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Lord Dawson of Penn

Lord Dawson of Penn

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Published by: Michael Cook on Nov 07, 2011
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Oxford Dictionary of National BiographyDawson, Bertrand Edward, Viscount Dawson of Penn (1864–1945), physicianby Stephen LockDawson, Bertrand Edward, Viscount Dawson of Penn (1864–1945), physician, was bornat Duppas Hill, Croydon, on 9 March 1864, the fourth son and fifth child of Henry Dawson, architect, and his wife, Frances Emily, daughter of Obadiah Wheeler. He was educated at St Paul's School and University College, London: he lived at University Hall when Henry Morley was principal. In 1884 he entered the London Hospital as a medical student; he graduated BSc in 1888 and qualified in 1890, becoming MRCS in the same year. He became MD and MRCP in 1893, and FRCP in 1903.Dawson earned his living through hospital appointments and as a lecturer, and in1896, when he became assistant physician at the London Hospital, he launched himself as a private consultant. He had consulting rooms in Harley Street, and from 1903 in Wimpole Street until the building was bombed in 1940. As was customaryat the time, his interests ranged widely. His textbook chapters dealt with diabetes mellitus, diabetes insipidus, influenza, rheumatoid arthritis, and the physical examination of the stomach and intestines. The Lancet later described his contribution to clinical medicine as ‘respectable rather than remarkable
’ (Lancet, 353). Remembering these years of struggle, with few opportunities for research, inlater life he took an active part in the foundation of a postgraduate medical school at London University (pressing that it should be sited at Kenwood, in Hampstead). On 18 December 1900 Dawson married Minnie Ethel Yarrow (b. 1878/9), daughter of Alfred Fernandez Yarrow, shipbuilder and also a principal patron of theLondon Hospital; they had three daughters. Dawson became full physician at the London Hospital in 1906 and was appointed physician-extraordinary to King EdwardVII, a post which he retained with King George V until 1914, when he became physician-in-ordinary. In 1911 he was appointed KCVO.After the outbreak of the First World War, Dawson, who had become commandant ofthe 2nd London General Hospital in the Territorial Army in 1908, went to Franceas consulting physician with the acting rank of major-general. He attended the king after he had suffered a serious fall from his horse on a visit to the frontin France in 1915, and remained in the country until 1919. Although his time waslargely occupied with hospital organization, Dawson used his experiences of warto write on paratyphoid, trench fever, infective gastroenteritis, and influenza; he also organized an official investigation into cases of jaundice in the trenches, which proved to be the newly described Weil
 
s disease. Nor was Dawson oblivious of the manifestations of battle stress in the troops, and he set up four base camps in France at Wimereux, Étaples, Rouen, and Étretat, which were specially concerned with studying and treating ‘soldiers
 
heart’. ‘The years in France convincedDawson that while the “diseases of invasion” were receding before the advance of medical knowledge the “diseases of stress” would multiply with the quickening pace of life’ (DNB).As in the case of recruits for the South African War, the First World War also revealed that the British standard of fitness was low. Dawson saw that it was going to become the duty of the medical profession as much to promote national health as to cure sickness in the individual. In particular, whatever the difficulties, the 1911 Insurance Act had to be linked with a universal health service. InJuly 1918 Dawson developed his ideas in two Cavendish lectures entitled ‘The nation
 
s welfare: the future of the medical profession’, given before the West London Medico-Chirurgical Society. Their audiences may have been small, but the influence of the lectures was immense. Widely publicized in both The Lancet and the British Medical Journal, they were reprinted as a pamphlet (to which Dawson added the term ‘health centre’, used for the first time). As a result he was drawn into thegovernment consultations concerning the formation of a ministry of health, and in 1919 he was made chairman of the consultative council on medical and allied services set up by Christopher Addison, the first minister of health.
 
This council was the first body in Britain to focus public opinion on systematized health services. Its report (the Dawson Report), published in 1920, foreshadowed by many years a national health service, the recommendations being repeatedin the Beveridge report of 1942, the government white paper of 1944, and the National Health Service legislation of 1946. Possibly adopting the terminology fromeducation (provided by Sir Arthur Morant, the first permanent secretary of theMinistry of Health), the report proposed a health service based on primary and secondary health centres (corresponding respectively to subsequent general-practitioner health centres and district general hospitals), with teaching hospitals at their head. Crucially, Morant died of influenza in 1920, financial retrenchment was in the air, and the report received a lukewarm official reception. Dawsonwas opposed to a compulsory full-time salaried service, and during the 1920s hebecame increasingly antagonistic towards a state medical service ‘which he identified with the threat posed by communism’ (Webster, 210). From advocating state collectivism in the provision of medical care he now promoted co-operation between existing agencies (ibid., 221).In 1920 Dawson was created a baron, taking the title of Lord Dawson of Penn, ofBuckinghamshire. In 1936 he became Viscount Dawson. He was the first medical manto enter the Lords as an active member of the profession. As its virtual spokesman he championed the special functions of the teaching hospitals, and in 1936 he opposed the Voluntary Euthanasia (Legalization) Bill in a characteristic speech:We do not lay down edicts for these things. It is a gradual growth of thought and feeling that entwines itself into the texture of our thoughts. … This is something which belongs to the wisdom and conscience of the medical profession and notto the realm of law. (DNB)A man of profound religious conviction, he supported the reform of the prayer book. Dawson was disturbed by what he perceived as a decline in Christian belief and teaching, and saw this reform as a means of reconciling old ideas with new. In 1937 he supported the Matrimonial Causes Bill and a year later was mainly responsible for the Infanticide Bill.Dawson also continued his private practice and hospital teaching, and his work as examiner for the London Hospital and Royal College of Physicians. In these years he held many hospital appointments; he served (from 1929) on the advisory committee to the Ministry of Health, the council of the King Edward
 
