22/07/2018 - The following written by Kevin Higgins is based on research undertaken by him over the last four years and is part of a much larger work. It gives us a clearer view of how the Tuam children were treated including my own sister and makes it even more urgent that a full exhumation takes place. An Inquest must be convened and post-mortems conducted to determine how the Children of the Tuam Home died.
Kevin Higgins has acted as my solicitor in the only litigation involving Mother and Baby Homes which has so far come before the High Court. Those proceedings will continue.
Peter Mulryan, Chairperson, Tuam Home Survivors Network.
Dr Thomas Bodkin Costello (and Friends)
Dr Thomas Bodkin Costello, local worthy, doctor, enthusiastic antiquarian and by popular acclaim, all-round 'good egg', became Medical Officer to the so-called Mother and Baby Home at Tuam when it opened in 1925. He had previously been Medical Officer to Tuam Workhouse, for many years, housed in those same buildings until its closure in 1921.
While we know from a number of disclosures in recent years, that any records kept by the Bon Secours Order when they managed the Home over thirty-six years, must be viewed with distrust, we should be able to treat official State documents with some credibility. In this instance, we should be able to look at the Death Certificates for 796 children issued by the State itself between 1925 and 1961 with some confidence. These Certificates deal only with those children who died within the Home itself and give no indication as to the life span or health and welfare of any child who left the Home. Furthermore, there is no certainty that the 796 Death Certificates available reflect the deaths of all children which occurred in the Home.
The causes of death which appear on the Tuam Certificates are very varied and many are deeply troubling. What is almost beyond belief is that despite the awful circumstances and causes of death of 796 young children, which were certified, in the course of thirty-six years, only two Inquests, one in 1925 another in 1928 and only three post mortems; one in 1926 another in 1927 and a third carried out in 1952 two years after Dr Costello's official retirement. This despite the fact that starvation or marasmus is the certified cause of death in no fewer than 14 cases.
There is no evidence of the attendance of Dr Thomas Bodkin Costello at the birth or death of a single child. Today, the infant victims of the many famines that constantly affect parts of the globe, could be said to have ultimately died from 'debility' rather than the violence, disease and famine caused by the main actors in geopolitics, but it does not reflect the actual truth. In the case of Tuam, 'debility' in the case of so many children may have more to do with the appalling conditions which prevailed within the Home, malnourishment, a lack of proper medical care and simply neglect and indifference to their condition or fate.
Tuam regrettably does not have an eye-witness account equal to that of the remarkable Dr James Deeny, first Chief Medical Office of the Department of Health who encountered the reality of Mother and Baby Homes at Bessborough. Writing in his 1989 Memoir, To Care and To Cure, he recalled that puzzled by a local spike in the figures for infant mortality, he traced it to the Home run in Cork by the Sisters of the Sacred Hearts of Jesus and Mary. In an unusual step for the Chief Medical Office of the State he visited Bessborough in person and was initially charmed by the place. His own account from his 1989 book cannot be bettered.
For example, going through the returns for infant deaths in Cork, I noticed that there was something unusual and traced the matter to a home for unmarried mothers at Bessborough outside the city, I found that in the previous year some 180 babies had been born there and that considerably more than 100 had died.
Shortly afterwards, when in Cork, I went to Bessboro. It was a beautiful institution, built on a lovely old house just before the war and seemed to be well run and spotlessly clean. I marched up and down and around and about and could not make out what was wrong; at last I took a notion and stripped all the babies and, unusually for a Chief Medical Adviser, examined them.
Every baby had some purulent infection of the skin and all had green diarrhoea, carefully covered up. There was obviously a staphylococcus infection about. Without any legal authority I closed the place down and sacked the matron, a nun, and also got rid of the medical officer. The deaths had been going on for years. They had done nothing about it, had accepted the situation and were quite complacent about it.
While Tuam had no Dr Deeny, it did have Julia Devanney, who lived in the home until the day it closed and whose recorded voice preserved on old reel to reel tape tells of the green diarrhoea flowing from toddlers who moved about the home without nappies.
Remarkably over the thirty-six year period of the Tuam Home, the informant on each Birth Certificate and each Death Certificate is that of Bina Rabbitte an unfortunate who had been in the control and service of the nuns since she was a child and remained there until the Home closed. The fingerprints of the good sisters do not appear on any such document.
