Neil Hamilton Fairley
Encyclopedia
Brigadier
Sir Neil Hamilton Fairley KBE
CStJ FRACP
FRCP
FRCPE
FRS
(15 July 1891 – 19 April 1966) was an Australia
n physician
, medical scientist, and army officer; who was instrumental in saving thousands of Allied lives from malaria
and other diseases.
A graduate of the University of Melbourne
, Fairley joined the Australian Army Medical Corps
in 1915. He investigated an epidemic of meningitis
that was occurring in Army camps in Australia. While with the 14th General Hospital in Cairo
, he investigated schistosomiasis
(then known as bilharzia) and developed tests and treatments for the disease. In the inter-war period he became renowned as an expert on tropical medicine.
Fairley returned to the Australian Army
during the Second World War as Director of Medicine. He played an important role in the planning for the Battle of Greece
, convincing the British Commander-in-Chief
, General
Sir Archibald Wavell
to alter his campaign plan
to reduce the danger from malaria
. In the South West Pacific Area
, Fairley became responsible for coordinating the activities of all allied forces in the fight against malaria and other tropical diseases. Fairley again sounded the alarm on the dangers of malaria, persuading authorities in the United States and United Kingdom to greatly step up production of anti-malarial drugs. Through the activities of the LHQ Medical Research Unit, he fast-tracked research into new drugs. Fairley convinced the Army of the efficacy of the new drug atebrin, and persuaded commanders to adopt a tough approach to administering the drug to the troops.
After the war Fairley returned to London where he became a consulting physician to the Hospital for Tropical Diseases
and Wellcome Professor of Tropical Medicine at the London School of Hygiene and Tropical Medicine. A serious illness in 1948 forced him to resign his professorship, but he retained his practice and membership of numerous committees, becoming an "elder statesman" of tropical medicine.
, on 15 July 1891, as the 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 a Doctor of Medicine
at the University of Melbourne
and an FRCS
in England and became a surgeon; he was later killed in action
in the First World War. A second also qualified as a Doctor of Medicine at the University of Melbourne, and later as an FRACP
and FRCP
; he became senior physician at Royal Melbourne Hospital
. A third son became a general practitioner
.
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, and his Doctor of Medicine (MD) in 1917. While there, he won the Australian inter-varsity high jump
ing championship and represented Victoria
in tennis
.
with the rank of captain on 1 August 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, and his first published paper was an analysis of this disease, documenting fifty cases. 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.
Fairley enlisted in the First Australian Imperial Force
(AIF) on 24 August 1916. On 5 September 1916, he embarked for Egypt
on RMS Kashgar, joining the 14th General Hospital in Cairo
. There he encountered Major Charles Martin
, formerly Professor of Physiology
at the University of Melbourne and Director of the Lister Institute from 1903 to 1930. At this time, Martin was working as a Consulting Physician to the AIF in Egypt and commanded the Anzac Field Laboratory.
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 snail
s, 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
. He studied its pathology
, confirming that the worms in the circulatory system
could be cured by intravenous tartaric acid
. Fairley also studied, and later published papers on typhus
, malaria
, and bacillary dysentery
.
Fairley married Staff Nurse Violet May Phillips at the Garrison Church, Abbassia, Cairo on 12 February 1919. They later divorced on 21 November 1924. 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. For his services in the First World War, Fairley was mentioned in despatches and made an Officer of the Military Division of the Order of the British Empire
. His citation read:
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, to become a research assistant
to Sydney Patterson, 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.
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
.
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
). However, his main interest was Tropical sprue
. But he was unable to determine its cause or discover a cure; in spite of contracting the disease himself and making some advances in its treatment. He was invalided out of India, travelling to the United Kingdom to recuperate in 1925. While in India he had met Mary Evelyn Greaves, and they were married at the Presbyterian Church, Marylebone
, on 28 October 1925.
Fairley returned to Australia in 1927 and rejoined the Walter and Eliza Hall Institute. He worked there for two years, collaborating with the new director, Charles Kellaway
in studies of snake venom
s and with Harold Dew on the development of diagnostic tests for echinococcosis
. Fairley dedicated most of 1928 to the snake venom programme, coordinating an enormous body of epidemiological data – including a questionnaire to Australian clinicians – on the frequency and outcome of bites by Australian elapid snakes. This work involved numerous milkings to establish typical and maximal venom yields, innovative studies of snake dentition using wax moulds, and detailed dissections to describe each species' biting apparatus. Fairley furthermore undertook in vivo studies of envenomation in a range of large animal species, in order to determine the efficacy of prevailing first-aid measures. He concluded that at best, ligature and local venesection might slow time to death after a significant envenomation. This reinforced the need for effective antivenenes (antivenoms) for the more dangerous local species of snakes, notably the tiger snake (Notechis scutatus), death adder (Acanthophis antarcticus) and copperhead (Austrelaps superbus), although only the former was suitable for manufacture by the Commonwealth Serum Laboratories (now CSL Limited
).
In 1928, Fairley received an appointment in London as Assistant Physician to the Hospital for Tropical Diseases
and Lecturer at the London School of Hygiene and Tropical Medicine. Although he and Kellaway convinced the governors to delay Fairley's commencement until their major venom work was completed, he departed for London by the end of that year. He also opened a consulting practice in Harley Street
. 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. In the process, he described methaemalbumin
, a previously unknown blood pigment. For his scientific accomplishments in London, Fairley was elected a Fellow of the Royal Society in 1942.
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. 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. 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. 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.
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 First World War, where very heavy casualties 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
decried their report as "typical of a very non-medical and non-military spirit", but a face-to-face meeting with Boyd and Fairley convinced Wavell that they were 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, away from the plains of Macedonia and the Vardar
and Struma River
basins, where malaria was hyper-endemic and heavy casualties had been suffered from malaria by British troops during the First World War.
Fairley tackled an outbreak of bacilliary dysentery among the troops in Egypt. In most cases the patients recovered of their own accord but some cases of shigellosis
became seriously ill and died. Fairley had some Shiga anti-toxin with him, but it proved ineffective in serious cases, even when administered in large doses. However, he also had an 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, and the patient soon recovered. Of the 21,015 Australian soldiers who contracted bacilliary dysentery during the Second World War, only 21 died.
