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DICKINSON WOODRUFF RICHARDS October30, 1895February23, 1973 BY ANDRE COURNAND It is only when Death bui/~ its frame around life that the portrait of a man is really hung on a wall.. HENRY JAMES Truefr~en~ create the charm of life, their passing, its bitterness. ANONYMOUS MODESTY AND GREATNESS seldom harmonize in one in- diviclual. Dickinson Woodruff Richards ("Dick"), to whose memory this biographical sketch is dedicated, is one of those few in whom these apparently opposite qualities bal- anced one another. Although modest to the point of shyness, he implementer! his natural intellectual gifts through strong character ant! hare! work, reaching the heights in whatever he undertook whether as a schoolboy, college and medical student, physiologist, medical scientist, clinician, chairman of a teaching service in a municipal hospital, organizer of two research laboratories in the field of carctiopulmonary physio- ~ The following account of my friend's life and works is derived from several briefer ones I published after his death at the request of societies to which he be- longed. It first appeared in my autobiography, From Roots . . . to Late Budding (New York: Gardner Press, Inc., 1986), pp. 165-182. 459
460 BIOGRAPHICAL MEMOIRS pathology at the College of Physicians and Surgeons of Co- lumbia University, medical consultant to a leading pharma- ceutical firm, adviser to the Committee of Medical Research (CMR) of the Office of Scientific Research and Development (OSRD), educator, historian, reformer, or humanist. This essay by his friend and close collaborator for more than forty years will evoke Dick's life and his fundamental contributions in these many and diverse situations in an at- tempt to recreate, ten years after his death, the image of a man who achieved greatness by exacting perfection of him- self in whatever activity he was engaged. A retrospective overview of a man's life may lack objectiv- ity when attempted shortly after his (leash, feeling then pre- vailing over critical ant! well-clocumented judgment. In this last of many tributes to my friend, the essential features of his character and accomplishments will be derivect from my personal recollections, from information tenderer! by mem- bers of his family, ant} by a number of his colleagues ant! students. Dick's correspondence, and his publisher! and un- published writings, will also contribute. FAMILY BACKGROUND: CHILDHOOD, SCHOOL, AND COLLEGE EDUCATION; MEDICAL AND PHYSIOLOGICAL TRAINING (1895-1928) Dickinson W. Richards was born October 30, IS95, in Orange, New Jersey. His ancestors on both sicles had settled in New England (Massachusetts and Connecticut) during the seventeenth century. His paternal grandfather was a Congre- gational minister, as was one of his uncles, and his father was a lawyer. On his maternal sicle, among the Lamberts, physi- cians prevailed. His grandfather practicer} general medicine in New York City after mectical training at Bellevue, then the city's largest municipal hospital. His three uncles achiever! leading positions in the mectical profession. All three were
DICKINSON WOODRUFF RICHARDS 461 . connecter! either with Bellevue Hospital or the College of Physicians ant! Surgeons, or both. Dick himself has this to say about the opposite traits of character to be fount! in both lines of forebears, all of whom were New Englanclers sharing a common tradition. On his father's side he saw them as "believers; conformist; non- curious; judicious, steady, firm; noninnovators; meditative, nonscholarly" ant! on his mother's side, "nonbelievers, non- ~ · · · · . ~ contormlsts; curious; vigorous, qulck-temperec ,; Innovators, crusaders; scholarly, nonmeditative." The harmonious selec- tion among both sets of traits was evident in Dick's own char- acter and behavior. Already in his early life are found traces of the distinctive aspects of his personality: innate shyness anct modesty, an enormous capacity for work, and the natural bent of a scholar. Dick's modesty did not interfere with the develop- ment of his aptitude for learning. A picture of the schoolboy ant! student at the Hotchkiss School in :Lakeville, Connecti- cut where, following a family tradition, he received a cIas- sical education in the humanities: English, Greek, and his- tory is drawn from the testimony of a classmate, William Albert Olsen, who later became his brother-in-law: "At com- mencement, it became automatic that Dick would be caller! to the platform to receive handsome books for being first in every course he took. He literally walked off with an armful of prizes!" On the wall of the study hall still remains the inscription: Dickinson Richards, fr., 1913. Total Year Average: 93.4. When he entered Yale University as an undergraduate, he was following a tradition upheld! by all the young men among his forebears, whether Richardses or Lamberts. According to Bert Olsen, "He won the Hugh Chamberlain prize for Greek entrance examinations with the highest mark ever obtained." Dick used to communicate in ancient Greek with his toom-
462 BIOGRAPHICAL MEMOIRS mate Bellinger (who later became a professor of Greek at Yale), discussing in this language everyday problems arising in college. Professor Bellinger, recalling his friendship with Dick, stated that, "when evaluating any tother] man, he al- ways usect the scale of D.W.R., set at 100." While at Yale, in aciclition to pursuing his studies in the humanities, Dick acquired a good background knowleclge of mathematics and natural sciences, anti, as Olsen reported, "lecI his entire class in gracles throughout his unclergraduate years." Yet these scholastic achievements clid not cleter him from fincling time for extracurricular or athletic activities. At both institutions he was editor in chief of the school journal. At Hotchkiss he received his letter in high jumping; at Yale he shifted to rowing, but was unsuccessful in his attempt to make the varsity squad. After graduation in 1917, Dick joined the army and, in 191S, near the end of WorIct War I, crossest the Atlantic with an artillery unit in which he served as lieutenant. Upon his return from Europe and discharge from the service in 1919, the time came for Dick to decide on a career. His choice was the medical profession not surprising, given a grandfather and three uncles who had responded to similar calls! Dick entered the College of Physicians and Surgeons in 19 ~ 9. Ow- ing to his enormous zest for work, he not only completed his medical studies brilliantly, obtaining his M.D. in 1923, but also his master's degree in physiology at the end of his third year under the guidance of Professor Ernest L. Scott. Forty- three years later, in 1966, Dick paid his debt of gratitude to his first teacher of physiology by bringing to light documents, totally ignored until then, upon which Scott's Ph.D. thesis tract been based: The data collectecl back in 191 ~ clearly demon- strated the favorable effect of a pancreatic extract, which he had prepared, upon depancreatizecl dogs. After graduation he continued his training in medicine as
