The Surgeon's Archive

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Almost 150 years after a collection of extraordinary Irish surgical photographs were captured by the photographer’s lens they are published for the first time ever in Scope. Eimear Vize delves into the medical archives to find out more about these unique Victorian images

A rare and historical collection of 19th century Irish surgical photographs has been retrieved from virtual obscurity by ophthalmic surgeon, Dr Stanley Burns. The New York-based physician, and internationally distinguished photo-historian, has amassed one of the world’s largest and most important portfolios of early medical photographs. Among these iconic images he has acquired some of the earliest Irish surgical photographs in existence, none of which have ever been published. Now, Scope is honoured to reproduce these important photographs for the first time in a two-part special.

Viewing this spectacular collection, which dates back to the 1870s, one is first struck by the fact that such a large collection of unusual surgical cases, some with severely disfiguring malignancies, should be gathered in one album. Most of the 26 images depict patients with large tumours on their face or body; some are “before” and “after” shots that demonstrate the surgeon’s skill in treating these challenging diseases at a time when surgical procedures were frequently crude.

Intrigued, one wonders if this could be the case portfolio of several surgeons or perhaps just one talented individual, who had the good fortune of being referred a large number of fascinating cases? And what happened to these unfortunate patients? Did they survive their radical surgery?

Dr Stanley Burns

Dr Burns is similarly interested in the narratives behind these incredible images but his efforts to investigate further have proved limited. To this end, he gave Scope access to this precious cache in the hope that a hunt on this side of the Atlantic in our medical archives might unearth the long-forgotten stories behind these images.

He felt sure that all of these images had appeared as engravings in a Dublin surgical journal, mostly during the years 1874 to 1878. 

So, with contact sheet in hand, Scope sought the expertise of Mary O’Doherty, who is Assistant Librarian (Special Collections and Archives) at the RCSI’s Mercer Library in Dublin. She had encountered a similar album before, credited to the esteemed 19th century surgeon Mr Maurice Henry Collis, and suggested that these patients could have come under the care of just one physician. A trawl through the yellowing annals of one of the top medical periodicals of the time, the Dublin Journal of Medical Science (DJMS), might turn up enough cases linking this portfolio to a particular surgeon.

Starting with volumes published in 1870, it wasn’t long before the first lithograph copied from Dr Burns’ photographs appeared. In fact, five of these artistic reproductions by John Falconer, Dublin, featured in one important article: “Reporting on twelve cases of excision of tumours” by the brilliant and controversial Mr Edward Stamer O’Grady, who was one of the top surgeons of the day at the Mercer’s Hospital, Dublin. A later edition of the same journal also documented another case by Mr O’Grady that features in Dr Burns’ photographs. It appeared we had identified our surgeon whose patient portfolio had found its way into the Burns Archive more than a century later.

“I have from time to time been indebted for a large share of important surgical cases – operative or otherwise,” wrote Mr O’Grady in the DJMS (Volume 60, Number 1 / July, 1875). His good fortune, in this regard, he attributed to “the affectionate remembrance borne to Mercer’s Hospital” by its past pupils, who referred on these odd surgical cases. “It has been my practice to keep accurate and more or less extended “notes” of these cases under observation in the hospital wards,” he added.

Mr O’Grady also acknowledged that it was of “comparatively infrequent occurrence” to have the opportunity to operate on tumours that had “reached a size of any considerable magnitude, and are so situated in the soft parts as to be capable of excision”.

By 1875, he had taken under his care a total of 23 tumour cases since commencing his duties as senior surgeon at the Mercer’s in 1866. A number of these fascinating cases are detailed below:

Removal of large fatty tumours from sub-occipital region and back of neck; Recovery.

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A 50-year-old labourer, whom Mr O’Grady referred to as “MM”, was admitted to Mercer’s Hospital on 17 February, 1875, for a large tumour “situated on the back of the neck and encroaching considerably on the base of the skull”.

Mr O’Grady observed that, while the tumour gave the appearance of being “firmly attached to the parts beneath”, it was quite free from pain and caused inconvenience only from size and sense of weight.

He described the operation to remove the sizable growth: “During the separation of the lateral integumental coverings, the haemorrhage was inclined to be free, and was carefully restrained by pressure, several small vessels being secured as the dissection progressed. As the tumour became fully exposed it was seen that tendinous bands crossed its superficial and deep surfaces, running from above downwards, and being most numerous towards the mesial line. These had very firm attachments above and below, as if the growth had been originally developed in and expanded the posterior ligamentous structures of the neck.”