Born in 1864. Dr Costello had graduated in Medicine in 1888. His private patient list was that of the good and the great and/or those who could afford his services. He also held the position of physician to various official bodies. These included the Royal Irish Constabulary, the Post Office and later the Civic Guard (An Garda Siochana) of the Irish Free State. He was a busy man and the amount of time spent in the Home is questionable. What is noticeable is that after his departure from the post, following his eighty-eight birthday, the number of deaths in the Home described as being caused by the convenient short-hand of debility are exactly nil.
Dr Costello of course was medical attendant to the Tuam Workhouse prior to 1925 and slipped easily with the passing of the old regime from being doctor to the Royal Irish Constabulary to doctor for the Civic Guard; from Workhouse doctor to being doctor for the Children’s Home. For such as Dr Costello belonging to a privileged professional class the transition from British dominion to Free State was seamless.
Highly regarded as a scholar, he contributed to many archaeological journals, was elected President of the Old Tuam Society, a member of the Royal Irish Academy and the National Museum of Ireland contains a number of items from his personal collection. He was a friend of Douglas Hyde, Founder of the Gaelic League and first President of the Irish Free State and of many other notables who joined the Gaelic League and indeed of Nobel Laureate W.B. Yeats.
It is surprising that his many interests left him much time for the practice of medicine, at least at the Tuam Home. Dr Costello belonged to comfortable and deeply conservative Catholic middle class, which redirected Irish Nationalism in the years after 1916. By the time the Irish Free State came into being, the revolutionaries, poets and dreamers were largely dead or quite literally outlawed and supressed with a ferocity that matched anything British imperialism had inflicted on the Irish populace. What is chilling however, is Dr Costello's statement during his time as medical attendant to the Tuam Home in giving his professional opinion, that there was nothing unusual in half of all children dying before the age of five.
From the very beginning the members of the “Local Board” which funded the Tuam Home were every bit as exercised as the Poor Law Guardians of the Workhouse had been about the cost of keeping children barely alive. The Connacht Tribune report of October 13th 1928 captures the outrage of Board members at the cost of maintaining children in the Home and their almost apoplectic spasm at the cost to the State at keeping them alive until the age of fifteen when 'boarded out’.
Luckily Dr Costello was available to provide reassurance that the children of the Home would not be such a burden on the public purse. The published report records him telling the members that it was the international norm that half of all children worldwide died before the age of five. It may have been the case that Dr Costello was a little out of touch or simply complacent that the death rate among the Tuam children was during some periods, merely four or five times that of the national average. Whatever his reasoning, Dr Costello clearly did not have extravagant expectations for the children under his care.
Dr Thomas Bodkin Costello whatever his personal virtues and talents exhibited an appalling degree of indifference in respect of the death toll in the Home, though in fairness to him there is no evidence that there was even a ripple at the level of any office in local or national government at the evidence that children were certified as dying from starvation, or that it led to any intervention. However, what emerges from even a cursory examination of the 796 Death Certificates for the children of the Home is very worrying. Where the specific causes of death are clustered and attributed to something such as measles they must be regarded as credible. Being highly contagious and at a time when treatment was poor, this is not unduly surprising.
Many of the apologist explanations for the death toll in Tuam point out that babies and infants were accommodated in poor and crowded conditions not uncommon at the time, where illnesses such a whooping cough virus could have been expected to run amok. The “Home” did not provide for quarantine or isolation but let 'nature' take its course. Deaths from whooping cough are recorded at intervals in some small clusters, The incubation period of whooping cough is generally seven to ten days and we can agree that Dr Costello may have then correctly identified it, despite the fact that it occurs without fever or inflammation. There are secondary and third phases, to this historic killer, the last being one of recovery if the patient survives.
What jars is the certification of death on the same day of two young girls both described as four-and-a-half-years old (in an institution where over 79% of children did not survive to one year), almost certainly unvaccinated and having allegedly lingered with whooping cough for eight weeks. Had they survived, the recuperation period could certainly have taken that time, but they did not and having reached the third stage, they would not have died from it. It may be some consolation to think that both are enjoying retirement in some sunny American state as a result of the child-trafficking business conducted by the Bon Secours, or not.