DICKINSON WOODRUFF RICHARDS 463 an intern and as a resident in medicine at the oIcI Presbyte- rian Hospital from 1923 to 1927. During this period he formed close friendships, which proved to be lifelong, with Robert Loeb and Dana AtchIey. Both were members of the staff of Presbyterian Hospital, newly affiliated with the Col- lege of Physicians and Surgeons. Both of these gifted friends guided Dick's earliest footsteps in hospital practice and clin- . . . . ca Investigation. However, the men who most affecter! his mind ant! actions in these years were, by his own account, two outstanding physiologists from whom he clerived his grounding in phys- iological research and his approach to scientific medicine ancI clinical investigation, which wouIct shortly rival the basic knowlecige acquirer] earlier in the century. Of their early in- fluences, Dick said: "A man's mine! and his actions are chiefly molded by a very few. For me, in the early years, these were Lawrence I. Henderson and Henry Hallet Dale." Although Dick never worked in the Fatigue Laboratory, created at the Harvard Business School by ~ I Henderson, the professor's influence on and interest in the budding phys- iologist were strengthened by numerous exchanges of letters anct by Dick's frequent visits to Cambridge, Massachusetts. These exchanges had been facilitated by Dick's Yale classmate and friend Cecil Murray. It was from Henderson that Dick derived what was to be the guiding idea of his work in human physiology and physiopathology. To his influence must be traced one of Dick's earliest publications (in 1927), "The Oxy- hemogIobin Dissociation Curves Ecurves defining the affinity of hemoglobin for oxygen at various pressures] of Whole Blooc! in Anemia," which supplied the first experimental evi- dence of a clisease-inducecl decrease in the affinity of hemo- gIobin for oxygen in man. Under Henderson's tutelage Dick published three papers cluring his residency: one on the circulatory adjustments in
464 BIOGRAPHICAL MEMOIRS anemia; another on the blood flow through the lung ant! systemic circulations, quantitatively clefinec} (for the first time) in a patient with tetralogy of Fallot; and a third one on the influence of posture upon the mechanics of blood flow. On several occasions Dick Richards paid tribute to Pro- fessor Henderson as his mentor in physiology anct his ideal as a scientist. The most notable of these was Dick's speech at the respiration dinner of the American Physiological Society held during its meeting in Chicago, in April 1957. Here, Dick offered the following portrait: It seemed to me he was quite a bit like Socrates, the Socrates of those early dialogues when he was young and lively, poking fun at aged philosophers and straining the wits of young ones.... It may as well be said now as later that in spite of his complete freedom of mind, in personal demeanor Hen- derson was always most courteous and considerate. That Jeffersonian phrase, "a decent respect for the opinions of mankind" applied well to his manner of life.... . . Dick's description of what it was like to discuss actual work in progress with Henderson vivictly depicts their personal relationship at this early time: What would happen was something like this. You would work and strive to put your experimental ideas together, then go to the Professor and tell him about them. He would then either decapitate your entire brainchild in a single whistling sentence, or else take about three more sentences to put your ideas in order for you, and you would come back and start to work. Then (after a while) you would go back again with what you had done, and again, with great kindness, yet with still the same unsparing critique, he would take your work apart. If there was anything left, after he finished with it, you would feel elated and go back and try some more. At the end of his residency, Columbia University awarded Dick a research fellowship to work at the National Institute for Medical Research in Lonclon, England, during the period 1927 to 1928. There he worked uncler the guidance of Henry
DICKINSON WOODRUFF RICHARDS 465 Dale. Looking back on this period of training in experimental physiology, Dick hacI this to say about his British mentor: [Sir] Henry Dale could theorize, too, but his tmind] was fas compared with that of L. I. Henderson] different. Dale was primarily an experimenter and continued this through almost all his active years.... On a day when an experiment was planned, Collison, the head technician, would start at some time in the dark British predawn; Walter tBauer]2 and I would arrive about nine . . . we were working on the dog's hepatic circulation. Just as we reached the key point of cannulating the blood vessels and bile duct, the laboratory door would fling open, and Sir Henry (Dr. Dale as was then) would come charging in, often in morning coat and striped trousers, grab a lab coat off the hook, and be with us in seconds. What is more, he would stay until the experiment was finished, whether at tea time, dinner time, or later. As it happened, it was in the spring of 1928 that the concept of the chemical transmission of the nervous impulse was born. Our job in this was the simplest, to test in cats the vasodilator principle supposedly his- tamine in extracts of horses' spleen. I recall one afternoon when the testing was finished, I had some extract left over, and I went on to acidify and then alkalinize samples of it and test them again, to find, suprisingly, that on the alkaline side of neutrality all vasodilator activity disappeared. This would not occur with histamine, but would with acetylcholine. I re- ported this to Dr. Dale at tea that day, and he said, "Hmm," no more. But this was clearly one small addition to many things he had been thinking about, because only a few days later he began to construct for us the pos- sibilities of acetylcholine as a biological agent. The generation of a great idea in a first-class research mind, over months and years, is a remarkable thing. One can only admire the way Dick modestly neglects to emphasize his own role, a trait that was so significant throughout his entire scientific life. In any case his work in Henry Dale's laboratory was sanctioned by the publication in the journal of Physiology of two papers, one in collaboration with Walter Bauer on the vasoclilator effect of acetates, and 2Bauer was another American research fellow with whom Dick maintained a life- long friendship.
