Neil Hamilton Fairley

From Wikipedia, the free encyclopedia

Neil Hamilton Fairley
15 July 1891-19 April 1966 (aged 74)
Image:Neil Hamilton Fairley.jpg
Brigadier Neil Hamilton Fairley
Place of birth Inglewood, Victoria
Place of death Sonning, Berkshire
Allegiance Flag of Australia Australia
Service/branch Australian Army
Years of service 1915-1946
Rank Brigadier
Battles/wars World War I:

World War II:
Awards KBE
mentioned in dispatches (2)

Brigadier Dr. Sir Neil Hamilton Fairley KBE CStJ MD DSc LL.D FRACP FRCP FRCPE FRS (15 July 1891 - 19 April 1966) was an Australian physician and soldier. During the Second World War he was Director of Medicine, Australian Military Forces with the rank of Brigadier. A renowned expert on tropical medicine, he was instrumental in saving thousands of allied lives from malaria and other diseases.

Contents

[edit] Early life

Neil Hamilton Fairley was born in Inglewood, Victoria on 15 July 1891, third of six sons of James Fairley, a bank manager, and his wife Margaret Louisa, née Jones. All of their four sons who survived to adulthood took up medicine as a career. One qualified as an MD at the University of Melbourne and an FRCS in England and became a surgeon; he was later killed in action in World War I. A second also qualified as an MD at the University of Melbourne, and later as an FRACP and FRCP; he became senior physician at Royal Melbourne Hospital. A third, younger, brother became a general practitioner.[1]

Neil was educated at Scotch College, Melbourne, where he was dux of his class. He attended the University of Melbourne, graduating with his Bachelor of Medicine and Surgery (MBBS) with first class honours in 1915.[1] While there, he won the Australian inter-varsity high jumping championship and represented Victoria in tennis.[2]

[edit] Great War

Fairley joined the Australian Army Medical Corps in 1915 and was posted to Royal Melbourne Hospital as a resident medical officer. He investigated an epidemic of meningitis that was occurring in local Army camps.[2] His first published paper was an analysis of this disease, documenting fifty cases.[1] In 1916, he co-authored a monograph published by the Federal government detailing 644 cases, of which 338 (52%) were fatal, this being before the invention of antibiotic drugs.[3]

Cairo, 1917. Group portrait of officers of 14 General Hospital. Major N. H. Fairley is second from the right.
Cairo, 1917. Group portrait of officers of 14 General Hospital. Major N. H. Fairley is second from the right.

On 5 September 1916, he embarked for Egypt on RMS Kashgar, joining the 14th General Hospital in Cairo.[4] There he encountered Major Charles Martin, formerly Professor of Physiology at the University of Melbourne and Director of the Lister Institute.[2] While in Egypt, Fairley investigated schistosomiasis (then known as bilharzia). The disease was known to be caused by contact with fresh water inhabited by certain species of snails, and orders had been issued that prohibited bathing in fresh water, but the troops were slow to appreciate the danger involved. In its toxic phase, the disease was easily confused with typhus, so Fairley developed a complement fixation test for the disease along the lines of the Wassermann test.[5] He studied its pathology, confirming that the worms in the circulatory system could be cured by intravenous tartaric acid.[6] Fairley also studied, and later published papers on, typhus,[7] malaria[8] and bacillary dysentery.[9]

Fairley married Staff Nurse Violet May Phillips at the Garrison Church, Abbassia, Cairo on 12 February 1919. They later divorced on 21 November 1924.[10] He was promoted to lieutenant colonel on 15 March 1919 and commanded the 14th General Hospital for a time before embarking for the United Kingdom in June 1919.[4]

For his services in the Great War, Fairley was mentioned in dispatches[11] and made an Officer of the Military Division Order of the British Empire.[12]