Malaria again 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
. For his services in the Middle East, Fairley was mentioned in despatches a second time, and made a Commander of the Military Division Order of the British Empire
for his "immense and specialised knowledge of tropical diseases in the Middle East".
into the war, Fairley flew to Java
in January 1942. 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 120 long tons (121.9 t). Fairley was informed that the quinine had been loaded on board two ships. One was never seen again. The other, the SS Klang, reached Fremantle
in March. Although 20 long tons (20.3 t) of quinine was loaded on board, it was apparently unloaded when the ship stopped at Tjilatjap, possibly due to fifth column
ists. Thus, none of the shipment reached Australia. Fairley himself departed Java with the I Corps staff on the transport Orcades on 21 February 1942 shortly before Java fell.
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
. 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.
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. "Our worst enemy in New Guinea," General Blamey declared, "is not the Nip—it’s the bite."
This caused Blamey to despatch 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. Fairley was able to secure supplies and expedite the delivery of those that were already on order but held up for lack of shipping or priority. In bringing the problem to the attention of the highest allied military and civil authorities overseas, he lifted the global profile and priority of malaria control measures.
It was calculated that Allied requirements for atebrin would be 200 long tons (203.2 t) per annum, of which 50 long tons (50.8 t) would be manufactured in the United Kingdom and 150 long tons (152.4 t) 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.
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", 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
, the Supreme Commander. MacArthur, who had himself suffered an attack of malaria back in 1904 (and a serious relapse the next year), 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.
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.
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. Fairley decided to establish a unit in Cairns to investigate malaria. The LHQ Medical Research Unit commenced work in June 1943.
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.
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. 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. The LHQ Medical Research Unit researched quinine
, sulphonamides
, atebrin
, 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 "the ball is in your court".
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.
Fairley's declining health prompted him to leave London and move to The Grove, Sonning
, Berkshire
, where he died on 19 April 1966, and was buried in the graveyard of St Andrew's Church, Sonning
. He was survived by his wife and their two sons, who were both medical doctors, and also by the son of his first marriage, who had become an Australian Army officer. His son Gordon Hamilton-Fairley
, a renowned oncologist
, was killed by a Provisional Irish Republican Army
bomb on 22 October 1975.
Sir William Dargie
painted a portrait of Fairley in 1943, which is in the possession the Fairley family. A later 1960 portrait by Dargie, together with a 1945 one by Nora Heysen
, is in the Australian War Memorial
. Neither is on display, although the latter can be viewed online. A 1954 Dargie portrait of Queen Elizabeth II
painted while Dargie was staying at Fairley's home at 81 Duke Street
, Grosvenor Square
, in London, and subsequently given to Fairley, was sold at auction to the National Museum of Australia
in 2009 for $120,000. Fairley's papers are in the Basser Library
at the Australian Academy of Science
. He is commemorated by the Neil Hamilton Fairley Overseas Clinical Fellowship, which provides full-time training in Australia and overseas in areas of clinical research including the social and behavioural sciences.
Source:
Brigadier
Brigadier is a senior military rank, the meaning of which is somewhat different in different military services. The brigadier rank is generally superior to the rank of colonel, and subordinate to major general....
Sir Neil Hamilton Fairley KBE
Order of the British Empire
The Most Excellent Order of the British Empire is an order of chivalry established on 4 June 1917 by George V of the United Kingdom. The Order comprises five classes in civil and military divisions...
CStJ FRACP
Royal Australasian College of Physicians
The Royal Australasian College of Physicians, or RACP, is the organisation responsible for training, educating, and representing over 9,000 physicians and paediatricians in Australia and New Zealand. It was founded in 1938....
FRCP
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...
FRCPE
Royal College of Physicians of Edinburgh
The Royal College of Physicians of Edinburgh was established in the 17th century. While the RCPE is based in Edinburgh, it is by no means just a Scottish professional body - more than half of its 7,700 Fellows, Members, Associates and Affiliates live and practice medicine outside Scotland, in 86...
FRS
Royal Society
The Royal Society of London for Improving Natural Knowledge, known simply as the Royal Society, is a learned society for science, and is possibly the oldest such society in existence. Founded in November 1660, it was granted a Royal Charter by King Charles II as the "Royal Society of London"...
(15 July 1891 – 19 April 1966) was an Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
n physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
, medical scientist, and army officer; who was instrumental in saving thousands of Allied lives from malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
and other diseases.
A graduate of the University of Melbourne
University of Melbourne
The University of Melbourne is a public university located in Melbourne, Victoria. Founded in 1853, it is the second oldest university in Australia and the oldest in Victoria...
, Fairley joined the Australian Army Medical Corps
Royal Australian Army Medical Corps
The Royal Australian Army Medical Corps is the branch of the Australian Army responsible for providing medical care to Army personnel. The AAMC was formed in 1902 and has participated in every Australian Army operation...
in 1915. He investigated an epidemic of meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
that was occurring in Army camps in Australia. While with the 14th General Hospital in Cairo
Cairo
Cairo , is the capital of Egypt and the largest city in the Arab world and Africa, and the 16th largest metropolitan area in the world. Nicknamed "The City of a Thousand Minarets" for its preponderance of Islamic architecture, Cairo has long been a centre of the region's political and cultural life...
, he investigated schistosomiasis
Schistosomiasis
Schistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...
(then known as bilharzia) and developed tests and treatments for the disease. In the inter-war period he became renowned as an expert on tropical medicine.
Fairley returned to the Australian Army
Australian Army
The Australian Army is Australia's military land force. It is part of the Australian Defence Force along with the Royal Australian Navy and the Royal Australian Air Force. While the Chief of Defence commands the Australian Defence Force , the Army is commanded by the Chief of Army...
during the Second World War as Director of Medicine. He played an important role in the planning for the Battle of Greece
Battle of Greece
The Battle of Greece is the common name for the invasion and conquest of Greece by Nazi Germany in April 1941. Greece was supported by British Commonwealth forces, while the Germans' Axis allies Italy and Bulgaria played secondary roles...
, convincing the British Commander-in-Chief
Commander-in-Chief
A commander-in-chief is the commander of a nation's military forces or significant element of those forces. In the latter case, the force element may be defined as those forces within a particular region or those forces which are associated by function. As a practical term it refers to the military...
, General
General
A general officer is an officer of high military rank, usually in the army, and in some nations, the air force. The term is widely used by many nations of the world, and when a country uses a different term, there is an equivalent title given....
