27

Noel Browne, Against the Tide (1986)

In 1948, at the age of thirty-three, Noel Browne became Minister of Health. This occurred on his first day in the Dáil as a TD. Browne’s early life had been defined by poverty and tuberculosis. Both his parents died from TB, his father in 1923 when he was eight, his mother when he was ten. When his mother was dying she moved the family to England and placed them in the care of her oldest daughter. Eileen Browne managed to get Noel into a Catholic preparatory school. From there he won a scholarship to Beaumont College. Beaumont was, in the words of its Jesuit Rector, what nearby Eton College once was, ‘a Catholic school for the sons of gentlemen’. He spent many of his school holidays as a guest of one or other of his classmates. The Irish family of Lady Eileen Chance, daughter of William Martin Murphy, the newspaper magnate who led the Dublin Lockout against Jim Larkin’s trade union in 1913, paid for his medical training at Trinity College Dublin. When Browne contracted TB in 1939 Lady Chance paid for his treatment in one of the best sanatoria in England. His experience as a patient influenced his subsequent medical career.

As one of the two Clann na Poblachta members of the 1948–51 Inter-Party government, the other being party leader Sean MacBride, Browne became embroiled in a controversy over the introduction of free health care for mothers and children, known as the Mother and Child Scheme. This brought down the government in 1951. Browne published the private correspondence between himself and MacBride about the affair. Browne’s accounts of events – first at the time of the crisis and retrospectively in his autobiography Against the Tide – became an anti-clerical equivalent of Emile Zola’s J’accuse. The Mother and Child Scheme controversy became one of the most picked-over events in the history of the Irish State and Browne’s own account was the standard one. Critics of this account have attributed much of the controversy to Browne’s political ineptitude. According to Conor Cruise O’Brien, then a civil servant working for MacBride, Browne was fatally undermined by his own (‘anti-socialist’) party leader.

Browne’s account of his childhood poverty is as striking as the one in Frank McCourt’s Angela’s Ashes. In both cases the narrators who looked back on the chaos, dangers and misery of poverty around the time of Irish independence went on to become educated men; McCourt a teacher in New York, Browne, a doctor. McCourt has been criticised as an unreliable narrator but his childhood circumstances were especially bleak. His father’s alcoholism precipitated and exacerbated the wretchedness of his children’s lives. Browne described his father as having worked himself to death as an Inspector with the National Society for the Prevention of Cruelty to Children in Athlone. The job was physically arduous; it involved cycling long distances and his father suffered from severe pulmonary tuberculosis. He attributed his mother’s early death at 42 years of age to the heavy burden of child-bearing and rearing while being afflicted with the same disease. One of his sisters also died in infancy. After his father’s death the family lost their home. He died in the Newcastle sanatorium where his son later worked as a medical officer. In Against the Tide, Browne describes reading of the hopelessness of his father’s case in his clinical notes:

Because there was no free tuberculosis service then, hospital care had to be paid for. Since there was no hope that the out-of-work patient could pay as his income had stopped with his work, or was simply inadequate, he would be sent home to die. In the process he would infect one or more of his loved ones. Discharge home from a sanatorium was, in effect, a sentence of death for the patient, and possibly for many members of his family. There were frequent examples of families, in desperate hope of saving the life of a loved husband, wife or child, being compelled to sell off their small farm or business in order to pay for medical expenses or hospital care. Consultants would agree to treat patients only so long as they had money; as soon as the money stopped, the treatment also stopped.

The early sections of Browne’s polemical memoir on the relationship between poverty and disease, though written several decades later, recall George Orwell’s classic of the same genre, The Road to Wigan Pier. In Orwell’s case a middle-class narrator inserts himself into the lives of the poor to make the case for socialist social reform. Orwell undoubtedly shaped the facts to best explain his case. Browne sculpted his memoir to explain his commitment to the radical reform of Irish health services. Browne’s above-quoted account of the lack of TB services for the poor isn’t quite accurate. The Tuberculosis Prevention (Ireland) Act (1908) authorised County Councils to establish sanatoria and dispensaries and take a range of measures believed to impede the spread of TB. Services gradually improved. Browne’s father, an ISPCC Inspector, was one of the 700,000 insured persons covered for free medical care under the 1911 Health Insurance Act. The act also provided for free care for those unable to pay.1 Against the Tide does not make this clear in making a broad point about health inequality.

