The neo-Hippocratic theory as basis of contemporary medical thought and practice / by A.P. Cawadias.

  • Alexander Polycleitos Cawadias
Date:
1928
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Licence: In copyright

Credit: The neo-Hippocratic theory as basis of contemporary medical thought and practice / by A.P. Cawadias. Source: Wellcome Collection.

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    of infection become really, as Metchnikoff himself has admitted, problems of general metabolism, an opinion which has been corroborated by the work reviewed in a recent publication of Herxheimer. Modern Diagnosis. The neo-Hippocratic theory has changed completely our conception of diagnosis, which now becomes a triple intellectual operation ; (a) disease diagnosis, (b) functional “ personality ” diagnosis, (c) diagnosis of the etiological constellation. (a) Disease diagnosis, which consists in placing the patient under one of the nosographical classifications, is according to the new conception, only the first step of diagnosis and not at all the whole diagnosis. “ Diseases ” are fictions, necessary for the statement of our knowledge ; they are means towards an end and illustrate an application of Vaihinger’s philosophy of the As If. They cannot be discarded as has been attempted by the so-called physio¬ logical school of Broussais, Wunderlich, Griesinger, and even Virchow, which resulted in confusion. As Knud Faber writes “ to the clinician the conception of the disease is essential; he cannot live, speak or act without the concept of morbid categories.” On the other hand, according to the neo-Hippocratic conceptions they must be considered only as stepping stones towards a more complete diagnosis. The clinician must pass on from the diagnosis of the disease to the diagnosis of the diseased individual. (b) The personal functional diagnosis is the answer to the question “ to what extent the individual is injured by his complaint,” and forms the real basis of neo- Hippocratic medicine. The whole of the individual, psychical as well as physical, is considered, and the procedure follows mainly the method of physiology. But the ultimate object is not to determine whether certain organs, heart, lungs or kidneys, are insufficient but whether and how the “ whole person ” is insufficient— or “ irresponsive ” that is, inferior in its adaptation towards the change of external environmental conditions. This personal functional diagnosis not only completes the nosographical diagnosis, but is also the only possible diagnosis for these numerous cases which cannot come under a nosographical label. It is well known now that long before the nosographical or visceral phase, disturbances exist whose diagnosis, as Professor Albert Robin and Sir James Mackenzie have shown, is of immense importance to the patient. Long before the appearance of the lesions of the joints in rheumatism certain metabolic functions such as sulphur metabolic functions are disturbed ; long before the appearance of an attack of angina pectoris disturbances in cholesterol metabolism may be detected. Thus, the “ personal
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