From the 5 of April 1926 to 30 April 1926 measles is recorded as taking the lives of eighteen children, some undoubtedly because they were unnecessarily exposed to the sickness that killed them. The dreadful practice of allowing children with communicable sicknesses to remain in unsegregated wards continued for decades and undoubtedly caused many further deaths. There is no evidence however to suggest that measles could not have taken such a toll. What is a little surprising is the length of time Dr Costello appears to state that a child suffered from measles before succumbing to it. It is difficult to accept that a young infant could have fought measles for ten weeks before dying. It simply flies in the face of general medical knowledge.
While it raises another issue, the period which frequently elapsed between the date on which a child was said to have died and the date of registration of their deaths by the local Civil Registrar was well beyond the norm. This among other factors raises an inference that the signing of Medical Certificates certifying cause of death was often done some considerable time after the fact of death, on information later supplied to Dr Costello, rather than on foot of his attendance and treatment of a child prior to, or at the time of death. Prior to the examination of the half-yearly Registers, the 'Local Board' received no immediate notification of death, even after the enactment of the Registration of Maternity Homes Act 1934, which required it to be done within twenty-four hours. In any such intervening period of course, the Bon Secours Order was paid a capitation fee for that child, who was deemed to be alive and in the Home. Fraud was the norm rather than the exception. This is transparently the case. Registration and the issue of a Death Certificate are often much later than the date of death. No audit, cross-referencing this documentation with the capitation fees paid to the Bon Secours was ever carried out by the State.
In writing his Medical Certificates certifying cause of death. Dr Costello could dazzle with his Latin terms: cause of death for instance varicella, which to the layman means chickenpox. Again a highly contagious disease in crowded and poor conditions. Dr Costello however, in certifying it as the cause of one child's death, seems to suggest that it lasted up to five months, before finally taking its life. It did not.
A child is certified as dying from sub-cutaneous abscesses almost half a century after it was practice to successfully drain such abscesses by means of one of the earlier versions of the Penrose-drain. One slightly surprising aspect of the Tuam records is the lack of a single reference to polio or poliomyelitis as Dr Costello would undoubtedly have called it. The deplorable and unhygienic conditions endured by children in Tuam might have been a breeding ground for this awful disease. But perhaps it did not register on Dr Costello's radar. The first polio vaccine was not introduced to Ireland until 1957 delivered orally to children on a sugar lump. Whether any children of the Tuam home ever received it prior to its closure in 1961 in uncertain, but a not single death is recorded over thirty-six years.
The number of Death Certificates however, in which meningitis is given as either as the cause or contributory factor in a death, suggests that he may not have recognised instances of polio; meningitis frequently being caused by the onset of polio. The outbreaks of polio in Ireland which are recorded during the period in which the Home operated, did cause significant loss of life (and indeed severe incapacity in later life for those who survived). It is a little surprising that an environment such as Tuam should have escaped. What is indisputable is that the unfortunate children in the Tuam Home received medical care at a standard well below that received by the general population and even further below that received by those who had the means to purchase decent care. What is also clear is that the causes of death on the alleged Medical Certificates are themselves suspect.
A much favoured explanation of the cause of death by Dr Costello as the Certificates show was debility. It is stated to be the main or contributory cause in the deaths of 193 of the 796 or some 25 % of the children registered as dying in the Home. The figure of 193 is provided by the Report of the Inter-Departmental Committee Report of July 16 2014, published in the wake of public concern over revelations about Tuam. In systematically going through the deaths registered from such a cause it is difficult to avoid the conclusion that this was little more than a label of convenience used to explain the deaths of so many children.
If we add to the numbers of those certified to have perished from 'debility' to those whose deaths are attributed to their being 'congenital idiots' and those certified as dying from starvation we arrive at a total of 221 deaths out of recorded 796 deaths.
There will be resentment in some quarters at this unflattering examination of a doctor who was such a significant figure in Tuam and somewhat iconic figure in Irish cultural circles and polite society. It might be said that such an appraisal is made with hindsight, unfairly and without regard to the realities of the time. Not true.
Writing in the Sunday Independent Life supplement shortly after the first public shock at the details of the Tuam mass grave, Dr Maurice Gueret Editor of the Irish Medical Directory argued for a more measured response. He noted that: I have been able to do some of my own research from old editions of the Irish Medical Directory and archives of local newspapers of the day.
The following extracts from his piece are in italics
A Grave Matter 29th June 2014
(1) If this country is to hold its head up high a century after independence we need to start manufacturing a lot more than outrage. Our reaction to the story of 800 deaths over four decades at the Tuam mother and baby home has not been proportionate....
