Against the Tide

by Noël Browne

  Major defects had frequently been criticised by the chairman of the National Health Insurance Board, Dr Dignan, the Bishop of Clonfert, as ‘reeking of pauperism’. In a plan submitted to the government he called for serious structural rather than mildly innovative changes if we were to end this serious discrimination against the poor. I had every intention of doing all that I could, with or without the approval and support of the Catholic Church, to secure badly needed improvements in the health services. Quite early on in my period as Minister for Health, I was to become involved in a series of fairly minor incidents and disagreements, arising out of the fact that the Church had for so long not been subjected to any serious criticism or examination in her administration of the health services. My most powerful and uncompromising opponent was Dr John Charles McQuaid.

  Dr McQuaid suggested that I should release the nurses who were members of religious orders from the obligation of doing night duty in St James’s Hospital in Dublin. At that time St James’s Hospital was a forbidding run-down emergent workhouse, long established in the city of Dublin. As part of my duties as Minister for Health I made a practice of travelling around to see all the institutions indirectly or directly under my control, and I decided to pay a visit to this sordid work-house hospital. It was surrounded by enormous high prison-like walls. Entrance was gained through a great doorway permanently closed. It was in this doorway, a century or so ago, that a little revolving contraption had been inserted in which mothers placed babies for whom they could no longer care. By turning it around they could send the little child into the awful prospect of almost certain death in the work-house.

  The inmates were dressed in shabby ill-fitting clothing and boots without laces, ignored rather than ill-cared for. The most disturbing feature, with my near phobia of high walls, was the fact that there were dozens of walls honeycombed within the great outside wall. Within these spaces the unfortunate inmates walked about, neglected and mostly disowned. Clearly the building was in the last stages of dilapidation. With the help of Mr Seamus Murphy, the Commissioner in charge of the hospital, we took out the plans of the old hospital within days. With my pencil I struck out all those walls, including the main outer wall which I felt should be removed at once, so that the public could see into the hospital. Later following major reconstruction it became possible to convert the grim institution to the modern St James’s Hospital.

  It was in this old work-house that Dr McQuaid asked me to permit the nuns not to do night duty. I could not accept this request: if the lay nurses could do night duty, so could the nuns. The Archbishop, irritated by my reply, in time removed the nuns altogether from the hospital. We had no trouble in providing lay nurses to do the work.

  An inequitable situation commonly existed in hospitals run by the religious orders, ensuring that lay nurses could not be promoted beyond the position of staff nurse. We made a new order which proposed that the highest nursing posts were to be open to all, and further, that in all hospitals promotion was to depend on professional qualifications and general suitability to the post. There was immediate uproar. Overnight, I became a ‘Communist who wanted to root the religious orders out of Ireland’. The defence of the nuns became a popular cause for craw-thumping councillors and deputies, including the members of the Labour Party. This was yet another occasion in which a minority of Fianna Fáil deputies took a marginally more mature and independent attitude, notably Martin Corry of Cork and Tommy Walshe of Kilkenny.

  The all-party opposition, fanned by the religious orders, suggested that if the nuns were removed from these supervisory positions the standard of care in the hospital and even the moral standards among the nursing staff would collapse. I pointed out to the deputies and councillors that they were being personally offensive in denouncing as incompetent, immoral, undependable and irresponsible their own daughters, their own sisters, and even their own working wives. These were all at present being victimised as lay nurses by this discriminatory system. Depressingly, our enlightened proposals were not supported by the nursing profession for whom I had specifically taken such action. Not one was prepared to stand and fight publicly on the issue or to give me any support. The Irish Nurses Organisation made no attempt to defend the proposals.

  Under the enervating influence of their homes and schools, general hospital nurses in Ireland developed the true docile ‘slave’ mind, in contrast to the members of the psychiatric nursing profession who had created their own independent trade union to defend their interests. The general hospital nurse for years held a snobbish attitude to trade union activity, as had the medical profession. Trade unionism was not ‘quite right’. The nurses overlooked the reality of the enormous power of the doctors, through their social, personal and political contacts. They did not need trade unions.

