In a stately room in the Royal College of Surgeons in Dublin hang the portraits of former presidents. All but one radiate a decorous solemnity. The odd one out portrays a lean and elegant man in a pinstriped suit, legs crossed as if posing for a 1930s illustration in the Strand Magazine. The subject is Terence Millin, a surgeon who trained in Dublin but made his name in London, a name which, in the 1950s, was linked with an operation performed in every major hospital in the world. He was also the perpetrator of the strangest case presentation ever made at the Royal Society of Medicine.
The operation he devised was posted on operation lists as the ‘Millin prostatectomy’. Until he introduced it, the removal of the prostate was a two-stage operation and, during the gap between the two surgical assaults, the poor patient was left with a partly open wound and rubber drainage tubes connected to devices designed to deal with his urine. As one of Millin’s contemporaries said: ‘If he’d done nothing else, we’d be grateful to him for improving the smell of urological wards.’
Though Millin won admiration, indeed reverence, from American and non-British European surgeons during his working life, the British surgical establishment was slow to give him the credit that history has shown was his due. He was regarded as an outsider because, though recognised as a brilliant operator, he wasn’t on the staff of a teaching hospital. Only after he retired did London, and indeed Dublin, grudgingly recognise the contribution he’d made to his craft.
Not that Millin minded. He was a lively, entertaining man unlikely to hit it off with any establishment. ‘I was born to be awkward,’ he said, ‘and I have a great suspicion of orthodoxy. There’s always a better way of doing things if you can be bothered to look.’ His suspicion of orthodoxy wasn’t confined to medicine. As a medical student, he captained the Trinity College rugby XV, and devised a new team formation using only seven forwards and eight backs. That year, Trinity beat every team it played – including what some reckoned was the strongest ever Oxford University side 26–3 at Oxford – and Millin won himself an Irish international cap.
He started his surgical training as an orthopaedic surgeon but turned to urology because he found it more interesting. ‘I began as a hewer of wood,’ he would say, ‘and ended as a drawer of water.’ He performed the first Millin prostatectomy in August 1945 and gave an account of twenty cases to the French Urological Congress in Paris in October that year. He was invited to present a case to the Royal Society of Medicine in November and knew that, as an outsider, he would have to do something special to engage the attention of the great and the good of London urological society.
On the evening of 30 November, on his way to the presentation, he stopped off in Oxford Street and bought one of the large ewers which, in those days, many people still had on wash-stands in their bedrooms. He then collected his patient, took him into a pub off Cavendish Square and for 45 minutes plied him with as much beer as he could consume. The pair of them then walked round the corner to the lecture theatre at the Royal Society of Medicine.
Millin’s presentation was not only strange but brief. He introduced himself to the audience, then introduced the patient. ‘How long is it since I removed your prostate?’ he asked.
‘Eight days, sir,’ mumbled the patient, dropping his trousers, raising his shirt, and proudly showing his scar.
‘Please pee into this,’ said Millin, holding out the ewer. The patient obliged with such enthusiasm that Millin later confessed he feared that he’d overdone it in the pub and one ewer would not be enough.
When the impressive stream finally dried up, Millin turned to the audience and savoured the bewilderment that had settled on most faces.
‘Now, gentlemen,’ he said. ‘If you want to know what I did to this man you can read a detailed description in the Lancet tomorrow morning.’
He then ushered the patient out and resumed his seat. Despite cajolement, he declined to give further details of the operation but was happy to engage the audience in amiable conversation on any other subject.
The Lancet paper appeared on 1 December 1945 and established Millin’s international reputation. American and European surgeons visited London to see him operate, and he toured surgical centres in Europe and North America demonstrating his technique. Twenty years later, a London surgeon pointed out that Millin’s was the last major advance in surgery to be made by an individual; later advances were made by teams.
Millin had always said surgeons should give up operating before they were sixty, when they would no longer be doing their best work, and he followed his own advice. After he retired, the Royal College of Surgeons in Ireland, rather belatedly, elected him as its president, and he made occasional forays to the USA to accept awards and to deliver provocative and entertaining lectures.
He wasn’t a great one for honours. When I first met him in 1967, he told me, ‘Honours are enjoyable, of course, but memories are more important, memories of patients and memories of barnstorming, bearding the Americans in their den, operating with fewer instruments than they were used to. And memories of adventures. Arriving to examine the President of Turkey in a bullet-proof car and operating on him in the presence of the entire Turkish cabinet, all gowned up. A bit like the birth of a royal baby, yet all I was delivering was a presidential prostate.’
He also described a style of surgical life that dissolved into history sometime in the 1950s. He was one of the last of the itinerant surgeons, travelling the world to visit his patients rather than expecting them to come to him. Among the mementoes dotted around his home was a photograph of Millin and his ‘operating team’ – theatre nurses and an anaesthetist – posed on the steps of an aircraft at Croydon airport before they set off to pluck the prostate from yet another distant potentate. The Dublin portrait captures not just the man but the era.