Thomas Peel Dunhill, the forgotten man of thyroid surgery.

THE MODERN surgeon approaches the surgery of thyrotoxicosis with confidence, the confidence derived from the excellence of modem anaesthesia, the euthyroid state of the patient and the knowledge that blood transfusion, antibiotics and the specific management of the occasional crisis are always available to extricate the patient from any of these complications. Though full of confidence in his own and others' abilities, he usually matches this by a profound ignorance of the contribution of the thyroid pioneers whose activities at the turn of the century helped to lay the foundation for the safe management of the thyrotoxic. One of these pioneers was an Australian, Thomas Peel Dunhill (fig. 1), whose contributions to thyroid surgery have been almost entirely forgotten. To understand fully the role of Dunhill, it is important to look at the position of thyroid surgery and in particular, the surgery of toxic goitre at the turn of the nineteenth century and in the first two decades of the twentieth century. It will then be possible to appreciate more fully the achievements of these thyroid pioneers, who enabled the mortality of the surgery of toxic goitre to be reduced from 30-50 per cent (it was 30 per cent at St. Thomas's Hospital, London, as recently as 1910) to a minute fraction of one per cent today. The early history of the surgery of the thyroid gland may be traced in Halsted's painstaking compilations included in his article. 'The operative story of goitrethe author's operation' in the Johns Hopkins Hospital Reports, 1920.1 However, the recognition of goitre goes back many thousands of years. The Arthorva Veda, an ancient Hindu collection of incantations dating from 2000 B.C., contains extensive forms of exorcisms for goitre. In more recent times, Julius Caesar remarked at the frequent occurrence of a big neck as one of the characteristics of the Gauls. Juvenal, the Roman poet, indicated the frequency of goitre when he wrote: 'Quis tumidum guttur miratur in Alpibus?' ('Who wonders at goitre in the Alps?') 'Goitre' is derived from the Latin 'guttur', the throat, and Fabricius ab Aquapendente of Padua was probably the first to employ this term when he described sufferers from goitre as 'gutturosi'. In the sixteenth to eighteenth centuries, it was also called 'struma' and often confused with enlargement of the cervical lymph nodes. That goitre was definitely associated with enlargement of the thyroid gland does not appear to have gained general recognition until the eighteenth century. Against this background Halsted's researches, based partly on his own work and that of the German medical historians Mandt and Gunther, showed that some 100 operations were performed on the thyroid gland between 1596 and 1861. The majority of these operations were