Authors: Noël Browne
This distressing disillusion with my religion was accelerated during my work as Minister for Health. I was left with a clear impression that the Church thrived on mass illiteracy and that the
welfare and care in the bodily sense of the bulk of our people was a secondary consideration to the need to maintain the religious orders in the health service.
The simple reality of falling religious vocations in the Republic, together with the increasing complexity and cost of modern health care, made such continuing control impossible. The necessity
for the replacement of our many run-down hospitals, dispensaries, and clinics was shown up well by the enormous size of our seven-thousand hospital bed building programme. Financially and from the
staffing point of view the religious orders alone could not continue their traditional role of caring for the sick, the aged and the indigent; the state had to intervene. Only public finances could
provide monies for the rapidly expanding scale of medical and paramedical personnel in our projected health services. Our hospitals were old, rundown, ill-equipped, to the extent that they were
more of a danger or hazard to health than they were capable of restoring patients to health.
I had not fully realised the wide measure of control exercised by the Catholic church in the operation of our health services through its nursing orders of brothers and nuns. These were used to
staff the senior administrative and management sectors of the voluntary hospitals, the county and district hospitals, many of our sanatoria, some of our psychiatric institutions, many of the
workhouses and their hospital extensions in the Republic. There were also religious orders who specialised in domiciliary care of the aged and disabled, such as the Sisters of Charity.
The Archbishop of Dublin, Dr John Charles McQuaid, through his control of the religious orders and in his capacity as Chairman of the Board of Directors of a number of Dublin hospitals, had
indirect control of the staffing and the management in the Dublin diocese. His instructions and principles were intended to be observed by the consultants and their patients irrespective of their
religious beliefs. I concluded that this was why, surprisingly in a country which so badly needed it, no serious attempt had been made by a native government to establish an independent Department
of Health until the late 1940s. None of them dared to interfere with or seek to expand or improve the overall primitive level of care within our hospitals and clinics for fear of political
reprisals by the church. It was presumably for this reason also that no attempt had been made to provide a national health service other than that made available at the most crude level under the
old British Poor Law national health insurance scheme. It was notable that even Clann na Poblachta, the latest and most radical of the Republican parties, in its first Clár (programme)
published in May 1948 made no serious reference whatever to our health services, nor did it refer to the desirability of establishing a comprehensive national health service.
Neither did the coalition government appreciate that in appointing as Minister for Health a Trinity Catholic, educated in a Protestant medical school, they had offered what turned out to be a
slight to the Archbishop of Dublin, further compounded by the fact that annually from the pulpit Dr McQuaid forbade Catholics to attend TCD under ‘pain of mortal sin’. Nor did the
coalition government appreciate that in the person of Dr Noël Browne they had a minister who had very clear views about the proper relationships between church and state in a democratic
society.
Little innovation was possible in our health services without the consent and support of the religious orders, and this was rarely forthcoming on my terms. Yet it was clear to all who cared to
examine the reality of our society, such as death-rate figures related to social classes, the death rate from tuberculosis and our infant mortality rate due to gastro-enteritis that the standard of
care in our hospitals and clinics was quite deplorable.
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 Minister 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.