Remembering the dark history of our hospitals to plan for a better future

Recent debate on RTÉ's Live Line about the case for a decent burial for the Irish giant, Cornelius McGrath, casts a light on how doctors portray the history of medicine.

Until recently, narratives were upbeat and positive, delineating progress and advances in the face of adversity and hardship.

This is exemplified by the Meath Hospital, the most celebrated of the voluntary hospitals founded in Dublin in the 18th century. The list of achievements of the hospital is impressive, particularly during its golden age (1826-43) arising from the remarkable partnership of two celebrated physicians, Robert Graves and William Stokes.

Dynamic, innovative and mutually supportive, they introduced bedside teaching to the English-speaking world, produced several key textbooks, described the syndromes of Graves disease and Stokes-Adams attacks, and oversaw radical changes in treatment.

Nepotism, sectarianism and divisive politics were part of its very fabric

Although the intensity of innovation was not sustained after their departure, the hospital remained central to clinical and academic medicine in Dublin. In the 20th century it was the first Irish hospital to provided dedicated services in liaison psychiatry, urology and acute stroke: it hosted key research on Helicobacter Pylorii in the 1980s.

After amalgamation with other voluntary hospitals and moving to Tallaght in 1998, proceeds from the sale of its site were channelled into the Meath Foundation, which continues the tradition of innovation through research and arts and health programmes in the new hospital.

Yet there is a darker aspect to this history, one more clearly delineated by historians who are not physicians. Nepotism, sectarianism and divisive politics were part of its very fabric, and yet these facets of its tradition rarely find expression in our professional discourse.

Medical staffing in such charitable hospitals was largely confined to those of the Protestant faith when the vast majority of the population was Roman Catholic. This bias was further exacerbated in the Meath by an arrangement whereby the medical board appointed their own successors in return for declining an annual payment of £100.

The new hospital board, packed with Catholic representatives for the first time, set up a new panel for the appointment

This led to frank nepotism and a remarkable persistence of some surnames (such as Stokes and Smyly) in the gilt and wood panels in the hallway of the hospital. A particularly egregious appointment in 1861 held a surgical post vacant for the under-qualified son of one of the surgeons, Josiah Smyly: this raised bitter discourse in The Irish Times and the House of Commons.

Although not remunerated, the reputational advantage of a position in a teaching hospital was enormous in terms of attracting private practice.

This sectarian nepotism continued through independence until 1949. At this point, frustration led the Knights of Columbanus to exploit a loophole which permitted any member of the public to become a director of the hospital for a modest fee.

The new hospital board, packed with Catholic representatives for the first time, set up a new panel for the appointment of the assistant physician and surgeon posts, heretofore the usual pathway for the favoured candidates for permanent posts.

Medical and legal chaos ensued, with assistant physicians and surgeons from both regimes in a fractious co-existence: at least one tragic death was linked to this disharmony. The government finally stepped in and legislated for a secular governance board, with more standard procedures for appointment of medical staff.

Without denying their often remarkable achievements, we see a fuller picture of how doctors perceive themselves

Exploring these twin aspects of the history of the Meath Hospital is valuable in many ways. It highlights the development of medical history from a doctor-centred study of positive achievements towards a more balanced perspective benefitting from the techniques of vocational historians.

In so doing, without denying their often remarkable achievements, we see a fuller picture of how doctors perceive themselves, often unaware of failing to recognise the intertwining of their social, economic and personal interests with protestations of professional autonomy.

Reading the contemporary defence by Meath Hospital physicians of practices that we would now recognise as unacceptable is salutary: we should avoid self-congratulation and reflect as to whether we give due recognition to our own conflicts of interest. A series of Irish studies detailing differences in medical treatment for public and private patients should give due cause for reflection.

Moving from the gentleman antiquarian model to that of interdisciplinary research in medical history requires an investment in time and energy, as exemplified by the medical humanities initiatives in many medical schools.

However, learning from the complex and multi-layered history of our great hospitals can assist us in formulating a better future for the profession and health systems. Such narratives reinforce Santayana’s aphorism that progress, far from depending on change, depends on retentiveness.

This column is based on a paper in Hektoen International: Prof Des O’Neill is co-chair of the Medical and Health Humanities Initiative in TCD