiences. Instead, there were aspects of the human essence—the most important aspects, in fact—that transcended anything we might have seen, heard, or reasoned. Without awareness of this, life becomes empty and purposeless. It was this transcendence that man sought in religion.
Emerson when on:
Whenever the pulpit is usurped by a formalist, then is the worshipper defrauded and disconsolate… My friends, in these errors, I think, I find the causes of a decaying church and a wasting unbelief…In the soul, then, let the redemption be sought… Faith makes us, and not we it, and faith makes its own forms… the remedy is, first, soul, and second, soul, and evermore, soul.
Emerson's sermon was roundly denounced within the established Unitarian community. “I did not like it at all,” said Edward Everett Hale. “Mr. E held that the Christianity of the present day is little better than none.”
But young Unitarians came away with a far different view. One in particular, a poor farmer's son named Theodore Parker, was inspired to take Emerson still further. He denied that Christianity held any unique mandate on religious truth. The Bible was merely a written history, no more or less valuable or reliable than any other history. “Christianity does not rest on the infallible authority of the New Testament,” Parker said in a sermon. “I cannot see that it depends on the personal authority of Jesus. He was the organ through which the Infinite spoke.”
This was too much for many established Unitarian ministers. The Boston Association of Ministers took up the question of what to do about Parker. So inflammatory were Parker's ideas that they resurrected an epithet that in the past had only been used against them—heresy. It was decided that Parker should be invited to a meeting to discuss the problem in the hope that he could either be persuaded to recant his views or prevailed upon to resign his ministry. Parker accepted the invitation, and the planned meeting took place in January 1843.
To those familiar with the Servetus trial and the general treatment of dissenters through the ages, the Boston Association's handling of the Parker controversy marked a watershed in the annals of religious toleration. Parker met with a number of important ministers, including Dr. Frothingham of the First Church, who cited their objections to Parker's views. Parker responded but refused to recant. He was then asked to voluntarily withdraw from the Association and resign his pastorate. Parker refused, stating that he believed that the right of free thought had never before had limitations placed on it within their movement. As the eminent Harvard Unitarian scholar, Conrad Wright, wrote:
It then became apparent that, while the members would have been very much relieved if Parker had taken the hint and resigned, they were not disposed to prescribe a doctrinal test for membership… So several of the members said kind things about Parker's sincerity; he burst into tears… Dr. Frothingham shook him cordially by the hand and expressed the hope that he would come to see him soon; and the closest the Unitarians ever came to a heresy trial was over.
The 1840s and '50s would mark the peak of Unitarian influence in America. However, the very spirit of inclusion and free inquiry that had allowed the movement to encompass so many disparate and conflicting philosophies as to the nature of God and His relationship with man worked against a strong, unified front. Unitarians splintered into factions.
While Unitarianism never fulfilled Jefferson's prophecy, the words of Emerson live on, as does the record of the decency with which the movement treated Theodore Parker.
“WITH EMERSON AND PARKER, Unitarianism moved back to its spiritual roots. In their words are the echoes of Michael Servetus, who, at age twenty, wrote, “God himself is our spirit dwelling in us and this is the Holy Spirit within us. In this we testify that there is in our spirit a certain working latent energy, a certain heavenly sense, a latent divinity and it bloweth where it listeth and I hear its voice and I know not whence it comes nor whither it goes.”
But even as the vision of Servetus had finally found expression, Servetus himself had been relegated to an afterthought—if even that— in the movement he had inspired.
It would take William Osler, a member of the religious mainstream, an Episcopalian and admirer of John Calvin, to gain Servetus at least some of the credit that his extraordinary life deserved.
CHAPTER TWENTY
WILLIAM OSLER WAS the most famous doctor of his time, and today there are many who still call him the greatest physician in history. He was the youngest professor of medicine ever at Canada's elite McGill Medical School; he was one of four doctors, memorialized in a portrait by Sargent, to start the Johns Hopkins Medical School; he was appointed Regius Professor of Medicine at Oxford, the only Canadian to achieve this honor. His patient list included Walt Whitman; Edward, Prince of Wales; Henry and William James; and Sir James Murray of Oxford English Dictionary fame. (“See that fine old man over there? He's Sir James Murray. The University pays me my stipend as Regius Professor to keep him alive till the Dictionary is finished,” Osler once told a friend.) Upon being informed that Dr. Osler had been knighted, one of his patients, a twelve-year-old girl, said, “Too bad. They should have made him king.”