[edit] Between the Wars

Fairley was one of a number of AIF officers granted leave "to visit various hospitals in the United Kingdom in order that they become conversant with the latest developments in the medical sciences".[4] For a time, he worked for Martin at the Lister Institute in London where he qualified for membership of the Royal College of Physicians of London. He also received a Diploma of Public Health from the University of Cambridge. He returned to Australia on the transport Orontes in February 1920,[4] to become a research assistant to Charles Kellaway, a wartime colleague, who had become director of the Walter and Eliza Hall Institute of Medical Research, where Fairley worked on developing a test for echinococcosis along the lines of the test that he had already developed for Bilharzia.[2]

Fairley remained for less than a year before resigning to take up a five-year appointment in Bombay as Chair of Clinical Tropical Medicine at a newly created School of Tropical Medicine, a post for which he had been nominated by the Royal Society. On arrival in India, he found that the scheme had been abandoned and that as his appointment could be terminated at six month's notice, he would no longer be required after October 1922. Fairley demanded and received an audience with the Governor of Bombay, Sir George Lloyd, the result of which was that the Secretary of State agreed to create a special five-year post of Medical Officer of the Bombay Bacteriological Laboratory and Honorary Consulting Physician to the Sir Jamshedjee Jeejebhoy Hospital and St George Hospital, Mumbai.[13]

In India, Fairley continued his research into schistosomiasis. The disease was unknown in India but snails were abundant and there was danger that troops returning from Egypt might introduce it. In the absence of human schistosoma, Fairley investigated bovine schistosoma, which infected water buffalo and other domesticated animals in the Bombay area. Experiments with monkeys proved that daily intravenous doses of Tartaric acid were an effective treatment. Fairley also carried out pioneering work on Guinea worm disease (dracunculiasis).[14] However, his main interest was Tropical sprue. Unfortunately, he was not only unable to determine the cause or discover a cure, although he did make some advances in its treatment, but wound up contracting the disease himself. He was invalided out of India, travelling to the United Kingdom to recuperate in 1925.[15] While in India Fairley had met Mary Evelyn Greaves, and they were married at the Presbyterian Church, Marylebone on 28 October 1925.[10]

Fairley returned to Australia in 1927 and rejoined the Walter and Eliza Hall Institute. worked there for two years, collaborating with Kellaway in studies of snake venoms and with Harold Dew on the development of diagnostic tests for echinococcosis.[15]

In 1929, Fairley resigned from the Walter and Eliza Hall Institute a second time, this time to take up an appointment in London as Assistant Physician to the Hospital for Tropical Diseases and Lecturer at the London School of Hygiene and Tropical Medicine. He also opened a consulting practice in Harley Street.[15] In London he encountered patients with filariasis and devised a test to diagnose the disease at an early stage; but when he went to write up his results he discovered that details of a similar test had already been published. In 1934, a sewer worker was referred to his ward with acute jaundice which Fairley diagnosed as caused by filariasis. The disease was revealed to be an occupational hazard of sewer workers, and steps were taken to protect the workers. Perhaps his most important work in this period was research into blackwater fever. Since malaria cases were uncommon in the United Kingdom, he made annual visits to the Malaria Research Laboratory of the League of Nations at the Refugee Hospital in Salonika.[16] In the process, he described methaemalbumin, a previous unknown blood pigment. For his scientific accomplishments in London, Fairley was elected a Fellow of the Royal Society in 1942.[15]

[edit] Second World War

[edit] Middle East

Group portrait of officers of Headquarters 1 Australian Corps gathered on the deck of the troop transport Orcades. Colonel N. H. Fairley is in the front row, second from the right.
Group portrait of officers of Headquarters 1 Australian Corps gathered on the deck of the troop transport Orcades. Colonel N. H. Fairley is in the front row, second from the right.

