Dickinson Richards (1969) - Hippocrates and History

Dickinson Richards (1969)

Hippocrates and History

Dickinson Richards (1969)

Hippocrates and History

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Good medical practice is as close to the humanities as to science, if not closer. This becomes apparent in the only talk that Dickinson Richards, one of the eminent clinical investigators and cardiologists of the 20th century, ever gave in Lindau. In 1940, he had established the world’s first cardiopulmonary laboratory at the Bellevue hospital in New York City together with his colleague André Cournand. There they introduced cardiac catheterization in man as an important diagnostic tool to improve the treatment of cardiovascular diseases, partly building on insights that Werner Forssmann had gained in self-experiments twelve years before. All three shared the Nobel Prize in Physiology and Medicine in 1956. As a „physician with severely limited classical as well as scientific background“, as Richards modestly understates his profound knowledge, here he revives Hippocrates’ legacy to counteract „rather frightening trends that we find in present day physical and biological affairs including medicine.“ Both in health and disease Hippocrates saw man as a part of nature. The basis of medical care therefore is to understand nature. Acute disease is caused by an imbalance of forces, and the physician’s task is to assist nature to restore the balance of forces. According to Hippocrates, Richards says, medical doctors have to follow their patients from the beginning of a disease to its end, whether recovery or death, and to be concerned about the patient’s mental and emotional state as well as the physical strains and excesses that lead up to his illness.This broad conception of medicine forms the core of the whole medical corpus of Hippocrates, which was the main source of textbooks at the better schools of medicine for a thousand years and more. „If one looks only at the medical and surgical observations one finds that there is much of value“, Richards emphasizes: „Where else have we a collection in a field of science so protected and used over such a long span of time?“ Hippocrates’ scope was far too wide to fit into „that rigid rubric of the Hippocratic doctrine of the four humors“. With the immense success of science that began in the 17th century, man became the master and nature „in its limitless profusion his servant“. Hippocrates’ holistic approach fell more and more into oblivion. Diseases became specific entities, which were looked upon as enemies. Both men and nature were increasingly regarded as objects of scientific endeavor and subjected to men’s ambition to become „Lord of Creation“. While many once deadly diseases were defeated and humankind’s crusader-like conquest of nature has increased its knowledge and overall quality of life, it also had severe adverse side effects, not least „two wars with their ghastly devastation“.In the face of challenges like pollution, overpopulation and the nuclear arms race, „it seems reasonable to suppose“, Richards concludes, „that Hippocrates would argue that man must now abandon the notion of conquering nature and become once more nature’s servant. Nature must be protected more than exploited and this must be men’s primary concern.“ One could, Richards jests, reply together with Horatio „There needs no ghost, my lord, come from the grave to tell us this“[1]. Yet that would miss the point: „The question is not one of novelty but of urgency.“[1] William Shakespeare, Hamlet, Act 1, Scene 5, The Arden Shakespeare Complete Works, London 1998, p. 301, v. 131f.Joachim Pietzsch

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