Swan M. Burnett, MD, PhD:  The Forgotten Father of Little Lord Fauntleroy FREE

A generation after the end of America's Civil War, a 7-year-old boy in a velvet suit and golden curls captured the fancy of readers around the country. Little Lord Fauntleroy, the literary creation of Frances Hodgson Burnett (Figure 1), sparked a sensation every bit as potent as that kindled by the Harry Potter series today.

Although better known to us now as the author of a later work, The Secret Garden, Frances Hodgson Burnett reached the pinnacle of her popularity when Fauntleroy appeared in 1886. The book sold hundreds of thousands of copies, was translated into multiple languages, became a household name around the world,^1(p110) influenced fashion for a generation (Figure 2), and created a marketing frenzy, which included dolls, candy, playing cards, and perfume. (It also embarrassed Frances's son Vivian who was known from then on as the real Little Lord Fauntleroy, as he was the inspiration for the character.²)

Harry Potter is a household name today, and many of us know the name of his creator, J. K. Rowling, but few of us could name the anesthesiologist to whom Rowling is married. Likewise, Fauntleroy endures in the American lexicon, and Frances Hodgson Burnett is still children's bedtime reading in many American homes, but few of us know that the husband of Frances and the father of Little Lord Fauntleroy was one of the most esteemed ophthalmologists of his day.

That his wife became a Gilded Age celebrity was both a blessing and a curse to Swan M. Burnett, MD, PhD (Figure 3). Although he was eclipsed in his lifetime and in history by the fame of the larger-than-life Frances, Swan's achievements are arguably more enduring. In 1892, he founded and equipped the first hospital-associated clinical laboratory in the city of Washington, DC, and one of the first in the nation. He also established the first eye and ear clinic in Washington, DC, and treated all who came there, including indigent and African American patients.

Swan was the first professor of ophthalmology in the School of Medicine at Georgetown University. He conducted groundbreaking research on the relationship of race with eye diseases, making original contributions to anthropology as well as medicine. He is still known in the field for his work in refraction. He also played an essential role in the understanding and correction of astigmatism.

A leader in the introduction of the Credé prophylaxis to protect the eyes of newborn children from gonorrhea, Swan also helped to improve the recently invented ophthalmoscope, improving medicine itself. Years before the appearance of the epochal Flexner Report, he was among the leading advocates for higher standards in American medical education to equal those in Europe. Somehow he also found time to develop one of the great personal libraries of his era and to achieve recognition as an ardent patron of the arts.

In contrast to the steady growth of his professional success, Swan's marriage to Frances began to fail long before she struck literary gold with Little Lord Fauntleroy. They met as teenagers and he pursued her for years before she agreed to marry him. He was by nature somewhat shy; she was anything but.^1(p27) She was also ambitious. Frances had supported herself, and often her family, with her writing since the age of 18 years.^1(p31) Her income was crucial in the early years of their marriage^1(p56); but as her popularity grew, so did the differences between them.

Most of Frances's stories were written in sentimental, romantic prose, excessive by current standards, but they featured strong female characters and touched on modern subjects: marital abuse and infidelity, illegitimate births, unhappy marriages, and independent women who crossed class lines.^1(pxiv) She wrote relentlessly, often to the point of exhaustion,^1(p69) and rarely revised her work, attributing her writing ability to a mysterious spiritual force.^1(pxiii)

Frances's enormous commercial success and unconventional, at times even notorious, behavior had from the early years of their marriage greatly overshadowed Swan's medical achievements. Frances chain-smoked^1(p20) and left her children with Swan or paid companions for months and sometimes years at a time as she traveled for business and pleasure (she crossed the Atlantic 33 times).^1(ppxiii-xv) She worked, socialized, and traveled with men without a chaperone. It is likely that she had affairs with many.^1(pxiv) She bought homes in America, England, and Bermuda^1(p10) and spent extravagant sums on the feminine fashions she adored.^1(p134)