With the outbreak of the Second World War, the Australian Army's Director General of Medical Services, Major General Rupert Downes tapped Fairley as Consulting Physician.[17] Fairley was seconded to the Second Australian Imperial Force (AIF) with the rank of colonel on 15 July 1940 and given the serial number VX38970.[4] He joined the AIF Headquarters in Cairo in September, taking advantage of the initial quiet period to familiarise himself with the AIF's medical units and their commanders.[18] As the British Army in the Middle East had no Consulting Physician in Tropical Diseases, Fairley accepted an offer to act in this capacity as well.[19]

In January 1941 the British Army began planning for operations in Greece. Fairley and his British colleague, Colonel J. S. K. Boyd, the consulting pathologist, drafted a medical appreciation. Drawing on the experience of the Salonika front in the Great War, where very heavy casualties were suffered from malaria, plus Fairley's more recent experience in that part of the world, they painted a gloomy picture, emphasising the grave risks, and going so far as to suggest that the Germans might attempt to entice the allies into a summer campaign in which they could be destroyed by malaria. The British Commander-in-Chief, General Sir Archibald Wavell was furious, decrying their report as "typical of a very non-medical and non-military spirit". A face-to-face meeting convinced Wavell that Fairley was serious and not merely uncooperative and Wavell promised his assistance in mitigating the danger. The campaign plan was altered to position allied forces further south.[20]

Fairley tackled an outbreak of bacilliary dysentery. In most cases the patients recovered of their own accord but some cases of shigellosis became seriously ill and died. Fairley brought a supply of Shiga anti-toxin with him but proved disappointingly ineffective in serious cases. However, Fairley also had a experimental supply of sulphaguanidine that had been given to him by Dr E. K. Marshall of Johns Hopkins Hospital. The drug was administered to a patient with severe shigellosis who was not expected to live. The results were dramatic, and the patient soon recovered.[21] Of the 21,015 Australian soldiers who contracted bacilliary dysentery during the Second World War, only 21 died.[22]

Malaria became a concern in the Syria-Lebanon Campaign. The Australian Army raised malaria control units for the first time and as soon as the operational situation permitted swamps and areas of open water were drained and mosquito breeding areas were sprayed. There were 2,435 cases of malaria in the AIF in 1941, a rate of 31.8 per thousand per year. Quinine was used as a prophylaxis. On Fairley's advice, patients with relapses were treated with intravenous quinine for three days followed by a course of atebrin and plasmoquine.[23]

For his services in the Middle East, Fairley was mentioned in dispatches a second time and made a Commander of the Military Division Order of the British Empire.[24]

[edit] South West Pacific

With the entry of Japan into the war, Fairley flew to Java in January 1942.[4] Fairley was well aware that Java produced 90% of the world's supply of quinine and that the implications would be serious if Java was lost. He arranged for the purchase of all available stocks of quinine, some 130 tonnes worth.[18] Fairley was informed that some 50 tonnes had been loaded on board two ships. One was never seen again. The other, the SS Klang, reached Fremantle in March. Although 20 tonnes of quinine was loaded on board, it was apparently unloaded when the ship stopped at Tjilatjap, possibly due to fifth columnists. Thus, none of the shipment reached Australia.[25] Fairley himself departed Java with the I Corps staff on the transport Orcades on 21 February 1942 shortly before Java fell.[4]

In General Sir Thomas Blamey's reorganisation of the Australian Army in April 1942, Fairley was appointed Director of Medicine at Allied Land Forces Headquarters (LHQ) in Melbourne.[26] Fairley was soon facing a series of medical emergencies caused by the Kokoda Track campaign. An epidemic of bacillary dysentery was headed off by Fairley's decision to rush all available supplies of sulphaguanadine to New Guinea. On Fairley's advice every man who complained of diarrhoea was given the drug and the epidemic was brought under control in ten days.[27]

Malaria research at the Medical Research Unit in Cairns
Malaria research at the Medical Research Unit in Cairns

But Fairley's main concern was malaria. Despite the experience with malaria in the Middle East, most of the troops had a poor understanding of anti-malaria precautions and few medical officers had encountered the disease. In combination with critical shortages of drugs and anti-malarial supplies such as netting, insecticides and repellents, the result was a medical disaster. In the 13 week period from 31 October 1942 to 1 January 1943, the Army reported 4,137 battle casualties, but 14,011 casualties from tropical diseases, of which 12,240 were from malaria. The government grimly contemplated disbanding divisions to replace malaria casualties.[28] "Our worst enemy in New Guinea," General Blamey declared, "is not the Nip – it’s the bite."[29]