Browne also shared Orwell’s personal austerity. In Against the Tide enemies are described as gluttons. Browne describes an audience with his namesake Bishop Michael Browne, where the Bishop called ‘in his rich round voice’ for a glass of champagne, saying, ‘I always like champagne in the afternoon’ and offered him one of his impeccable hand-made cigarettes. ‘These cigarettes’, he intoned, ‘I had to have made on Bond Street.’ Browne’s cabinet enemy and Labour Party leader William Norton, is described as wallowing in the sumptuous banquets arranged for visiting foreign dignitaries:

My wife and I would watch incredulously as he would call for a second helping of his favourite sweet, a spun sugar confection which stood about four inches high and was shaped like a bird’s nest. With his table napkin tucked firmly into his straining white collar, his flickering brown monkey’s eyes would lovingly follow the waiter and his spoon as he loaded the plate down for the second time. Spoon and fork filled the sugary syrup into his mouth until there remained only the melted warm honey mixture on his plate. This too was greedily scooped into his now slobbering mouth. Like a hungry suckling piglet, frantically probing the fat sow’s belly, spoon and fork were followed by his chubby fingers and last of all his thumb, each of them lovingly and lingeringly sucked dry. Fingers licked clean, he would hold a lighted scarlet and gold-labelled Havana in one sticky hand and caress his well-filled brandy glass in the other. Norton, the worker’s leader, lived Larkin’s ‘Nothing is too good for the working classes.’ But for the Irish worker the good things of life stopped at Norton.

Browne blamed Norton for undermining his efforts to promote the Mother and Child Scheme within government with the argument that he would not support a free health service for those who could afford to pay – a benefit that the fur-coated ladies of Foxrock would be entitled to – and with various other arguments against universal entitlement that were taken up by MacBride and Fine Gael.

Why the Mother and Child Scheme proposal resulted in such controversy puzzled Browne. It had been contained in the 1947 Health Bill drawn up by the previous Fianna Fáil government. It was more modest than the National Health Service reforms that had been implemented in Northern Ireland with little criticism from the Catholic Church. In the United Kingdom the medical profession successfully resisted collectivisation into NHS clinics, in the Irish case no such threat to the autonomy of privately practiced medicine was envisaged. But opposition from both the Irish medical profession and the Church began to gather steam and found expression in a shrill campaign that warned of the dangers of communism and children being forced to submit to intimate physical inspections by state officials. Browne was, as the title of John Horgan’s biography puts it, a passionate outsider who misunderstood and wilfully ignored the rules of Irish politics.2 He joined a small political party that came to hold the balance of power, having only been briefly an activist in a single-issue group of doctors concerned about TB. He describes shocking fellow members of the 1948–51 Cabinet with his opposition to political appointments for unqualified party hacks and friends of government ministers. He was the product of four Catholic schools but professed not to understand Catholic theology or social thought. As he had received secondary education in England and his medical training in Trinity, he did not experience the typical Irish Catholic formation of his medical peers and fellow politicians.

A letter from the Archbishops and Bishops of Ireland on 10 October 1950 to the Taoiseach, John A. Costello, suggested that the proposed Mother and Child Health Service was contrary to Catholic moral teaching and described it as contrary to Catholic social thought. The proposed service, if adopted into law, was described as constituting ‘a readymade instrument for future totalitarian aggression’. Ceding the principle of a state role in the control of health care for families might, it argued, open up the way for birth control and abortion. There was no guarantee that State officials would not give gynaecological care in accordance with Catholic principles.

Browne was outmanoeuvred by the hierarchy. He believed that accommodation was possible. He prepared a memorandum and submitted it to the Taoiseach, intended for transmission to the Hierarchy (‘Protocol insisted that a mere Cabinet minister had no direct access to an Archbishop’s office’) but Browne’s effort at compromise was not passed on. This included a commitment ‘that whatever guarantees the hierarchy wish in the matter of instruction of mothers would be unreservedly given’. On 10 October 1950 Browne was, in his own words, ‘ordered to Archbishop McQuaid’s palace by a telephone call from his secretary’. He was informed that there would be three bishops present and was ‘bluntly told’ that he might not bring his Departmental Secretary. At the meeting on the following day McQuaid read out the letter from the hierarchy to the government and having done so assumed that the meeting was over. Browne argued back, making his case for a free health service for the poor but he also proposed compromises. After the meeting McQuaid depicted Browne as unwilling to compromise his demands for a universal system.