466 BIOGRAPHICAL MEMOIRS the seconc} in collaboration with Walter Bauer ant! Henry Dale on the control of the circulation in the liver. More significant for his career as an investigator, Dick's training in Dale's laboratory was to prove of particular value in later years when he familiarized himself with the technique of right-heart catheterization in experiments on clogs anct in a chimpanzee. At the end of the tenure of his research fellowship, Dick Richards returned to New York. In 1928 to 1929 he began his career as a clinician, teacher, and independent clinical investigator, pursued entirely at the Columbia-Presbyterian Meclical Center ant! at the Columbia University Division of Bellevue Hospital until his official retirement. EARLY CLINICAL INVESTIGATIONS (1928-1932) Upon his return from London in the fall of 1928, Dick was to join the other members of the Department of Medi- cine in the newly creates! Columbia University-Presbyterian Hospital Medical Center as an assistant in medicine anc! as- sistant physician. The members of the department, under the chairmanship of Walter Palmer, included one of the most brilliant groups of fulitime investigators, clinicians, and teachers in North America. Dick turned to the problem of how to equilibrate O2 anct CO2 in a lung-bag system in order to estimate their concen- tration in the mixer! venous blood. A first application of the method, known as "indirect Fick," was to stucly the effect of therapeutic pneumothorax upon the pulmonary blood flow. It so happened! that this investigation was to play an impor- tant role in Dick's personal life as well. A young graduate of Wellesley College, Constance Riley, came to work in Dick's lab as a technician. They became engaged in 1930 and married in September 1931. A survey of Dick's scientific activity after his return from
DICKINSON WOODRUFF RICHARDS 467 London is not limitect to the research already mentioned. In 1929, in collaboration with Alvin Barach (a part-time mem- ber of the Presbyterian Hospital clinical staff), he initiated a series of investigations, pursued during the next five years. The studies concerned the effects of oxygen therapy in chronic cardiac anti pulmonary diseases, including cardiac failure, pulmonary tuberculosis, pulmonary fibrosis, ant! em- physema. Dick was well prepared for these studies since they had as their particular focus of interest the effects of oxygen therapy on serial bloocl respiratory gas anct electrolyte re- sponses. For the first time, they observed the seemingly par- a(loxical response to O2 therapy in certain pulmonary clis- eases (fibrosis and emphysema) of a high CO2 tension that developer} as a result of the relief of hypoxia followed by reclucec] ventilation. THIRTY YEARS OF COLLABORATION WITH A. COURNAND ( 1 932-196 1 ) To Dick himself shouIc! be left the occasion to present, in his own terms, how he envisioned the long perioc! of his col- laboration with me. This purpose will be served by reference to the contents of a letter he wrote in December 1972, to Julius Comroe, a distinguished colleague who since the mid- 1940s had greatly contributes! to pulmonary physiology ant} physiopathology. In this letter Dick established the natural sequence of his investigative work. The first sequence, termed by Dick "BloocI and Circulation," deals with the in- vestigations mentioner! previously during the period 1922 to 1932. The seconc! sequence is the signal of his extending interest from "Blood to Lung" in order to cope with "neglect of lung performance by cardiocirculatory physiologists." This latter perioc! stretched from 1932 to 1942. A series of tests and the equipment these necessitates! were clevisec! for the analysis of the various components of the pulmonary func-
468 BIOGRAPHICAL MEMOIRS tions as they were observed in normal subjects in whom stan- ciarc! measurements were establishect anct in patients with various forms of chronic pulmonary diseases. The beginning of the third sequence, from 1940 to 1961, termed! by Dick "Lungs, BloocI, and Circulation," is heraldec! by the introduction into clinical investigation of the technique of cardiac catheterization. This additional technique enabled the exploration of the dynamics of the cardiac functions output, filling and ejection pressure, pulmonary and systemic blood flow. In association with implementation of the tech- niques established during the previous periods, the new tech- nique heralcled the crowning fulfillment of the plan laicI clown for him by his mentor, L. I. Henderson, allowing the description of the successive phases of respiratory gas trans- port from the atmosphere to the tissues in normal humans as well as in an almost limitless variety of diseases. Our daily collaboration over several decades provided a unique opportunity for observation and insight. To begin with, my recollections, vivid in my mind, are of his display of technical skill he was truly ambidextrousand efficiency; of his care and caution in studying human subjects; of his implementation of self-experiment in the true tradition of the British and Scandinavian respiratory physiologists; of his foresight ant! careful planning, which included taking aclvan- tage of the unexpected and stressed methoclological inno- vations; and of his thorough knowledge of medical literature, current ant! classical. For all his affability, even temper, anti friendliness, Dick was a hare! taskmaster and a clemancling teacher, always prob- ing the prior question, exacting high accuracy in the collec- tion of data and strict objectivity in their interpretation. He expected from his associates, if not the perfection, then at least the work pace that he set for himself. In(lee(1 ~ recall my mixed feelings when confronted by a deluge of books,
DICKINSON WOODRUFF RICHARDS 469 manuscripts, and reprints fed to me in our early meetings and cluring my initiation into the many techniques I was sup- posed rapidly to master. Dick Richards's contributions to medical research were not limitecl to physiology and physiopathology. In ~934, with- out any letup in his other activities, he became medical ad- visor to Merck's research organizations. His expanding knowlecige of medical science and meclical affairs was a great asset in formulating therapeutic research policies. These pol- ~c~es were particularly fruitful during World War Il. as they lect to close cooperation among scientists in government, in- dustry, and the universities. They also lee] to a valuable re- cluction in the time lag between discovery, clinical testing, and practical use of such agents as cirugs, antibiotics, and vita- mins. . . At the enc! of the war, in 1945, he became the head of Columbia University's First Medical Division at Bellevue Hos- pital; at the same time he was promoted to the fulItime Lam- bert Professorship of Medicine at the College of Physicians and Surgeons. In these functions he gave his full measure as a leacler in clinical medicine. One of his former residents, Thomas Q. Morris, recalls him as a teacher of physicians in these terms: Members of the Bellevue Hospital House Staff who made rounds with Dr. Richards saw him as a multifaceted man clinician, teacher-scientist, and chief-of-service. His impact on physicians in training can be fully appre- ciated only in his meld of these three roles. As a gentle clinician con- cerned in the utmost for the comfort of his patient, but, above all, the master of clinical judgment able to discern the proper course in a laby- rinth of clinical and laboratory data though never reluctant to seek con- sultative advice. As a teacher-scientist applying principles and results of research to interpretation of clinical phenomena and toward improved medical treatment, and awakening investigative potential in residents and interns through his attitude of constant inquiry. And finally as chief:of- service always available to members of his house staff, fostering an at-
470 BIOGRAPHICAL MEMOIRS mosphere conducive to the happy blend of excellent patient care and fruit- ful clinical investigation, and willing (and able) to do combat with the administrative structure of a municipal hospital system. Indeed, as a member of the Bellevue Meclical Board, Dick was outspoken anct unyielding in his criticism of the city's neglect of its hospitals anti in his efforts to bring to bear pressure to oblige the city to erect a new hospital building. On the occasion of his retirement in 1961, he received, as a commemorative gift from his colleagues, a bronze replica of the casting surrounding the elevator call buttons in the an- cient (dilapiciated) A ant! B Buildings of Bellevue. Dick's retirement was, of course, anything but that. Arounc] that time, with Alfred Fishman's help, he was cleeply engaged in the planning and editing of the book Circulation of the Blood: Men and Ideas. An unrelentingly critical, albeit sympathetic, editor Dick was nerhans the most severe judge of his own thought ant! expression. 1 1~ - - A- - ~- His last ten years, without letup, were clevotect to multiple scholarly undertakings and to a quest for a more decent world and a safer environment. To the medical historian we owe a deep anct illuminating knowledge of his two medical heroes, Harvey, the scientist, and Hippocrates, the practicing physician and natural phi- losopher; and the creation anct implementation of a program of teaching in biomedical history that emphasizes men and ideas rather than facts and chronology. One of D.W.R.'s most notable achievements was to (lis- cover what his hero, Hippocrates of Cos, Coked like and who he was. This search for an authentic portrait of Hippocrates anct his interpretation of the famous First Aphorism, "I ife is short, art is long, opportunity fleeting, experiment treach- erous, judgment ctifficult," are landmarks in the field of an- thropological detection anct testament to his perseverant cu- riosity anct profound knowledge of the Greek language. An