Swan meanwhile remained in Washington, DC, practicing medicine and building a reputation as a noted clinician and scientist, specializing in ophthalmology and otology. In May 1890, the 17th year of his marriage to Frances, he delivered the commencement address to the graduating class of the Georgetown University School of Medicine. Among his comments were these:

No man can give another a sure receipt for success, because no 2 men ever achieve success in exactly the same way. . . . Always be yourself. Never be an imitation of someone else, and never strive for success by the apparently successful methods of another which are not in perfect harmony with that which is best and noblest in you. Better be a failure in the eyes of the world than a miserable disappointment to this best self.³

Whether he ever had cause to be disappointed in his own best self, his personal life certainly gave him cause for misery. There was already the pain of a marriage in shambles; now there was news that his teenage son Lionel was dying of tuberculosis. Lionel was his first-born child and he would be dead before the year's end.

That spring found Frances in Europe, developing her literary projects with her “artistic assistant,” Stephen Townesend, MD. Townesend was 10 years her junior^1(p131) and eventually would become an actor in Frances's plays.^1(p153) He was also assumed to be her lover.^1(p189) When Frances learned that Lionel was dying, she sailed for America. Removing Lionel from his father and home in Washington, DC, she brought him first to specialists on the Eastern seaboard and then to spas in Europe in the hope of finding a cure. There was none. Lionel died in Paris that December at age 16 years; Swan received the news from Frances by cable.^1(p147) The heartbroken father managed his grief by doing what he always did when faced with adversity: immersing himself in his work and in what semblance of a family life remained.

From newspaper archives, biographies of Frances, obituaries, and other sources, Swan emerges as a respected and admired physician and scientist. He became known for his devotion to his profession and to the poor and needy patients of Washington, DC. He was a cultured and much-sought-after presence at Washington soirees, weddings, and important dinners, with his attendance duly noted in the newspapers.

Swan M. Burnett's forebears were a poor branch of a distinguished family who traced their descent from Huguenots who had emigrated from France to South Carolina in the 17th century. He was the third of 7 children, born on March 16, 1847. Swan's father, Dr John M. Burnett,was a local general practitioner in New Market, Tennessee. Dr Burnett traveled the district on 1 of the family's 2 white mules with saddlebags packed with medicines and instruments. His patients were often charity cases who paid with goods or food.^1(p27)

Swan's mother, Lydia Ann Peck Burnett, was from a distinguished and prosperous southern family. A disciplinarian with a “puritan primness about her,” according to Swan's son Vivian; she was nevertheless “kindly hearted and neighborly,” especially to Frances's family, who arrived from England and moved in next door to the Burnetts in the summer of 1865.

Like his father, Swan loved to read and he received an apparently solid formal education at the New Market Academy. He wrote well and enjoyed intellectual pursuits; later in his career he made notable translations of French and German medical writings into English. Quiet and studious, he grew up reading his father's medical books and determined at a young age that he would follow his father into medicine.^4(pp35-39)

Frances Hodgson, her widowed mother, and her younger siblings came to America to join an uncle after their fortunes declined in England.^1(p24) Swan and his sisters soon became good friends with the Hodgson children. The shy and bookish teenager was immediately smitten with the vivacious and imaginative Frances, who was a year younger and who would tease and play small practical jokes on him. Years later, their daughter-in-law observed that Swan was never completely relaxed when around Frances.^1(p27)

Frances apparently cared deeply for Swan from the beginning. She never liked or used his given name, calling him first Jerome (a more “masculinized” name at that time) and later Doro, after he teased her that her housekeeping abilities were like those of the giddy young wife, Dora, in Charles Dickens's David Copperfield.^1(p54) The name Doro stuck; Swan's children eventually used it as well to refer to their father.

