Terence John Millin FRCSI

FRCS Fellowship of the Royal Colleges of Surgeons (FRCS) is a professional certification, professional qualification to practise as a senior surgeon in Republic of Ireland, Ireland or the United Kingdom. It is bestowed on an wikt:intercollegiate, ...

LRCP The Royal College of Physicians of London, commonly referred to simply as the Royal College of Physicians (RCP), is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of p ...

(9 January 1903 - 1980) was a British-born Irish

urological Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary system and the reproductive organs. Orga ...

surgeon, who in 1945, introduced a surgical treatment of benign large prostates using the retropubic

prostatectomy Prostatectomy (from the Ancient Greek language, Greek , "prostate" and , "excision") is the surgical removal of all or part of the prostate gland. This operation is done for benignity, benign conditions that cause urinary retention, as well as ...

, later known as the Millin's prostatectomy, where he approached the

prostate The prostate is an male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemica ...

from behind the pubic bone and through the

prostatic capsule On either side of the urethral crest is a slightly depressed fossa, the prostatic sinus, the floor of which is perforated by numerous apertures, the orifices of the prostatic ducts from the lateral lobes of the prostate The prostate is an ma ...

, removing the prostate through the

retropubic space Retropubic space is a potential avascular space located between the pubic symphysis and the urinary bladder. The retropubic space is a preperitoneal space, located behind the transversalis fascia and in front of peritoneum. Other names for the ...

and hence avoided cutting into the bladder. It superseded the technique of transvesical prostatectomy used by

Peter Freyer Sir Peter Freyer (2 July 1851 – 9 September 1921) was an Irish surgeon with an expertise in urology, genitourinary surgery, best known at first as an Indian Medical Service (IMS) officer, for making popular the procedure for crushing bladder ...

, where the prostate was removed through the bladder. Millin graduated in medicine in 1927 from

Trinity College Dublin Trinity College Dublin (), officially titled The College of the Holy and Undivided Trinity of Queen Elizabeth near Dublin, and legally incorporated as Trinity College, the University of Dublin (TCD), is the sole constituent college of the Unive ...

after also gaining a degree in maths and arts, and representing both his university and Ireland at rugby. He first became a house surgeon at Sir Patrick Dun's Hospital, Dublin, following which he gained postgraduate qualifications and moved to London with a travelling scholarship. Here, he came across the Irish urologist Edward Canny Ryall at All Saints' Hospital in

Pimlico Pimlico () is a district in Central London, in the City of Westminster, built as a southern extension to neighbouring Belgravia. It is known for its garden squares and distinctive Regency architecture. Pimlico is demarcated to the north by Lon ...

, and in 1934, inherited Ryall's practice. His three-page article on the retropubic prostatectomy, published in ''

The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...

'' on 1 December 1945, demonstrated a method of removing the prostate without the traditional cut through the bladder, thus reducing complications, and he became renowned for the procedure. He later moved back to Ireland, served as president of the

British Association of Urological Surgeons The British Association of Urological Surgeons (BAUS) is a professional association in the United Kingdom for urology professionals. Its official journal is the '' BJU International'', established in 1929, which is also the journal of the Urolo ...

between 1953 and 1955, and also as president of the

. He was given honorary membership of the Urological Section of the

Royal Society of Medicine The Royal Society of Medicine (RSM) is a medical society based at 1 Wimpole Street, London, UK. It is a registered charity, with admission through membership. Its Chief Executive is Michele Acton. History The Royal Society of Medicine (R ...

, and in 1963 was elected president of

Royal College of Surgeons in Ireland The Royal College of Surgeons in Ireland (RCSI) is a not-for-profit medical professional and educational institution, which is also known as RCSI University of Medicine and Health Sciences. It was established in 1784 as the national body ...

(RCSI).

Early life

Terence Millin was born on 9 January 1903 into a Protestant family in

Helen's Bay Helen's Bay is a village on the northern coast of County Down, Northern Ireland. It is within the townland of Ballygrot (), between Holywood, County Down, Holywood, Crawfordsburn and Bangor, County Down, Bangor. It is served by a Helen's Bay rai ...

County Down County Down () is one of the six counties of Northern Ireland, one of the nine counties of Ulster and one of the traditional thirty-two counties of Ireland. It covers an area of and has a population of 552,261. It borders County Antrim to the ...

, Northern Ireland. Millin Bay in County Down is named after the family. Related to Sir

James Pitcairn Sir James Pitcairn (18 July 1776 – 12 January 1859) was a British physician, who became Director-General of the Medical Department for Ireland. He was Chief of the house of Pitcairn, twenty-second in descent. Life James Pitcairn was born on 18 ...

