Australian Dictionary of Biography

Neil Hamilton Fairley (1891-1966), by William Dargie

Australian War Memorial, ART27685

Sir Neil Hamilton Fairley (1891-1966), physician, medical scientist and army officer, was born on 15 July 1891 at Inglewood, Victoria, third of six sons of native-born parents James Fairley, bank manager, and his wife Margaret Louisa, née Jones. Their four sons who survived to adulthood all took up medicine as a career. Neil was educated at Scotch College, East Melbourne, where he excelled at high-jumping. Graduating from the University of Melbourne (M.B., B.S., 1915; M.D., 1917; D.Sc., 1927) with first-class honours in 1915, he served his residency at the Melbourne Hospital and investigated an epidemic of cerebral meningitis.

On 5 September 1916 Fairley was appointed captain, Australian Army Medical Corps, Australian Imperial Force, and posted to the 14th Australian General Hospital in the Middle East. There he came under the influence of (Sir) Charles Martin, director of the Lister Institute of Preventive Medicine, London. In Egypt and Palestine Fairley investigated schistosomiasis, dysentery, typhus and malaria, making significant contributions in each and kindling an enduring interest in tropical medicine. By 1918 he had become senior physician to the hospital. Promoted temporary lieutenant colonel in 1919, he was mentioned in dispatches and appointed O.B.E. On 12 February that year at the Garrison Church, Abbasiya, Cairo, he married Violet May Phillips; they were to be divorced on 21 November 1924.

After the war Fairley worked for two years with Martin at the Lister Institute and qualified as a member of the Royal College of Physicians, London. In 1920 he gained a diploma of tropical health and hygiene from the University of Cambridge and joined the Walter and Eliza Hall Institute of Research in Pathology and Medicine, Melbourne, before accepting a five-year appointment in Bombay, nominally as Tata professor of clinical tropical medicine but ultimately as medical research officer of the Bombay Bacteriological Laboratory and honorary consulting physician at two of the city's leading hospitals. Continuing his investigations of schistosomiasis, he carried out pioneering work on dracunculiasis and sprue. Fairley contracted sprue and was eventually invalided out of India. On 28 October 1925 at the Presbyterian Church, St Marylebone, London, he married Mary Evelyn Greaves. He returned to the Hall Institute in 1927 and worked there for two years, collaborating with its director Charles Kellaway in studies of snake-venoms and with (Sir) Harold Dew on the development of diagnostic tests for hydatid disease.

In 1929 Fairley returned to London to take up private practice in tropical medicine; he held appointments as assistant-physician and pathologist at the Hospital for Tropical Diseases, and as lecturer at the London School of Hygiene and Tropical Medicine. Although he investigated filariasis and leptospiral jaundice, his major research interest at this time was in malaria; in Salonica (Thessaloniki), Greece, he did notable work on Macedonian blackwater fever.

Appointed colonel in the A.I.F. on 15 July 1940, Fairley served as consulting physician to the Australian forces in the Middle East and also acted as honorary consultant in tropical diseases at British Army headquarters in that region. He focussed his attention on dysenteries and malaria. His earlier experience with malaria in Macedonia led to a confrontation with General Sir Archibald (Earl) Wavell over the proposed invasion of Greece in 1941, which led Wavell to change his plans, although in the event the British and Australian troops were driven from Greece before the malaria season began. Back in Australia in March 1942, next month Fairley was appointed director of medicine at Land Headquarters, Melbourne. He was to be promoted temporary brigadier in February 1944.

From the beginning of the war in the Far East and the Pacific, dysentery and malaria took a terrible toll of the allied forces. Building on his studies in Palestine of the use of sulphonamides for the treatment of bacillary dysentery, in 1942 Fairley sent all available supplies of sulphaguanidine to the front line in Papua where dysentery was threatening the effort by Australian troops to prevent the capture of Port Moresby. Early in 1943, at Fairley's instigation, General Douglas MacArthur established a combined advisory committee on tropical medicine, hygiene and sanitation, with Fairley as chairman.

Malaria, hyper-endemic throughout the theatre of operations, was even more threatening. In February 1942 Fairley had visited Java and succeeded in buying 120 tons of quinine, which was loaded in two ships. Neither reached Australia, and Fairley himself escaped in one of the last ships to get through. With quinine supplies in Japanese hands, Fairley went to London and Washington to urge the manufacture of atebrin (mepacrine) which was then the only other potent anti-malarial drug. In 1943 he and his colleagues E. V. Keogh and H. K. Ward persuaded the Australian army to establish the Land Headquarters Medical Research Unit (directed by Fairley) at Cairns, Queensland. The sole objective of this unit was to investigate malarial pathogenesis and chemoprophylaxis, using human 'guinea pigs'. Fairley made it his own task to appeal for these people, addressing military units and explaining carefully the objectives of the work. He elaborated on the potential dangers and likely discomforts, and his convincing sincerity succeeded.