Sir Archibald Wavell
Archibald Wavell, 1st Earl Wavell
Field Marshal Archibald Percival Wavell, 1st Earl Wavell GCB, GCSI, GCIE, CMG, MC, PC was a British field marshal and the commander of British Army forces in the Middle East during the Second World War. He led British forces to victory over the Italians, only to be defeated by the German army...
to alter his campaign plan
Campaign plan
Campaign plan is a plan to achieve an objective, usually of a large-scale over an extended period of time. It usually coordinates many activities and uses of resources involving multiple organizations. A campaign plan could also have subordinate objectives or intermediate milestones and is often...
to reduce the danger from malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
. In the South West Pacific Area
South West Pacific Area
South West Pacific Area was the name given to the Allied supreme military command in the South West Pacific Theatre of World War II. It was one of four major Allied commands in the Pacific theatres of World War II, during 1942–45...
, Fairley became responsible for coordinating the activities of all allied forces in the fight against malaria and other tropical diseases. Fairley again sounded the alarm on the dangers of malaria, persuading authorities in the United States and United Kingdom to greatly step up production of anti-malarial drugs. Through the activities of the LHQ Medical Research Unit, he fast-tracked research into new drugs. Fairley convinced the Army of the efficacy of the new drug atebrin, and persuaded commanders to adopt a tough approach to administering the drug to the troops.
After the war Fairley returned to London where he became a consulting physician to the Hospital for Tropical Diseases
Hospital for Tropical Diseases
The Hospital for Tropical Diseases is a specialist tropical disease hospital located in London, United Kingdom. It is part of the University College London Hospitals NHS Foundation Trust and is closely associated with University College London and the London School of Hygiene & Tropical Medicine...
and Wellcome Professor of Tropical Medicine at the London School of Hygiene and Tropical Medicine. A serious illness in 1948 forced him to resign his professorship, but he retained his practice and membership of numerous committees, becoming an "elder statesman" of tropical medicine.
Early life
Neil Hamilton Fairley was born in Inglewood, VictoriaInglewood, Victoria
Inglewood is a town in Victoria, Australia, located on the Calder Highway, in the Shire of Loddon. At the 2006 census, Inglewood had a population of 834...
, on 15 July 1891, as the 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 a Doctor of Medicine
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...
at the University of Melbourne
University of Melbourne
The University of Melbourne is a public university located in Melbourne, Victoria. Founded in 1853, it is the second oldest university in Australia and the oldest in Victoria...
and an FRCS
Fellowship of the Royal College of Surgeons
Fellowship of the Royal College of Surgeons is a professional qualification to practise as a surgeon in the United Kingdom and Republic of Ireland...
in England and became a surgeon; he was later killed in action
Killed in action
Killed in action is a casualty classification generally used by militaries to describe the deaths of their own forces at the hands of hostile forces. The United States Department of Defense, for example, says that those declared KIA need not have fired their weapons but have been killed due to...
in the First World War. A second also qualified as a Doctor of Medicine at the University of Melbourne, and later as an FRACP
Royal Australasian College of Physicians
The Royal Australasian College of Physicians, or RACP, is the organisation responsible for training, educating, and representing over 9,000 physicians and paediatricians in Australia and New Zealand. It was founded in 1938....
and FRCP
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...
; he became senior physician at Royal Melbourne Hospital
Royal Melbourne Hospital
The Royal Melbourne Hospital , located in Parkville, Victoria an inner suburb of Melbourne is one of Australia’s leading public hospitals. It is a major teaching hospital for tertiary health care with a reputation in clinical research...
. A third son became a general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
.
Neil was educated at Scotch College, Melbourne
Scotch College, Melbourne
Scotch College, Melbourne is an independent, Presbyterian, day and boarding school for boys, located in Hawthorn, an inner-eastern suburb of Melbourne, Victoria, Australia....
, where he was dux
Dux
Dux is Latin for leader and later for Duke and its variant forms ....
of his class. He attended the University of Melbourne
University of Melbourne
The University of Melbourne is a public university located in Melbourne, Victoria. Founded in 1853, it is the second oldest university in Australia and the oldest in Victoria...
, graduating with his Bachelor of Medicine and Surgery
Bachelor of Medicine and Surgery
Bachelor of Medicine, Bachelor of Surgery, or in Latin Medicinae Baccalaureus, Baccalaureus Chirurgiae , are the two first professional degrees awarded upon graduation from medical school in medicine and surgery by universities in various countries...
(MBBS) with first class honours in 1915, and his Doctor of Medicine (MD) in 1917. While there, he won the Australian inter-varsity high jump
High jump
The high jump is a track and field athletics event in which competitors must jump over a horizontal bar placed at measured heights without the aid of certain devices in its modern most practiced format; auxiliary weights and mounds have been used for assistance; rules have changed over the years....
ing championship and represented Victoria
Victoria (Australia)
Victoria is the second most populous state in Australia. Geographically the smallest mainland state, Victoria is bordered by New South Wales, South Australia, and Tasmania on Boundary Islet to the north, west and south respectively....
in tennis
Tennis
Tennis is a sport usually played between two players or between two teams of two players each . Each player uses a racket that is strung to strike a hollow rubber ball covered with felt over a net into the opponent's court. Tennis is an Olympic sport and is played at all levels of society at all...
.
First World War
Fairley joined the Australian Army Medical CorpsRoyal Australian Army Medical Corps
The Royal Australian Army Medical Corps is the branch of the Australian Army responsible for providing medical care to Army personnel. The AAMC was formed in 1902 and has participated in every Australian Army operation...
with the rank of captain on 1 August 1915 and was posted to Royal Melbourne Hospital as a resident medical officer. He investigated an epidemic of meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
that was occurring in local Army camps, and his first published paper was an analysis of this disease, documenting fifty cases. In 1916, he co-authored a monograph published by the Federal government
Government of Australia
The Commonwealth of Australia is a federal constitutional monarchy under a parliamentary democracy. The Commonwealth of Australia was formed in 1901 as a result of an agreement among six self-governing British colonies, which became the six states...
detailing 644 cases, of which 338 (52%) were fatal, this being before the invention of antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
drugs.
First Australian Imperial Force
The First Australian Imperial Force was the main expeditionary force of the Australian Army during World War I. It was formed from 15 August 1914, following Britain's declaration of war on Germany. Generally known at the time as the AIF, it is today referred to as the 1st AIF to distinguish from...