DICKINSON WOODRUFF RICHARDS 471 article published in the June 17, 1963 issue of the Journal of the American Medical Association recounts the story of the ctis- covery anc! identification of a marble bust of Hippocrates in 1940 near the ruins of Ostia Antica, a seaport of imperial Rome. The worcl-by-word analysis of the quartet of epigrams forming the first part of the First Aphorism was published in the 196 ~ issue of Perspectives in Biology and Medicine. Richards, a science philosopher, proposed a system of clis- eases in which recognizable biologic trends have nonho- meostatic properties: the excessive, the defective, and the in- appropriate. He also rejuvenated the Platonic concept of Taraxis, or disorder, which our whole human experience im- poses on the interpretation of environmental phenomena anct the events of life. He emphasized that the chaos, the senseless, and the suffering lead in medicine to the reestab- lishment of orcler. In many lectures, Richards, the reformer, acivocated new methods of medical teaching, stigmatizing the pretension of man to become the Lord of Creation without anticipating the consequences of his ill-usecI power over nature. In the humanist we can admire a sense of the human, which is not a mere orientation of the intellect but a profound attitude involving the entire being. In the reformer, we ad- mire the man concerned with the consolidation of the prom- ise of the future anct the limitation of its threats. But life was not only work; it was also relaxation in the country surroundings where Dick brought up his four daughters. Each summer he enjoyoct his return to the large and simple house built by his parents on Lake Sunapee in New Hampshire. There, many years ago, a lonely foreigner, sitting at the table over which Dick's mother presided, dis- coverect and enjoyed the comforting and warm spirit of a closely knit American family. In this setting also, roughing it along the trails of the White Mountains, grew and ripened a
472 BIOGRAPHICAL MEMOIRS friendship, of which, on another memorable occasion, ~ said that "its essence was not to look in each other's eyes, but to look in the same direction." Late in his retirement, he published a small volume, Med- ical Priesthoods and Other Essays, that contained those of his lectures he believed to be entertaining anti to express his general ideas on medicine and the physiology of the heart and lungs, as well as on other topics. In this volume, in line with his dominant intellectual concerns, we hear him com- menting on the relegation of a stethoscope to a display case in a university hospital: Let us pause for a moment and contemplate this humble little device, the stethoscope, by and for itself. Look at it as it hangs on its hook, with its ears up and its rubber legs twisted. Has anyone ever commented how remarkably in this posture it simu- lates the snakes of the caduceus, the symbol of our friend Aesculapius? Well, one can say that in this particular posture it is indeed equally sym- bolic, and equally useless with the aesculapian wand. But now suppose we put the thing into operation. There occurs a metamorphosis.... This ancient and outdated instrument of nickel, rub- ber, and plastic has one attribute that transcends all the laboratories that ever were or ever will be built. In order for the stethoscope to function . . . there has to be . . . a sick man at one end of it and a doctor at the other. The doctor has to be within 30 inches of his patient. It won't work by long distance telephone, or by word of mouth through half a dozen interme- diaries, or by radio, or by television, or in a dry clinic, or even in a com- mittee.... We are concerned over the widening gap between the clinic and the laboratory, the interest in the measurement and the neglect of the person.... Be assured that I am in no sense arguing against the physician working in the laboratory. But once a physician does take upon himself the responsibility for a patient's care, he becomes a different man. He accepts a social discipline. He must define the problem anew . . . in each particular case.... Human suffering pervades the whole sick man, and this whole must be cared for. Hippocrates said it more clearly .. . than anyone: "It is necessary for the physician to provide not only the needed treatment, but to provide for the sick man himself, and for those beside him, and to provide for his outside affairs."
DICKINSON WOODRUFF RICHARDS 473 In Medical Priesthoods there also were two of his writings on Hippocrates, long of interest to him and now, according to his preface, his "chief preoccupation." In one of these es- says, "Hippocrates and History," he succeedecl in weaving into one fabric his dominant intellectual concerns those of physician, classical scholar, humanist, and social critic. One facet of Richards the social critic ~ have already mentioned in connection with his effort to provide a better plant at Bellevue. Important as this was, it would not JO to leave the matter there, for like his uncle Alexancler Lambert, who in the 1920s urged that the medical profession clevelop what we today would no cloubt term new models of health care to better meet the neecis of the population at large, Dick was not always content with existing patterns of practice. To my mind this illustrates one aspect of Dick's extraor- inary progression: the chil(1 and young man, brought up in a New Englanc! tradition, from early on demanding perfec- tion of himself, presenting a rare example of a happy mar- riage from which issued four daughters anct many granct- chilclren; mastering medicine and contributing substantially to carcliopulmonary physiology; withstanding with easy grace the challenge to personal integrity occasioned by the highest recognition affordecI scientists and physicians; remaining the man formed by his early training, education, and culture, and yet going far beyond them, as reflected! in one sense in the above statement and in another in his inspired new understancling of Hippocrates. As ~ noted at the outset, Dick's modesty remained fun- damental throughout his life. When he was awarcled the No- be} Prize in Physiology or Medicine in 1956 and the Kober Medal in 1970, he converted each occasion into one for the detailed! appreciation of the work of his colleagues and peers. Proffered many (doctorates honoras causa, he accepted but two: one from his alma mater ant] the other from the univer-
474 BIOGRAPHICAL MEMOIRS sity with which he was to be connected for more than fifty years. In the task of paying a last tribute to my friend, ~ have been guided by what appeared essential in the man. Ancl yet ~ have not touched on his enormous correspondence, couched in his fine, precise writing, which he sustained on a multitude of topics with scientists, philosophers, historians, colleagues, former students, ant] friends. Nor have ~ listect all the honors, endowed lectureships, editorships, committee memberships, ant! organizational assignments bestowed upon him. Such an enumeration would not have satisfied his deliberate avoidance of easy effects. What, then, of the essence of the man? With Alfred North Whitehead and Shmue} Sambursky, Dick affirmer! that the "language of Science is incapable of application to, or use in the description of, the qualities of consciousness." To char- acterize "man's essence actual" he cited, with his deeply felt pessimism, Measure for Measure: . . . man, proud man, Drest in a little brief authority, Most ignorant of what he's most assured, His glassy essence, like an angry ape, Plays such fantastic tricks before high heaven As make the angels weep. Ancl of"man's essence ideal" he wrote to me, "Man's potentiality, or in these days his survival, will clepenct on his consciousness, more specifically his conscience, more specif- ically still, the ability of the leaclers ant! their followers to change character, into more merciful beings." If one believes, as he did, that science is of no use in the description of the transformation of which he writes, those who knew him may yet fee! that his character provides an example of what can be accomplished.