  Our decision to proceed with the building of St Vincent’s Hospital at Elm Park led to another clash. The superior of the Sisters of Charity, backed by the solicitor Arthur Cox, sought to retain their old hospital buildings in St Stephen’s Green. I understand that they hoped to use the building as a private nursing home. A formidable and prestigious deputation, which included the Reverend Mother, Arthur Cox, members of the Board of the National University and the hospital consultant staff, met us at the Department. I had also been lobbied by my Cabinet colleagues. I declined their request to retain the old building in Stephen’s Green, pointing to an agreement which a predecessor of mine had already made with the religious order. In recognition of monies granted, St Vincent’s Hospital had been conceded to the Department of Health for disposal as it wished. I informed them that the old hospital could readily be converted into an old persons’ home, sited as it was in the city centre. Disappointed, no doubt, the deputation departed, but they were successful with another Minister for Health. Some years later I noticed that the old hospital building had been converted into a modern office block called Seán Lemass House. Such are our priorities.

  It is also possible that I had been a source of irritation to Dr McQuaid because I had declined to visit Rome during the Holy Year, 1950. Each of my Cabinet colleagues had made the journey. In Rome they were photographed in full white tie and tails with the Pope, and the photographs were ‘expressed’ back to the national and provincial newspapers. Because it appeared to me that my colleagues were flaunting their religion for political reasons, I did not travel. As part of his duties as Foreign Minister, Seán MacBride was photographed at the formal opening ceremony of the Holy Door.

  I next drew Dr McQuaid’s attention to the problem of children who had temporarily lost their mothers following their admission to a sanatorium with tuberculosis. This traumatic separation could last up to two years. It was my hope that Dr McQuaid would persuade one of the religious orders to visit the houses of those families. The nuns could prepare breakfast for the children and help those going to school; in the evening they could have their supper cooked, help them with their homework, then put them to bed. The children would benefit from the presence of a mother substitute. Dr McQuaid declined to help. Unbelieving, I listened to his bizarre explanation. He claimed that the sight of nuns going into a home where the wife was known to be absent in a sanatorium with tuberculosis ‘would give scandal’.

  As with the nurses on night duty, we had no difficulty in getting lay women to do this work. It is surely a strange irony, in the context of Dr McQuaid’s peculiar decision, to recall the fine work done through the centuries by the French Sisters of Charity in their domiciliary care of those in need among the poor of many cities of Europe.

  Following the decision to proceed with our long-delayed and badly needed Children’s Hospital at Crumlin, I tried unsuccessfully to transfer control of that magnificent new hospital to the more democratic supervision of the Dublin Health Authority and the Local Appointments Commission, instead of exclusively Catholic control by the Archbishop of Dublin and his nominees. I was to find that this control had already been designated to the Archbishop by Seán T. O’Kelly, when he had been Minist
er for Local Government and Public Health, and I had no choice but to honour his signature. The virtue of control by a Health Authority is that the appointment must be made on merit by the Local Appointments Commission. This Commission was one of the few valuable contributions to ensuring that fair and just decisions are taken in the matter of local authority appointments, and was established by the first Cumann na nGaedheal government. On the other hand, medical appointments in the voluntary hospitals are commonly made on hereditary or sectarian religious grounds — the Protestant-dominated hospitals through the Masonic Order, and the Catholic through the reverend mothers, members of the hierarchy or the Knights of Columbanus. Quality of personnel and patient care becomes a secondary consideration.

  Some time later, one of my Cabinet colleagues asked me to receive a well-known and popular Capuchin Father, who wanted me to visit the Bon Secours Hospital, then just completed in North Dublin. Since the whole enterprise was sponsored by Dr McQuaid, this was a surprising request. The Reverend Mother kindly offered to show us over the hospital. It was clear that it was an excellent one in every way for its time, and it was to be staffed by a chosen panel of physicians and surgeons, all Catholics, no doubt.