(AIF) on 24 August 1916. On 5 September 1916, he embarked for Egypt
Egypt
Egypt , officially the Arab Republic of Egypt, Arabic: , is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Southwest Asia. Egypt is thus a transcontinental country, and a major power in Africa, the Mediterranean Basin, the Middle East and the Muslim world...
on RMS Kashgar, joining the 14th General Hospital in Cairo
Cairo
Cairo , is the capital of Egypt and the largest city in the Arab world and Africa, and the 16th largest metropolitan area in the world. Nicknamed "The City of a Thousand Minarets" for its preponderance of Islamic architecture, Cairo has long been a centre of the region's political and cultural life...
. There he encountered Major Charles Martin
Charles James Martin
Charles James Martin, FRS, FRCS was a British scientist who did seminal work on protein denaturation, nutrition, snake toxins and other medical topics...
, formerly Professor of Physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
at the University of Melbourne and Director of the Lister Institute from 1903 to 1930. At this time, Martin was working as a Consulting Physician to the AIF in Egypt and commanded the Anzac Field Laboratory.
While in Egypt, Fairley investigated schistosomiasis
Schistosomiasis
Schistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...
(then known as bilharzia). The disease was known to be caused by contact with fresh water inhabited by certain species of snail
Snail
Snail is a common name applied to most of the members of the molluscan class Gastropoda that have coiled shells in the adult stage. When the word is used in its most general sense, it includes sea snails, land snails and freshwater snails. The word snail without any qualifier is however more often...
s, 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
Typhus
Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters...
, so Fairley developed a complement fixation test for the disease along the lines of the Wassermann test
Wassermann test
The Wassermann test or Wassermann reaction is an antibody test for syphilis, named after the bacteriologist August Paul von Wassermann, based on complement-fixation.-Method:...
. He studied its pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, confirming that the worms in the circulatory system
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
could be cured by intravenous tartaric acid
Tartaric acid
Tartaric acid is a white crystalline diprotic organic acid. It occurs naturally in many plants, particularly grapes, bananas, and tamarinds; is commonly combined with baking soda to function as a leavening agent in recipes, and is one of the main acids found in wine. It is added to other foods to...
. Fairley also studied, and later published papers on typhus
Typhus
Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters...
, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, and bacillary dysentery
Shigellosis
Shigellosis, also known as bacillary dysentery or Marlow Syndrome, in its most severe manifestation, is a foodborne illness caused by infection by bacteria of the genus Shigella. Shigellosis rarely occurs in animals other than humans and other primates like monkeys and chimpanzees...
.
Fairley married Staff Nurse Violet May Phillips at the Garrison Church, Abbassia, Cairo on 12 February 1919. They later divorced on 21 November 1924. He was promoted to lieutenant colonel
Lieutenant colonel
Lieutenant colonel is a rank of commissioned officer in the armies and most marine forces and some air forces of the world, typically ranking above a major and below a colonel. The rank of lieutenant colonel is often shortened to simply "colonel" in conversation and in unofficial correspondence...
on 15 March 1919 and commanded the 14th General Hospital for a time before embarking for the United Kingdom in June 1919. For his services in the First World War, Fairley was mentioned in despatches and made an Officer of the Military Division of the Order of the British Empire
Order of the British Empire
The Most Excellent Order of the British Empire is an order of chivalry established on 4 June 1917 by George V of the United Kingdom. The Order comprises five classes in civil and military divisions...
. His citation read:
Between the wars
Fairley was one of a number of AIF officers granted leave "to visit various hospitals in the United Kingdom so that they become conversant with the latest developments in the medical sciences". For a time, he worked for Martin at the Lister Institute in LondonLondon
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
where he qualified for membership of the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...
of London. He also received a Diploma of Public Health from the University of Cambridge
University of Cambridge
The University of Cambridge is a public research university located in Cambridge, United Kingdom. It is the second-oldest university in both the United Kingdom and the English-speaking world , and the seventh-oldest globally...
. He returned to Australia on the transport Orontes in February 1920, to become a research assistant
Research assistant
A research assistant is a researcher employed, often on a temporary contract, by a university or a research institute, for the purpose of assisting in academic research...
to Sydney Patterson, director of the Walter and Eliza Hall Institute of Medical Research
Walter and Eliza Hall Institute of Medical Research
The Walter and Eliza Hall Institute of Medical Research is Australia's oldest medical research institute.In 2011, the institute is home to more than 650 researchers who are working to understand, prevent and treat diseases including blood, breast and ovarian cancers; inflammatory diseases such as...
, where Fairley worked on developing a test for echinococcosis
Echinococcosis
Echinococcosis, which is often referred to as hydatid disease or echinococcal disease, is a parasitic disease that affects both humans and other mammals, such as sheep, dogs, rodents and horses. There are three different forms of echinococcosis found in humans, each of which is caused by the larval...
along the lines of the test that he had already developed for bilharzia.
Fairley remained for less than a year before resigning to take up a five-year appointment in Bombay
Mumbai
Mumbai , formerly known as Bombay in English, is the capital of the Indian state of Maharashtra. It is the most populous city in India, and the fourth most populous city in the world, with a total metropolitan area population of approximately 20.5 million...
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
Royal Society
The Royal Society of London for Improving Natural Knowledge, known simply as the Royal Society, is a learned society for science, and is possibly the oldest such society in existence. Founded in November 1660, it was granted a Royal Charter by King Charles II as the "Royal Society of London"...
. On arrival in India
British Raj
British Raj was the British rule in the Indian subcontinent between 1858 and 1947; The term can also refer to the period of dominion...
, 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
Haffkine Institute
The Haffkine Institute was established on 10, January, 1899 by Dr. Waldemar Mordecai Haffkine, an orthodox Jewish Russian scientist from the Pasteur Institute, that aasigned him to work in India, then in the throes of major plague and cholera outbreaks...
and Honorary Consulting Physician to the Sir Jamshedjee Jeejebhoy Hospital
Grant Medical College and Sir Jamshedjee Jeejebhoy Group of Hospitals
The Grant Medical College, Mumbai is a medical school affiliated to the Maharashtra University of Health Sciences, Nashik. Founded in 1845, it is one of the premier medical institutions in India and is one of the oldest institutions teaching Western medicine in Asia.The Sir Jamsetjee Jeejebhoy...
and St George Hospital
St George Hospital, Mumbai
St George Hospital is a multispeciality hospital in Chhatrapati Shivaji Terminus , in the Fort district of Mumbai. It was also known as the European General Hospital as it initially catered for European patients only....
