Authors: Noël Browne
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 implementation 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.
A broad white silk shawl covered his frail bent shoulders, falling down on each side to cover his hands, in which he clasped the glinting gold processional monstrance. His dark eyes, glittering
in a masklike face, were transfixed on the shimmering white sacred Host. He had a long, straight thin nose and a saturnine appearance, with an awesome fixity of expression, and the strong mouth of
an obsessional. One shoulder was slightly raised; it was said that he had had a major surgical operation for tuberculosis (possibly a thorocoplasty). Drowsily fantasising on the imposing and
fearful procession in a mixture of dream and nightmare, I was nudged into wakefulness by Laithwaite. ‘What an impressive figure, Noël: would he not make a notable addition to the
distinguished company of Spanish Inquisitors?’
Some strange happenings during the whole period of the mother and child controversy have never been fully explained. For instance, the proposals under Section 26 of the 1947 Act to which Dr
McQuaid and the Catholic hierarchy would later take exception had passed through the Oireachtas uncontested or unquestioned by any member of the hierarchy. Dr O’Higgins made no reference
whatever to what he later described as the ‘socialisation’ of medicine involved. Neither did Dr. O’Higgins contest the mother and child health scheme proposals or refer to any
aspect of the scheme whatever as being objectionable during our discussions in Cabinet on the Amending Bill to the 1947 Act, presented by myself in June 1948. My proposals for the amendment of the
Fianna Fáil Health Act, as was the practice, had been circulated in advance to each member of the Cabinet.
Seán MacBride would later assert that I had gone ahead ‘impetuously’ with the free no-means-test scheme without the consent of the Cabinet. This was demonstrably untrue. The
book of estimates for 1948 notes the sum of money agreed between my department and Mr McGilligan’s Department of Finance. Neither of us could or would have gone ahead with a scheme of that
magnitude without the consent of the government.
Neither has it been clarified why the Taoiseach’s Department never referred to the fact that de Valera had privately received a protest from the Catholic hierarchy, on 6 September 1947,
about the free no-means-test principle of the health scheme sometime
after
the passage of the Act.
It appears that the Catholic hierarchy, on 6 September 1947, had sent a letter privately to the Taoiseach’s office in which they belatedly expressed their disapproval of the new 1947
Health Act and its free, no-means-test proposals. This important letter claimed that ‘for the State, under the Act, to empower the public authority to provide for the health of all children,
and to treat their ailments, and to educate women in regard to health, and to provide them with gynaecological services, was directly and entirely contrary to Catholic social teaching, the rights
of the family, the rights of the Church in education, and the rights of the medical profession, and of voluntary institutions’.
The peculiar feature about that letter was that de Valera did not reply to it until 16 February 1948, that is, nearly five months
after
having received it and a mere two days before the
general election in which his government was to be defeated. In his brief reply he made no attempt to protest about this clear intrusion by the bishops in a matter already decided on by the
Oireachtas, and claimed that the matter was
sub judice
.
Following the change of government, Mr de Valera’s department appears to have made no attempt to warn the new Taoiseach, Mr Costello, about this threatening letter. It is true that in
1951, during the debate on my resignation, Mr Costello for the first time made a vague passing reference to having seen it. Why was it that the Department of Health did not appear to have been
warned of the receipt of that letter? It is possible that de Valera did not choose to disclose the receipt of the letter to the Department of Health, yet he did write a letter to the Minister for
Health, Dr Ryan, now available in the records of the State Paper Office in Dublin Castle. If the civil servants in the Taoiseach’s office knew of the letter, why did they not draw Mr
Costello’s attention to it? If, on the other hand, they did tell Costello of the existence of this protest by the Hierarchy, why did he not refer to it during the Cabinet discussion of my
amending Health Bill in June 1948? If Mr Costello knew of the letter of protest, why did he choose to ignore it? Did he fear the possibility of a conflict in Cabinet? Did he fail to read the file
carefully? Did he fail to understand its implications? Did he understand its implications, and suppress the letter for later use against a troublesome Minister for Health?
While I always believed that a conflict with the medical profession was nearly inevitable, and I was well prepared for it when it did come, I had no reason to believe that there would be
opposition from the hierarchy. Even if I had known I would still have expected the Cabinet to implement the law.
The amending Bill proposed by me to the Cabinet in June 1948 kept the no-means-test principle of the 1947 Fianna Fáil Act as it was. From the centre of the long Cabinet table, beside the
Taoiseach, John Costello, and in the proletarian voice which he affected on such occasions, Bill Norton, the Labour Party leader, shouted down to me, ‘Yer not goin’ to let the doctors
walk on ye, Noël?’ Before I could answer him, the Taoiseach asked, ‘What would you prefer, Doctor?’ I replied that I would prefer to keep the existing proposals, free of
direct charge, and with no means test, already included in the Fianna Fáil Health Act.