s Hospital Fund, and the Medical Research Council; and he became chairman of the army medical advisory board. From 1928 to 1930 he was president of the Royal Society of Medicine and in 1932 he was elected president of the British Medical Association (BMA)for its centenary year. From 1931 to 1938 he was president of the Royal Collegeof Physicians, and widened its reputation by encouraging active participation by its junior fellows and the election of doctors who were members of the salaried government service rather than clinicians.Dawson was a freethinker and liberal (so much so that the king had queried his elevation to the Lords), and though he sat on the Liberal benches in the Lords hewas not constrained by party opinions. As an undergraduate he had been influenced by Charles Bradlaugh and T. H. Huxley, and he showed an interest in social and political problems that was to persist for the rest of his life; he wrote an early Malthusian pamphlet. He championed sanatoria and spas for preventive health, through the National Fitness Council, and he chose the church congress to promote his advanced views on birth control, which included criticism of the Lambethconference. At the end of his life he was proselytizing for the formation of anacademy of medicine which would represent all its diverse strands (as did his proposal for a national health service and its reliance on health centres); thisscheme was many decades ahead of its time.By the Second World War, Dawson had lost his earlier radicalism and was against
 
significant state intervention in medicine. A member of the medical planning commission (MPC) set up in 1940 by the BMA to consider health service for the nation, Dawson argued that it was essential that voluntary hospitals should be savedand suggested a dual system whereby voluntary and municipal hospitals existed under the aegis of a central hospitals board. However, when he read the MPC draftinterim report of 1942 he saw it as too favourable to socialized medicine and urged instead ‘the inevitability of gradualness’ (Webster, 223). Given his increasingconservatism it was not surprising that he was re-elected president of the BMA in September 1943 following the death of Sir Beckwith Whitehouse, who had himselfbeen ‘an uncompromising defender of tradition’ (Webster, 225). Dawson was by this time approaching the end of his life and had little involvement in the negotiations between the government and medical profession over the establishment of a national health service. By now, in fact, he had come to see health centres as a step on the road to a full-time salaried service and had thus ‘drifted into condemning the institutions of which he was the virtual founder’ (Webster, 226).Much of Dawson
 
s public prominence came from his care of the royal family. Dawson had been called into consultation during the last illness of Edward VII (though he did not sign the authorized account published in The Lancet), but his mainresponsibility was for the health of George V. In 1929 George V suffered a nearfatal illness, developing from a streptococcal infection of the chest into a large abscess. As the king lay seemingly dying, on 12 December, Dawson
 
s syringe found the abscess and he drew off 16 ounces of fluid. Some medical colleagues werenevertheless indignant that Dawson had failed to consult the thoracic specialist Arthur Tudor Edwards in the matter. This was not the only time when Dawson
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s treatment of his royal patients had angered colleagues. After a dispute over thecare of one of the royal children, Lord Moynihan composed the jingle:Lord Dawson of PennHas killed lots of menSo that
 
s why we singGod Save the King.(Rose, 358)The king, however, respected Dawson and liked his direct approach. Dawson was byno means unaided when dealing with royal illnesses: during the crisis of 1929 eleven doctors stood round the royal bed. In 1936 Dawson was in continual attendance during the king
 
s final illness. It was Dawson who composed on a menu card the celebrated lines, ‘the King
 
s life is moving peacefully towards its close’, having modified this from what he described as ‘a very commonplace’ final bulletin used for Edward VII. Dawson
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s private Sandringham notebook also shows that he indeed ensured a peaceful conclusion to King George
 
s life; to this end, during the death agony, he injected three-quarters of a grain of morphine and one grain of cocaine into a distended jugular vein.Like many other famous men, Dawson was a paradox. No more than an ordinary clinician, he yet had far more influence on health care and delivery than many others, though his ideas were rediscovered and developed only many years later. He wasa less than consummate politician, but his enthusiasm and commitment were sufficient to persuade people about important issues beyond the delivery of health care, such as contraception. Much of his success in these matters was due to his charm and his capacity to inspire trust in such people as Archbishop Lang and Lloyd George, with whom he visited Hitler at Berchtesgaden in 1936. He also appeared to have time for everybody (he was notoriously unpunctual). Dawson received many honours and appointments: CB (1916), GCVO (1917), KCMG (1919), and KCB (1926); honorary degrees from McGill University and the universities of Pennsylvania,Oxford, Edinburgh, Bristol, Padua, Athens; and honorary fellowships of the American College of Surgeons and the Royal College of Surgeons, London. Dawson died of bronchopneumonia at 2 Weymouth Street, London, on 7 March 1945, and his peerage became extinct. He was survived by his wife.Stephen Lock

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