A gynaecologist who popularised the concept of premenstrual syndrome and wrote the best-selling book Once a Month. Born in London, UK, on Nov 11, 1916, she died on Sept 17, 2004, aged 87 years.
Katharina Dalton began her career as a chiropodist, and even wrote a textbook on the subject, but is best known for her work describing premenstrual syndrome (PMS). Robert Frank had described “premenstrual tension” in 1931, but Dalton, along with Raymond Greene—Graham Greene's brother—published the first paper on PMS in the BMJ in 1953. Soon after that, she established the world's first PMS clinic at University College Hospital, London, UK.
The 1953 BMJ paper was the first of many published by Dalton on PMS, based on research with tens of thousands of patients. Because she didn't do placebo-controlled studies, some have questioned her results, although hardly anyone doubts her critical role in convincing the medical establishment that PMS was a real condition. For example, one of her beliefs—that progesterone would be an effective treatment for PMS—has not been borne out by scientific scrutiny. For the few patients for whom progesterone worked, it was probably not because of regulation of levels of the hormone itself, according to University of California, Los Angeles professor of obstetrics and gynaecology Andrea Rapkin, but because one of its metabolites, when given as a suppository, acts at the GABA receptor and has a stress-modulating effect. “Part of the problem was that she wasn't rigorous”, Rapkin told The Lancet. “In that way it was logical to criticise her. But on the other hand, being able to say that premenstrual behaviour was really not related to women wanting to get pregnant or have sex or whatever men were saying at the time was important.”
“She was a pioneer”, said Uriel Halbreich, professor of psychiatry and gynaecology at the State University of New York at Buffalo, “and pioneers are not necessarily the ones providing the definitive answers”. She was “a really persistent and effective advocate of the recognition of PMS” in the UK, and her work was quite well accepted there, he said. It was less accepted by US physicians, he added, but she was admired by many women and garnered much publicity.
Some of the publicity was due to high-profile court cases in which Dalton served as an expert witness. She turned down several cases in which attorneys were planning a “PMS defence” because the women didn't have a cyclical pattern of behaviour that responded to treatment. But in 1980, she took the cases of Sandie Smith, who had convictions for crimes such as arson and assault and was charged with threatening to kill a police officer, and Christine English, charged with murder. Smith got probation after Dalton showed her crimes had occurred at monthly intervals, and English was allowed to plead guilty to manslaughter due to diminished responsibility. The cases were the first successful uses of the PMS defence. Dalton later took similar cases, but was strict about the ones she accepted, concerned that the plea was not abused. “The genuine cases are few and far between”, she wrote, “it is important to ensure that PMS is not made a universal defense”.
In 1978, Dalton published Once a Month: Understanding and Treating PMS. Much of its advice would today be thought quaint—eg, avoiding driving tests and work stress at certain times—and was toned down in later editions. It was a family affair; Dalton's daughter Wendy Holton, the founder of PMS Help, co-wrote several editions, and a granddaughter, Jennie, wrote a chapter in the 1999 edition. The book recommends a diet in which women “eat small starchy snacks every three hours during the waking hours and within one hour of waking and retiring to bed”, along with “adequate protein and plenty of fruit and vegetables”. It is intended to prevent the blood level of progesterone dropping, which has been shown to happen, in some studies, after a large meal.
Dalton later turned her attention to postpartum depression, which she attributed to fluctuations of the same hormones as she did PMS. She also, with her son Michael, studied the effects of vitamin B6 toxicity, and their study formed part of the basis of the 1997 UK Committee on Toxicity restriction of the sale of the vitamin to 10 mg per day. The study was later questioned by The Lancet (1998; 351:351:1523) and by some researchers (1998;352: 62).
Dalton started medical school at the Royal Free Hospital after her first husband, Wilfred Thompson, was killed in combat in World War II. She qualified on the day in 1948 in which the NHS began its existence. Her second husband, Tom Dalton, predeceased her in 1992. She is survived by her four children.