This caused Blamey to dispatch a medical mission headed by Fairley to the United States and the United Kingdom in September 1942 to present the Army's case for a more adequate and equitable share of anti-malarial supplies. The mission was successful. Not only was Fairley able to secure supplies and expedite the delivery of those that were already on order but held up for lack of shipping or priority, but in bringing the problem to the attention of the highest authorities overseas, he lifted the global profile and priority of malaria control measures, with the matter being brought to the attention of the highest allied military and civil authorities.[30]

It was calculated that Allied requirements for atebrin would be 200 tonnes per annum, of which 50 tonnes would be manufactured in the United Kingdom and 150 tonnes in the United States. American production in 1942 was estimated at 60 tons but efforts were soon under way to increase production. The possibility of producing atebrin in Australia was considered, but the drug was complicated to synthesise and required little shipping space, although steps were taken to produce mosquito repellent. As in the Middle East, the Army relied on a combination of quinine, atebrin and plasmoquine (QAP) to cure malaria. The United States and United Kingdom agreed to each produce two tons of plasmoquine each per annum. The requested drugs and supplies began arriving in December 1942.[31]

Atherton Conference. Brigadier N. H. Fairley is at the right of the second row.
Atherton Conference. Brigadier N. H. Fairley is at the right of the second row.

As "one of the reasons for the lamentable record in malaria control in 1942 and early 1943 was the absence of medical authority at the level of the theatre commander’s headquarters",[32] Fairley suggested that there be a body responsible for coordinating the activities of all allied forces in the South West Pacific Area. General Blamey took the matter up with the General Douglas MacArthur,[33] the Supreme Commander. MacArthur, who had himself suffered an attack of malaria back in 1904 (and a serious relapse the next year),[34] created the Combined Advisory Committee on Tropical Medicine, Hygiene and Sanitation with Colonel Fairley as its chairman in March 1943. After its first meeting, Fairley met with Macarthur, who emphasised that he did not wish the committee to concern itself with matters of academic interest but to make concrete recommendations on essential medical matters. The committee proceeded to make a series of recommendations regarding training, discipline, equipment, procedures and priorities, which then went out as GHQ orders to all commands.[35]

Fairley's proposed use of atebrin as a prophylactic agent was accepted and Fairley switched the Australian Army over to using atebrin as a prophylaxis instead of quinine in March 1943. The most acute problem at this time was a shortage of atebrin. The Australian Army had only seven weeks' stock was on hand in March 1943 and US forces in both the South West Pacific and South Pacific Area were drawing on Australian Army stocks as they had not yet received adequate stocks of their own. The drug is also a dye, and had the known side effect of making the skin and eyeballs of the user go yellow in colour after repeated use but this was an acceptable drawback in wartime. Prolonged use could cause lichen planus and psychosis in rare cases, but atebrin still turned out to be much safer than quinine. Blackwater fever - which had a mortality rate of 25% - disappeared entirely.[36]

Fairley was acutely aware that much remained unknown about malaria. In particular, he was interested in the possibility that sulphaguanidine (or a related sulphonamide) might be a causal prophylactic against malaria, as they could be manufactured in Australia, unlike atebrin and plasmoquine.[37] Fairley decided to establish a unit in Cairns to investigate malaria. The LHQ Medical Research Unit commenced work in June 1943.[38]

Fairley travelled to New Guinea at the end of June 1943 and arranged for Plasmodium falciparum cases to be evacuated to Cairns for treatment. As the flight time from Port Moresby to Cairns was only a few hours, this was considered safe, but since the disease can be fatal if not treated promptly, Fairley was concerned lest the cases be delayed for some reason. Movement Control suggested that a special priority be allocated to such cases, and Major General Frank Berryman suggested calling it priority Neil after Fairley himself. Because movement priorities had to have five letters, an extra L was added on the end. Priority Neill soon came to be applied to the entire Cairns project.[39]

