William Dock

William Dock (1898 – 1990)

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.


Biography

  • 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

Medical Eponyms

Dock’s murmur (1967)

Heard at the left third intercostal space, an initial early diastolic murmur similar to that of aortic regurgitation with an additional presystolic accentuation

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

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

Notable Quotables

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 generation

William Dock 1985 – said in his latter years while reportedly reflecting on the future of medicine.

Major Publications


References


eponymictionary CTA

eponym

the person behind the name

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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