An Irishman’s Diary on how a Fenian and a surgeon made medical and legal history

The O’Donovan Rossa centenary has sparked much commentary on the Fenian era. Medicine was not immune from the turmoil of the times, as illustrated by the trial in 1871 of Robert Kelly for the murder of Thomas Talbot, former head constable of the RIC.

Talbot, a scourge of the Fenians, was a notorious figure in Dublin and the archetype for the informer Harvey Duff in Boucicault's Shaughraun.

It was not in doubt that he had been shot in the neck by Kelly – at stake at the trial was whether he had died as a result of the bullet or the subsequent surgical treatment.

The surgeon in question was Sir William Stokes, son of the celebrated physician of the same name, and a pillar of the medical and Anglo-Irish establishment. Although Lister had described his antiseptic process in the 1860s, the practice of antiseptic surgery was not widespread in Ireland at this time and death from post-operative infection was a major concern.

After the shooting in Hardwicke Street, Talbot was brought to the Richmond Hospital where Stokes probed the wound twice while in the patient’s room.

Later in the day he transferred him to the operating theatre, where arteries were cut and an instrument was left deep in the wound to staunch the bleeding. Over the next few days Talbot became weaker and more unwell, dying four days later.

In a move unthinkable by the standards of today, Stokes performed the postmortem on his own patient, reporting the findings of a shattered bullet, fractured neck bones and a virulent meningitis to which he attributed the cause of death.

The wheels of justice moved swiftly, and Isaac Butt led the defence at the trial three months later. The proceedings aroused international attention, as dramatised by Roger McHugh as Trial at Green Street Courthouse in 1941.

The celebrated lawyer had prepared well, spending a number of evenings in the dissection room of the medical school in Cecilia Street with William Hegarty O’Leary, a surgeon at St Vincent’s Hospital and future home rule MP for Drogheda.

The bolt from the blue for Stokes and Dublin Castle was the defence argument that Talbot had died from bleeding following the surgery. Butt even proposed that Stokes rather than Kelly should be tried for manslaughter.

In an era when litigation for negligence was almost non-existent, it is clear that the prosecutor and Stokes were caught off-balance. When asked whether the criticism applied to Stokes’s clinical judgment or skills, Butt replied that it applied to both.

He intended to show, he said, that probing and cutting for the ball under the circumstances was an act of “complete unskilfulness and recklessness”.

The forces of the establishment were mobilised, with a letter of support for Stokes appearing in the London Times, signed by an array of English surgical luminaries.

His position was not helped when the first set of medical notes presented to the court were found to have been doctored to the advantage of Stokes and the Richmond Hospital.

Indeed, the original notes supported Butt’s contention that bleeding was a significant contributor to Talbot’s death.

Robert Kelly was acquitted but sentenced to 20 years penal servitude for another shooting.

Within six weeks the British Medical Journal published a self-serving paper by Stokes which not only mentioned Talbot by name but also thanked Stokes's supporters. The article was accompanied by a paper by one of these supporters which extolled the virtues of the surgical approach taken by Stokes.

Viewed through contemporary lens, some of the regrettable practices of this episode have radically changed – antiseptic care is the norm, anonymity of patients in medical journals is sacrosanct, and postmortem examinations in violent death are carried out through an independent service. Medical colleges and journals would also be unlikely to weigh in on conflicting medical advice in a specific court case.

A lingering warning to future generations is the degree to which the medical opinions in this case mirrored the sharp political and sectarian divisions of the day.

While such influences may be more subtle in modern life, a role of medical humanities (increasingly a presence in medical schools) is to ensure that present and future generations of doctors appreciate the vulnerability of professional independence and autonomy to broader social and political impulses in the society to which they belong.