DICKINSON WOODRUFF RICHARDS 475 SELECTED BIBLIOGRAPHY 1927 With A. F. Coburn. Diet determinations. A graphic method. Arch. Intern. Med., 39:93. With M. L. Strauss. Oxyhemoglobin dissociation curves of whole blood in anemia. I. Clin. Invest., 4: 105. On the mechanics of blood flow with special reference to the influ- ence of change of posture. Proc. Natl. Acad. Sci. USA, 13:354. 1928 With M. L. Strauss. Circulatory adjustment in anemia. J. Clin. In- vest., 5:161. With W. Bauer. A vasodilator action of acetates. I. Physiol., 66:371. 1929 With A. L. Barach, A. T. Milhorat, and R. L. Levy. Effects of oxy- gen therapy on patients with congestive heart failure. Proc. Soc. Exp. Biol. Med., 27:308. 1930 With M. L. Strauss. Carbon dioxide and oxygen tensions of the mixed venous blood of man at rest. I. Clin. Invest., 9:474. 1931 With A. L. Barach. Effects of treatment with oxygen in cardiac failure. Arch. Intern. Med., 48:325. With D. W. Atchley and E. M. Benedict. Blood electrolyte studies during histamine shock in dogs. I. Clin. Invest., 10: 1. With C. B. Riley and M. Hiscock. Congenital heart disease. Mea- surements of the circulation. Arch. Intern. Med., 47:484. 1932 Chronic familial edema, affecting all extremities, a variant of Mil- roy's disease. Med. Clin. North Am., 15:1369. With W. Bauer, H. H. Dale, and L. T. Poulsson. The control of circulation through the liver. J. Physiol., 74:343. With R. F. Loeb, D. W. Atchley, E. M. Benedict, and M. E. Driscoll. On the mechanism of nephrotic edema. I. Clin. Invest., 11:621. With C. B. Riley and M. Hiscock. Cardiac output following artificial pneumothorax in man. Arch. Intern. Med., 49:994.
476 BIOGRAPHICAL MEMOIRS With A. L. Barach. Oxygen therapy in pulmonary tuberculosis. Am. Rev. Tuberc., 26:241. With A. L. Barach. The effects of oxygen treatment over long periods of time in patients with pulmonary fibrosis. Am. Rev. Tuberc., 26:253. 1933 With D. W. Atchley, R. F. Loeb, E. M. Benedict, and M. E. Driscoll. On diabetic acidosis. A detailed study of electrolyte balances following the withdrawal and reestablishment of insulin ther- apy. I. Clin. Invest., 12: 297. 1934 With A. L. Barach. Prolonged residence in high oxygen atmo- spheres. Effects on normal individuals and on patients with chronic cardiac and pulmonary insufficiency. Q. I. Med., 3:437. 1935 With A. Cournand and N. A. Bryan. Applicability of rebreathing method for determining mixed venous CO2 in cases of chronic pulmonary disease. l. Clin. Invest., 14:173. With A. Cournand and N. A. Bryan. Cardiac output in relation to unilateral pneumothorax in man. I. Clin. Invest., 14:181. With A. Cournand and I. Rappaport. Relation of the regulatory mechanism of respiration to clinical dyspnea. Proc. Natl. Acad. Sci. USA, 21:498. 1936 With A. L. Barach and W. B. Parsons. Oxygen treatment and thy- roid ablation in the treatment of heart disease. Ann. Intern. Med., 9:1513. With A Cournand, H. J. Brock, and I. Rappaport. Disturbance of action of respiratory muscles as a contributing cause of dyspnea. Arch. Intern. Med., 57:1008. 1937 With H. C. A. Lassen and A. Cournand. Distribution of respiratory gases in a closed breathing circuit. I. In normal subjects. I. Clin. Invest., 16: 1. With A. Cournand and H. C. A. Lassen. Distribution of respiratory
DICKINSON WOODRUFF RICHARDS 477 gases in a closed breathing circuit. II. Pulmonary fibrosis and emphysema. I. Clin. Invest., 16:9. With l. L. Caughey, A. Cournand, and F. L. Chamberlain. Intra- venous saline infusion as a clinical test for right heart and left heart failure. Trans. Assoc. Am. Physicians, 52:250. 1938 With A. Lambert, F. B. Berry, and A. Cournand. Pulmonary and circulatory function before and after thoracoplasty. i. Thorac. Surg., 7:302. A modified nasal catheter for use in oxygen therapy. N.Y. State l. Med., 38:19. 1939 With A. Cournand and R. C. Darling. Graphic tracings of respi- ration in study of pulmonary disease. Am Rev. Tuberc., 40:487. 1940 With A. L. Barach and H. A. Cromwell. Use of vaporized bron- chodilator solutions in asthma and emphysema. A continuous inhalation method for severe asthmatic states. Am I. Med. Sci., 199:225. Extension of the specialty of tuberculosis to that of diseases of the chest. Am. Rev. Tuberc., 42:426. With R. C. Darling, A. Cournand, and I. S. Mansfield. Studies on the intrapulmonary mixture of gases. I. Nitrogen elimination from blood and body tissues during high oxygen breathing. J. Clin. Invest., 19:591. With A. Cournand, R. C. Darling, and I. S. Mansfield. Studies on the intrapulmonary mixture of gases. II. Analysis of the re- breathing method (closed circuit) for measuring residual air. }. Clin. Invest., 19:599. With R. C. Darling and A. Cournand. Studies on the intrapulmon- ary mixture of gases. III. An open circuit method for measur- ing residual air. I. Clin. Invest., 19:609. 1941 With A. Cournand. Pulmonary insufficiency. I. Discussion of a physiological classification and presentation of clinical tests. Am. Rev. Tuberc., 44:26.