Osler was born on July 12, 1849, in the wilds of the Ontario frontier. His father, Featherstone Lake Osler, was an English naval officer who had the distinction of being the man who turned down the position of naturalist aboard the Beagle just prior to its being offered to Charles Darwin. When the British government changed hands in 1832 and the Whigs came to power, Featherstone, a Tory, found himself without a ship. His naval career stymied, he decided to enter the ministry, fully expecting to lead a quiet life in an English country parish. Instead, as a result of his seafaring background, he was assigned to the British colonies north of Toronto, the most remote outpost in North America.
He and his wife Ellen went unwillingly; life in much of Canada was primitive, cold, bleak, and desperate. In England, the phrase “to go to Halifax” was slang for dying.
The Oslers, who began their new life in a tiny one-room shed that had originally housed a horse, persevered and were rewarded with s
uccess and social position that would have been unattainable had they stayed in England. William was the eighth child born to the family, and the youngest son. He planned to become a minister like his father, but his life turned when, at seventeen, a sporting injury forced him to spend a winter in bed. While he was convalescing, one of his teachers, Reverend William Arthur Johnson of Trinity College, introduced him to the world of natural science.
Johnson had a microscope, a rarity in western Canada in 1867. He and the school physician, Dr. James Bovell, who was treating Osler's leg, often met to examine slides that Osler had helped prepare during the long months of enforced rest. When his leg improved, the three went tramping through riverbanks and in marshes collecting shells, rocks, worms, algae, and other interesting specimens. Additionally, Bovell had one of the best medical libraries in Canada, and Osler spent many evenings with the doctor and his books. “That winter gave me a good first-hand acquaintance with the original works of many of the great masters,” Osler wrote.
In 1868, Osler enrolled in the Toronto School of Medicine. He was drawn immediately to the potential of autopsy in the advancement of medicine—he would regularly eat his lunch in the dissection room. After two years at Toronto he switched to McGill and at twenty-two he graduated. His senior thesis, a report based on twenty postmortems he had conducted, illustrated with specimen slides, was so impressive that the school urged him to stay on and teach, but he elected instead to continue his medical studies in Europe. He attended the University of London and afterward schools in Berlin and Vienna, where he was instructed by some of the finest teachers in Europe. When he returned home, McGill made him a full professor even though he was only twenty-five and younger than some of his students. They called him the Baby Professor.
Medical school salaries were small at McGill—Osler earned just over one thousand dollars a year—and professors were expected to supplement their incomes by becoming practicing physicians. In 1874, Osler took a job as physician in the smallpox ward at Montreal General Hospital. (This paid six hundred dollars. He spent the money on fifteen microscopes from Paris for his students.) Although by this time a vaccine was available, many in Montreal refused to take it, and hundreds died from the disease each year. “Doctors feared and hated smallpox almost as much as the general public did,” wrote Osler's most recent biographer, Michael Bliss. “Being a smallpox doctor, a physician in the pesthouse, was to practice on the bottom rung of the medical ladder.” Osler treated more than eighty patients over a two-year period, observing the disease in all of its stages, trying to help those for whom he knew there was no help. He performed many postmortems, and worked with patients with open sores in an attempt to forestall the ravaging effects of the disease. As a result, he caught smallpox himself, although he had previously been vaccinated, which saved him: “My attack was wonderfully light,” he wrote. His old teacher, the Reverend Johnson, was not so lucky; he died from smallpox a few years later.
Over the course of the next ten years, Osler's reputation grew. He delivered papers at international conferences and published lectures. He traveled widely, keeping abreast of developments in Germany and spending time in Boston at the Harvard Medical School. He was held in such high esteem that when the chair in clinical medicine at the University of Pennsylvania fell vacant, the trustees unanimously invited Osler to accept the position.
“WHEN OSLER CAME TO AMERICA, medicine was just emerging from a dark age. Medical hygiene in particular had remained medieval in the United States. Despite centuries of evidence, from men like Richard Mead, of the role that sanitary conditions could play in preventing infection and disease, physicians in nineteenth-century America were often stupendously unsanitary. They didn't wear masks or wash their hands or instruments between patients. Surgeons, whose chief experience in most cases had been treating war wounded, sometimes smoked cigars in the operating room. Death from infection was far more widespread than death from primary disease or injury. In fact, it was considered preferable to perform surgery in a patient's home, often on a table in the kitchen, rather than in a hospital, where postoperative infection was a far greater hazard.