.
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
Dracunculiasis
Dracunculiasis , also called guinea worm disease , is a parasitic infection caused by Dracunculus medinensis, a long and very thin nematode . The infection begins when a person drinks stagnant water contaminated with copepods infested by the larvae of the guinea worm...
). However, his main interest was Tropical sprue
Tropical sprue
Tropical sprue is a malabsorption disease commonly found in the tropical regions, marked with abnormal flattening of the villi and inflammation of the lining of the small intestine.It differs significantly from coeliac sprue.-Symptoms and signs:...
. But he was unable to determine its cause or discover a cure; in spite of contracting the disease himself and making some advances in its treatment. He was invalided out of India, travelling to the United Kingdom to recuperate in 1925. While in India he had met Mary Evelyn Greaves, and they were married at the Presbyterian Church, Marylebone
Marylebone
Marylebone is an affluent inner-city area of central London, located within the City of Westminster. It is sometimes written as St. Marylebone or Mary-le-bone....
, on 28 October 1925.
Fairley returned to Australia in 1927 and rejoined the Walter and Eliza Hall Institute. He worked there for two years, collaborating with the new director, Charles Kellaway
Charles Kellaway
Charles Halliley Kellaway, MB, BS, MD, MS, MC, FRS, was an Australian medical researcher and science administrator.-Early years and education:...
in studies of snake venom
Snake venom
Snake venom is highly modified saliva that is produced by special glands of certain species of snakes. The glands which secrete the zootoxin are a modification of the parotid salivary gland of other vertebrates, and are usually situated on each side of the head below and behind the eye,...
s and with Harold Dew on the development of diagnostic tests for echinococcosis
Echinococcosis
Echinococcosis, which is often referred to as hydatid disease or echinococcal disease, is a parasitic disease that affects both humans and other mammals, such as sheep, dogs, rodents and horses. There are three different forms of echinococcosis found in humans, each of which is caused by the larval...
. Fairley dedicated most of 1928 to the snake venom programme, coordinating an enormous body of epidemiological data – including a questionnaire to Australian clinicians – on the frequency and outcome of bites by Australian elapid snakes. This work involved numerous milkings to establish typical and maximal venom yields, innovative studies of snake dentition using wax moulds, and detailed dissections to describe each species' biting apparatus. Fairley furthermore undertook in vivo studies of envenomation in a range of large animal species, in order to determine the efficacy of prevailing first-aid measures. He concluded that at best, ligature and local venesection might slow time to death after a significant envenomation. This reinforced the need for effective antivenenes (antivenoms) for the more dangerous local species of snakes, notably the tiger snake (Notechis scutatus), death adder (Acanthophis antarcticus) and copperhead (Austrelaps superbus), although only the former was suitable for manufacture by the Commonwealth Serum Laboratories (now CSL Limited
CSL Limited
CSL Limited is a global specialty biopharmaceutical company that researches, develops, manufactures and markets products to treat and prevent serious human medical conditions...
).
In 1928, Fairley received an appointment in London as Assistant Physician to the Hospital for Tropical Diseases
Hospital for Tropical Diseases
The Hospital for Tropical Diseases is a specialist tropical disease hospital located in London, United Kingdom. It is part of the University College London Hospitals NHS Foundation Trust and is closely associated with University College London and the London School of Hygiene & Tropical Medicine...
and Lecturer at the London School of Hygiene and Tropical Medicine. Although he and Kellaway convinced the governors to delay Fairley's commencement until their major venom work was completed, he departed for London by the end of that year. He also opened a consulting practice in Harley Street
Harley Street
Harley Street is a street in the City of Westminster in London, England which has been noted since the 19th century for its large number of private specialists in medicine and surgery.- Overview :...
. In London he encountered patients with filariasis
Filariasis
Filariasis is a parasitic disease and is considered an infectious tropical disease, that is caused by thread-like nematodes belonging to the superfamily Filarioidea, also known as "filariae"....
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
Jaundice
Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...
which Fairley diagnosed as caused by filariasis
Filariasis
Filariasis is a parasitic disease and is considered an infectious tropical disease, that is caused by thread-like nematodes belonging to the superfamily Filarioidea, also known as "filariae"....
. 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
Blackwater fever
Blackwater fever is a complication of malaria in which red blood cells burst in the bloodstream , releasing hemoglobin directly into the blood vessels and into the urine, frequently leading to kidney failure...
. Since malaria cases were uncommon in the United Kingdom, he made annual visits to the Malaria Research Laboratory of the League of Nations
League of Nations
The League of Nations was an intergovernmental organization founded as a result of the Paris Peace Conference that ended the First World War. It was the first permanent international organization whose principal mission was to maintain world peace...
at the Refugee Hospital in Salonika. In the process, he described methaemalbumin
Methemalbumin
Methemalbumin is an albumin complex consisting of albumin and heme.This complex gives brown color to plasma and occurs in hemolytic and hemorrhagic disorders.Its presence in plasma is used to differentiate between hemorrhagic and edematous pancreatitis....
, a previously unknown blood pigment. For his scientific accomplishments in London, Fairley was elected a Fellow of the Royal Society in 1942.
Middle East
Major General (Australia)
Major General is a senior rank of the Australian Army, and was created as a direct equivalent of the British military rank of Major General. It is the third-highest active rank of the Australian Army, and is considered to be equivalent to a two-star rank...
Rupert Downes
Rupert Downes
Major General Rupert Major Downes CMG, KStJ, VD, FRACS was an Australian soldier, general, surgeon and historian in the first half of the 20th century. Downes attended the University of Melbourne, graduating with his medical degrees in 1907...
tapped Fairley as consulting physician. Fairley was seconded to the Second Australian Imperial Force
Second Australian Imperial Force
The Second Australian Imperial Force was the name given to the volunteer personnel of the Australian Army in World War II. Under the Defence Act , neither the part-time Militia nor the full-time Permanent Military Force could serve outside Australia or its territories unless they volunteered to...
