Hilary Roche was born at East Melbourne, Victoria, the only son of JF Roche, a prominent Melbourne company director. He was educated at Kew College, Melbourne and the University of Melbourne.

He acquired tuberculosis during his final years as a medical student, and as with many physicians of earlier generations, this probably influenced his choice of chest medicine as a career. He completed an RMO appointment at the Alfred Hospital in 1922 and acquired the MD in the same year. He was house physician at the Brompton Chest Hospital, London in 1923 and then spent several years in England and on the continent studying chest diseases. In 1927 he became physician superintendent of the British sanatorium, Montana Hall, Montana, Switzerland. At the time, this remarkable institution was the only sanatorium in Switzerland under British control, with a British medical and nursing staff, and solely for the treatment of British tuberculosis patients.

It inevitably closed for British patients during the war years, and Dr Roche went to Canada as senior staff physician at Cornwell Sanatorium, Ontario. During this time he introduced chest tomographic techniques he had developed in Montana, quite new to his Canadian colleagues. In 1941 he returned to Australia and became medical superintendent of the Austin Hospital, Melbourne, the major Victorian centre for treatment of all forms of tuberculosis. He there formed a close relationship with Mr (later Sir) James Officer Brown who was senior thoracic surgeon, and under their leadership the Hospital attained a high national and international reputation.

In October, 1946, Dr Roche returned to Switzerland as physician superintendent of his beloved Montana Hall. Unfortunately the introduction of the new British Health Service and monetary devaluation forced the sanatorium to discontinue its British connection in 1951. He returned to Australia at the end of that year, and was appointed Assistant Commonwealth Director of Tuberculosis. By his international writings, overseas visits and lectures he soon gained an international reputation as an authority in the rapidly developing field of diagnosis, management and control of tuberculosis. He became Commonwealth Director of Tuberculosis in 1957, following the voluntary retirement of Sir Harry Wunderly.

Apart from being a learned skilled physician with broad vision and determination, Hilary Roche was a warm, approachable man. He had a wide circle of friends in Australia and abroad. He kept in touch with a host of ex-patients, friends and co-workers from his years at Montana Hall. He had a deep knowledge of European culture and literature, as well as a talent for languages. This latter would occasionally surprise some of the migrant patients under his care in Australia. His first wife, Janet, died tragically in 1947 and in 1948 he married Barbara Pallister who was matron at Montana Hall. There were no children of the marriages. Barbara (a Nightingale gold medallist graduate of St Thomas' Hospital nursing school) often gave her warm support and valuable experience in the Canberra chest clinic, and at the Royal Canberra Hospital during their years together in the capital. Their home was a centre for delightful, stimulating, happy occasions, with their many close friends and colleagues.