Over the period 1943 to 1945 several hundred volunteers were infected with malaria parasites—mainly with Plasmodium falciparum—without a single death. The results of these investigations were subsequently published and contained contributions of theoretical and practical importance. A direct transfusion of 7-18 fl. oz. (200-500 ml) of blood between human volunteers gave positive results for about seven minutes after the bite of an infected mosquito, and again after six to seven days with malignant tertian (falciparum) malaria and eight to nine days after benign tertian (vivax) malaria, foreshadowing the discovery of the exoerythrocytic cycle. Using the 'subinoculation' technique, the investigations showed that atebrin in adequate doses, when taken daily with unfailing regularity, would suppress vivax malaria and act as a causal prophylactic and cure for falciparum malaria, even under conditions of long and exhausting marches with full equipment, extremes of heat and cold, shortages of food and water, and lack of sleep. Having satisfied the immediate requirement, investigations followed into the atebrin resistance of certain strains of Plasmodium falciparum, and a number of other drugs were examined, among them plasmoquine, paludrine and chloroquin. The findings, recorded in great detail, have never been challenged, and provide unique information, unobtainable under any conditions except those of a major war.

As an outcome of the findings with atebrin, the Australian army promulgated orders to ensure that the proper dosage was taken regularly, and that the responsibility for ensuring this procedure rested with the unit commander, not with the medical officer. The results were dramatic. Whereas early in the Papuan campaign the malaria rate had been as high as 2496 per thousand per annum, it fell to 740 per thousand in December 1943 and to 26 per thousand by November 1944. Earl Mountbatten, allied supreme commander, South-East Asia, adopted the Australian orders, with similar results among his forces. The control of malaria was a turning-point in the war in Burma and the Islands.

When World War II had ended, Fairley returned to the Hospital for Tropical Diseases, London; in 1945 he was appointed the first Wellcome professor of clinical tropical medicine at the London School of Hygiene and Tropical Medicine. On 3 July 1946 he transferred to the Reserve of Officers. In 1948, while at the height of his career, he suffered a serious illness from which he never fully recovered. He resigned his chair in 1949, but continued in practice and contributed to many committees, becoming the elder statesman of tropical medicine in Britain.

Fairley had made major contributions in several fields of tropical medicine. His publications comprised 149 scientific papers. He was thorough and meticulous in all he did, and spared no effort in exploring all possible interpretations of his results. Possessing great singleness of purpose, he threw himself into anything that he undertook, and was not to be deflected from his course. From the time of his investigations in Macedonia he showed an uncommon ability to delegate responsibility, a capacity that served him well in the supervision from Melbourne of the complex operations of the L.H.Q. Medical Research Unit at Cairns. His stature and authority in tropical medicine enabled him to persuade General Sir Thomas Blamey and MacArthur of the operational importance of measures to control malaria and other disabling tropical diseases, and he was capable of making difficult and painful decisions if necessary. He had a slightly 'bulldoggish' appearance, especially in profile, which matched his attributes of intellectual and scientific courage, his tenacity, and his loyalty to colleagues.

Beneath Fairley's somewhat daunting 'working' exterior, there lay a warm personality that endeared him to many. His ability to gain enthusiastic co-operation was crucial to the success of his greatest work, the study of malaria pathogenesis and chemoprophylaxis in human volunteers. He inspired loyalty in his subordinates, and did everything he could to further their careers.

Fairley's contributions were honoured during his lifetime and commemorated after his death. He had been appointed C.B.E. (1941), a commander brother of the Order of St John (1947) and K.B.E. (1950). He became a fellow of the Royal colleges of physicians of London (1928), Australasia (1940) and Edinburgh (honorary, 1947). Elected a fellow of the Royal Society in 1942, he received honorary degrees from the universities of Adelaide (M.D., 1949), Melbourne (LL.D., 1951) and Sydney (D.Sc., 1956). He was awarded numerous medals and prizes, including the Chalmers memorial medal for research in tropical medicine (1931), the Richard Pierson Strong medal of the American Foundation of Tropical Medicine (1946), the Moxon medal of the Royal College of Physicians (1948), the Manson medal of the Royal Society of Tropical Medicine and Hygiene (1950), and the Buchanan medal of the Royal Society (1957).

Survived by his wife and their two sons, and by the son of his first marriage, Sir Neil died on 19 April 1966 at The Grove, Sonning, Berkshire, England, and was buried nearby in the graveyard of St Andrew's Church. A portrait (1943) by (Sir) William Dargie is held by the family; other portraits (by Dargie and Nora Heysen) are held at the Australian War Memorial, Canberra.

In 1968 the Royal College of Physicians, London, in association with the Royal Australasian College of Physicians, inaugurated the Neil Hamilton Fairley medal, awarded alternately by each college every five years 'to any citizen of any country of any age who has made outstanding contributions to medicine'. A memorial stone commemorating his work in the L.H.Q. Medical Research Unit was unveiled in 1972 at Cairns, near the site of the wartime laboratories. In 1980 the National Health and Medical Research Council created Neil Hamilton Fairley fellowships 'to provide training in scientific research methods which can be applied to any area of clinical or community medicine'.