  We returned to the Superioress’s office for tea, and began discussions about the cost of hospital building at the time. Then we discussed the future use of the hospital. The Reverend Mother referred to her genuinely fine achievement in having built and equipped the hospital; the approximate cost amounted to about six million pounds in present terms. This was a considerable sum, but reasonable for the size of the hospital. To the astonishment of the Reverend Mother and to the delight of the Capuchin present, who had acted as entrepreneur, I made light of the sum, and offered to pay it from Department funds. I informed her that there was only one condition: that the hospital would be administered by Dublin Corporation and would be open for use by the general public.

  The Reverend Mother’s beaming smile was replaced by a look of mystified pain. Distinctly unsmiling, she dismissed my proposal. The ‘lower orders’ must be excluded from this hospital; it should be used for middle and upper class patients exclusively. It certainly was hard to credit that for reasons of class alone this Reverend Mother had declined my offer, not only of a cheque for the equivalent of six million pounds, but of the chance to give her life to the care of the sick poor of Dublin.

  I then became involved in an unseemly sectarian struggle. It appears that an ‘ambush’ had been contrived by the Knights of Columbanus, who were said to be ‘close’ to the Archbishop at that time, to swamp the Board of Management of the predominantly Protestant Meath Hospital with Catholics, and convert it into a Catholic hospital. The ambush was prepared through a use of membership qualifications, and was to take place at the annual meeting of the hospital. The Meath Hospital at the time was notoriously bigoted and Protestant in its appointment preferences. It was in dire financial difficulties, and sought help from my department. After consideration of all the issues, I agreed to help, on the condition that neither religious sect could have overall control of the hospital. We would introduce the Meath Hospital Bill into the Dáil, and would require a governing board of thirteen members. Of the thirteen, seven must be nominated by Dublin Corporation, thus ensuring that control of the hospital would not be under the control of either of the religions.

  There were exceptions to this kind of behaviour by the religious in Ireland. Publicly I have acknowledged the scope of the work done by religious orders for the mentally handicapped. We allocated considerable funds to the St John of God’s order both for reconstruction of old hospitals and the building of new ones where required. But it was unfortunate that in Ireland we were taught to believe that religious orders had a monopoly of concern and compassion for the sick, the disabled and the aged.

  Health had already been a contentious issue before I entered Leinster House. In 1946 Dr Con Ward, Parliamentary Secretary to the Minister for Health, Mr MacEntee, had introduced a Health bill which was opposed by Fine Gael, who tabled so many amendments that the government was compelled to withdraw it. Dr Ward resigned from office shortly afterwards.

  There was no doubt in my mind that the various compulsory proposals in the Bill — compulsory notification of tuberculosis, inspection of residences and homes, restrictions on the right of tubercular patients to travel on public transport or to attend without notification public gatherings, whether in churches, cinemas, or theatres — were all dangerously unnecessary infringements on civil liberty. They were also impractical. Hotel and guest-house owners would be forced to spy on and notify the authorities if a resident designated in the Bill as a ‘possible source of infection’ was staying in their hotel. The panic nature of these proposals, with the implied suggestion that tuberculosis had become virtually uncontrollable, was a measure of the government’s failure to cope with the epidemic.

  From the public health point of view the effect of such compulsory notification would be to drive this very infectious disease underground, which would increase and not diminish the possibility of its spread. The penalty clauses would encourage people to conceal their tuberculosis, and to delay diagnosis if it meant that they would become an outcast in the community. Correspondence about these compulsory proposals took place in the Irish Medical Journal between myself, as a medical officer in the tuberculosis services, and Dr James Deeney, Chief Medical Adviser in the Department of Health. It was the first occasion on which I had been involved in controversy in the public press.

