William Dock (1898 – 1990) was an American cardiologist.
Renowned for his skills in bedside physical examination he is considered a leading cardiologist of his generation. He was integral in establishing the link between high-fat diets and atherosclerosis, other notable work included championing ‘bed to chair‘ movement within the first 48 hours of acute myocardial infarct.
Although extensively published he is best known for an eponymously named diastolic murmur indicating severe stenosis of the left anterior descending coronary artery and ‘Sutton’s Law‘ (Dock’s Law) stating; if ‘the money‘ resides in a specific diagnostic test, then that test should be conducted immediately instead of several steps into a general algorithm.
- Born 1898 Ann Arbor, Michigan. Son of Dr George Dock former professor of medicine at the University of Michigan and Washington University.
- 1922-1924 – Internship/residency at Peter Bent Brigham Hospital in Boston
- 1923 – Graduated from Rush Medical College in Chicago
- 1924 – Postgraduate work in Vienna where he studied under Karel Frederik Wenckebach
- 1925 – Additional residency at Stanford
- Awarded Croix de Guerre for his service as a volunteer ambulance driver for the French army during World War I
- 1936 – Professor of Pathology at Stanford
- Served as an Army major in World War II
- 1941 – Professor of Pathology at Cornell
- Died October 17, 1990
Dock’s murmur (1967)
Early diastolic murmur similar to that of aortic regurgitation and is heard at the left second or third intercostal space. Similar to that of aortic regurgitation with an additional presystolic accentuation.
Associated with severe stenosis of the left anterior descending coronary artery. The murmur produced is diastolic since the coronary arteries fill in diastole. It is described as early diastolic and decrescendo sounding similar to the murmur of aortic regurgitation.
…when he [the patient] is erect, one can record a continuous, high-pitched diastolic murmur, with striking early and late (presystolic) accentuation…a decrescendo early diastolic murmur and diamond-shaped high pitched presystolic murmur.
In this area (left of midline, third interspace), but only when he is erect, one can record a continuous, high-pitched diastolic murmur, with striking early and late (presystolic) accentuation. It seems likely this is due to a coronary A-V (atrioventricular) fistula, or a coronary anomaly with one vessel entering the pulmonary artery and retrograde flow from collaterals connecting with the normal artery.Dock W, Zoneraich S. 1967
Dock’s murmur occurs when there is a severe stenosis of the left anterior descending coronary artery. The murmur produced is diastolic since the coronary arteries fill in diastole. It is described as early diastolic and decrescendo sounding similar to the murmur of aortic regurgitation with a late accentuation.
Sutton’s Law (Dock’s Law) (1961)
Sutton’s law: When making a diagnosis one should first consider the obvious, and initially conduct those tests which could confirm (or rule out) the most likely diagnosis.
Go to the patient, because that’s where the diagnosis is.Dock’s Law
Dock explains the 99 diphthong misnomer (1973)
Tactile fremitus has been used to describe precordial vibrations perceived in a tactile, rather than acoustic, manner. Students have been taught to instruct the patient to utter the number ‘99‘ to best elicit these vibrations.
However this is a literal translation error from the original German “neun und neunzig.” This term uses a diphthong not found in “ninety nine” but similar to “toy boat.” Research has shown this diphthong is essential to the characteristic of the sound useful for diagnostics.
When our medical ancestors studied in Austria or Germany, they observed that physicians asked patients to say neun und neunzig to evoke fremitus over the thorax. When they came home they taught their patients to say ninety-nine, thus translating literally, but not phonetically, what they had heard.
This was a serious error, since their teachers would have asked patients to say: nein, nein, if that was the sound they had wanted. Nein, nein was what every girl had been taught to say to overeager swains, and men said it to friends who wanted a loan. Neun und neunzig is pronounced noyn unt noynzig and the oy is what it takes to evoke palpable, low-pitched vibrations, most effectively transmitted from the larynx to the rib-cage.
“Nein, nein” and ninety-nine are high-pitched sounds, useless for evoking fremitus. We continue to translate the one phrase we should have left in German, while leaving untranslated, or mistranslated and mispronounced, bruits and rales. We should use “boy boy”, or “boogy woogy”, as equivalents of “neun und neunzig”Dock 1973
I really envy the newer generation for having at its disposal so many new techniques which supplement, complete, and confirm clinical data. In my time we had to rely on our clinical experience and on some graphic techniques. You should consider yourself a lucky generationWilliam Dock 1985 – said in his latter years while reportedly reflecting on the future of medicine.
- Dock W. Mode of production of the first heart sound. Arch lntern Med, 1933; 737-746
- Dock W. The evil sequelae of complete bed rest. JAMA. 1944; 125(16): 1083-1085
- Dock W. Presbycardia, or aging of the myocardium. NY State J Med 1945 45,983-986
- Dock W. The mechanism and management of circulatory failure. Bull N Y Acad Med. 1951 Nov;27(11):645-52
- Dock W. Hypercholesteremia; its clinical significance and management. Med Clin North Am. 1952 May;36(3):865-74
- Dock W, Zoneraich S. A diastolic murmur arising in a stenosed coronary artery. Am J Med. 1967 Apr;42(4):617-9
- Dock W. Atherosclerosis: the facts and the mysteries. Bull N Y Acad Med. 1967 Sep;43(9):792-7.
- Dock W. Examination of the chest: advantages of conducting and reporting it in English. Bull NY Acad Med 1973;49: 575-582
- Dock W. Proteinuria: the story of 280 years of trials, errors, and rectifications. Bull N Y Acad Med. 1974 Jun;50(6):659-66
- Sangster JF, Oakley CM. Diastolic murmur of coronary artery stenosis. Br Heart J. 1973 Aug; 35(8): 840–844.
- Weisse AB. William Dock, M.D. Hosp Pract (Off Ed). 1987 Aug 15;22(8):43-5, 49, 52-6 passim.
- Zoneraich S. The legacy of William dock, a giant of American cardiology. Clin. Cardiol. 1994; 17,95-97
- Rytand DA. Sutton’s or Dock’s law? N Engl J Med. 1980 Apr 24;302(17):972.
- Altman LK. A Law Named for Willie Sutton Assists Physician. The New York Times. Jan 3 1970
- Cheng O. William Dock, Willie Sutton and Sutton’s Law. Int J Cardiol. 2010 Jun 11;141(3):209-13
- Fowler G. Dr. William Dock, 91, innovator who questioned medical beliefs. New York Times. October 23, 1990.
- Zoneraich S. William Dock as I knew him. American Journal of Cardiology. 1986 Feb 15;57(6):467-70.
- Robbins A, Zhang G. Name that murmur. LITFL 2019
- Mark N. Tactile Fremitus: Lost in Translation. ICU OnePager 2020
the person behind the name