Swan's adult portraits show a pleasant face with regular features, a full head of hair, a handlebar mustache, and an “imperial,” a pointed beard growing from his lower lip. He had an extremely pleasant voice and always dressed well.⁵ He was of average height and had a pronounced limp; as a boy, he accidentally stabbed himself in the knee with a penknife and the wound became infected, which left the knee permanently bent.^4(p35) He was healthy, but not physically active or robust, certainly not one of the “manly” men of Frances's romantic adult novels; but it seems that this brought out the tender side of Frances; it may have been one reason why she married him.^1(p38)

Swan was in his early teens when the Civil War broke out; he was aged 18 years when it ended and he embarked on his career in a society still reeling from the destruction of the war. He began his medical studies with his father. In the winter of 1866-1867, he left home to attend the Miami Medical College of Cincinnati.⁶ One of his professors there was Elkanah Williams, MD, who 6 years earlier had been appointed to the first professorship of ophthalmology in the United States.⁷ Williams appears to have strongly influenced Swan, both in developing an interest in ophthalmology and otolaryngology and in eventually training in these areas in Europe.

On returning to Tennessee, Swan practiced general medicine with his father. In 1869, barely aged 22 years, he was put in charge of a hospital of the State Guards at Nashville. Later that year, he attended Bellevue Hospital Medical College in New York to obtain additional training in ophthalmology. In 1870, he received his medical degree,⁶ after which he returned to Knoxville.⁵ From 1870 to 1873, he struggled in general practice; his work included fighting the 1873 cholera epidemic in Tennessee, but he was also the first eye, ear, nose, and throat specialist to practice in Knoxville, and he was determined to win the hand of Frances Hodgson in marriage, which he succeeded in doing in 1873.⁸

By 1875, his wife's success as an author had provided them with the means to move to Europe for a year. There Swan was able to study with the leading ophthalmic specialists on the continent and in England.⁶ From Paris, Frances wrote to her sister about this time, during which she mainly stayed in their 2-bedroom furnished flat and churned out stories to finance their stay and her husband's studies:

When I am the wife of the greatest ophthalmologist in 2 hemispheres, I shall forget my present troubles. . . . D is just as busy in his way as I am in mine—studying all morning, at the hospitals all evening and study again at night. D feels he is reaping great benefit from his stay here, and if he does, my end will be accomplished to a great extent.

In another letter she wrote:

D. is getting along splendidly. He is drawing and painting eyes, and says he would not have missed these opportunities for anything. He has met so many celebrated men.^1(p57)

Yet later, after becoming pregnant with their second child, still needing to write constantly to provide funds that barely covered their expenses, Frances became seriously exhausted and depressed. She wrote a poem that she showed to no one but that survived in her papers; it revealed a clear resentment toward Swan as she drove herself to exhaustion during her pregnancy while he went off each day to his studies.^1(p59)

The family returned to America in 1876. Knoxville, they felt, was too limiting to their future, so they decided to settle in Washington, DC. Initially, Frances and the children stayed with his parents in New Market, while Swan went to Washington alone to establish his practice as an eye and ear physician.^1(pp62-63) He later described to his sister-in-law Edith what this lonely time was like:

We came back from Europe not only penniless but in debt, and I came to Washington without money or friends or even acquaintances to establish myself in my profession. . . . As I look back at it now I don't see how I had the courage to attempt it. But I had determined that I would and I came. I won't tell you how I suffered and almost starved—of the dreary months of loneliness and despair, but still I would not give it up. Finally patients began to come in—very slowly—but they came and have continued to come in slowly increasing quantities all the time since (personal letter, August 24, 1881, Penny Deupree private collection).

Frances's writing still provided most of their support. That same year, she made Swan her business manager. He would handle all noneditorial correspondence between her publishers, and when Frances became better known,^1(p64) he would persuade them to reprint her earlier stories to prevent others from pirating her work.^1(p71) Swan was Frances's most ardent reader, and he pushed her to do her best. Perhaps he failed to appreciate the toll it was taking.

