Sir Neil Hamilton Fairley (15 July 1891 – 19 April 1966) was an Australian 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, where he was resident of Ormond College, 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 co-ordinating 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.
Early life Neil Hamilton Fairley was born in Inglewood, Victoria, on 15 July 1891, as the third of six sons of James Fairley, a bank manager, and his wife Margaret Louisa, née Jones. All four of their sons who survived to adulthood took up medicine as a career. One qualified as a Doctor of Medicine at the University of Melbourne and a Fellow of the Royal College of Surgeons in England and became a surgeon; he was 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 a Fellow of the Royal Australasian College of Physicians and Fellow of the Royal College of Physicians; 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 with first class honours in 1915, and his Doctor of Medicine in 1917. While there, he won the Australian inter-varsity high jumping championship and represented Victoria in tennis.
First World War Fairley joined the Australian Army Medical Corps 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 (before the invention of antibiotic drugs).N. Hamilton Fairley and C. A. Stewart, Commonwealth of Australia Quarantine Service – Service Publication No. 9 – Cerebro-Spinal Fever (1916)
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 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. 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 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:
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 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, 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-months' 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). His main interest was tropical sprue, but he was unable to determine its cause or discover a cure. He contracted the disease himself and made some advances in its treatment. He was invalided out of India, and travelled 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 venoms and with Harold Dew on the development of diagnostic tests for echinococcosis. Fairley dedicated most of 1928 to the snake venom programme, co-ordinating 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, 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.
Second World War
Middle East
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.