Dickinson W. Richards

Dickinson W. Richards: The Physician Who Entered the Heart

For most of medical history the living human heart was a closed room. Doctors could listen to it, feel its pressure indirectly and open the chest of a corpse to see what had gone wrong, but they could not measure what the organ was doing while it worked. Dickinson W. Richards, working with André Cournand in the wards of Bellevue Hospital, turned a thin flexible tube threaded through a vein into a standard clinical instrument — and in doing so converted cardiology from an art of inference into a science of measurement. The Nobel Prize followed in 1956.

A Classicist's Beginning

Richards was born on 30 October 1895 in Orange, New Jersey. He was educated at the Hotchkiss School in Connecticut and entered Yale University in 1913, where he read English and Ancient Greek rather than science — a training that shows in the precision of his later writing. He graduated in 1917 as a member of the Scroll and Key senior society.

That was the year the United States entered the First World War. Richards joined the Army in 1917 as an artillery instructor and served as an artillery officer in France through 1918 and 1919. He came to medicine afterward and comparatively late, entering Columbia University's College of Physicians and Surgeons and taking an M.A. in 1922 and his M.D. in 1923.

Learning the Circulation

He served on the staff of Presbyterian Hospital in New York until 1927, then crossed the Atlantic for a formative year abroad. From 1927 to 1928 he worked at the National Institute for Medical Research in London under Sir Henry Dale, studying the control of liver circulation — an apprenticeship in the physiology of blood flow with one of the era's most exacting investigators.

Returning to Presbyterian Hospital in 1928, Richards took up research on pulmonary and circulatory physiology under Lawrence Henderson of Harvard. He had begun teaching at Columbia in 1925, and the twin commitments — clinical medicine and laboratory physiology — would define the rest of his working life. The question that increasingly organized his work was deceptively simple: what do the heart and lungs actually do, in a living person, moment to moment, and how would you know?

The Bellevue Partnership

The answer came out of a collaboration with André Cournand, begun on pulmonary function research at Bellevue Hospital. In 1945 Richards moved his laboratory there outright. Together the two men developed the techniques of cardiac catheterization: passing a slender catheter through a peripheral vein into the chambers of the heart itself, where pressures could be read and blood samples drawn directly from the source.

The procedure sounds modest. Its consequences were not. Catheterization gave physicians their first direct, quantitative window into the working circulation of a living patient, and Richards and Cournand used it to open one clinical question after another. They characterized traumatic shock — knowledge with obvious and immediate wartime application. They mapped the physiology of heart failure, establishing what actually fails when a heart fails. They measured the effects of cardiac drugs on the circulation rather than merely on symptoms. They defined the dysfunction underlying chronic cardiac and pulmonary disease, and they developed methods for diagnosing congenital heart disease — which meant, for the first time, that malformations present from birth could be identified precisely enough to be considered for surgical repair. Nearly all of modern interventional cardiology descends from that catheter.

Professor and Public Figure

In 1947 Richards was named Lambert Professor of Medicine at Columbia University, capping more than two decades of teaching there. Beyond the university he served as an adviser to the pharmaceutical firm Merck Sharp and Dohme and edited the *Merck Manual*, the compact reference that generations of physicians kept within arm's reach — an unglamorous form of influence that reached far more doctors than any research paper.

His interests ran past medicine. Richards was a signatory to the world constitution agreement, contributing to the first World Constituent Assembly convened to draft a Constitution for the Federation of Earth — an internationalist gesture characteristic of a scientific generation that had watched two world wars pass through its laboratories and hospitals.

The Prize and the Later Years

In 1956 Richards received the Nobel Prize in Physiology or Medicine, shared with André Cournand and Werner Forssmann — the German physician who had first threaded a catheter into a human heart by performing the experiment on himself. The award recognized a rare thing: a technique, developed and validated by different hands in different countries, that had reshaped an entire specialty.

Further honours accumulated. The American College of Physicians gave him its John Phillips Memorial Award in 1960. France made him a Chevalier de la Légion d'Honneur in 1963. The Trudeau Medal came in 1968 and the Association of American Physicians' Kober Medal in 1970.

Richards retired from his positions at Bellevue and Columbia in 1961, closing a career that had begun with Ancient Greek at Yale and ended having placed a measuring instrument inside the human heart. He died on 23 February 1973 in Lakeville, Connecticut, at seventy-seven.