A letter Frances wrote to him from New Market in 1876 reveals that even then some discord had begun to intrude into their relationship:

I am a better girl than you think & I won't be bad to you now you may be lonely & want comfort. I will work like a Trojan & help you until your good luck comes. It has been on its way so long it must come soon. . . . I have set my heart on your success in your own groove & I know it will come. Someday I shall drive the boys out in that pony carriage. You don't know yet how unbounded my faith in you is. [Signed] Your Little Wife.^1(p65)

However, even with the discord in their relationship, Frances continued to write and the Burnetts continued to be on the move. In April 1877, when Frances and the boys finally joined Swan^1(p68) in Washington City, as it was known then,^1(p77) they moved into a rented 2-story brick house on M Street that they characterized later as “uncomfortable, inconvenient and insanitary.” At their next house at 813 13th St, they began to entertain regularly.^1(p81) Soon they moved again to 1215 I St, at one time the home of former President Ulysses S. Grant.^1(p79) Down the street lived General James A. Garfield, who was elected president in 1880 and assassinated a year later. Prior to Garfield's election as president, his children played with the Burnett boys,^1(p82) and the parents became cordial friends, with newly elected President Garfield allowing the Burnett boys to ride their bikes down the halls of the White House.^1(p97)

In the roomy 3-story house on I Street, Frances wrote Little Lord Fauntleroy, which was serialized in St Nicholas Magazine in 1885. It became an instant hit and was published as a book in 1886 to wild success. It was her most successful children's book and brought her fame and fortune.^1(pp109-110)

Swan spent the rest of his personal and professional life in Washington, DC, initially as a specialist in ophthalmology and otology, but gradually moving entirely into the sphere of ophthalmology.⁶ He was appointed as the ophthalmologist and otologist to the Children's and Providence Hospital in Washington, DC,⁵ and in 1878 founded the Eye and Ear Clinic at the Central Dispensary and Emergency Hospital (Figure 4). In that same year he was elected to the American Ophthalmological Society⁶ and was appointed lecturer on ophthalmology and otology at the School of Medicine at Georgetown University, a position he held until 1883, when he was made a clinical professor.⁵ In 1879, Swan established a postgraduate course in ophthalmology and otology in connection with his hospital and private practice.⁸ He served on the attending staff of the Central Dispensary and Emergency Hospital and was president of that institution. It was here that he later founded and equipped the Lionel Laboratory, in memory of his older son, for clinical, bacteriological, and pathological research, the first such laboratory in Washington, DC.⁹

His contemporaries described Swan as a skillful surgeon.⁵ In an interesting historical note, it was Swan who removed the damaged eye of a 7-year-old boy who would grow up to be the famed humorist James Thurber. After Thurber's brother accidentally shot him in his left eye with an arrow, their parents took Thurber to the local physician, who simply bandaged the eye. Thurber's mother was experimenting with Christian Science at the time, so there was some delay in getting him to a specialist. But when the pain grew too great, they took him to “Dr. Swann [sic] Burnett, a noted Washington eye specialist,” who removed the eye. (Unfortunately, the right eye was already inflamed, through the onset of sympathetic ophthalmia, which might have been prevented if the left eye had been removed sooner. Thurber's eyesight gradually deteriorated, and by middle age he was legally blind.¹⁰)

Swan was also described as an excellent teacher. His distinguished student, H. V. Würdemann, MD, later wrote:

I look back to the year of 1888, spent as his assistant, with particular pleasure, and know that his teaching was one of the principal factors in getting me interested in scientific ophthalmology, and to his example and advice I owe my literary inclinations. He aided me in scientific work more than any teacher I have ever had. In him I particularly feel the loss not only of teacher, but of steadfast friend, and believe that I feebly express the feeling of the medical profession. His life and example will remain one of the guiding stars of ophthalmic practice.⁵

As he matured, the once shy young man became more outgoing and charming. One of his wife's biographers noted that at one of their many parties, Swan flirted with the other female guests^1(pp96-97); but the character patterned after Swan in one of Frances's novels was not flattering.^4(pp120-121) The husband in the story was “weak and capricious,” and the wife was coming to terms with the fact that she had “married a man who loved her” rather than being true to her own heart.^1(p96) As the years passed, Frances grew to resent Swan as a hindrance to her travels and plans.