Atebrin parade in New Guinea
Atebrin parade in New Guinea

The LHQ Medical Research Unit used human test subjects, all volunteers drawn from the Australian Army, including a small but notable group of 'Dunera Boys' (Jewish refugees) from the 8th Employment Company.[40] The volunteers were infected with strains of malaria from infected mosquitoes of from the blood of other test subjects, which was then treated with various drugs. The volunteers were rewarded with three weeks' leave and a certificate of appreciation signed by General Blamey.[41] The LHQ Medical Research Unit researched quinine, sulphonamides, atebrin, chloroquine, plasmoquine, and paludrine.

In June 1944, a conference was held at Atherton, Queensland on "Prevention of Disease in Warfare". Chaired by Lieutenant General Vernon Sturdee, the commander of the First Army, it was attended by key corps and division commanders. Fairley, who had been promoted to brigadier in February 1944, described the results of the work at Cairns on anti-malarial drugs; other officers described practical measures that could be taken to reduce the toll of disease on the men. The Director General of Medical Services, Major General S. R. (Ginger) Burston, told the senior commanders that "the ball is in your court".[42]

Using draconian drills that required officers to place atebrin tablets in their men's mouths, the Army attempted to reduce the incidence of malaria to zero. For the most part they were successful but in the Aitape-Wewak campaign the 6th Division suffered an epidemic of malaria despite its best efforts. Fairley was urgently recalled from a tour of South East Asia Command and given orders by General Blamey to personally proceed to Wewak and investigate the situation. A special section was formed from the LHQ Medical Research Unit to assist the 6th Division and certain relapsing personnel were evacuated to Cairns. The epidemic was ultimately brought under control by doubling the dosage of atebrin. Fairley was forced to confront the fact - confirmed by research at Cairns - that an atebrin resistant strain of malaria had arisen. The ability of malaria to develop resistant strains would have profound implications in the post-war world.[43]

[edit] Later life

After the war Fairley returned to London where he became Consulting Physician to the Hospital for Tropical Diseases and Wellcome Professor of Tropical Medicine at the London School of Hygiene and Tropical Medicine. His early post war research was a continuation of his wartime work on malaria.[44]

He suffered a serious illness in 1948 from which he did not completely recover and was forced to resign his professorship. He retained his practice and membership of numerous committees, becoming a kind of "elder statesman" of tropical medicine.[45] In recognition of his service to tropical medicine, he was created a Knight Commander of the Order of the British Empire on 8 June 1950.[46]

Fairley died after a long illness on 19 April 1966 at The Grove, Sonning, Berkshire. Survived by his wife and their two sons (both medical doctors), and by the son of his first marriage (an Australian Army officer), he was buried nearby in the graveyard of St Andrew's Church.[10] His son Gordon Hamilton-Fairley, a renowned oncologist, was killed by the Provisional Irish Republican Army in 1975.

A 1943 portrait by Sir William Dargie is held by the Fairley family. A later 1960 portrait by Dargie and a 1945 one by Nora Heysen are held by the Australian War Memorial but are not on display (although they can be viewed online). His papers are held in the Basser Library at the Australian Academy of Science. The Neil Hamilton Fairley Overseas Clinical Fellowship provides full-time training overseas and in Australia in the areas of clinical research including the social and behavioural sciences.[47]

[edit] Dates and age of rank

[edit] Honours and awards

[edit] Decorations

Knight Commander of the Order of the British Empire Civil division (1950)
Commander of the Order of the British Empire Military division (1941)
Officer of the Order of the British Empire Military division (1919)
World War I Victory Medal
British War Medal
1939-1945 Star
Africa Star
Pacific Star
Australia Service Medal 1939-45
War Medal, 1939-45
Defence Medal

