Dunea, George

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MB BS 1958 FRCP (Lon) FRCP (Edin) FACP FASN

George Dunea began writing his ‘Letter from Chicago’ for the British Medical Journal in 1975, and has published 302 columns to date. He has been Chairman of the Division of Nephrology at Cook County Hospital since 1969.

George graduated from Medicine in 1958 and completed his Internship at the Royal North Shore Hospital, followed by a Residency at the Parramatta District Hospital in 1959. In 1960, he travelled to England and worked at Oldchurch Hospital in Essex and Orpington Hospital in Kent. For the next three years, he remained in England as registrar at various hospitals, as well as having several clinical attachments. He first worked in kidney disease at the Royal Free Hospital in London under Stanley Shaldon, a pioneer in dialysis who had developed one of the first dialysis units in England and initiated percutaneous cannulation of the femoral vessels as a means of accessing the circulation.

In 1964, George decided to further his training in Nephrology by accepting a fellowship in the Department of Artificial Organs at the Cleveland Clinic, Ohio. There he worked under the direction of Willem J Kolff, who had constructed the first artificial kidney in the Netherlands during World War II, had developed one of the earliest dialysis centres in the United States, and was pioneering cadaver kidney transplantation. According to George:

Stimulated by the work of Dr Yatsidis in Athens, we constructed a “charcoal artificial kidney” for hemoperfusion and attempted to treat patients with renal failure. We thus were the second ones to ever pass patients’ blood over activated charcoal, a method that for some time became popular and widely used for treating intoxications.[1]

In 1965 George moved to Chicago to continue his fellowship at Presbyterian St Luke’s and University of Illinois Hospital, under the direction of Robert M Kark, who had pioneered the introduction of kidney biopsy in the United States. During his fellowship, George carried out research in several fields and described the acute renal failure of thrombotic thrombocytopenic purpura and the nephropathy of brucellosis.

In 1966, he accepted the position of attending physician at Cook County Hospital and in 1969 became chairman of the Renal Division. However, money was scarce, inventiveness called for. George describes how he converted a Maytag washing machine into a dialysis machine:

The washing machine system we used in Chicago was based on an earlier one by Kolff. But whereas he used four shallow coils and no blood pump, we threw out the ringer and connected the drain to a commercially available dialyzer for recirculation and were able to use a regular finger pump to propel the blood. When we had enough funds to acquire regular dialysis machines we allowed the old washing machine to disappear into the bowels of the County Hospital.[1]

Research was continued in several fields, resulting in the eventual publication of some 150 scientific papers, including on dialysis encephalopathy:

Dialysis encephalopathy due to aluminium interaction was first reported by Dr Alfrey in Colorado. We published the second series in The Lancet, rather dramatically calling it a mysterious and fatal disorder and coining the name ‘dialysis dementia’, which stuck. We later confirmed that it was due to a change in the Michigan Lake water purification system and that indeed it was due to aluminium, as shown by Alfrey.[1]

Further papers published by his team dealt with developing better ways to treat chronic renal failure, descriptions of various clinical conditions, and basic work designed to stop the progression of renal disease. Numerous fellows were trained in nephrology in association with the School of Medicine, University of Illinois.

In 1975, he began to write a regular column for the British Medical Journal called Letter from Chicago, now called Soundings. As with his other achievements, George is somewhat self effacing:

In 1964 I wrote a ‘Personal View’ for the BMJ. It led to my being invited by their new editor, Dr Stephen Lock, to write a regular letter from Chicago. Others were supposed to write from Leningrad, Paris, Adelaide, etc, but eventually they all dropped out (as they probably had better things to do!). I had not done much non-technical writing before that, and at the beginning found writing somewhat difficult. But my column was strangely successful; I received lots of fan mail from a variety of people from all over the world. Some years ago my former father-in-law, a journalist, commented that it was most unusual for any journal or newspaper column to go on for such a long time. I believe that they may be planning make some changes, but for the time being I am continuing to write – even though I may be burning out and have often thought it is about time to quit.[1]

According to Yvonne Cossart, George’s column was significant because it provided the British audience with some missing cultural understanding of the practice of medicine in the United States, as they had up to that point only been exposed to highly technical material from there. George’s writing provided the more humane view of the technology used in medicine.[1] In his 302 columns, he has addressed a variety of topics on health care under such inviting and humorous titles as Confusion Oriental Medical Records, Sweet and Sour Pills, Psychiatrists in Restraints, Writing about Dying, Hyperactive Judges, Freeing the Women, Swallowing the Golden Ball, Consultants and Consultoids, Dangers of Afghan Food, Venice from the Air, Downsizing a Rhinoceros General, Cunegonde’s ears or multiple medical errors, The Gas we Pass, Au Zinc, Some diseases must Declare Themselves, Client on Diets, If I Ruled the World, Speech that Irritates, and Cats, Mice, and Cocaine.

In addition, he has written numerous scientific articles and edited various journals and texts. He was one of the editors of the Third Edition of The Oxford Illustrated Medical Companion.

In 1991, he became President and CEO of the Hektoen Institute of Medicine that supports research and education through grants, lectures, and learned activities. George remains President and CEO of Hektoen Institute of Medicine; Chairman, Division of Nephrology-Hypertension at Cook County Hospital; and Professor of Medicine at the University of Illinois.

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Citation: Mellor, Lise (2008) Dunea, George. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.