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Department Head, 1928-1949
The Department of Ophthalmology at the University of Iowa seemed to spring from nowhere in 1928 and was soon to be known as a good place to learn ophthalmology. This was due to a combination of auspicious circumstances in Iowa City and to the energetic personality of the new professor and head, Cecil Starling O'Brien. Dr. O'Brien is primarily remembered for his educational accomplishments. His chief contribution was a department in Iowa with a tradition of excellence.
Cecil Starling O'Brien was born in Manhattan, Indiana, on September 27, 1889. Cecil O'Brien grew up in Danville, Indiana, received a Bachelor of Science degree from Central Normal College in Danville, Indiana in 1907 and received his medical degree from Indiana University in 1913.
Dr. O'Brien did four months on the medical wards as an intern at Johns Hopkins University Hospital, but left Baltimore because of his father's illness. He completed his internship at Deaconess Hospital in Indianapolis, Indiana.
From 1914 to 1920, Dr. C. S. O'Brien served in the medical department of the U.S. Navy advancing to rank of Lt. Commander. His first year included a six-month postgraduate course in Tropical Medicine at the Naval Medical School in Washington, D.C. He then spent two and a half years in the Far East serving in various hospitals in China and with the U.S. River Patrol on the Yangtze River.
In 1918, Dr. O'Brien was working in the office of the Surgeon General of the United States when he volunteered for assignment to Europe. He was attached to the 11th Regiment of the Marine Corps and assigned as a surgeon, to command a battlefield station near the battle of Belleau Wood in France. Dr. O'Brien was proud of his military experience, and anecdotes from those years can still be heard from his former residents. For example, his field experience with neurosurgery led him to an interest in neurology that probably contributed to his development, between 1927 and 1929, of the O'Brien facial nerve anesthesia block, a form of ophthalmic local anesthesia that is still widely used today.
At the end of World War I, in 1919, Dr. O'Brien was placed in charge of a 600 bed Internal Medicine Service at Pelham Naval Hospital in New York City. He later served in the Eye Clinic at the League Island Hospital in Philadelphia. This assignment convinced Dr. O'Brien that ophthalmology was what he wanted to do.
In 1920 he resigned from the Navy and entered the Postgraduate School of Medicine at the University of Pennsylvania. He had eight months of academic instruction in Ophthalmology, and then completed his residency with another 18 months at Wills Eye Hospital. During this time he was most impressed and influenced by two of his teachers: George E. de Schweinitz and Thomas B. Holloway.
In 1922, Dr. C.S. O'Brien was certified by the National Board for Ophthalmic Examinations and began the practice of ophthalmology in Toledo, Ohio where he remained in practice for two years. There, in 1923, he married Mary V. Gray and they had a daughter, Patricia, in 1924. Later that year the family moved to Indianapolis where Dr. O'Brien opened a private practice and was appointed Clinical Assistant in Ophthalmology at Indiana University School of Medicine.
Meanwhile in Iowa City there had been great changes at the College of Medicine since 1915. Strong full-time departments were being formed and there was talk of building a brand new medical campus just west of town. Ophthalmology was to be a separate department reporting to the Dean rather than to the Head of Surgery. Prior to O'Brien's arrival, the ophthalmology clinic at the University of Iowa had been directed by Dr. William Boiler, an Iowa City ophthalmologist . The otolaryngology clinic was run by Dr. Dean M. Lierle, a young assistant professor, under the general supervision of the Dean of the Medical College, Dr. Lee W. Dean, who was also an Eye, Ear, Nose, and Throat specialist, with a preference for otolaryngology.
Construction of the new University Hospital began in 1926 and in 1928, Dr. Lierle was appointed Professor and Head of the new Ear, Nose, and Throat Department, and Dr. O'Brien was appointed Professor and Head of a new Ophthalmology Department.
When he was promised the job of Head of the new Ophthalmology Department in 1925, Dr. O'Brien's goal was to establish an outstanding Department of Ophthalmology at Iowa. He realized that, for this job, he would need additional training. Through the Rockefeller Foundation, Dr. O'Brien received a grant to study pathology and surgery in London, Prague, and Vienna. His study and his plans were influenced by Herbert Parsons of London, Anton Elschnig of Prague, Ernst Fuchs and Maximilien Salzman of Vienna. In 1927 he returned to Iowa City.
Dr. O'Brien had definite ideas about how to teach ophthalmology and wanted his program to be one of the very best. He structured the program so that each resident was trained thoroughly with a gradually increasing sequence of responsibilities. Lectures in the basic sciences of pathology, histology, pharmacology and optics were given every afternoon. First year residents were put to work doing complete ocular examinations (mostly on university students) including refractions and some visual fields. Later in the first year they began to do simple surgery of the extraocular muscles, enucleations, and some lid procedures to learn the mechanics and fundamentals of ophthalmic surgery. They began cataract surgery in the second year. Research was encouraged, but it was not permitted to interfere with patient care.
Residents were carefully selected. In 1927 O'Brien chose Merle Taylor from Oregon as his first resident before the new University Hospital was built. A new resident was selected every six months and rotated through the program. Dr. O'Brien felt that if he selected residents from different states, Iowa's reputation in ophthalmology would be spread far and wide. This philosophy produced many department chairmen including James H. Allen (Tulane University), Alson E. Braley (New York University and later University of Iowa), Kenneth C. Swan (University of Oregon), Thomas D. Duane (Wills Eye Hospital), Philip P. Ellis (University of Colorado), Phillips L. Thygeson (Director of the Proctor Foundation at the University of California, San Francisco).