Medical education reflected the practice of medicine. With the exception of a few high-grade schools, doctors received their training in glorified butcher shops. In most states, medical schools were privately operated and unlicensed, answerable to no standards but their own. There was little or no clinical training, and the bulk of learning was acquired through apprenticeships with practicing physicians—an ongoing source of cheap labor for the doctor.
As the nation grew, so did the demand for doctors. Since all it took to open a medical school was a hall and a group of physicians willing to lecture—with students required to buy tickets to those lectures—the profit potential in opening a medical school was substantial. Forty-seven medical schools opened between 1840 and 1875—more than the total number previously in existence—most with no academic admission requirements at all. Schools attracted brawlers and drunkards. It was not uncommon for some of these budding doctors to be illiterate. In 1870, the president of Harvard, the nation's finest medical school, wrote, “The ignorance and general incompetency of the average graduate of American Medical Schools, at the time when he receives the degree which turns him loose upon the community, is something horrible to contemplate.”
Government was no help. American medical students were not much better off than Vesalius. Until 1830, the dissection of human corpses was illegal in every state in the union. Students had to sneak their own cadavers into school in order to study the body. Colleges sometimes put body snatchers on the payroll. Even after Massachusetts legalized autopsies in 1830, it took decades for dissection to become a widespread tool.
There were intermittent stabs at raising standards. In 1847, the respectable side of the medical profession created its own organization, the American Medical Association. As one of its first acts, the AMA set up a committee to study medical education. Soon afterward it issued a report advocating extending the school year from four months to eight, establishing a minimum requirement of seven faculty members of different specialities to open a medical school, observing more rigorous standards for admittance, and adopting a more intensive curriculum. The two medical schools that attempted to institute the recommended changes suffered a disastrous drop in enrollment and would have been forced to close had they not returned to lower standards.
The Civil War was a boon to the medical profession, but not to upgrading the practice of medicine. Demand for physicians overwhelmed supply. With virtually every physician and surgeon pressed into service, regardless of skill or training, even the maintenance of low professional standards became a laughable impossibility. Still, the war was not without its benefits. Doctors near the front often received more clinical experience after one battle than they would get for the rest of their lives. As with Galen at the gladiatorial school, the horrible wounds that modern weapons such as the lethal Minié-ball bullet produced gave many of them their first real opportunity to look inside the human body. But the mass-production cutting and stitching and the enormous numbers of amputations did little to advance science. When these doctors left the army, many turned to teaching as a means of increasing the often meager income that came from the treatment of patients.
Medical schools again boomed, more than tripling between 1860 and 1900. Competition for students became more acute. As had happened after the AMA report, anytime a school tried to raise its standards, it saw enrollment shrink as students switched to a less demanding curriculum. Thus student bodies became a mishmash of the motivated and the venal, the qualified and the dregs.
Writing in 1885, a member of the faculty at Rush Medical School in Chicago described his class:
The students were of all types. The refined well-educated, neatly dressed, well-to-do student, twenty-one to twenty-three, who had high ideals concerning his chosen career, might sit next to a poorly dressed, thirty-year-old man, who, likewise with high ideals, was working
his way through college. Or his neighbor might be a rougher specimen who, after twenty or thirty years as a teacher, druggist, traveling salesman, or western farmer, had given up his former occupation because he believed he could make more money as a doctor. In my class of 1888, there were only seven men out of the one hundred thirty five who could show diplomas from colleges of literature, science, and arts.
In fact, of the over sixteen thousand medical students in the United States in 1890, fewer than eight percent had college degrees.
Even in the better medical schools, such as those at Harvard or Yale, the curriculum was overwhelmingly weighted toward lecture and classroom study. It was possible even in these institutions to graduate without ever having actually seen a patient. Other facilities were far worse. As late as 1903, most medical education was, as reported by the AMA's Council on Medical Education, “absolutely worthless,” with some schools “no better equipped to teach medicine than is a Turkish-bath establishment or a barbershop.”
It was William Osler, more than any other physician, who revolutionized the practice of medicine as well as the way new doctors were to be trained in America.
From his trips to Europe, Osler came to realize that the classroom lectures that dominated American medical education were no substitute for clinical experience. Medical students in Germany, Austria, France, and Britain spent a large portion of their training dealing directly with patients. Osler opposed the prevailing ethos in America that clinical training was harmful because students would rarely encounter diseases in textbook form, and many diseases might not be encountered at all. At the University of Pennsylvania, he immediately intensified the clinical training of his students.
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