[edit] Honours

[edit] Medals and prizes

  • 1920 Dublin Research Prize
  • 1921 David Syme Research Prize and Medal
  • 1931 Chalmers Memorial Medal for Research in Tropical Medicine
  • 1945 Bancroft Memorial Medal
  • 1946 Richard Pierson Strong Medal, American Foundation of Tropical Medicine
  • 1948 Moxon Medal, Royal College of Physicians
  • 1949 Mary Kingsley Medal, Liverpool School of Tropical Medicine
  • 1950 Manson Medal, Royal Society of Tropical Medicine and Hygiene
  • 1951 James Cook Medal, Royal Society of NSW
  • 1957 Buchanan Medal, Royal Society of London

[edit] Notes

  1. ^ a b c Boyd 1966, p. 123
  2. ^ a b c d Ford 1969, p. 991
  3. ^ N. Hamilton Fairley and C. A. Stewart, Commonwealth of Australia Quarantine Service - Service Publication No. 9 - Cerebro-Spinal Fever (1916)
  4. ^ a b c d e f g Fairley, Neil Hamilton personnel file, NAA: B883 VX38970
  5. ^ Boyd 1966, p. 125
  6. ^ Butler 1938, p. 776
  7. ^ Boyd 1966, pp. 124-125
  8. ^ Boyd 1966, p. 142
  9. ^ Butler 1938, pp. 459-460
  10. ^ a b c ' Fairley, Sir Neil Hamilton (1891 - 1966)', Australian Dictionary of Biography
  11. ^ London Gazette: (Supplement) no. 31138, page 1165, 21 January 1919. Retrieved on 2008-05-31.
  12. ^ London Gazette: (Supplement) no. 31093, page 54, 1 January 1919. Retrieved on 2008-05-31.
  13. ^ Boyd 1966, p. 127
  14. ^ Boyd 1966, pp. 127-128
  15. ^ a b c d Ford 1969, p. 992
  16. ^ Boyd 1966, pp. 130-133
  17. ^ Walker 1953, p. 32
  18. ^ a b Keogh 1966, p. 723
  19. ^ Boyd 1966, p. 133
  20. ^ Walker 1953, pp. 230-231
  21. ^ Boyd 1966, p. 133
  22. ^ Walker 1952, p. 4
  23. ^ Walker 1953, pp. 357-359
  24. ^ London Gazette: (Supplement) no. 35396, page 7357, 26 December 1941. Retrieved on 2008-05-31.
  25. ^ Walker 1953, p. 465
  26. ^ Walker 1953, p. 449
  27. ^ Boyd 1966, p. 134
  28. ^ Defence Committee Agendum No. 14/1943, 4 March 1943, NAA: A5954 473/4
  29. ^ Sweeney 2003, p. 19
  30. ^ Walker 1952, p. 84
  31. ^ Walker 1952, pp. 84-89
  32. ^ Coates 1963, p. 540
  33. ^ Sweeney 2003, pp. 33-34
  34. ^ James 1970, p. 90
  35. ^ Walker 1952, pp. 99-100,111-112
  36. ^ Sweeney 2003, pp. 75-76
  37. ^ Sweeney 2003, p. 40
  38. ^ Boyd 1966, p. 135
  39. ^ Sweeney 2003, pp. 47-48
  40. ^ Sweeney 2003, p. 262
  41. ^ Sweeney 2003, pp. 223, 235
  42. ^ Walker 1952, pp. 117-118
  43. ^ Sweeney 2003, pp. 167-190
  44. ^ Boyd 1966, pp. 138-139
  45. ^ Boyd 1966, p. 139
  46. ^ London Gazette: (Supplement) no. 38930, page 2810, 2 June 1950. Retrieved on 2008-05-31.
  47. ^ Neil Hamilton Fairley Overseas Clinical Fellowship

[edit] References

  • James, D. Clayton (1970), The Years of MacArthur Volume I, 1880–1941, vol. 1, ISBN 0-395-10948-5