, surgeon and descended from the ancient Pitcairn family of that Ilk, Fifeshire and a cousin of

Edward John Chalmers Morton Edward John Chalmers Morton (1856 – 3 October 1902), known as E. J. C. Morton, was a British barrister and Liberal Party politician who sat in the House of Commons as a member of parliament (MP) for Devonport from 1892 until his death. Biog ...

of Frocester Court, Glos, MP for Davenport, his father was a successful barrister and honorary librarian of the

Statistical and Social Inquiry Society of Ireland The Statistical and Social Inquiry Society of Ireland (SSISI) is a learned society which analyses the major changes that have taken place in population, employment, legal and administrative systems and social services in Ireland. It operates as ...

. He began his early education at the

Abbey School The Abbey School is a private selective day school for girls, in Reading, Berkshire, England. Overview The Abbey School provides education for girls aged 3 to 18 years. The school is based in the centre of Reading, on Kendrick Road. The curren ...

in Tipparary. In 1907, his family moved to Dublin and he then completed his education at St Andrew's College. He played rugby for St Andrews, which in 1921 won the

Leinster Schools Rugby Senior Cup The Leinster Schools Senior Challenge Cup is the premier rugby union competition for secondary schools affiliated to the Leinster Branch of the Irish Rugby Football Union (IRFU), and was first held in 1887. Attendances are high for a schoolboy ...

.Bouchier-Hayes, Davi
Terence Millin: pioneer of the retropubic space
''

British Journal of Urology International ''BJU International'' (or ''BJUI'', formerly known as the ''British Journal of Urology'') is a monthly peer-reviewed medical journal that was established in 1929. The editor-in-chief is Freddie Hamdy and the journal is published by Wiley-Blackwell ...

''. Vol. 96, Issue 6 (29 October 2019), pp. 768-771. After completing school, he gained admission to

in 1921, with a scholarship to study arts and mathematics. Later, he changed career path and gained a place to study medicine. He also represented both

( DUFC) and Ireland at rugby. He graduated in medicine in 1927.

Career

Millin first became a house surgeon at Sir Patrick Dun's Hospital, Dublin, a familiar hospital where he had spent time as a medical student. Within the first year, he passed the fellowship of the

at first attempt, and achieved the conjoint diploma of the London Royal Colleges (

Royal College of Surgeons of England The Royal College of Surgeons of England (RCS England) is an independent professional body and registered charity that promotes and advances standards of surgery, surgical care for patients, and regulates surgery and dentistry in England and Wa ...

and

Royal College of Physicians of London The Royal College of Physicians of London, commonly referred to simply as the Royal College of Physicians (RCP), is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of ph ...

). He was awarded a travelling fellowship from Dublin University and moved to London where he took up jobs at the

Middlesex Hospital Middlesex Hospital was a teaching hospital located in the Fitzrovia area of London, England. First opened as the Middlesex Infirmary in 1745 on Windmill Street, it was moved in 1757 to Mortimer Street where it remained until it was finally clos ...

and

Guy's Hospital Guy's Hospital is an NHS hospital founded by philanthropist Thomas Guy in 1721, located in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the Kin ...

. Subsequently, he entered the

Royal National Orthopaedic Hospital The Royal National Orthopaedic Hospital (RNOH) is a specialist orthopaedic hospital located in Stanmore in the London Borough of Harrow, run by the Royal National Orthopaedic Hospital NHS Trust. It provides the most comprehensive range of neuro- ...

, Great Portland Street, and the All Saints' Hospital in

, where he came across the Irish urologist Edward Canny Ryall. In 1930, he became a Fellow of the Royal College of Surgeons of England and the following year took the optional subject of genito-urinary surgery in his MCh examination at Dublin, when he came first place. In 1934, following the death of Ryall, Millin took over his position at All Saints and his private practice at 75 Harley Street. On 1 December 1945, ''

'' published a three-page article by Millin on a surgical approach to the partial or complete removal of the prostate, for benign large prostates, “Retropubic Prostatectomy. A new extravesical technique: report on twenty cases”, a procedure he had demonstrated at the French Urological Society in Paris in the preceding October. The operation involved a direct incision into the abdomen and the removal of the prostate through the

. The use of

sulphonamides In organic chemistry, the sulfonamide functional group (also spelled sulphonamide) is an organosulfur group with the structure . It consists of a sulfonyl group () connected to an amine group (). Relatively speaking this group is unreactive. B ...

reduced mortality by infection and Millin became renowned for the procedure. He followed this up two years later with his book titled ''Retropubic Urinary Surgery'' which contained further observations on prostatectomies and other surgical procedures. The procedure came to be known as the Millin Retropubic Prostatectomy and it superseded the technique of transvesical prostatectomy used by

.Marchant, Nick
''Diseases of the Prostate''
Office of Health Economics, London (1995). P. 11. Ellis, Harold
"The Birth of Modern Surgery"
in ''A History of Surgery''. Greenwich Medical Media Limited, London (2001), p. 121-122. In 1950, he moved back to Ireland to 250-acre Georgian estate, “Byblox”, near

Cork "Cork" or "CORK" may refer to: Materials * Cork (material), an impermeable buoyant plant product ** Stopper (plug), or "cork", a cylindrical or conical object used to seal a container *** Wine cork an item to seal or reseal wine Places Ireland * ...

