Patricia Dolores Horne obituary: Surgeon and psychiatrist worked in Ireland and Africa

Born: September 19th, 1927. Died: October 29th, 2012

At the age of 28 Patricia Horne found herself performing complicated surgeries by Tilly lamp in a missionary hospital in Eastern Nigeria. The reason being, in part, to keep her father Dr Andrew Horne, an assistant master at the National Maternity Hospital (NMH), happy.

Horne was the only doctor on the staff of St Teresa’s Hospital run by the Holy Rosary Sisters in Nkussa, some 400 miles upriver from Port Harcourt .

There was neither running water nor electricity. Water had to be fetched by bucket from a river nearby before being boiled and filtered; operations, including childbirths, had to be carried out at night time with the aid of oil lamps in theatres where, to counter the heat and humidity, windows had to be left open, attracting in all kinds of flying insects. These, attracted to the lights of the lamps, would be dispatched on reaching their coverings into water bowls especially placed underneath the lamps for that purpose, to prevent the insects settling on the patients.

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Horne’s initial intention had been to work overseas in public health and she had applied for jobs in Hong Kong, Africa and India. However, according to Dr Ida Milne of Carlow Institute of Technology who interviewed her at length before her death, her father insisted that if she went overseas it would be with Irish nuns. His opinion was informed by the difficulties he himself experienced working with the Royal Army Medical Corps in Gallipoli; he felt that if she got sick the nuns would look after her, according to Milne.

Ultimately she accepted the two-year placement in Nkussa over three-year contracts she had been offered by the Franciscans and the Medical Missionaries of Mary in Kenya.

Horne attended the Ursuline secondary school in Waterford and studied medicine at UCD, graduating in 1955. While at UCD she captained the women’s hockey team to victory in the Irish Senior Cup. After graduation she worked as a surgeon in Cashel and on her mother’s advice – given the limited job opportunities for women in medicine at the time – she took a diploma in public health. Her thesis was on medical services in developing countries. (She supplemented it with a diploma in tropical medicine from Liverpool University in 1963.)

Tuberculosis and yaws – a spirochete infection of the skin, bone and cartilage – were endemic in Eastern Nigeria in the 1950s and treating them consumed much of Horne’s time. She also dealt with complicated obstetric cases referred to the hospital from the Holy Rosary Sisters network of clinics.

Among the procedures she carried out were symphysiotomies which involve cutting the cartilage and ligaments of a pelvic joint to facilitate delivery. The operation is now seen as controversial because of the chronic post-operative complications suffered by many women as a result.

However, as Horne explained to Milne, the treatment was employed in Nigeria to avoid potentially worse consequences as a result of Caesarean sections. These included the onward infection of the uterus. This was seen as a significant risk once the mothers left hospital to return to their home villages where antibiotic treatments, such as penicillin, were not available.

Psychiatry

Returning to Ireland when still only 30, Horne became a surgical registrar at the Mater Hospital in Dublin. But her desired career to be a surgeon was cut short by a slipped disc, so she changed tack to study psychiatry.

Her new specialism brought her to work with Dr John Owens at St Davnet’s Hospital, Monaghan. It was in the days before the development of the anti-depressant drug therapies now almost taken for granted, but which only became gradually available from the late 1960s onwards. She recalled in her interviews with Milne that many patients, especially male patients with a tendency to be violent, often languished in hospital for decades.

Some, she explained, had been left in the hospital as young as 18 or 19, and “stayed because there was nothing for them”. Working with Dr Owens, whom she came to admire greatly, Horne became one of a new generation of psychiatrists, led by the example of Dr Ivor Browne at St Brendan’s Hospital in Dublin, who gradually introduced the concept, aided by new medications, of allowing psychiatric patients to once again live in the wider community.

After retirement in 1992, and feeling frustrated that her medical skills were no longer being used, Horne volunteered at an age when many look forward to putting their feet up – this time in Zambia caring for Aids patients. Again it was in very difficult circumstances where the new anti-viral drugs to combat Aids were still only in development and were too expensive for medical services in developing countries to afford.

Patricia Horne’s mother, Delia (nee Moclair), was also an obstetrician at the NMH, which her grandfather, also Andrew Horne, had co-founded in 1894. Predeceased by her brother Andrew, she is survived by her twin sister, Margaret.