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Successfully removed, the mass weighed 27 ounces and exhibited, on section, “the ordinary appearance of fatty tumours.” Although “the operation was well borne and subsequent condition of the patient was most satisfactory,” five hours after surgery another problem arose.

The patient, wanting to urinate, found he could not. Mr O’Grady inserted a full-sized gum elastic catheter, which “passed in with all possible facility” and eight ounces of urine were drawn off.

“Immediately after MM fainted, and became badly collapsed; the pulse for several minutes was not to be felt at the wrist, the heart scarcely more than beat, surface cold, lips blue, and general appearance very alarming. Mustard sinapisms were quickly applied over the region and to the calves of the legs, hot punch and aromatic spirits of ammonia being also freely given. After a time the patient slowly rallied.”

To avoid repeated distress, on four other occasions that the catheter had to be employed, the patient first received “an opiate and stimulant draught, and no further unpleasantness occurred”. The patient “went home quite well” on the 22 March.

Removal of a very large tumour from the right Parotid, Facial and Cervical Regions; Recovery

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From his written account, one could imagine Mr O’Grady sitting across from the 60-year-old widow whose lower right face and neck was severely disfigured by a large tumour. “It has been 15 years growing and now in size equalled that of a cocoa-nut with the husk on,” O’Grady remarked with his typical penchant for detail. “The patient, a tall wiry looking woman but with feeble circulation, says she has been healthy and accustomed to walk long distances, but for the last year and a half the shaking of the mass, specially when the wind chanced to be high, made locomotion on foot or otherwise very painful.”

The operation took place on 27 September 1873 and all of his hospital colleagues gave their “able assistance,” Mr O’Grady noted.

He recounted the intricate procedure: “Two incisions, enclosing between them an elliptical piece of integument an inch wide in the middle, were made, extending from the upper to the lower margins of the tumour, and kept well forward on it. The posterior flap or curtain of the skin was then shelled back, and the ear freed, by careful dissection, from the intimate attachments.

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“The integument over the anterior portion of the tumour was raised with the greatest ease, a firm fibrous expansion was next divided, and the growth was now grasped by a large and powerful vulsellum, which gave great assistance by lifting and drawing it in various directions, as the deeper portions of the dissection proceeded.

The adhesions now were intimate, and a part of the tumour dipped in deep behind the jaw; excision here had to be effected with great caution, by repeated short touches of the knife.”

The excised tumour weighted a hefty 5 pounds 8 ounces. He recorded that, during the patient’s month-long recovery in hospital, her face was swollen and “quite bland and devoid of expression” on the right side. However, by the time she was discharged, she had regained facial movement, and “I have since learned that, after a little time, the puckered appearance of the skin at the operation site also faded away completely,” O’Grady stated.

Removal of a fatty tumour from the perineum; apparent recovery, and subsequent death from pyaemia.

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 “A health-looking man, 42 years-of-age” was admitted on 17 August 1874 for a sizable tumour in the perinaeum that had been growing about six years. Mr O’Grady said it bore a general resemblance to the shape of a large kidney, although far exceeded in size. He added that “the peculiarity of shape” was not captured by the photograph, from which the lithographic plate was copied,  “owing to the constrained position, as the man lay for the photograph”.

On inspection, he found that the skin was quite free and moveable over the tumour. Subsequently, the surgery proved uncomplicated: “The integument was divided lengthwise over it, and the mass extracted with no other pressure than what had been employed to steady the parts for the cut, a very small surface posteriorly being alone adherent to the skin or deeper parts. No vessels required to be secured; there was no bleeding”.

Mr O’Grady was pleased to record that the progress of the case was all that could be desired; the wound contracted and healed rapidly, and by the end of the month was almost entirely cicatrized, the patient going about apparently in perfect health.

“He was to have left for home on September 1st but awoke that morning, anxious and depressed, feeling chilly and unwell, and with pain in the right chest. At morning visit his pulse was 140, temperature 103.4…general condition very low.”

The next day, the patient was in much the same state but was now complaining of pain in the upper part of the leg; he had also become quite deaf.

“The principle trouble now was a severe pain in the left hip, which had seized on him suddenly, nothing amiss could be detected with or near the joint…..matters now grew worse and worse….eventually death took place on the 10th, profuse sweating and high temperature having been present for some days. On the day before death both knees rather suddenly swelled. The deafness also disappeared the day before his decease, the hearing returning and becoming even acute. At the autopsy a small abscess was found in the base of the right lung, with surrounding inflamed tissue; there was congestion of liver and spleen, and pus in both knee joints…”

Mr O’Grady stressed that this case illustrated the fact “now and then brought home to all surgeons that at no period of convalescence can any patient with breech of surface be pronounced safe.

