Barry O'Donnell: Irish surgeons and surgery in the twentieth century

Abstract

With the birth of the new Irish Free State in 1922, Willie Phelan was, at the age of 25 years (!), appointed to be in charge of the newly created Kilkenny Central Hospital comprising the old Workhouse Hospital, the County Infirmary and the Fever Hospital. These remnants of eighteenth and nineteenth century Irish medicine were amalgamated to make the new Kilkenny County Hospital in 1942 (thanks to the Irish Hospital sweepstake) and Willie became the county surgeon, a post he held until his death in 1963. Willie Phelan was a relative of mine and the family lore was that he smoked while operating, cheerily commenting that ash was sterile and not to worry if some of it fell into the wound. The Babcock forceps was especially useful for holding the cigarette during the trickier moments of surgery. Willie Phelan’s career nicely encapsulates what this book is about. It describes the men (and they were all men) who worked tirelessly, often in poor conditions in Ireland throughout the twentieth century to help their fellow citizens. In 1922, only one hospital was in existence for less than 80 years. In the early years of the century, surgeons could not achieve very much; appendicitis had a 10% mortality (Edward VII was lucky) and a strangulated hernia was fatal. Fractures were treated and abscesses drained, but an anaesthetic longer that 1 h might easily put one into the ‘‘dead’’ level of anaesthesia. As the century progressed, facilities, training and technology improved greatly and effective health-care systems slowly emerged. Today, surgeons (many women) are highly trained professionals who deliver state-of-the-art surgery to the population in hospitals, which are being transformed into high quality networks. The people who caused these changes to happen and worked hard at their task throughout the last century are the subjects of this book. One of the most interesting and amusing sections of the book relates to the way surgeons were paid for their services before the modern era. In 1912, P. J. Keogh, an ENT surgeon, travelled by train from Dublin to Kildare to drain a quinsy. When asked why he charged a fee of £17 4 s 10 d (€1500.00 in today’s money) he replied: ‘‘It was all the money she had in the house’’. The monocled, cigar-smoking surgeon (Johnny) McArdle from St Vincent’s Hospital also had a penchant for especially reserved trains to carry him around the country to see patients. When the consultation fee had risen (fallen?) to three guineas in the 1960s, one doctor’s secretary would make sure that the £1.17 s change was readily at hand as ‘‘it’s the shillings that pay your salary’’. Robert Dwyer Joyce (1938) is attributed with saying ‘‘Fifty guineas for one cataract equals one housemaid for a year’’. The greater part of this book, however, comprises short biographies of virtually all the surgeons of the twentieth century in Ireland, some by their own choice were excluded. The two Irelands North and South are here, and to be included one had to have retired or died before 2005. The result is 673 biographies, which include all the surgical specialities, the great and the good, the presidents, the professors, the soldiers, the knights (no Lords) and the men who simply turned up day after day and did the job. This is an outstanding tribute to our surgical fathers and grandfathers and gives a wonderful slice of Irish social history. Writing this book was a phenomenal undertaking. Reading it is like catching up with one’s extended family, you knew the names, but now you know who they were, whom they P. A. Grace (&) University of Limerick, Limerick, Ireland e-mail: pagrace@eircom.net