Richard W. Lippman

Tribute by Dr. Linus Pauling

Today we are here to talk about and to think about our friend Dr. Richard Lippman. There was no one just like him in the world, no one else with his great combination of respect, love, and concern for all human beings, his inflexible moral integrity, his dedication to his patients, his extraordinary ability in science as well as medicine, and his love for research, which is the effort to discover the truth. It is hard to accept the idea that he is no longer with us, and there is no way of justifying it, except as an example of how far the world is from perfection. I am sure he would feel that our duty now is to continue to strive toward that ideal of perfection that he had so clearly in mind.

Richard Lippman graduated with honors from Yale and in 1940 received his M.D. degree from Columbia. He volunteered for service for his country the day after Pearl Harbor, and served for four years, two years overseas. He was a Major in the Medical Corps at the end of his service, and for some years held his commission as Major in the Medical Reserve Corps. The last year of his active service was devoted to the reconditioning of convalescent patients, especially those who had amputations of limbs. This experience led to the first group of his scientific and medical publications, which in all amount to 70 papers, in addition to his book on diagnosis of kidney diseases. In these early papers, written before he was thirty years old, he emphasized the broadening of the physician's responsibility to include the period of convalescence, and also emphasized the importance of research in this field, as in other fields of medicine.

Then there began the period in which he carried out his vigorous and productive attack on the problem of nephritis and other diseases of the kidney. For two years Dr. Lippman worked as a collaborator with Dr. Thomas Addis in the Stanford University School of Medicine in San Francisco. Dr. Addis had formulated a concept of the nature of glomerular nephritis that differed greatly from the one accepted by most specialists in the field. This concept led him to the conclusion that, despite the deficiency in protein of the blood plasma of the patients, the kidney lesion should be treated by decreasing, rather than by increasing, the amount of protein in the diet of the patient, in order that the work done by the kidney might thereby be minimized, and the resting kidney thus be given the chance to heal itself. The problem facing Dr. Addis and Dr. Lippman was that of verifying or disproving this idea. They could not do this by placing some patients on this treatment and some on the other treatment, which they believed to be inferior, and then comparing the courses of the disease in the two groups of patients, because the conscientious physician has the obligation to give to every one of his patients the treatment that he considers to be the best one. Instead, they treated the patients in the way they believed to be best, and also carried out with rats an extensive series of experimental studies on the functioning of the kidney and the relation of diet to the healing of kidney lesions. After Dr. Addis' death in 1949 Dr. Lippman completed the publication of the results of these joint researches in a series of papers, and also continued his own studies on nephritis, culminating in his formulation of a general theory of human glomerular nephritis and nephrosis as resulting from an allergic response to anti-kidney antibodies manufactured by the patient.

During this period Dr. Lippman had become one of the leading authorities on kidney disease in the United States. His medical practice was flourishing, and he was often called in for consultation by other physicians. His interest in medical research became greater and greater. In 1948 he was appointed to a research position in the Institute for Medical Research of the Cedars of Lebanon Hospital in Los Angeles. In 1950 he was appointed a Fellow of the John Simon Guggenheim Memorial Foundation, and the next year he was given a research grant by the U.S. Public Health Service. His research program on the nature of kidney disease began to move forward at a great rate. He himself, in discussing the methods that he later described in his book "Urine and Urinary Sediment," said about the kidney that "there are few organs that offer such ready and convenient access to the thoughtful clinician" - and he was a truly thoughtful clinician.

And then, suddenly, this great work was brought to a stop.

Just before Christmas in 1951 he learned that he would be dropped from the medical staff of the Cedars of Lebanon Hospital. A letter that I wrote to the President of the Board of Trustees, whom I knew, asking that Dr. Lippman be given a hearing and a statement of reason, remained unanswered.

Dr. Harry Goldblatt, the Director of the Cedars of Lebanon Research Institute, did not cancel Dr. Lippman's appointment at the Institute, and for a few months Dr. Lippman continued his researches. But then his research grant was stopped; the Board of Trustees had asked the U.S. Public Health Service not to send any more payments; and in this way his work on kidney disease was brought to an end.

