The Use of Sulfathiazole in the Treatment of Subacute and Chronic Osteomyelitis*: Frank D. Dickson MD (1882–1964), Rex L. Diveley MD, Richard Kiene MD The 4th President of the AAOS 1935 (FDD)

Frank Drake Dickson was born in 1882, in Pittsburgh, PA. His paternal grandfather had opened the first soft coal mine in the western part of Pennsylvania and was one of the builders of the Pennsylvania Railroad [4]. He obtained an undergraduate degree from the University of Pennsylvania in 1902, and his MD degree in 1905. He then studied abroad for a year and a half, and subsequently took an internship in Philadelphia. He became a Professor of Orthopaedic Surgery at the University of Pennsylvania in 1912. In 1916, Dr. Dickson was offered a position at the new Christian Church Hospital in Kansas City. He stated, “My intention was to spend about two years in Kansas City, then return to Philadelphia” [4]. He was, however, a captain in the military reserve and when the United States entered WW I, he resigned his position at the hospital and his professorship at the University of Kansas Medical School, and went to England with the unit that Dr. Joel Goldthwait (Boston) had organized. He was transferred to France in late 1917. After the war he decided to return to Kansas City to resume his work at the University of Kansas and the Christian Church Hospital where he met Dr. Rex Diveley (who became the 15(th) President of the AAOS). The two later (1927) established the Dickson-Diveley Clinic and the following year moved their practice to the new St. Luke’s Hospital. He continued limited practice and served as a consultant at the Clinic up until the time of his death. Dr. Dickson was one of eight individuals at the business meeting of the Clinical Orthopaedic Society, October 30, 1931, when the first concrete steps toward organizing the AAOS were taken [2]. (The Clinical Orthopaedic Society had originally been established as a regional association in 1912 as the Central States Orthopaedic Club with a name change in 1923 to the Clinical Orthopaedic Society [1].) Dr. Dickson was involved in a number of organizations, and was President not only of the AAOS but also the AOA in 1940 (he later served as the AOA treasurer in 1951) and the Clinical Orthopaedic Society [4], the two organizations which founded the AAOS. The article we reproduce here illustrates an early use of sulfathiazole to treat chronic osteomyelitis, coauthored with Dr. Rex Diveley [3]. They outline the four traditional treatments of osteomyelitis: débridement and packing to provide drainage, débridement and treatment with maggots, débridement and irrigation with Dakin’s solution, and the Orr method of débridement, packing with Vaseline gauze, and immobilization in plaster for long periods. Key and his colleagues [5], about the same time, had advocated the use of sulfanilamide in contaminated wounds. Dickson and Diveley decided to try sulfathiazole because it was more effective against staphylococcus (which at the time was the infective organism 90% of the time). (The sulfonamides had been synthesized in the 1930s in Germany, with the first publication in 1935. Hundreds of manufacturers quickly developed products, including Elixir Sulfonamide, which lead to the deaths of at least 100 people from ethylene glycol in the product. The outrage led to the Federal Food, Drug, and Cosmetic Act in 1938, which greatly expanded the authority of the FDA [6].) Their approach was based upon a concentration shown by Key et al. [5] to kill any bacteria. Their 22 patients were treated by preoperative sulfathiazole by mouth for three days prior to surgery (monitoring blood concentrations from 1 to 13 milligrams per 100 cubic centimeters), then thorough débridement (after injecting the sinuses with methylene blue to identify their extent), and the application of 1 to 2 grams of sulfathiazole powder to the wound using a nasal insufflator, followed by firm dressings and casting. The first patient was treated August 1, 1940, and the report (published in July, 1941) described the use of the approach in 22 patients, 18 of which had hematogenous osteomylitic foci. Fourteen of the 18 patients healed within 23 days, and two were too recent to know the results. This was a remarkable outcome for the time. (Equally remarkable is publication in July of 1941, when the series began only in August of the previous year.) [Figure: see text] References 1. About the COS. 2007. Clinical Orthopaedic Society Web site. Available at: http://www.cosociety.org/about/history.html. Accessed August 31, 2007. 2. Brown T. The American Orthopaedic Association: A Centennial History. Chicago, IL: The American Orthopaedic Association; 1987. 3. Dickson FD, Diveley RL. The use of sulfathiazole in the treatment of subacute and chronic osteomyelitis. J Bone Joint Surg Am. 1941;23:516–512. 4. Dr. Frank Dickson dies at age of 81. The Kansas City Times, Mo. January 20, 1964;Obituaries. 5. Key JA, Frankel CJ, Burford TH. The local use of sulfanilamide in various tissues. J Bone Joint Surg Am. 1940;22:952–958. 6. Sulfonamide (medicine). 2007. Wikipedia. Available at: http://en.wikipedia.org/wiki/Sulfonamide_%28medicine%29. Accessed August 31, 2007.