Frances went away for months and years at a time, and as she developed ever more expensive tastes to match her income, Swan usually let her have her way to preserve the marriage.^1(p107) This may explain why he tolerated her absences from him and the boys as well as her affairs, if he was aware of them.

In 1886 the family moved again to a leased house at 1734 K St, which was fashionably designed and decorated, but Frances left Swan and the boys there almost immediately and started traveling again. In 1887 the house caught fire; Frances, home for a few winter months, was carried out after grabbing her manuscript and trying to save her clothes. Soon after, she left Swan in Washington, alone in the repaired K Street house, taking the boys with her to England and Italy for almost 2 years.^1(pp111-113)

When she returned in 1889, they moved into a huge 22-room house at 1770 Massachusetts Ave, which Frances purchased and lavishly furnished as a showcase of her commercial success. In letters she described the purchase and decoration of the house but never mentioned Swan; the purchase papers were in her name.^1(p126) It was from this house that Swan later moved out permanently, during Vivian's second year of college.^1(p202)

Despite his marriage troubles, Swan's star continued to rise in medicine. In 1889, Swan was appointed a full academic professor of ophthalmology and otology at Georgetown University, a position he held until his death.⁸ He was also a member of the consulting staff of the Episcopal Eye, Ear, and Throat Hospital. He became president of the Medical Society of the District of Columbia in 1889, and in 1890 he received an honorary doctor of philosophy degree from Georgetown.⁵

In addition, Swan belonged to many professional societies and clubs. He was a chief organizer and the first president of the Society of Ophthalmologists and Otologists of Washington⁹ and a member of the Anthropological and Philosophical Societies of Washington,¹¹ the National Geographic Society,¹² and the Washington Academy of Sciences.⁸ In 1896, he was elected president of the distinguished Cosmos Club.⁹ He was also recognized as a contributor to the National Medical Dictionary.⁶ At the time of his death in 1906, he had 64 contributions to the medical literature recorded in the Surgeon General's Catalogue at Washington.⁸

Swan's major contribution to ophthalmology was in the area of refraction. In 1879, he added to the literature an English translation of Edmond Landolt's A Manual of Examination of the Eyes, which was a course of lectures delivered at the Ecole Pratique of the University of Paris.⁵ Swan considered the leading American textbooks to be insufficiently detailed and in 1887 he produced the beautifully written and illustrated A Theoretical and Practical Treatise on Astigmatism, based on his ophthalmic experience.¹³ In 1888, he published the study “An Analysis of the Refraction of 576 Healthy Human Corneae Examined With the Ophthalmometer of Javal and Schiötz.”⁵ On the basis of his investigations, he derived Burnett's Rule:

One may estimate the actual amount of astigmatic error [accordingly]: for the total subjective astigmatism, subtract 0.50 diopters from the corneal astigmatism when it is according to the rule, and add 0.50 diopters if the corneal astigmatism is against the rule.

In 1890 he presented a mathematical model, worked out at his request by Charles F. Prentice of New York, New York, to demonstrate the mathematical basis of refraction by crossed cylinders.¹⁴ The model is still used in determining refraction. In 1904, he published a 67-page monograph entitled The Principles of Refraction Based on the Laws of Conjugate Foci, and in 1905, shortly before his death, he published his final article entitled, “Study of Refraction From a New Viewpoint.”⁵