(AIF) with the rank of colonel
Colonel
Colonel , abbreviated Col or COL, is a military rank of a senior commissioned officer. It or a corresponding rank exists in most armies and in many air forces; the naval equivalent rank is generally "Captain". It is also used in some police forces and other paramilitary rank structures...
on 15 July 1940 and given the serial number VX38970. 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. As the British Army
British Army
The British Army is the land warfare branch of Her Majesty's Armed Forces in the United Kingdom. It came into being with the unification of the Kingdom of England and Scotland into the Kingdom of Great Britain in 1707. The new British Army incorporated Regiments that had already existed in England...
in the Middle East had no consulting physician in tropical diseases, Fairley accepted an offer to act in this capacity as well.
In January 1941 the British Army began planning for operations in Greece
Battle of Greece
The Battle of Greece is the common name for the invasion and conquest of Greece by Nazi Germany in April 1941. Greece was supported by British Commonwealth forces, while the Germans' Axis allies Italy and Bulgaria played secondary roles...
. 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
Macedonian front (World War I)
The Macedonian Front resulted from an attempt by the Allied Powers to aid Serbia, in the autumn of 1915, against the combined attack of Germany, Austria-Hungary and Bulgaria. The expedition came too late and in insufficient force to prevent the fall of Serbia, and was complicated by the internal...
in the First World War, where very heavy casualties 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
Commander-in-Chief
A commander-in-chief is the commander of a nation's military forces or significant element of those forces. In the latter case, the force element may be defined as those forces within a particular region or those forces which are associated by function. As a practical term it refers to the military...
, General
General
A general officer is an officer of high military rank, usually in the army, and in some nations, the air force. The term is widely used by many nations of the world, and when a country uses a different term, there is an equivalent title given....
Sir Archibald Wavell
Archibald Wavell, 1st Earl Wavell
Field Marshal Archibald Percival Wavell, 1st Earl Wavell GCB, GCSI, GCIE, CMG, MC, PC was a British field marshal and the commander of British Army forces in the Middle East during the Second World War. He led British forces to victory over the Italians, only to be defeated by the German army...
decried their report as "typical of a very non-medical and non-military spirit", but a face-to-face meeting with Boyd and Fairley convinced Wavell that they were 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, away from the plains of Macedonia and the Vardar
Vardar
The Vardar or Axios is the longest and major river in the Republic of Macedonia and also a major river of Greece. It is long, and drains an area of around . The maximum depth of river is ....
and Struma River
Struma River
The Struma or Strymónas is a river in Bulgaria and Greece. Its ancient name was Strymōn . Its catchment area is 10,800 km²...
basins, where malaria was hyper-endemic and heavy casualties had been suffered from malaria by British troops during the First World War.
Fairley tackled an outbreak of bacilliary dysentery among the troops in Egypt. In most cases the patients recovered of their own accord but some cases of shigellosis
Shigellosis
Shigellosis, also known as bacillary dysentery or Marlow Syndrome, in its most severe manifestation, is a foodborne illness caused by infection by bacteria of the genus Shigella. Shigellosis rarely occurs in animals other than humans and other primates like monkeys and chimpanzees...
became seriously ill and died. Fairley had some Shiga anti-toxin with him, but it proved ineffective in serious cases, even when administered in large doses. However, he also had an experimental supply of sulphaguanidine that had been given to him by Dr E. K. Marshall of Johns Hopkins Hospital
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
. The drug was administered to a patient with severe shigellosis who was not expected to live, and the patient soon recovered. Of the 21,015 Australian soldiers who contracted bacilliary dysentery during the Second World War, only 21 died.
Malaria again became a concern in the Syria-Lebanon Campaign
Syria-Lebanon campaign
The Syria–Lebanon campaign, also known as Operation Exporter, was the Allied invasion of Vichy French-controlled Syria and Lebanon, in June–July 1941, during World War II. Time Magazine referred to the fighting as a "mixed show" while it was taking place and the campaign remains little known, even...
. 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
Quinine
Quinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...
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
Quinacrine
Quinacrine is a drug with a number of different medical applications. It is related to mefloquine.-Uses:Its main effects are as an antiprotozoal, antirheumatic and an intrapleural sclerosing agent....
and plasmoquine
Chloroquine
Chloroquine is a 4-aminoquinoline drug used in the treatment or prevention of malaria.-History:Chloroquine , N'--N,N-diethyl-pentane-1,4-diamine, was discovered in 1934 by Hans Andersag and co-workers at the Bayer laboratories who named it "Resochin". It was ignored for a decade because it was...
. For his services in the Middle East, Fairley was mentioned in despatches a second time, and made a Commander of the Military Division Order of the British Empire
Order of the British Empire
The Most Excellent Order of the British Empire is an order of chivalry established on 4 June 1917 by George V of the United Kingdom. The Order comprises five classes in civil and military divisions...
for his "immense and specialised knowledge of tropical diseases in the Middle East".
South West Pacific
With the entry of JapanEmpire of Japan
The Empire of Japan is the name of the state of Japan that existed from the Meiji Restoration on 3 January 1868 to the enactment of the post-World War II Constitution of...
into the war, Fairley flew to Java
Java
Java is an island of Indonesia. With a population of 135 million , it is the world's most populous island, and one of the most densely populated regions in the world. It is home to 60% of Indonesia's population. The Indonesian capital city, Jakarta, is in west Java...
in January 1942. 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 120 long tons (121.9 t). Fairley was informed that the quinine had been loaded on board two ships. One was never seen again. The other, the SS Klang, reached Fremantle
Fremantle, Western Australia
Fremantle is a city in Western Australia, located at the mouth of the Swan River. Fremantle Harbour serves as the port of Perth, the state capital. Fremantle was the first area settled by the Swan River colonists in 1829...
in March. Although 20 long tons (20.3 t) of quinine was loaded on board, it was apparently unloaded when the ship stopped at Tjilatjap, possibly due to fifth column
Fifth column
A fifth column is a group of people who clandestinely undermine a larger group such as a nation from within.-Origin:The term originated with a 1936 radio address by Emilio Mola, a Nationalist General during the 1936–39 Spanish Civil War...
ists. Thus, none of the shipment reached Australia. Fairley himself departed Java with the I Corps staff on the transport Orcades on 21 February 1942 shortly before Java fell.
In General
General (Australia)
General is the second highest rank, and the highest active rank, of the Australian Army and was created as a direct equivalent of the British military rank of General; it is also considered a four-star rank....