478 BIOGRAPHICAL MEMOIRS With A. Cournand. Pulmonary insufficiency. II. The effects of var- ious types of collapse therapy upon cardiopulmonary function. Am. Rev. Tuberc., 44:123. With A. Cournand and H. C. Maier. Pulmonary insufficiency. III. Cases demonstrating advanced cardiopulmonary insufficiency following artificial pneumothorax and thoracoplasty. Am. Rev. Tuberc., 44:272. With A. Cournand, E. deF. Baldwin, and R. C. Darling. Studies on the intrapulmonary mixture of gases. IV. The significance of the pulmonary emptying rate and a simplified open circuit mea- surement of residual air. l. Clin. Invest., 20:681. With A. Cournand, R. C. Darling, and W. H. Gillespie. Pressure in the right auricle of man, in normal subjects and in patients with congestive heart failure. Trans. Assoc. Am. Physicians, 56:218. 1942 With A. Cournand, R. C. Darling, W. H. Gillespie, and E. deF. Baldwin. Pressure of blood in the right auricle, in animals and in man under normal conditions and in right heart failure. Am. J.Physiol.,136:115. 1943 With A. Cournand et al. Studies of the circulation in clinical shock. Surgery, 13:964. 1944 With R. C. Darling and A. Cournand. Studies on intrapulmonary mixture of gases. V. Forms of inadequate ventilation in normal and emphysematous lungs, analyzed by means of breathing pure oxygen. J. Clin. Invest., 23:55. The circulation in traumatic shock in man. Bull. N.Y. Acad. Med., 20:363. With A. Cournand et al. Chemical, clinical, and immunological studies on the products of human plasma fractionation. VIII. Clinical use of concentrated human sews albumin in shock, and comparison with whole blood and with rapid saline infusion. J. Clin. Invest., 23:491. With A. Cournand. Circulation in shock. Mechanical and vaso- motor factors. Trans. Assoc. Am. Physicians, 58:11 I. The circulation in traumatic shock in man. Harvey Lect., 39:217.
DICKINSON WOODRUFF RICHARDS 479 1945 With A Cournand, R. L. Riley, E. S. Breed, and E. deF. Baldwin. Measurement of cardiac output in man using the technique of catheterization of the right auricle or ventricle. I. Clin. Invest., 24:106. Cardiac output by the catheterization technique in various clinical conditions. Fed. Proc. Fed. Am. Soc. Exp. Biol., 4:215. With H. N. Harkins, O. Cope, E. I. Evans, and R. A. Phillips. The fluid and nutritional therapy of burns. I. Am. Med. Assoc., 128:475. . . . . 1946 With R. A. Bloomfield, H. D. Lauson, A. Cournand, and E. S. Breed. Recording of right heart pressures in normal subjects and in patients with chronic pulmonary disease and with vari- ous types of cardiocirculatory disease. i. Clin. Invest., 25:639. Observations on the dynamics of the systemic circulation in man. Bull. N.Y. Acad. Med., 22:630. With A. Cournand, H. L. Motley, A. Himmelstein, and D. T. Dres- dale. Latent period between electrical and pressure pulse waves corresponding to right auricular systole. Proc. Soc. Exp. Biol. Med., 63:148. With H. L. Motley, A. Cournand, and M. Eckman. Physiological studies on man with the pneumatic balance resuscitator, "Burns model." l. Aviat. Med., 17:431. With A. Cournand and H. L. Motley. Effects on circulatory and respirator functions of various forms of respirator. Trans. As- soc. Am. Physicians, 59:102. 1 947 With H. L. Motley, A. Cournand, L. Werko, D. T. Dresdale, and A. Himmelstein. Intravascular and intracardiac pressure record- ing in man: electrical apparatus compared with the Hamilton manometer. Proc. Soc. Exp. Biol. Med., 64:241. Conditions of pressure and flow in the heart and great vessels in congestive heart failure. Acta Med. Scand., 1 96 Supply.: 1 1 6. With A. Lowell and A. Cournand. Changes in plasma volume and mean arterial pressure after the intravenous injection of con-
480 BIOGRAPHICAL MEMOIRS centrated human serum albumin in thirty-eight patients with oligemia and hypotension. Surgery, 22:442. Bronchitis. In: A Textbook of Medicine, ed. R. L. Cecil, p. 917. Phil- adelphia: W. B. Saunders Co. Contributions of right heart catheterization to the physiology of congestive heart failure. Am. I. Med., 3:434. With H. L. Motley, L. Werko, and A. Cournand. Observations on the clinical use of intermittent positive pressure. I. Aviat. Med. 18:417. With A. Cournand, H. L. Motley, D. T. Dresdale, and M. I. Ferrer. Relation between electrical and mechanical events of the cardiac cycle in normal and abnormal clinical states. Trans. Assoc. Am. Physicians, 60:65. 1948 The effects of hemorrhage on the circulation. Ann. N.Y. Acad. Sci., 44:534. With A. Cournand, H. L. Motley, and L. Werko. The physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man. Am. I. Physiol., 152: 162. With H. L. Motley, A. Cournand, L. Werko, D. T. Dresdale, and A. Himmelstein. Intermittent positive pressure breathing. A means of administering artificial respiration in man. I. Am. Med. Assoc., 137:370. With M. I. Ferrer, R. M. Harvey, L. Werko, D. T. Dresdale, and A. Cournand. Some effects of quinidine sulfate on the heart and circulation in man. Am. Heart I., 36:816. With W. F. Hamilton et al. Comparison of the Fick and dye injec- tion methods of measuring the cardiac output in man. Am. I. Physiol., 153:309. With E. deF. Baldwin and A. Cournand. Pulmonary insufficiency. I. Physiological classification, clinical methods of analysis, stan- dard values in normal subjects. Medicine, 27:243. .. . ~ ~ . . . . 1949 With E. deF. Baldwin and A. Cournand. Pulmonary insufficiency. II. A study of thirty-nine cases of pulmonary fibrosis. Medicine, 28:1. With E. deF. Baldwin and A. Cournand. Pulmonary insufficiency.
