Lilly Dubowitz (1930-2016)
A phrase was introduced to neonatal units in the 1970s, “Have you Dubowitzed the baby?”, which referred to a new, accurate technique for estimating the gestational age or period of time between conception and birth of a newborn child, pioneered by Lilly and Victor Dubowitz, a feisty Hungarian and her South African husband. Both were based in England. Their method was simple but groundbreaking: they tested a baby for a number of neurological signs that change as it matures. Until then, there was no clear-cut method for assessing whether a small baby was premature or undernourished.
The obstetrician Valerie Farr had already identified superficial or external signs of a baby’s maturation, including skin colour. The Dubowitz Score, as it became known was revolutionary in quantifying accurately the developmental phases of the newborn. It comprised oftwo charts.Each contained a set of signs identifying stages of superficial and neurological development in the baby, such as whether or not they could flex their arms and legs. They graded each developmental sign on a scale of 0 to 4 or 5.
No other paediatrician had defined the stages of maturation in newborns so clearly.Neither had they used a score to break down each phase. Lilly and Victor Dubowitz anticipated that neurological development signs would give a better estimate than the superficial. The reverse by a slight margin proved to be true. Lilly then had a brain-wave. She added together the total score for both groups of signs. The results correlated astonishingly closely to the true gestational age of the babies.
A meticulous clinician,she based her research on 400 babies observed in isolation. Subsequently, she interviewed theirmothers about theirmenstrual cycle prior to pregnancy and the date of their last period. This factor was key to estimating the gestational age of the baby. Of the 400, 167 gave data sufficiently accurate for further analysis. Dubowitz worked at the Jessop Hospital for Women in Sheffield where her husband was in charge of the paediatric ward. Always close, the couple were engaged within a fortnight of meeting in 1960. A friend of Victor’s had promised Lilly a picnic in Virginia Water. When his vintage car sprang aleak, he enlisted Victor as chauffeur.
Smitten, he married Lilly three months later at the West London Synagogue.“Those Hungarian salami sandwiches she brought to the picnic went straight through my stomach and into my heart,” he said. Their research partnership was strong: Victor, who is an expert in muscular dystrophy, drew the original stick- baby figures for the Dubowitz Score. Easy to use, this was laid out on note-pads, only requiring the clinician to circle in pen the stages of maturation applying most closely to the baby under observation.
Dubowitz was collating her data when the head of paediatrics at Cornell Medical School in New York, who had met the familyin America, came to stay. Fascinated, he pressed herto publish in an American paediatric journal. Printed in 1970, the score was a great success. Within a month, 200 reprints were ordered. It was later translated. By then, Lilly was 40 and accustomed to radical changes. Born in Budapest as Lilly Magdalene Suzanne Sebök, she was the daughter of Julius, a Jewish textile engineer who was sent to a labour camp by the Nazis. He died of a heart attack after his release. His wife and daughter hid in a safe house with false papers provided by the Swedish embassy.
At 16, Lilly emigrated to Australia. Although she spoke little English and suffered from dyslexia, she found work as a technician in a biochemistry laboratory. She then persuaded the University of Melbourne to allow her to work by day and study medicine by night. Graduating in 1956,she was posted to London two years later to train in endocrinology at Hammersmith hospital. According to her own words, she became a paediatrician “by accident”, after moving to Sheffield.
Awaiting the transfer of a medical research grant, she was offered a temporary post in paediatrics. She had worked briefly in the field in Melbourne and accepted the challenge readily. Yearning to conduct research, she organised her timetable so that she visited neonatal wards by night and was free by day to do the school runs for her four sons: David,who has become a radiologist; Michael, who is a cardiologist; Gerald, who is an anaesthetist; and Daniel, who is an architect.
Asked how she combined mothering four boisterous boys with intense clinical research, Dubowitz would reply, “They know who’s in charge”. In 1973 she was awarded a doctorate in medicine by Sheffield university. She loathed fuss. Her tests were always simple, such as using a red ball of wool to test infant eyesight, or a rattle to evaluate hearing. Warm and empathetic, she was concerned that her research was of practical use, especially in the third world.
She and her husband visited remote jungle areas of Papua New Guinea to assess newborn babies. Using the score, they could evaluate if a baby was underweight due to malnutrition or premature birth or possibly illness, such as malaria in the mother. In a refugee camp on the Thai border with Burma, Dubowitz trained an uneducated Karen woman as her assistant. On migrating to America, the woman was employed as a hospital cleaner. Hearing this, Dubowitz telephoned the hospital and said, “This woman is the co-author of one of my papers.” A job was duly found for her as an assessor of newborn babies.
Retirement in 1995 did not dampen Dubowitz’s dynamism. She embarked on a 20-year investigation into the life of her uncle, Stefan Sebök, an architect who vanished in Russia during the Second World War. Armed with a clutch of photographs and family anecdotes, she visited archives abroad and accessed KGB files. A woman who rarely accepted “no” as an answer, she discovered that Sebök had collaborated extensively with the Bauhaus architect Walter Gropius. “Lilly was always very inquiring and questioned everything,” her husband recalled. The result, The Forgotten Architect, was published in 2012.
Before her death from cancer, Dubowitz and her son Daniel put the story on to a website. For leisure,she restored Persian rugs and her husband is the owner of a fine green silk tie, made by Dubowitz, and patterned with stick-figure babies.
Lilly Dubowitz, paediatrician, was born on March 20, 1930. She died on March 14, 2016, aged 85
cover photo: Lilly with Victor Dubowitz in 1960.
This article was originally published in The Times June 14 2016