Thomas Peel Dunhill

Thomas Peel Dunhill was born at Tragowel, a grazing property near Kerang, Victoria, on 3 December 1876. He was the oldest of two sons of John Webster Dunhill, an overseer on a cattle station, and Mary Elizabeth Dunhill née Peel. He had a younger brother, John Webster Dunhill.^[1][2] His father died from typhoid fever on 19 April 1878,^[3] and the family moved to his mother's home town of Inverleigh, Victoria, where Thomas attended Inverleigh State School.^[4] On 29 May 1888 his mother married William Lawry,^[5] and the family moved to Daylesford, Victoria, where Lawry managed a gold mine,^[1][2] and Thomas completed his secondary education at Daylesford Grammar School.^[6]

Dunhill passed the entrance examinations of the University of Melbourne in English, Geometry, Arithmetic, Greek and French, but did not study Latin, which was a prerequisite for medicine.^[4] He took a course in pharmacy. Each day he worked as an apprentice in a chemist shop in Daylesford. After work he caught the train to Ballarat, Victoria, for evening lectures at the Ballarat School of Mines. At 02:30 he would walk to Ballarat Railway Station and catch the 03:00 train back to Daylesford and open the shop at 08:00.^[4] He passed his final qualifying examination at the Victorian College of Pharmacy on 11 March 1898,^[7] and was registered as a pharmacist on 11 June.^[4] He opened his own chemist shop in Rochester, Victoria.^[6]

Charles Martin, the professor of physiology at the University of Melbourne influenced a decision by Dunhill to pursue a career in medicine.^[6] He studied Latin and passed the subject in 1896.^[4] He disposed of his business,^[6] and entered the University of Melbourne in 1899,^[1] becoming a resident of Ormond College.^[6] He published his first paper in 1902.^[4][8] He graduated from the clinical school at Melbourne Hospital with his Bachelor of Medicine (MB) degree in December 1903,^[9] with three first-class honours and exhibitions in medicine and in obstetrics and gynaecology,^[1][10] and was appointed house physician to Henry Carr Maudsley at the Melbourne Hospital.^[2] He became a tutor in medicine at Ormond College, and was for some years a lecturer in materia medica and an instructor in clinical surgery at the University of Melbourne.^[6]

Despite his achievements, Dunhill's career prospects at Melbourne Hospital were dim, as he was a country boy with no social connections in Melbourne.^[1] Charles Martin and Harry Allen, the professor of pathology at the University of Melbourne, were advisors to Anne Daly (Mother Mary Berchmans), the rectress of St Vincent's Hospital, Melbourne, and they persuaded her to extend an invitation to Dunhill to join her staff. There were no surgical vacancies at the time, but he became a physician to outpatients.^[4] He was awarded his Doctor of Medicine (MD) degree in September 1906 and became a surgeon to St Vincent's outpatients.^[1][11]

Dunhill became interested in the treatment of exophthalmic goitre, a disease of the thyroid for which there were few treatments at the time. When he was a surgical resident at Melbourne Hospital, he had witnessed surgeon William Moore operate on two toxic multinodular goitre patients under chloroform general anaesthesia; both died.^[4] Toxic goitre patients frequently entered the hospital emaciated and sometimes blind, and often succumbed to cardiac arrest or hyperpyrexia. Various other treatments were tried, including sodium phosphate, sodium chloride, ergot, belladonna, morphia and bromides, all without any effect.^[4] At St Vincent's, patients were given the milk of goats from which the thyroid had been surgically removed. The goats were kept in a pen on the hospital grounds, and Dunhill tended them, milking them each morning, and taking the milk to his patients. While some patients showed improvement, he came to regard the treatment as unsatisfactory.^[6]

On 25 March 1907, a 36-year-old woman, Mary Lynch, with an advanced stage of toxic goitre was admitted. She was an outpatient who had been treated for thyrotoxicosis.^[4] She did not respond to treatments, and Dunhill decided that surgery was required.^[6] He always stressed the importance of gaining the patient's confidence before an operation, especially if they were frightened, and he became known for his sympathy as well as his surgery.^[2] Lynch understood that an operation would be very risky, but felt that her quality of life was such that she was willing to take the chance. A conventional operation using a general anaesthesia was ruled out, so on 30 July 1907, with the assistance of his chief, Murray Morton, Dunhill removed the right lobe of her thyroid under local anaesthesia using eucaine and adrenaline. At the conclusion of the operation, Lynch got up from the operating table and walked back to her bed. She was discharged from the hospital on 15 August. She subsequently relapsed, and most of the remaining lobe of her thyroid was removed in March 1908. This cured her thyrotoxicosis. She was able to work again, and became a cook at a Victorian country hotel.^[4][6]

Dunhill went on to perform thyroidectomies on patients who were suffering from cardiac failure as a result of a hyperactive thyroid.^[1] At the time, thyroidectomies were seldom performed, partly because the mortality rate for surgery performed for exophthalmic goitre at St Thomas’s Hospital in London in 1910 was 33 per cent,^[4] whereas that for patients treated without surgery was 25 per cent.^[2] Dunhill's achievement was to pioneer a safer way to perform the procedure. The use of local anaesthesia removed the danger of nausea and vomiting that often accompanied the use of chloroform, and patients could drink water immediately afterwards, reducing the risk of dehydration. Instead of using a scalpel and forceps, he dislocated the thyroid gland with a blunt dissection using his fingers, and dissected the vascular pedicles early on in the procedure, thereby minimising blood loss. He published his first paper on the procedure later that year.^[4][12] By 1910 he had performed 312 thyroid operations,^[1] with a mortality rate of 1.5 per cent, and had become renowned as an expert on what is now known as Hartley-Dunhill resection.^[2][13]

Along with Hugh Devine and Anne Daly, he was instrumental in St Vincent's becoming a clinical school in conjunction with the University of Melbourne in 1910. Devine and Dunhill became the first tutors at the new clinical school.^[6][4] That year Devine and Dunhill assisted Douglas Shields when he operated on the Countess of Dudley, the wife of William Ward, 2nd Earl of Dudley, the Governor-General of Australia, to remove a stone that had lodged in her ureter. The operation, which was successful, was performed in the ballroom of Government House, which had been converted into a makeshift operating theatre.^[4][14]

In 1911 Dunhill travelled to Britain and the United States.^[1] In Britain he went to Leeds to see Berkeley Moynihan operate, and to Edinburgh to see Harold Stiles. In the United States he visited Howard Kelly, Harvey Cushing, George Washington Crile, William Halsted and the Mayo brothers. Halsted, Crile and Charles Mayo adopted his procedure. He then returned to the UK, where, on 13 February 1912, he delivered a paper at the Royal Society of Medicine in London outlining his surgical treatment of exophthalmic goitre.^[4][15]

When Dunhill returned to Australia later that year, he became the surgeon to in-patients at St Vincent's and the chairman of the medical staff in succession to Shields, who left for the UK.^[4] On 12 February 1914, he married a widow, Edith Florence McKellar née Affleck at Scots Church in St Kilda, Victoria, in a ceremony conducted by Alexander Yule. They had no children together,^[1][16] but she had a son and a daughter from her first marriage.^[17]