The introduction to Against the Tide made it clear that Browne was neither a diarist nor historian and stated that he had kept no records. Later in his book Browne described how, having resigned as Minister of Health, he destroyed all documents in his files ‘likely to be used or misused’ against him.3 Details of his narrative have been challenged by other advocates of health reform, notably by James Deeny, the Chief Medical Officer who designed and named the ‘Mother and Child Scheme’ in 1947. Deeny had been involved in the fight against TB for a number of years before Browne became Minister for Health. His 1989 memoir To Cure and to Care describes first meeting Browne when he was an assistant medical officer at (but doing most of the work in) a hospital that had changed little over the previous fifty years, having been himself a TB patient and having been trained in top English sanatoria:

He had himself been very ill with tuberculosis himself and was lucky to be alive. Because of this, and for other reasons which at the time I did not know, he was very kind indeed to the patients, who adored him. Most of his professional life had been spent in TB institutions of one form or another, large or small, here and in England. Now, just as patients can become institutionalised, so can staff, and life for such people becomes a matter of living in a small world, with limited human experience and equally limited medical experience.

Deeny may have been right about Browne’s medical career but not about his earlier life. In Against the Tide Browne describes how his childhood was an ‘ephemeral, roller-coaster existence of continually appearing and then disappearing people, landmarks, and relationships’. Whilst very young he had to learn how to form instantaneous, superficially warm relationships with total strangers and form a succession of friendships in different families. When he was catapulted from the rank of junior medical officer to the post of Minister of Health it wasn’t the first time that he found himself in a new milieu.

He claimed in his memoir that within a short period in office he quickly achieved 2,000 new bed spaces for TB patients. Deeny’s memoir described how these had become available after a long period of planning that had begun before Browne entered politics. Browne claimed responsibility for radical improvements in Irish hospitals that Deeny described in detail as the result of efforts over decades of many doctors and civil servants to improve public health services. A number of influential doctors had worked to improve TB services during the early 1940s, including Robert Collis and Theo Dillon, a brother of Fine Gael’s James Dillon, who also took up the issue.4 Against Browne’s ‘one man against the world’ account of his time in government, Deeny emphasised the importance of scientific innovations in disease control and of improvements in the statistical monitoring of infant mortality. He also gave examples of behind-the-scenes conflicts. For example, he describes how in a home for unmarried mothers outside Cork city, 100 babies out a total of 280 born in a single year were found to have died at birth. On inspection infection was found to be everywhere. The home was closed down, its matron (a nun), and its medical officer sacked.

The Mother and Child Scheme controversy provided a simplistic but very influential account of the workings of Catholic power. In the wider analysis Catholic power was never just a matter of episcopal decree but emanated from a Catholic culture that had become the dominant societal one in the century since Cardinal Cullen’s devotional revolution. Catholic politicians saw no need to ask clerics what to do. Catholic doctors like Deeny pursued on-going reform of health services in ways that did not place them in direct conflict with the Church. Catholic control of the education system and health care were seen as strategically necessary for the intergenerational reproduction of this Catholic Ireland. Browne challenged that status quo at a time when most of Ireland’s social and political elite were part of it. His political project was never one directed against Catholicism. It was characterised by a socialist perspective that none of his Cabinet colleagues, certainly not those in the Labour Party, shared. Browne depicted himself as the only impediment to joint plans by the hierarchy and the medical consultants to deprive the public of a badly needed health scheme and while this scheme was important, the real challenge being mounted by the hierarchy was their implicit claim to be the effective government of the country. When Browne made public his correspondence with the hierarchy he brought down the government he was part of. His account of these events entered Irish political folklore and became a crucial nail in the coffin of Catholic power in Ireland.

Against the Tide is a political memoir by an arch-iconoclast who resigned from five political parties. After leaving Clann na Poblachta he tried to join the Labour Party but was blocked by Norton. After a spell as an independent TD he joined Fianna Fáil in 1954, recalling years later that he enjoyed the company of the party’s rank and file. They were mildly iconoclastic and independent and ‘given any chance at all would be first-class material for a properly developed society’. He was a member of the party’s executive under the leadership of Eamon de Valera. He depicted de Valera as the architect of a conservative, sectarian Irish republicanism that bore little resemblance to his and Wolfe Tone’s liberal secular kind. Again and again Against the Tide praises the English for their kindness to him and for their National Health Service. After his expulsion from Fianna Fáil in 1958, he co-founded a new party, the National Progressive Democrats. When this disbanded in 1964 he became a member of the Labour Party. He was elected an independent TD in 1977 and subsequently joined the Socialist Labour Party. He retired from politics in 1982.

BF

Notes

1James Deeny, ‘Towards balancing a distorted record: An Assessment of Against the Tide by Noel Browne’, Irish Medical Journal, 80,8 (August 1987), pp.222–5.

2John Horgan, Noel Browne: Passionate Outsider (Dublin: Gill and Macmillan, 2009).

3James Deeny, To Cure and to Care (Dublin: Glendale Press, 1989), p.161.

4Ruth Barrington, Health, Medicine and Politics in Ireland 1900–1970 (Dublin: Institute of Public Administration, 1987), p.161.