Second only to Swan's interest in refraction was his fascination with the influence of race on disease. He considered this an offshoot of his inquiries into anthropology. His first published article, in fact, was entitled, “Trachoma as Influenced by Race,” which appeared in the Transactions of the International Ophthalmic Congress of 1876. He mentions it in a footnote to another article he wrote entitled, “Results of an Examination of the Color-Sense of 3,040 Children in the Colored Schools of the District of Columbia,” published in the Archives of Ophthalmology in 1879. In this article, he concluded that African Americans appeared to be “quite, if not entirely, free” of trachoma, at that time a common bacterial infection that often caused blindness.¹⁵

For the next several years, Swan's professional writings focused mainly on color blindness. By 1884, however, his earlier report on trachoma and race had become controversial. It was attacked by the noted researcher and teacher Henry D. Noyes, MD, who claimed that he had observed “colored trachoma” in New York. Swan now published a much more comprehensive study based on 2325 patients examined in the Eye Department of the Central Dispensary. One-third were white and two-thirds were African American. Swan observed, “When there is an admixture of negro blood, even to a small extent, the patient was registered as ‘colored.’ This, it must be confessed, is hardly fair to the colored race, but under the circumstances it seemed unavoidable.”^16(p188)

In this study, Swan found that 44 cases of trachoma were encountered in white individuals, whereas African Americans had none, “though their proportional share should have been 80. This is too great a discrepancy to be accounted for by a mere coincidence.”^16(p193) In addition, Swan found that African Americans had a disproportionately large number of inflammations of the cornea of all kinds, twice the percentage of iritis as white people, a much higher occurrence of glaucoma, “especially the chronic simple form,” and a lower occurrence of refractive errors and strabismus. Sympathetic ophthalmia affected the 2 races equally.^16(p198)

In 1896, in the American Journal of Ophthalmology, Swan published his final article on the subject entitled, “The Racial and Geographic Distribution of Trachoma in the United States of America.” He noted that at the meeting of the International Medical Congress in Berlin, he clashed with Dr Paul Chibret of Clermont-Ferrand, France, over the issue of trachoma and race, “Chibret pointing out that the pure Celt was to an extent immune and I that the negro in the United States was practically exempt.”^17(p257) Swan stated:

 . . . during a period of more than 15 years, and with about 10,000 ‘colored’ eye cases, I have seen not more than 6 negroes in which there was a suspicion even, of trachoma; and I have never seen a case of entropion in that race.^17(p260)

He then included a survey of 11 ophthalmologists from around the United States who concurred with his finding.

Swan made other significant contributions. During the last quarter of the 19th century, physicians referred patients to ophthalmologists when the fundus, the eye's interior surface, needed examination. The ophthalmoscope was still in its infancy. Swan made active use of the new tool, including in his published case reports detailed descriptions and drawings of his observations.¹⁸ Also, in 1892, he published an article on ophthalmia that affected newborns in the Century Magazine. It contained a powerful argument for the adoption of silver nitrate prophylaxis to prevent this disease.¹⁹ This article was widely published thereafter.

In addition to his professional pursuits, Swan was a lifelong collector of books, art, and weapons. He bought thousands of first edition books, several of which were inscribed or autographed. He was also an art connoisseur, amassing a large collection of valuable paintings and an extensive collection of Japanese art objects, many purchased from Japanese noblemen. His weapons collection featured swords and helmets.⁵

In 1902, The Washington Post reported that he donated a complete set of the first edition of the plays and poems of William Shakespeare to be printed in America to the Library of Congress, which at the time “ranked as one of the rarest and most valuable publications in the whole range of Americana.”²⁰ The article concluded by noting

Dr. Burnett . . . is known as one of the most accomplished and talented bibliophiles and collectors in Washington. His collection of first editions, Americana, plates, posters, paintings, engravings, and objects of Japanese art is priceless and contains many things that are not to be found outside of 2 or 3 of the leading museums and libraries in the world.

Three months after Swan's death, The Washington Post reported that his rare book collection was to be sold at auction in New York.²¹ A year after his death, his collection of antique Japanese art objects and curios was sold at an unrestricted public sale in New York, with a 108-page catalogue issued by the American Art Association. Today, the catalogue can be found in The New York Public Library Research Collection.

