Hewan Archdale Dewar

Hewan Archdale Dewar is likely to be remembered chiefly as a pioneer of fibrinolysis. His interest began in 1961 with the publication of a pilot study of fibrinolytic treatment of coronary thrombosis and ended with a report on the effect of exercise and heart rate on fibrinolytic activity in 1993 (some 12 years after his retirement from the NHS). His work features prominently in a witness seminar published by the Wellcome Trust Centre for the History of Medicine, where key references may be found.1 The original pilot study in 1961 was followed two years later by an account, with four collaborators, of 75 cases. The negative result of this was applauded as an example of how such a trial should be conducted, but Dewar knew that it had serious flaws. The material used was thought to consist largely of streptokinase but in fact was mostly composed of plasmin, which was so rapidly neutralised in the bloodstream as to be useless for dissolving coronary thrombi. It was also given too late after onset.

During these 32 years, members of his staff and several junior colleagues working in department contributed widely under his guidance. In 1968 Dewar started to take an interest in the possible fibrinolytic properties of garlic and promoted attempts to develop chemical derivatives of garlic that were free of the odour but retained the fibrinolytic potential. He was disappointed to find that they were inseparable. In 1968 he collaborated with M Verstraete of Leuven in a multicentre trial, comparing heparin and streptokinase in recent myocardial infarction. Like many other trials mounted at that time, the result was negative partly because there were too few cases, but mostly because they were not treated early enough. Nevertheless Dewar was confident that fibrinolysis had a future in the treatment of acute …