O'Brien was a strict disciplinarian and was said to have run his department like the Marine Corps. The residents respected and adhered to the policies and routines established by Dr. O'Brien. Residents were expected to be present and on time wearing a tie and a clean white coat regardless of outside factors such as their own weddings, floods, or department parties the night before. First year residents were required to live in the hospital (that's why they were called "residents" after all). If a resident wished to be married and wanted to stay in the program, he needed to have O'Brien's - generally reluctant - approval.
Many of his former residents mentioned in interviews that they had concerns as new residents about having to work with O'Brien, but all were quick to say that their fears soon resolved into respect for his knowledge and for his determination to train residents well.
Daily routines were established and very strictly followed. Many of these routines are still practiced today at the University and many are carried on at other academic facilities influenced by Iowa. Morning rounds began at 8:00 a.m. sharp, seven days a week, even on Sunday. Patients were brought into the clinic for these rounds. Everyone then had the opportunity to see all the interesting patients and discuss the problematic cases. When Dr. O'Brien asked a question, the resident was expected to provide an answer complete with a reason or explanation. Following the presentation of cases in the clinic, the residents followed O'Brien to the ward to examine the post-operative patients that were still confined to bed. On Sundays, a paper was given by one of the residents. During the week, daily lectures were given promptly at 4:00 p.m. in the lecture room. If clinic patients were not finished in time for the lecture, the patient was asked to wait until after the lecture. The lecture topics were chosen by Dr. O'Brien, but the lectures were given by the faculty.
O'Brien with his faculty (P.J. Leinfelder, Jimmy Allen) and residents in 1940
Dr. O'Brien supported and encouraged his residents, yet he demanded perfection. He was himself a facile surgeon and he would not tolerate work below his standards. Residents began by helping Dr. O'Brien in the operating room, first as a surgical assistant and then, on all except private patients, doing increasing amounts of the operation. They were expected to have read up on the procedure and to be alert enough to be helpful and to be cool enough to withstand sharp orders and reprimands.
O'Brien was a strong, forceful disciplinarian. Dr. Otis Lee (resident, 1941-1944) remembered Dr. O'Brien's method of discipline. "He gave me hell during practically every surgery. Finally I said, 'Dr. O'Brien, I thought I was doing everything you wanted me to do. Why do you still give me hell?' Dr. O'Brien replied with a characteristically rough compliment, 'Otis, I just want to remind you that it costs me a lot of effort to give you hell. So if I chew you out, it is because I think you are worth the investment.' "
When not in the clinic, Dr. O'Brien was gracious, friendly, and helpful. He hosted parties for the residents and faculty at his home in the country every week or two. Although these parties lasted until late at night, the residents and faculty were expected to report on time for morning rounds the following day.
An annual reunion of former residents was held at his home. Many alumni returned for these reunions to share stories with the current residents.
O'Brien's activities reached far beyond Iowa. In 1928 he was elected to the American Ophthalmological Society; he was an active member until 1951. He was also elected to the Ophthalmic Pathology Study Club and taught ocular pathology at the Lancaster Course in Maine for many years, and he served three terms on the American Board of Ophthalmology (1937-1950). For five years he was the Secretary and Treasurer of the Association for Research in Ophthalmology, and he served on the Executive Committee of the Ophthalmological Study Council, and on various committees of the Pan-American Association of Ophthalmology. He was recognized as one of the outstanding teachers of Ophthalmolgy of his era.
Dr. C.S. O'Brien retired from his position as Head of the Department of Ophthalmology in 1949 when he was only sixty years old. He said that the pain and stiffness in his hands were interfering with his surgery. In his youth, O'Brien had played semi-professional baseball as a catcher; this was thought to have contributed to his developing arthritis.
O'Brien knew that it had been his Department, and he didn't want his successor to be burdened by the past, so he said he would never return to the department, and he never did. But he did come back to Iowa City for an occasional University of Iowa football game. O'Brien always wanted to own a cattle ranch, so he bought a place about sixty miles south of Tucson, Arizona, near the Mexican border, and successfully raised cattle for a few years. In 1957, the O'Briens moved to La Jolla, California to live near the ocean and have the advantage of good weather for his arthritis.
Dr. O'Brien remained in La Jolla until his death on December 11, 1977. His ashes were spread over the bay near La Jolla. The last forty years of his life were warmed by the grace and intelligent companionship of his wife Lillian.
Dr. O'Brien's training in the Marines and his relative maturity when learning ophthalmology were important factors in his life and, in turn, influenced the Department of Ophthalmology at the University of Iowa. He seemed to know how to express his feelings, not only his anger and irritation, but his compassion and love for the people around him, and he learned to do it now, in the present - he was reluctant to dwell on the past.
Remembering Dr. O'Brien
From 1993 to 1996 Dr. John C. Lee did video interviews with many of Dr O'Brien's former residents; here are some quotes:
This sketch of Dr C.S. O'Brien was adapted from a paper by Drs. John C. Lee and H. Stanley Thompson published in Documenta Ophthalmologica 94: 161-178, Jan 1997 and read at the tenth annual meeting of the Cogan Ophthalmic History Society, Philadelphia College of Physicians, March 8 and 9, 1997.