DICKINSON WOODRUFF RICHARDS 481 III. A study of 122 cases of chronic pulmonary emphysema. Medicine, 28:20 1. With H. H. Coopersmith, W. Perkins, I. Leland, and K. I. Thom- son. The treatment of pneumonia with penicillin. Comparison of penicillin in water-in-oil emulsion and penicillin in water so- lution. N.Y. State J. Med., 49:535. With B. Coblentz, R. M. Harvey, M. I. Ferrer, and A. Cournand. The relationship between electrical and mechanical events in the cardiac cycle. Br. Heart I., 11:1. Dynamics of congestive heart failure. Am. I. Med., 6:772. With R. M. Harvey, M. I. Ferrer, R. T. Cathcart, and A. Cournand. Some effects of digozin upon the heart and circulation in man. Digoxin in left ventricular failure. Am. I. Med., 7:439. 1950 With M. I. Ferrer, R. M. Harvey, R. T. Cathcart, C. A. Webster, and A. Cournand. Some effects of digoxin upon the heart and cir- culation in man. Digoxin in chronic cor pulmonale. Circulation, 1:161. Pulmonary physiology. In: Research in Medical Science, ed. D. E. Green and W. E. Knox, p. 259. New York: MacMillan. Cardiac failure. Bull. N.Y. Acad. Med., 26:384. Respiratory system: external respiration. In: Medical Physics, vol. 2, p. 836. Chicago: Year Book Publishers, Inc. With E. deF. Baldwin, K. A. Harden, D. G. Greene, and A. Cour- nand. Pulmonary insufficiency. IV. A study of sixteen cases of large pulmonary air cysts or bullae. Medicine, 29:169. Pulmonary function. Conn. State Med. I., 14:1061. With R. M. Harvey, M. I. Ferrer, I. R. West, R. T. Cathcart, and A. Cournand. The influence of mitral valvular disease of rheu- matic origin upon the dynamics of the circulation, with special reference to indications for surgery. C. R. Congres. Cardiol., 3:1. 1951 With J. R. West et al. Effects of cortisone and ACTH in cases of chronic pulmonary disease with impairment of alveolar- capillary diffusion. Am. I. Med., 10: 156. With I. R. West, E. deF. Baldwin, and A. Cournand. Physiopath-
482 BIOGRAPHICAL MEMOIRS ologic aspects of chronic pulmonary emphysema. Am. J. Med., 10:481. Bronchitis. In: A Textbook of Medicine, 8th ea., ed. R. L. Cecil and R. F. Loeb, p. 822. Philadelphia: W. B. Saunders Co. Pulmonary function in health and disease. In: A Textbook of Medi- cine, 8th ea., ed. R. L. Cecil and R. F. Loeb, p. 842. Philadel- phia: W. B. Saunders Co. Emphysema. In: A Textbook of Medicine, 8th ea., ed. R. L. Cecil and R. F. Loeb, p. 875. Philadelphia: W. B. Saunders Co. With R. M. Harvey, M. I. Ferrer, and A. Cournand. Influence of chronic pulmonary disease on the heart and circulation. Am. I. Med., 10:719. Saline solution in the treatment of injuries with shock. U.S. Armed ForcesMed.~.,2:1289. 1952 With M. I. Ferrer, R. M. Harvey, R. T. Cathcart, and A. Cournand. Hemodynamic studies in rheumatic heart disease. Circulation, 6:688. 1953 With M. I. Ferrer, R. M. Harvey, M. Kuschner, and A. Cournand. Hemodynamic studies in tricuspid stenosis of rheumatic origin. Circ. Res., 1:49. The nature of cardiac and of pulmonary dyspnea. The Lewis A. Conner Lecture, American Heart Association. Circulation, 7:15. With R. T. Cathcart and W. W. Field. Comparison of cardiac output determined by the ballistocardiograph (Nickerson apparatus) and by the direct Fick method. }. Clin. Invest., 32:5. With I. R. West, H. A. Bliss, and I. A. Wood. Pulmonary function in rheumatic heart disease and its relation to exertional dyspnea in ambulatory patients. Circulation, 8:178. With R. M. Harvey, M. I. Ferrer, R. T. Cathcart, and A. Cournand. Mechanical and myocardial factors in chronic constrictive per- icarditis. Circulation, 8:695. Homeostasis versus hyperexis: or St. George and the dragon. Sci. Monthly, 77:289. Teaching of medicine: ivory tower or horse and buggy? Trans. Am. Clin. Climatol. Assoc., 76:91.
DICKINSON WOODRUFF RICHARDS 483 1954 With I. Cohn. Interventricular septal defect, pulmonary artery aneurysm with thrombosis, "cyanose tardive," and paradoxical systemic arterial embolizations. Am. Heart I., 47:313. Nature and treatment of shock. Circulation, 9:606. With l. H. McClement. Granulomas: pulmonary granulomatoses, pulmonary fibrosis, other pulmonary conditions. In: Medical Uses of Cortisone, ed. l. W. Lukens, p. 387. New York: Blakiston Co. With A. Cournand, R. A. Bader, M. E. Bader, and A. P. Fishman. The oxygen cost of breathing. Trans. Assoc. Am. Physicians, 67:162. 1955 With F. B. Berry, l. H. Comroe, Jr., A. Cournand, M. Galdston, and W. B. Sherman. Current concepts in the management of asthma, emphysema, and chronic pulmonary infections. Bull. N.Y. Acad. Med., 31:36. With R. M. Harvey et al. Mechanical and myorcardial factors in rheumatic heart disease with mitral stenosis. Circulation, 11:531. Discussion of Starling's law of the heart. Physiol. Rev., 35: 156. With I. K. Alexander, l. R. West, and I. A. Wood. Analysis of the respiratory response to carbon dioxide inhalation in varying clinical states of hypercapnia, anoxia, and acid-base derange- ment. I. Clin. Invest., 34:511. Diseases of the bronchi. In: A Textbook of Medicine, 9th ea., ed. R. L. Cecil and R. F. Loeb, p. 988. Philadelphia: W. B. Saunders Co. Diseases of the lungs. In: A Textbook of Medicine, 9th ea., ed. R. L. Cecil and R. F. Loeb, p.1008. Philadelphia: W. B. Saunders Co. With H. i. Robinson, C. Morgan, B. M. Frost, and E. Alpert. Pre- liminary clinical observaitons on oxamycin: a new antibiotic. Antibiot. Med., 1:351. With M. I. Ferrer et al. Circulatory effects of mitral commissuro- tomy with particular reference to selection of patients for sur- gery. Circulation, 12:7. The problem of shock in myocardial infarction. J. Chronic Dis., 2:220. With R. M. Harvey, M. I. Ferrer, and A. Cournand. Cardiocircu- latory performance in atrial flutter. Circulation, 12:507.