Swan was also an amateur anthropologist of some standing. He was a member of the Anthropological Society of Washington, publishing several articles in the journal American Anthropologist.¹¹ His studies of how race affects the etiology of eye and ear diseases and original observations of the African American population in Washington, DC, were recognized as significant contributions to the field of anthropology.

On the personal side, Swan was a proud and loving father and was often the only parent for his sons when Frances was absent on her extensive travels. Of the 2, he was the sterner disciplinarian. When Vivian attended Harvard University, Swan contributed $500 and then $50 a month thereafter, refusing to cover his son's extravagant spending. Frances, who had personally engineered Vivian's admission, picked up all the other expenses while complaining about Swan's frugality; she refused to acknowledge that Vivian's behavior might be the result of her indulgence.^1(p180)

In fact, Frances took pains to make sure the boys would not grow up to be just like their father. She took a 2-year overseas tour with them in 1887 for the sake of their development as gentlemen of the world. She was afraid that unless she intervened, the boys would settle into a complacent and provincial life like Swan’s.^1(p115) At that point, Swan was simply trying to hold on to the marriage. Frances's latest biographer, Gretchen Holbrook Gerzina, PhD, speculates that by then they had come to an agreement to be “publicly married and privately free.”^1(p163)

Five years after his son Lionel's death in 1895, Swan moved out of the couple's home, denying to the press that he and Frances were separating. Three years later, Frances filed for divorce on the grounds of desertion and failure to provide, which was a formality—they had lived apart for years and her fortune was much larger than his. The divorce was by mutual consent and Swan did not contest it. In fact, he was lonely and, as Frances had realized, he would like to marry again if his first marriage was truly finished.^1(p204) The newspapers reported that the divorce “did not come as a surprise to the intimate friends of Dr and Mrs Burnett.”²² Frances soon married Stephen Townesend,^1(p214) only to divorce him 2 years later.^1(pp229-230)

Divorce did nothing to improve the relationship between Swan and Frances. Swan disparaged Frances in front of Vivian, but the son refused to indulge his father's anger. He carefully navigated the turbulent waters between his parents, both of whom he loved. Swan's opinions of his former wife did not survive on paper; Frances's opinions of Swan are preserved in her letters:

He has never assumed a man's responsibility in his life. . . . He has never had money for anything but his own self-indulgence & it is not easy for me to forget that everything I have he has actually claimed the credit for himself.^1(p222)

In 1904, Swan married an old family friend, Margaret Brady, who The Washington Post described as an “accomplished woman,” with “many friends in the city.” The Burnett boys had known her for years as Aunt Margaret.^1(p204) She was the daughter of Jasper B. Brady, who, the Post reported, was a friend of Abraham Lincoln and chief clerk of the Paymaster General's Office.²³ Sadly the new couple had only 2 years together as husband and wife.

On January 18, 1906, after suffering for a few hours from pulmonary edema, Swan died.⁵ He was 58 years old. As reported by the Washington newspapers, the funeral service of Dr Burnett, “the noted oculist and scientist,” was “very simple in character,” though the large parlors of his home at 916 Farragut Sq were filled with “the greatest profusion” of floral wreaths, tokens, and tributes from scores of his friends and professional colleagues. Among his pallbearers were fellow physicians and the US Army Surgeon General.⁹ On hearing of Swan's death, Frances wrote to Vivian:

Oh, it must be peace now—and if souls do meet each other who would meet him first but Lionel? Perhaps he knows all the things I wanted him to know but could never tell him. Peace be with him—Love be with him—God be with him. My darling, darling one, I send you all my heart of love and sympathy & understanding of your feeling. When you are alone with him, kiss him once on his cheek for me. He may know what it means.^1(p244)