“Fortunately our acquaintance with pyaemic complications in Mercer’s Hospital has heretofore been very scant,” he remarked, adding that this is one of only two cases of death in his patients after excision of tumour.

Disarticulation of shoulder joint for malignant disease of humerus

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 In this case, which was published in the DJMS in 1878, Mr O’Grady encountered a pensioner aged 35 with severe pain and swelling above his elbow. He observed: “This man had led an irregular life but had married young and never had syphilis. In India he suffered severely from ‘liver’, intermittent fever, and dysentery...the general aspect of the patient is in a marked degree leucocythaemic. He, however, considers himself, not withstanding, to be a strong healthy man.

“Some five months previously to his apply at Mercer’s, the left humerus, immediately above the elbow, began to be the seat of severe pain, and was soon after noticed commencing to swell, the growth being attended with increasing suffering, which soon became and continued to be, intense. There was also oedema of the forearm.”

When the man came under Mr O’Grady’s care, he noted that the lower end of the humerus was now greatly enlarged, “being in size fully equal to that of a large orange or Spanish onion...it was the seat of severe and uninterrmitting pain”.

The surgeon was keenly aware that his patient’s “sufferings were very urgent”, and a few days after his admission the limb was amputated through the shoulder-joint. “The operation was well rallied from; the patient, relieved from his long standing suffering, slept as it were through the first few day.

His recovery was not uneventful, however, as on the fifth day he developed sudden and “considerable febrile disturbances”, accompanied by severe swelling of the stump. “Newly formed adhesions” were observed which were ruptured and “about 10 ounces of stinking sanguinolent fluid escaped with a gush”.

Drainage was secured, the stump was then poulticed and a brisk purgative enema given, Mr O’Grady recalled. “In a few hours the alarming symptoms had entirely disappeared, and thereafter amendment rapidly progressed.”

The patient was able to sit up on the tenth day; in three weeks the wound had virtually healed and in a month he took his discharge in excellent health and able at once to resume his ordinary duties as one of the City Commissioners. The photograph was taken more than four years after the operation.

Dr Stanley Burns

Dr Stanley Burns is a New York City ophthalmic surgeon and Clinical Professor of Medicine and Psychiatry at New York University Langone Medical Center. That alone would keep most professionals unquestionably busy but Dr Burns has also turned his passion for vintage photography into an internationally distinguished career as author, curator, historian, collector and archivist.

He is the man behind the renowned Burns Collection containing more than one million images in every imaginable 19th century genre. It is the most important private comprehensive collection of early photography (1840-1950) and the world’s largest collection of historic medical photography. Among these 70,000 medical images are the medical photographic “national treasures” of several countries, including Ireland. The vast majority of the photographs depict patients with diseases long since conquered, and medical treatments, technologies and practices long since outmoded. They also depict hospital and nursing personnel at work, along with related healthcare practitioners.

In 1975, when Dr Burns first became interested in daguerreotypes – the first successful photographic process – and other early photographs, he embarked on an aggressive buying and connoisseurship agenda. By 1978, he had acquired one of America's most important collections of early photography.

Around that time, he founded the Burns Archive to share his discoveries and embarked on a prolific writing career. He has since authored 42 photo-historical texts and over 1,000 articles, while also curating over 50 photographic exhibitions worldwide. Among his 30-plus medical photographic historical books are the medical specialties series – four volumes each on respiratory disease, oncology, psychiatry, dermatology, nephrology and ophthalmology. The books can be seen on www.burnspress.com.

Dr Burns’ photographs have also been the source of numerous Hollywood feature films, documentaries and museum exhibitions. Among the films are The Others, Fur, Jacobs Ladder, Sleepers, Starship Troopers, and Looking for Richard. A film company produced the documentary “Death in America”, which was based on his 1990 classic book “Sleeping Beauty: Memorial Photography in America”.

He spends his time lecturing, creating exhibits, and writing books on underappreciated areas of history and photography. He is now preparing five catalogues on various aspects of the collection. His blog – www.theburnsarchive.blogspot.com – offers a wonderful opportunity to view some of the photographs.

 

O’Grady - The powerhouse surgeon

For more than 30 years, Mr Edward Stamer O’Grady was the proverbial thorn in the sides of the Governors of Mercer’s Hospital in Dublin. He persistently and publicly accused officers of the Board of nepotism, of turning a blind eye to slipshod practices, and even of “an indecent outrage… on the modesty of a female patient”.

While historical records indicate that O’Grady had a reputation for being bull-headed and abrasive in his dealings with some nursing and medical colleagues, many accounts reinforce this remarkable surgeon’s huge popularity among his patients and peers.

