In celebration of medical essayists.

This month, the Postgraduate Medical Journal celebrates its 90th anniversary. By a nice coincidence, this happens to be the 90th article I have contributed to its pages, mainly in the form of reflective essays in this column. I feel privileged to be associated with the journal, and to be following in the footsteps of Sir William Osler, who helped to found the Fellowship of Postgraduate Medicine, became its first president, and was one of the greatest medical essayists of all time. It seems an appropriate moment to celebrate the place of the essay in medical journalism, and to pay tribute to some of its most distinguished practitioners. As Osler demonstrated, it is essays that put the flesh of medical dialogue and debate on the bare bones of science. Although medical journals publish a great deal of original research, most of them also include more discursive articles on wider topics, including politics, ethics and clinical controversies. Often, the other parts of a journal, including editorials, reviews, letters and case descriptions are written in essay form too. In many ways, the essay therefore is the defining form of medical writing. The essay is part of a wider culture than medicine, and it goes back a long way. The French philosopher Michel de Montaigne defined the literary form in the sixteenth century, with his own collection, entitled simply ‘Essays’. These were delightful reflections on human affairs, psychology, writing and just about any topic under the sun that caught his fancy. Later on, great English essayists including Joseph Addison and Samuel Johnson set up periodicals like the Spectator, and essays have formed the backbone of such publications ever since. Many great novelists, including George Orwell and Mark Twain, became famous for their essay-writing as much as for their books. The same is true of some historians and philosophers. In medicine, the physician Sir Thomas Browne began a distinguished tradition of essays with ‘Religio Medici’ in 1642. From then onwards, until the emergence of the standardised research article in the middle of the 20th century, medical knowledge was generally presented in essay form, as vintage issues of the PMJ make clear. My own favourite medical essayist has always been Richard Asher. He was a physician at the Central Middlesex Hospital during the 1950s and 60s. His classic articles included ‘The dangers of going to bed’, ‘Myxoedematous madness’ and ‘Why are medical journals so dull?’. They are all masterpieces of clear writing and common sense. He also offered a model of how to make an essay punchy and funny, while at the same time being accurate, humane and pragmatic. He influenced the entire next generation of great essayists, including Michael O’Donnell, who edited a wonderfully irreverent magazine called World Medicine. Following that magazine’s demise in the 1980s, many people predicted that the printed medical essay would soon die out, especially given the prodigious amount of research that doctors were expected to read and write, and the limited time this left doctors for so-called ‘light reading’.