On the patient’s influence on the postoperative healing process: an experimentum crucis

In a followup study conducted from 1950 onwards, significant and relevant differences in mortality were found among survivors of the atomic bombs in Hiroshima and Nagasaki who had been exposed to the same levels of radiation, with or without additional physical damage. This was unexpected, as it had been assumed that five years after surviving the somatic damage, both groups would be classified as part of the normal population and that both had been exposed to identical levels of radiation.W. Kofler assumed that each person has a limited ability to organize healing processes. The group with additional physical damage from the atomic bombs then differed from the group without these additional demands. Different results were therefore to be expected. It was inadmissible to draw conclusions about the generalizability of the data from the survivors of Hiroshima and Nagasaki. However, the chosen approach also corresponded to that of an «Experimentum crucis» (F. Bacon). In this case, the paradigm that took into account limited organizational capacity proved to be more effective than the one that did not. This should have had farreaching consequences. However, these could be avoided by relying on an argument based on the current state of knowledge. Since radiation exposure is based on quantum effects, predictions would only be possible for large numbers (populationbased approach). For individual cases, however, the uncertainty principle must be taken into account. It would therefore be worth discussing whether the epidemiologically proven assumption of the usefulness of only limited organizational capacity can be transferred to a capacity that every individual possesses. This objection can only be addressed in a case study. The present study demonstrates the greater significance of a view of the current state of knowledge that is expanded to include limited organizational effectiveness regarding biological and psychophysiological processes, e.g. in wound healing. It had been predicted that the healing process in individual lung cancer surgery would be faster if the patient was able to temporarily suspend competing processes that are not currently needed and that require the use of organizational capacity. The relevance of managing individual capacity to organize homeostatic functions is demonstrated in the described clinical case study.