Sir Thomas Blamey
Thomas Blamey
Field Marshal Sir Thomas Albert Blamey GBE, KCB, CMG, DSO, ED was an Australian general of the First and Second World Wars, and the only Australian to date to attain the rank of field marshal....
's reorganisation of the Australian Army in April 1942, Fairley was appointed director of medicine at Allied Land Forces Headquarters (LHQ) in Melbourne
Melbourne
Melbourne is the capital and most populous city in the state of Victoria, and the second most populous city in Australia. The Melbourne City Centre is the hub of the greater metropolitan area and the Census statistical division—of which "Melbourne" is the common name. As of June 2009, the greater...
. Fairley was soon facing a series of medical emergencies caused by the Kokoda Track campaign
Kokoda Track campaign
The Kokoda Track campaign or Kokoda Trail campaign was part of the Pacific War of World War II. The campaign consisted of a series of battles fought between July and November 1942 between Japanese and Allied—primarily Australian—forces in what was then the Australian territory of Papua...
. 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.
This caused Blamey to despatch 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. Fairley was able to secure supplies and expedite the delivery of those that were already on order but held up for lack of shipping or priority. In bringing the problem to the attention of the highest allied military and civil authorities overseas, he lifted the global profile and priority of malaria control measures.
It was calculated that Allied requirements for atebrin would be 200 long tons (203.2 t) per annum, of which 50 long tons (50.8 t) would be manufactured in the United Kingdom and 150 long tons (152.4 t) 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.
South West Pacific theatre of World War II
The South West Pacific Theatre, technically the South West Pacific Area, between 1942 and 1945, was one of two designated area commands and war theatres enumerated by the Combined Chiefs of Staff of World War II in the Pacific region....
. General Blamey took the matter up with the General Douglas MacArthur
Douglas MacArthur
General of the Army Douglas MacArthur was an American general and field marshal of the Philippine Army. He was a Chief of Staff of the United States Army during the 1930s and played a prominent role in the Pacific theater during World War II. He received the Medal of Honor for his service in the...
, the Supreme Commander. MacArthur, who had himself suffered an attack of malaria back in 1904 (and a serious relapse the next year), 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.
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
Lichen planus
Lichen planus is a chronic mucocutaneous disease that affects the skin, tongue, and oral mucosa. The disease presents itself in the form of papules, lesions, or rashes. Lichen planus does not involve lichens, the fungus/algae symbionts that often grow on tree trunks; the name refers to the dry and...
and psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
in rare cases, but atebrin still turned out to be much safer than quinine. Blackwater fever
Blackwater fever
Blackwater fever is a complication of malaria in which red blood cells burst in the bloodstream , releasing hemoglobin directly into the blood vessels and into the urine, frequently leading to kidney failure...
—which had a mortality rate of 25%—disappeared entirely.
Fairley was acutely aware that much remained unknown about malaria. In particular, he was interested in the possibility that sulphaguanidine (or a related sulphonamide
Sulfonamide (medicine)
Sulfonamide or sulphonamide is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group. Some sulfonamides are also devoid of antibacterial activity, e.g., the anticonvulsant sultiame...
) might be a causal prophylactic against malaria, as they could be manufactured in Australia, unlike atebrin and plasmoquine. Fairley decided to establish a unit in Cairns to investigate malaria. The LHQ Medical Research Unit commenced work in June 1943.
Fairley travelled to New Guinea at the end of June 1943 and arranged for Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum is a protozoan parasite, one of the species of Plasmodium that cause malaria in humans. It is transmitted by the female Anopheles mosquito. Malaria caused by this species is the most dangerous form of malaria, with the highest rates of complications and mortality...
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
Frank Horton Berryman
Lieutenant General Sir Frank Horton Berryman, KCVO, CB, CBE, DSO was an Australian Army officer who rose to the rank of lieutenant general during the Second World War. The son of an engine driver, he entered Duntroon in 1913. Graduating early due to the First World War, he served on the Western...
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.
HMT Dunera
His Majesty's Transport Dunera was a British passenger ship built as a troop transport in the late 1930s. She also operated as a passenger liner and as an educational cruise ship. Dunera saw extensive service throughout the Second World War....
' (Jewish refugees
Jewish refugees
In the course of history, Jewish populations have been expelled or ostracised by various local authorities and have sought asylum from antisemitism numerous times...
) from the 8th Employment Company. 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. The LHQ Medical Research Unit researched quinine
Quinine
Quinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...
, sulphonamides
Sulfonamide (medicine)
Sulfonamide or sulphonamide is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group. Some sulfonamides are also devoid of antibacterial activity, e.g., the anticonvulsant sultiame...
, atebrin
Quinacrine
Quinacrine is a drug with a number of different medical applications. It is related to mefloquine.-Uses:Its main effects are as an antiprotozoal, antirheumatic and an intrapleural sclerosing agent....
, plasmoquine
Chloroquine
Chloroquine is a 4-aminoquinoline drug used in the treatment or prevention of malaria.-History:Chloroquine , N'--N,N-diethyl-pentane-1,4-diamine, was discovered in 1934 by Hans Andersag and co-workers at the Bayer laboratories who named it "Resochin". It was ignored for a decade because it was...
, and paludrine
Proguanil
Proguanil is a prophylactic antimalarial drug.Proguanil is effective against sporozoites.Proguanil hydrochloride is marketed as Paludrine by AstraZeneca.-Mechanism:...
.
In June 1944, a conference was held at Atherton, Queensland
Atherton, Queensland
Atherton is a town on the Atherton Tablelands of Far North Queensland, Australia. At the 2006 census, Atherton had a population of 7,068.-Roads:...
on "Prevention of Disease in Warfare". Chaired by Lieutenant General
Lieutenant General
Lieutenant General is a military rank used in many countries. The rank traces its origins to the Middle Ages where the title of Lieutenant General was held by the second in command on the battlefield, who was normally subordinate to a Captain General....
Vernon Sturdee
Vernon Sturdee
Lieutenant General Sir Vernon Ashton Hobart Sturdee KBE, CB, DSO was an Australian Army commander who served two terms as Chief of the General Staff...
, 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
Samuel Burston
Major General Sir Samuel Roy Burston KBE, CB, DSO, VD, FRCP, FRCPE, FRACP was an Australian soldier, physician, and horse racing identity....
, told the senior commanders "the ball is in your court".