In August 1881, Swan wrote what was to become one of his few surviving personal letters (Penny Deupree private collection), to his sister-in-law Edith. It illustrates the essence and character of the distinguished physician well:

You ask if I will tell you about myself. Most certainly my dear, if you want to know. Some how it dont occur to me that I am of sufficient importance to make it worthwhile to enquire how I got along. I dont know as I often stop to enquire myself. That, however, [is] not a good plan, since I think we should occasionally stop on the path of life and take stock of ourselves, as it were and see if we have made any progress. So tonight I will spend a moment or two with you, my dear, in looking at my unimportant affairs. Starting from where we left off together—when I went to Europe and left you in Knoxville—I think I can say that I have made some progress in certain directions. I have a wider knowledge of the world (a very doubtful advance) and have made it acknowledge a few things which I always intended it should. I dont think I am any better—but I have learned how to make people imagine things which dont exist. But there are a few old fashioned notions, dear Trot, which I had when we all lived together in Vagabondia which I am not yet ready to give up. I learned in those old days the value of love, and faithfulness and unselfishness, and my more extended experience has only taught me to value them still more highly. It has taught me moreover that happiness [comes] from within and not from without. And do you know, there have been times when I would have been glad to have gone back to the old days with all its hardness and uncertainty? It held at least hope and confidence and it has not always been thus since we last met. . . . 

I dont make a great deal of money—I dont think I ever shall. A man who makes money must give himself up to that and I never could do that. But I think I can truly say I have a good place in my profession. I think there are few oculists in this country or even in Europe but would know my name if you were to mention it to them—and I think they would speak well of the work I had done. And that was my ambition. I have no other desire for fame than that my friends should love me and that those best capable of judging should speak well of my work.

I do a good deal of literary work in the line of my profession and contribute to the finest medical journals of the day. I am associated in editing the journals published in N.Y. and in Germany by Dr Knapp who is perhaps the finest oculist living. Moreover he is my strong personal friend.

I have established a Dispensary for treating the diseases of the eye—the first one in the city, and am doing more work in that way than all the others combined—When I took hold of it there were only 4 or 5 patients a month and we have now from 20 to 40 patients on every day of service. This of course gives me a large field for study without which I could not get along. . . . 

Now! Dont you think I have talked a good deal about myself? As regards the others, they were well a day or two ago. Frances has finished her play and it will be put on the stage at the Madison Square Theatre, N.Y. about the 1st of October. I hope it may be a success. It has cost her enough in various ways to make it. . . . 

Any news I send you about the President [Garfield, who was wounded in an assassination attempt in July and died on September 19, 1881] will of course be stale by the time it reaches you. I can only say that he is very ill and we can only hope for the best. This is a long letter for me to write, I can assure you, but I thought you wanted it and so I gave it to you. Give my most kind regards to Blanche and to all the members of her family and my love to dear Ned and Frank and accept a great deal for yourself from

Your affectionate Bro

Doro

Although his life has been overshadowed by the writings and celebrity of his wife, Dr Swan Burnett's legacy in the medical field of ophthalmology endures to this day. His intelligence, hard work, and compassion combine to make him a memorable figure in the history of medicine. He will always be best known as the husband of Frances Hodgson Burnett, but he should be remembered for his enduring accomplishments as a pioneering ophthalmologist in his own right.

Correspondence: Daniel M. Albert, MD, MS, Department of Ophthalmology and Visual Sciences, University of Wisconsin–Madison, Room K6/412 Clinical Science Center, 600 Highland Ave, Madison, WI 53792 (dalbert@wisc.edu).

Submitted for Publication: January 11, 2009; final revision received March 11, 2009; accepted March 23, 2009.

Financial Disclosure: None reported.

Additional Contributions: The authors thank Kate Fahl for her hard work gathering and putting together the facts on Frances Hodgson Burnett's life and would also like to thank Swan and Frances's great-granddaughter, Penny Deupree, for giving us permission to reprint their private letters and photographs.