Hippocrates in Modern Dress

HIPPOCRATES IN MODERN DRESS RENE DUBOS, Ph.D., ScD.* When your Institute and Society were founded fifty years ago, the specialists in infectious disease, nutrition, and metabolism were still the scientific heroes of the medical world. Their disciplines had yielded rich harvests ofpractical results, and had enlarged man's understanding ofhis relation to the environment. The intellectual atmosphere in medical schools, however, was even then beginning to change. In 1920, the development ofa practical method for theproduction ofinsulin made it obvious that medicine had entered a new phase; emphasis had shifted from the external to the internal agents of disease. Today the focus of attention is shifting even further away from the preoccupations of the early 1900's. More and more scientific medicine is identified with the esoteric knowledge of molecular biology or biological electronics, and with the spectacular performances ofmedical engineering in the lungs, the brain, the heart or the kidneys. The ceremony marking your fiftieth anniversary is a salute to the past, but also a dedication to the future. As a representative ofone ofthe downgraded scientific disciplines, medical microbiology, I should therefore feel embarrassed at speaking for the future. But instead, I feel gently amused because I am convinced that the glamorous achievements of today will appear old fashioned fifty years hence. In fact, I shall take advantage of your invitation to play the prophet, and tell you of some of the topics likely to occupy a prominent place on your programs when you meet to celebrate your hundredth anniversary. As there is no good prospective without retrospective, I shall first try to review briefly the forces which have been at work during the past 2,500 years to prepare the forthcoming change in direction of medical * Member and professor ofthe Rockfeller University, New York, New York. This paper was presented at a joint meeting of the Institute of Medicine of Chicago, and the Chicago Society ofInternal Medicine, Chicago, Illinois, February 22, 1965, and reprinted with the kind permission ofthe Proceedings ofthe Institute ofMedicine ofChicago. 275 effort. I shall first say a few words ofHippocratic medicine, which came to an end one hundred years ago. Then I shall define the two complementary medical philosophies which, in succession, have dominated postHippocratic medicine during the past century. Finally I shall announce, with tongue in cheek, the advent ofneo-Hippocratic medicine based on a new science dedicated to the interplay between whole man and his environment . Hippocrates and the Birth ofEnvironmental Medicine The Hippocratic tradition remained a living force in Western medicine until the last two decades of the 19th century. Surprising as it may seem to us, the treatise on "Airs, Waters, and Places" was reprinted for use in medical schools as late as 1874 and may have been used as a textbook by some ofyour founders. The 19th century physicians recognized, ofcourse, that the Hippocratic writings were not directly applicable to the clinical problems of their time; they went to Hippocrates for general medical wisdom rather than for practical information. I shall limit my remarks to a discussion ofone aspect ofthis wisdom, namely the role ofthe external environment on the characteristics of man in health and in disease. The treatise on "Airs, Waters, and Places" did more than relate the types and frequency ofdiseases to environmental conditions. It boldly suggested that climate, topography, soil, food, and water affect not only the physical stature, health, and temperament of different national groups, but also their military prowess and social institutions. The relevance of environmental forces to the problems ofhuman biology, medicine, and sociology has never been formulated with greater breadth and sharper vision than it was at the dawn of scientific history! The intellectual basis of Hippocratic medicine was thus the beliefthat many important physiological and behavioral characteristics are conditioned, and to a large extent, determined by the environmental conditions under which man is born and develops. This generalization is probably unpalatable to those ofour contemporaries who have been brainwashed—either by political or scientific propaganda—into believing that nothing biological is ofmuch importance except the genetic endowment. But, in fact, recent experiments in animals , and observations in human children, have established beyond doubt that early environmental influences affect the whole...