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
Aitape-Wewak campaign
The Aitape–Wewak campaign was one of the final campaigns of the Pacific Theatre of World War II. Between November 1944 and the end of the war in August 1945, the Australian 6th Division, with air and naval support, fought the Imperial Japanese 18th Army in northern New Guinea...
the 6th Division suffered an epidemic of malaria despite its best efforts. Fairley was urgently recalled from a tour of South East Asia Command
South East Asia Command
South East Asia Command was the body set up to be in overall charge of Allied operations in the South-East Asian Theatre during World War II.-Background:...
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.
Later life
After the war Australian medical research was substantially reorganised, but Fairley joined the ranks of senior Australian medical scientists who spent the remainder of their professional lives in Britain. In London 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. He became seriously ill in 1948 and his health steadily declined thereafter, forcing him to resign his professorship. He retained his practice and membership of numerous committees, becoming an "elder statesman" of tropical medicine. 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.Fairley's declining health prompted him to leave London and move to The Grove, Sonning
Sonning
Sonning, occasionally called Sonning-on-Thames is a village and civil parish in the Borough of Wokingham in the English county of Berkshire, a few miles east of Reading. The village is situated on the River Thames and was described by Jerome K...
, Berkshire
Berkshire
Berkshire is a historic county in the South of England. It is also often referred to as the Royal County of Berkshire because of the presence of the royal residence of Windsor Castle in the county; this usage, which dates to the 19th century at least, was recognised by the Queen in 1957, and...
, where he died on 19 April 1966, and was buried in the graveyard of St Andrew's Church, Sonning
St Andrew's Church, Sonning
St Andrew's Church is in a central position in the village of Sonning, Berkshire, England, close to the River Thames.- Location :The church is located close to the historic Bishop's Palace, which has long since disappeared apart from some grassy mounds. The historic Bull Inn is immediately next to...
. He was survived by his wife and their two sons, who were both medical doctors, and also by the son of his first marriage, who had become an Australian Army officer. His son Gordon Hamilton-Fairley
Gordon Hamilton-Fairley
Gordon Hamilton Fairley DM, FRCP was a professor of medical oncology. Born and raised in Australia, he moved to the United Kingdom where he studied and worked. He was killed by an IRA bomb intended to kill Sir Hugh Fraser....
, a renowned oncologist
Oncology
Oncology is a branch of medicine that deals with cancer...
, was killed by a Provisional Irish Republican Army
Provisional Irish Republican Army
The Provisional Irish Republican Army is an Irish republican paramilitary organisation whose aim was to remove Northern Ireland from the United Kingdom and bring about a socialist republic within a united Ireland by force of arms and political persuasion...
bomb on 22 October 1975.
Sir William Dargie
William Dargie
Sir William Alexander Dargie CBE was an Australian painter, known especially for his portrait paintings. He holds the record for the most Archibald Prize wins; eight. He was an official Australian War Artist during World War II.- Biography :William Dargie was born in Footscray, Victoria, the first...
painted a portrait of Fairley in 1943, which is in the possession the Fairley family. A later 1960 portrait by Dargie, together with a 1945 one by Nora Heysen
Nora Heysen
Nora Heysen AM was an Australian artist, the first woman to win the prestigious Archibald Prize for portraiture and the first Australian woman appointed as an official war artist.-Biography:...
, is in the Australian War Memorial
Australian War Memorial
The Australian War Memorial is Australia's national memorial to the members of all its armed forces and supporting organisations who have died or participated in the wars of the Commonwealth of Australia...
. Neither is on display, although the latter can be viewed online. A 1954 Dargie portrait of Queen Elizabeth II
Elizabeth II of the United Kingdom
Elizabeth II is the constitutional monarch of 16 sovereign states known as the Commonwealth realms: the United Kingdom, Canada, Australia, New Zealand, Jamaica, Barbados, the Bahamas, Grenada, Papua New Guinea, the Solomon Islands, Tuvalu, Saint Lucia, Saint Vincent and the Grenadines, Belize,...
painted while Dargie was staying at Fairley's home at 81 Duke Street
Duke Street, Marylebone
Duke Street is a street crossing the western half of Oxford Street, London and connecting Wigmore Street and Grosvenor Square. It is best known as the setting for the TV series The Duchess of Duke Street and as the headquarters of the Artists' Rifles.It is often confused with the relatively...
, Grosvenor Square
Grosvenor Square
Grosvenor Square is a large garden square in the exclusive Mayfair district of London, England. It is the centrepiece of the Mayfair property of the Duke of Westminster, and takes its name from their surname, "Grosvenor".-History:...
, in London, and subsequently given to Fairley, was sold at auction to the National Museum of Australia
National Museum of Australia
The National Museum of Australia was formally established by the National Museum of Australia Act 1980. The National Museum preserves and interprets Australia's social history, exploring the key issues, people and events that have shaped the nation....
in 2009 for $120,000. Fairley's papers are in the Basser Library
Basser Library
The Basser Library is the library of the Australian Academy of Science, established in 1960 following the donation of £25,000 , by philanthropist Sir Adolph Basser...
at the Australian Academy of Science
Australian Academy of Science
The Australian Academy of Science was founded in 1954 by a group of distinguished Australians, including Australian Fellows of the Royal Society of London. The first president was Sir Mark Oliphant. The Academy is modelled after the Royal Society and operates under a Royal Charter; as such it is...
. He is commemorated by the Neil Hamilton Fairley Overseas Clinical Fellowship, which provides full-time training in Australia and overseas in areas of clinical research including the social and behavioural sciences.
Medical awards and prizes
- 1920 Dublin Research Prize
- 1921 David Syme Research PrizeDavid Syme Research PrizeThe David Syme Research Prize is an annual award administered by the University of Melbourne for the best original research work in biology, physics, chemistry or geology, produced in Australia during the preceding two years, particular preference is given to original research to enhance industrial...
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 KingsleyMary KingsleyMary Henrietta Kingsley was an English writer and explorer who greatly influenced European ideas about Africa and African people.-Early life:Kingsley was born in Islington, London on 13 October 1862...
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 MedalBuchanan MedalThe Buchanan Medal is awarded by the Royal Society every year "in recognition of distinguished contribution to the medical sciences generally". The award was created in 1897 from a fund to the memory of London physician Sir George Buchanan . It was to be awarded once every five years, but since...
, Royal Society of London
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