. His social circle included the novelist Elizabeth Bowen, writer Edward, 5th Baron Sackville, The Slazengers of Powerscourt and Stephen and Lady Ursula Vernon of Bruree, the latter a daughter of 'Bendor', 2nd Duke of Westminster. In the late 1950s, he worked with pioneering nurse educator Eithne O'Domhnaill.Key influence in raising profile and the standard of Irish nursing
''

The Irish Times ''The Irish Times'' is an Irish daily broadsheet newspaper and online digital publication. It was launched on 29 March 1859. The editor is Ruadhán Mac Cormaic. It is published every day except Sundays. ''The Irish Times'' is Ireland's leading n ...

''. 2 September 2000. He later moved to

County Wicklow County Wicklow ( ; ) is a Counties of Ireland, county in Republic of Ireland, Ireland. The last of the traditional 32 counties, having been formed as late as 1606 in Ireland, 1606, it is part of the Eastern and Midland Region and the Provinces ...

, and later lived at the palladian villa of Knockmore

Enniskerry Enniskerry (historically ''Annaskerry'', from ) is a village in County Wicklow, Ireland. The population was 2,008 at the 2022 census. Location The village is situated on the Glencullen River in the foothills of the Wicklow Mountains in the ...

and

Kilcoole Kilcoole () is a town in County Wicklow, Ireland. It is south of Greystones, north of Wicklow, and about south of Dublin. The town is in a townland and civil parish of the same name. Kilcoole was used as a filming location for the Irish tele ...

Awards and honours

In either 1953 or 1954, he became president of the

and was given honorary membership of the Urological Section of the

. He was elected president of RCSI for 1963–1966. He was a recipient of the

St Peter's Medal The St Peter's Medal is awarded annually by the British Association of Urological Surgeons (BAUS) for contributions to the surgical field of urology. The medal was designed and produced by sculptor William Bloye of the Birmingham School of Art ...

Death and legacy

In 1980, he died of

cancer of the larynx Laryngeal cancer is a kind of cancer that can develop in any part of the larynx (voice box). It is typically a squamous-cell carcinoma, reflecting its origin from the epithelium of the larynx. The prognosis is affected by the location of the tumo ...

. The RCSI commemorates him in the annual Millin Scientific Meeting, in which the speaker receives the Millin Medal. A student residence and the Millin Room at the RCSI were named his honour.

Selected publications

Articles

"Investigation and Treatment of Sterility in the Male"
''

Postgraduate Medical Journal The ''Postgraduate Medical Journal'' is a monthly peer-reviewed medical journal that was established in 1925 by the Fellowship of Postgraduate Medicine, of which it is the official journal. It is currently published on behalf of the Fellowship by ...

''. Vol. 20, No. 225 (1944), pp. 229–232. ,
"Retropubic prostatectomy; a new extravesical technique; report of 20 cases"
''

''. Vol. 2, No. 6380 (1 December 1945), pp. 693–694.
"Prostatectomy"
''The Lancet''. Vol. 1, No. 6384 (5 January 1946), p. 34. , . Co-authored with Winsbury-White H. P.
"Retropubic Prostatectomy"
''

Proceedings of the Royal Society of Medicine The ''Journal of the Royal Society of Medicine'' is a peer-reviewed medical journal. It is the flagship journal of the Royal Society of Medicine, located in London, with full editorial independence. Its continuous publication history dates back to ...

''. Vol. 34, No. 6 (31 January 1946), pp. 327–328. .
"The Ureter, the Gynæcologist and the Urologist"
President's Address in the ''Proceedings of the Royal Society of Medicine''. Vol. 42, No. 1 (January 1949), pp. 37–46. .
"Retropubic prostatectomy; experiences based on 757 cases."
''The Lancet''. Vol. 1, No. 6549 (5 March 1949), pp. 381–385. . Co-authored with Macalister, C. L. and Kelly, P.M.
"Some Irish urology: ancient and modern. The seventh Ferdinand C. Valentine memorial lecture"
'' Bulletin of the New York Academy of Medicine''. Vol. 45, No. 1 (January 1969), pp. 75–94.

Books

*''Retropubic Urinary Surgery''. Williams and Wilkins Company, Baltimore (1947).