Mr O’Grady was born on 23 November 1838 in Baggot Street, Dublin. He studied medicine at Trinity College Dublin against the wishes of his relatives and, after graduating in 1859, he perused further study at hospitals and medical schools across Europe and the US, before returning to work in the City of Dublin Hospital, Upper Baggot Street. He also lectured on surgical anatomy at the Carmichael School of Medicine, Dublin.

Mercer's Hospital, Dublin

He joined the surgical staff in the Mercer’s Hospital in 1866 and “threw himself into the work with great energy. He was a bold operator, and earned a high reputation throughout Ireland for his skill in this department,” a colleague later wrote of him (British Medical Journal, 23 October, 1897).

But Mr O’Grady attracted considerable controversy during his years at the Mercer, and on more than one occasion he found himself at the centre of an inquiry into the conduct of hospital governors as well as his own behaviour towards certain staff. The BMJ first reported in November 1884 on a rumpus within the Mercer’s walls sparked by the defiant Mr O’Grady. Apparently, he broke all protocol in urging the recently widowed wife of a patient, who he believed was mismanaged by the resident medical officer, to request the coronor to inquire into the circumstances of his death “for the sake of the other patients”.

It emerged from the subsequent inquest that Mr O’Grady had made several similar accusations of neglect against this resident medical officer, in writing to the proper hospital authority, but without producing any result, despite evidence to the contrary.

Not surprisingly, the officer in question had a close family connection on the Board of Governors. O’Grady felt a coronor’s inquest was the only way to get “an unbiased general inquiry held”. He was to be disappointed, however, as the inquiry “limited itself to the circumstance of the patient’s death, returning a simple verdict that the deceased died from typhus fever, and declined to attach any rider to it”.

The Board of Governors was livid that the whole sordid affair had been laid bare for public consumption. Mr O’Grady was seen as a troublemaker. The following year, he was rocking the Governor’s boat once again. At a meeting of the house committee held in March 1885, the surgeon gave notice of a motion: “that in consequence of an indecent outrage by a governor on the modesty of a female patient, no lay governor shall persistently dally in the female wards at unreasonable hours”.

In 1887, a case was taken to the Four Courts in Dublin by some members of the Board of Governors physicians against the senior surgeon to have him dismissed for offences “against the duty of his office”. The case dragged on for years and provided salacious reading in the national and international press.

The numerous hearings expounded details of O’Grady’s mutinous behaviour directed towards the hospital authorities, and claims that he was verbally abusive towards nursing staff and some of his medical colleagues.  His earlier accusations of indecent behaviour by a Governor as well as his breach of protocol involving the coroner’s court were raised by the prosecution.

In Mr O’Grady defence, several of his colleagues gave evidence as to his competence and efficiency as a surgeon, his popularity among the students and staff, and his “zeal and his kindness” to patients. “He often paid out of his pocket for wine, chickens and other extras for his patients,” Dr George F Duffy, a former surgeon to the hospital testified.

By December 1887, the case against Mr O’Grady completely collapsed and he was exonerated. “Mr O’Grady has come out of the ordeal unscathed and with the sympathy of the public. The institution ought to be reformed and the governors could not do better than to set about this work at once,” the BMJ reported on 24 December 1887.

However, the enduring disagreements between the Mercer’s governors and some members of the staff culminated in May 1897 when the board dismissed the entire medical and surgical staff. But Mr O’Grady – “a stout man” – refused to leave, according to Sir John Lumsden in his article “Personal reminiscences of Mercer’s Hospital” (Irish Journal of Medical Science, January 1935).

The “discarded officers’ were allowed to reapply for their jobs but Mr O’Grady refused to seek re-election. In defiance, he continued to visit the wards and tend to his patients. He disputed the power of the governors to deprive the staff of their appointments, without notice or cause, and would have had his day in court – he had initiated proceedings against the Board - but for his sudden death on 18 October that year.

“No one who knew anything of him could fail to recognise his high sense of right and honour; and his dogged persistence in holding to the view which he believed to be right had much, perhaps, to do with the opinion, of those who looked at him askance. He was a generous friend of the poor, and if his friendships in the profession were not many they were very true,” his obituary in the BMJ stated.

“His death puts an end apparently to the legal side of the Mercer's trouble; but, however that ending may be desired, the public and the profession have lost a good surgeon and a man of high and unswerving honour.”

 AUTHOR'S NOTE: For more rare and unusual photographs from the Burns Archive, check out these incredible slideshows on Newsweek  http://www.newsweek.com/2010/10/04/a-collection-of-vernacular-and-historical-images.html and CBS News http://www.cbsnews.com/2300-204_162-10007019.html