To what extent did this action of the Cedars of Lebanon Hospital interfere with the progress of medicine, with the conquest of nephritis? How many patients have been and will be lost because of it? I do not know; nobody knows; but I do know that it is the people of southern California, the people of the whole world, who have suffered because of this inexcusable interference in the effort that Dr. Lippman was making to use his great gifts for the benefit of mankind.

Dr. Lippman told me that during the year after he had been dropped from the Cedars of Lebanon medical staff he was several times asked by physicians to serve as a consultant on the kidney for patients in that Hospital, and that each time as he approached the Hospital he was prevented from entering. Then there came the time when a member of the Board of Trustees was told by his physician that he should be examined by an authority on the kidney. Dr. Lippman was then allowed to enter the Hospital, in order to do this duty as a responsible and conscientious physician.

What had caused this action of the Hospital? It was no doubt caused by some of the efforts that Dr. Lippman had made during the preceding years to be of service to his fellow man in ways other than the practice of medicine and the prosecution of medical research. He was a reformer by nature, a crusader against corruption, an intense man with deep convictions, with something of the spirit of Savonarola, and he, too, has become a martyr, because I think there is little doubt that the ailments that caused his death were exacerbated by his trials and turmoil. He lectured with fervor and conviction in the cause of peace and against nuclear bomb tests and war. He fought the loyalty-oath bills for physicians and other licensed professionals that were introduced in the California legislature, and helped to defeat them. With his strong belief in democracy, he strove to introduce democratic methods into the Los Angeles County Medical Society; presumably as a result of these efforts, his retransfer of membership back to the Los Angeles County Medical Society from the Bronx Medical Society, where he had gone when he accepted a hospital research position that was then withdrawn, was denied in 1952, and he lost therefore his membership in the American Medical Association, a loss that he felt keenly.

For some time after 1952 he tried to make arrangements with some institution in the western Los Angeles region to carry on his researches, but with little success. While continuing his practice, he collaborated with Professor Dan H. Campbell of the California Institute of Technology on problems of immunology and protein chemistry, and then in 1956 he accepted an appointment in the California Institute of Technology. For three years he was able to carry on in his vigorous, productive, and inspired way an attack on the chemical basis of mental disease, especially mental deficiency, as the Medical Research Director of the Ford Foundation Project in this field. He was strongly attracted to the field of mental disease, which was new to him, because of its importance and because of the possibility that discoveries made through research in this field could contribute significantly to decrease the amount of human suffering in the world.

(Ten percent of Americans are hospitalized by mental disease at some time during their lives, and as mental patients they occupy half of the hospital beds in the country.)

He rapidly mastered this new field and, with the aid of a loyal and enthusiastic group of research associates, formulated and initiated an imaginative and promising research program. Now, just at the time when he has had to give it up, this program is yielding significant results, especially about the molecular mechanisms of the manifestations of mental diseases and about the recognition and characterization of genetic diseases involving mental deficiency that had not previously been recognized as distinct clinical entities. As part of this work he, in association with Dr. Lawrence Snyder, President of the University of Hawaii, set up last year a research program on mental deficiency in that University. He had great hopes for this project, which for a few months has been developing well with the support of a five-year grant from the U.S. Public Health Service, made in response to an application prepared by him and President Snyder. During the days before his last illness he wrote out and discussed with me his plans for the Honolulu project, some ideas about new methods of attack on the mental-disease problem, and the analysis of the experimental results recently obtained in Pasadena, dealing with genetic factors leading to mental deficiency.

In three years of research he made a significant contribution in the field of mental disease; if it had only been possible for him to have carried on his research program in this field for thirty years his contribution would surely have been a great one.

But it is as a physician, filled with compassion for his fellow man, that we may best remember him. On the day of his death, a man, with tears in his eyes, said to me "He saved my wife's life, and I love him." This was his goal: he strived to heal the ills of the world, to be a physician to the human race - and he earned the love and gratitude of the human race.