  Following the withdrawal of the Bill, Fianna Fáil introduced the 1947 Health Bill. It was from this fine piece of legislation that we were to derive our power to introduce both the free no-means-test provisions for the tuberculosis scheme and the controversial mother and child scheme. The main opposition to the 1947 Health Bill was led by James Dillon. He opposed particularly the power given to local authorities to compel children to submit themselves for medical examination in schools. The Bill also sought to limit the present constitutional right of parents to send their children to primary schools at all. On the principle that any interference whatever by the state, in either health or educational matters, was unwelcome, this opposition was supported by the Catholic Hierarchy. It was their opposition to these clauses which led to the confusion later, in 1951, as to whether the church had protested against the mother and child proposals in part three of the 1947 Act.

  On becoming Minister for Health I was determined to extend the no-means-test principle of the 1947 Act to the health care of mothers and their children. Knowing what had occurred in Britain, where the British Medical Association had opposed Aneurin Bevan’s National Health Scheme, and in the United States where the medical profession had successfully opposed Truman’s health proposals, I warned the members of the coalition that the passage of the mother and child scheme would not be easy.

  It is important to clear up some of the misconceptions about the mother and child health service. I first entered the Dáil early in 1948, after the 1947 Health Act, which permitted the introduction of the mother and child health scheme, had become law. During the passage of the mother and child health proposals through the Dáil in 1947, the bishops did not contest those issues. It is true that the church did protest during the passage of that Act in 1947, but only about the relatively minor matter of the powers to introduce compulsory school medical inspection. It is also true that the Irish Medical Association had opposed the passage of the 1947 Bill on the grounds that they considered it to represent the ‘socialisation of medicine’. The Irish scheme would have been even more advanced in its basic principles than the Bevan national health scheme. The British scheme operates on an insurance principle: everyone must make an insurance contribution. Our scheme would have introduced a genuinely socialist redistribution, paid for out of general taxation. This already existed in primary education, childrens’ allowances and the T.B. and infectious fevers health facilities.

  There were two main personalities in the conspiracy to subvert my imp
lementation of the free no-means-test mother and child scheme which the 1947 Act had authorised, representing two of the most powerful pressure groups in our society. One was the Minister for Defence, Dr Tom O’Higgins, who represented the Irish Medical Association. The other was Archbishop John Charles McQuaid.

  Dr O’Higgins was probably the most experienced and shrewd politician in the Cabinet, and his advice was respected and listened to by the Taoiseach. He was a brother of Kevin O’Higgins, the Cumann na nGaedheal Minister for Justice assassinated on 10 July 1927, and had been Minister for Finance in the same government. A doctor from a rural medical family, he had been a member of the Executive of the IMA. It was this link between the Cabinet and the medical profession which was to be an important relationship leading to the defeat of the mother and child health proposals.

  Dr McQuaid ruled his archdiocese with an unbending conviction that his rigid, triumphalist, conservative approach to Catholicism was the only appropriate stance. He had family associations with the medical profession, and would instinctively sympathise with the doctors in their campaign against the threat of socialised medicine. Of even greater importance was that he considered the health scheme an encroachment by the state on the church’s role, which he considered to be, among much else, ‘to determine and to control the social attitudes of the family in the Republic, especially in the delicate matters of maternity and sexuality’.

  Let an old Clongownian, the then British Ambassador Sir Gilbert Laithwaite, join with me in describing Dr McQuaid. We were at High Mass in the Pro-Cathedral. The Archbishop approached in procession, with all the panoply of the church ‘en fête’: the demure child acolytes, the robed clerical students, the imposing shining gilt crucifix carried by its tall student bearer. Scented incense rose from the gently moving thurible. Embroidered vestments glowed, bejewelled, ornate and colourful, on the supporting clergy, the distinctive insignia of office of ascending seniority and importance. They contrasted with the stark archaic chalkwhite of the formidable Dominicans and Carmelites, the reassuring benevolent brown of the Franciscan friars. And at its heart walked the Archbishop of Dublin.