484 BIOGRAPHICAL MEMOIRS 1956 With I. A. Wood, I K. Alexander, C. W. Frank, and I. R. West. Some clinical and physiologic effects of mitral commissurotomy. Circulation, 13:178. The aging lung. Bull. N.Y. Acad. Med., 32:407. With A. P. Fishman. The management of cor pulmonale in chronic pulmonary disease, with particular reference to the associated disturbances in the pulmonary circulation. Am. Heart }, 52:149. With M. I. Ferrer, R. M. Harvey, and A. Cournand. Cardiocircu- latory studies in pulsus alternans of the systemic and pulmo- nary circulations. Circulation, 14: 163. 1957 Lecture: Le Prix Nobel. Stockholm: P. A. Norstedt & Soners Forlag AB. With A. Cournand. Normal respiratory and pulmonary circulatory functions. In: Clinical Physiology, ed. A. Grollman, p. 381. New York: McGraw-Hill. With A. Cournand. Physiologic derangements of the respiratory system. In: Clinical Physiology, ed. A. Grollman, p. 416. New York: McGraw-Hill. Right heart catheterization. Its contributions to physiology and medicine. Science, 125: 1 181. The contributions of right heart catheterization to physiology and medicine, with some observations on the physiopathology of pulmonary heart disease. Am. Heart l., 54: 161. 1958 With H. W. Fritts, fir. and A. L. Davis. Observations on the control of respiration in emphysema: the effects of oxygen on ventila- tory response to CO2 inhalation. Trans. Assoc. Am. Physicians, 71:142. 1959 Research in Chronic Pulmonary Disease. Ciba Foundation Sym- posium on Significant Trends in Medical Research, p. 196. Bos- ton: Little, Brown & Co. With C. A. Chidsey III, H. W. Fritts, fir., A. Hardewig, and A. Cour-
DICKINSON WOODRUFF RICHARDS 485 nand. Fate of radioactive krypton (Kr 85) introduced intra- venously in man. J. Appl. Physiol., 14:63. 1960 Cardiovascular physiology: concepts and development of knowl- edge. In: Disease and the Advancement of Basic Science, ed. H. K. Beecher. Cambridge: Harvard University Press. Pulmonary emphysema: etiologic factors and clinical forms. Ann. Intern. Med., 53: 1105. With H. W. Fritts, Jr. Respiratory system: external respiration. In: Medical Physics, vol. 3, ed. O. Glasser. Chicago: Year Book Pub- lishers. Homeostasis: its dislocations and perturbations. Perspect. Biol. Med., 3:238. 1961 With H. W. Fritts, tr. and A. Cournand. Oxygen consumption of tissues in the human lung. Science, 133:1070. The first aphorism of Hippocrates. Perspect. Biol. Med., 5:61. 1962 Medical priesthoods, past and present. Presidential address. Trans. Assoc. Am. Physicians, 75: 1. With V. M. Ingram and A. P. Fishman. Hemoglobin: molecular structure and function, biosynthesis, evolution, and genetics. Science, 138:996. 1963 With R. O. Levy and C. F. de la Chapelle. Heart disease in drivers of public motor vehicles as a cause of highway accidents. i. Am. Med. Assoc., 164:481. With A. Cournand. Physiologic derangements of the respiration system. In: The Functional Pathology of Disease, ed. A. Grollman, p. 431. New York: McGraw-Hill. Objectives of a medical education in our decade. American Medical Association Annual Meeting, Billings Lecture. l. Am. Med. As- soc., 186:845. Pulmonary changes due to aging. In: Handbook of Physiology, Res- piration II, p. 1525. Baltimore: Williams & Wilkins.
486 BIOGRAPHICAL MEMOIRS 1964 Ed. D. W. Richards and A. P. Fishman. Circulation of the blood. In: Men and Ideas. London: Oxford University Press. A clinician's view of advances in therapeutics. In: Drugs in our So- ciety. Baltimore: Johns Hopkins University Press. 1965 Research and independence. Arch. Environ. Health, 11: 110. 1966 The Uses of History in Medicine. Address given at the dedication of the Countway Library of Medicine, May 26, Harvard Medical School, p. 46. Cambridge: Harvard University Press. Circulatory ejects of hyperventilation and hypoventilation. In: Handbook of Physiology Circulation, vol. 3, p. 1887. Baltimore: Williams & Wilkins. The right heart and the lung. The }. Burns Amberson Lecture. Am. Rev. Respir. Dis., 94:691. The effect of pancreas extract on depancreatized dogs: Ernest L. Scott's thesis of 1911. Perspect. Biol. Med., 10:84. 1968 Hippocrates of Ostia. J. Am. Med. Assoc., 204: 1049 Acceptance of Trudeau Medal. Presented in Houston, Texas, May 19, by I. B. Amberson. Am. Rev. Respir. Dis., 98:726. 1969 Presentation of the Kober Medal for 1969 to Dana W. Atchley. Trans. Assoc. Am. Physicians, 82:44. 1970 Hippokrates und die Geschichte. Naturwiss. Rundsch., 5:173. Acceptance of the Kober Medal for 1970. Presented by Dr. Andre Cournand. Trans. Assoc. Am. Physicians., 83:43. Presentation of the Academy Plaque to James Turns Amberson, M.D. Bull. N.Y. Acad. Med., 46:663. Medicine's responsibilities. Mt. Sinai I. Med. N.Y., 37:577.
DICKINSON WOODRUFF RICHARDS 487 1971 Continuing education. Symposium, Introduction to Old Age. Bull. N.Y. Acad. Med., 47:1257. The hospital and the city. Res. Staff Physician, 17: 1 15. Are our medical school faculties qualified to teach medicine? Res. Staff Physician, 17:76. 1972 The chimpanzee experiment. Coll. Physicians Surg. Alum. Q., 17:15.