(2) a newspaper arranging to do a radar survey in a graveyard does little to bring clarity to a complicated story.
(3) ... it’s no secret that many children died young especially in the 1920s and 30s. They were dying all over Ireland from infectious diseases. Principal causes were TB, Dysentery, Diphtheria Meningitis, Bacterial Pneumonia and complications of Measles and Polio.
(4) It was no state secret that orphanages that looked after large numbers of vulnerable children mostly under the age of five had higher death rates than the community at large.
(1) I have no idea if Dr Gueret has changed his view in the intervening four years but his research might have told him that the Home remained open for thirty-six years and not 'over four decades', if by this he meant forty years and I cannot agree that 'our' reaction has been disproportionate.
(2) The ground radar survey commissioned by the Irish Mail on Sunday newspaper, brought a great deal of clarity, identifying the area which an excavation later ordered by the Commission of Investigation, disclosed as a mass grave.
(3) Indeed it is a fact that many children in the 1920s and 30s died young, but the children in the Tuam Home were dying at various times at four and five times the rate of children in the worst Dublin slums. Furthermore, despite the many young lives they took, Dr Costello did not certify a single case of either Diphtheria or Polio or Dysentery (though he did record deaths from gastroenteritis), despite the fact that a vaccine for Diphtheria was not introduced to even part of the general population until seven years after the Home had opened and a polio vaccine until some thirty years later. This is distinctly odd, Dr Gueret correctly identifying both, as do all reputable statistics, as deadly and frequent killers of children during the relevant period.
(4) The Irish State has never created or administered a single orphanage. All orphanages described and operating as such were administered by religious bodies almost all of them by orders of Catholic nuns. Tuam was not an orphanage, it was a penal institution created by legislation of Dail Eireann and run without interference, by the Bon Secours nuns and I like many others, reserve the right to be outraged to any degree I see fit, at their treatment of the children who died in such numbers under their control. The fact that various arms of the State knew of this death toll does not diminish the right of those only lately aware of such horror, to be outraged in proportion to the degree of that horror.
With respect to Dr Gueret's apparent view that the horror of Tuam has led to manufactured outrage, my own outrage is entirely instinctive but reinforced by my having the privilege of knowing survivors of all the major 'mother and baby homes' and others who lost family members in an obscene Irish creation. Should Dr Gueret wish to meet some of them, I have no doubt that it can be arranged. What may surprise him, as it has others, is the immense humanity of those people and may cause him to wonder, as to how such balanced, intelligent and decent human beings, could have emerged from the treatment they received in such a vile system. But their outrage is neither manufactured or out of proportion.
And yes, on a crucial issue, Dr Gueret is correct, the great and the good were aware of this human carnage and for confirmation, we have the following contribution from Dr Robert Rowlette TD in Dail Eireann on 23 April 1937:
It is satisfactory that the infant death-rate has shown improvement. But there is one black spot in connection with this statement of the infant death-rate, to which one, cannot but draw attention. According to the information from the Minister's Department the infantile death-rate is three-and-a-half times as great in the case of illegitimate children as in the case of legitimate children.
Comment is made on that in the report of the Department in the following words: "Doubtless the great proportion of deaths in these cases is due to congenital debility, congenital malformation and other ante-natal causes traceable to the conditions associated with the unfortunate lot of the unmarried mother." I do not know on what that is based. I do not know of any evidence that will prove that there is greater general congenital debility or malformation in the illegitimate child than in the legitimate child. I suggest the difficulty is not ante-natal but is rather post-natal, that is, the lack of care given to the illegitimate child compared with that given to the child that is more welcome.
I know it is a difficult problem but I do not know whether any particular attention is paid to it, or whether any particular scheme has been tried to ensure that these children whose lot, at best, should call for sympathy, are given the same chance, or nearly the same chance as the legitimate child in getting through its first year of life. It is a disgrace to a civilised country, and to a Christian country like this, that three-and-a-half times more illegitimates are condemned to death in the first year of their existence than legitimate children. The responsibility rests upon the community. I press upon the Minister the necessity of taking special steps to deal with this blot on an otherwise satisfactory report in regard to infantile mortality.
So spoke Dr Rowlette in the national parliament 81 years ago. He was of course correct; there was no evidence to support the spin which the Department put on the grotesque death-rate among the most vulnerable children. From whatever documentation remains, and the State has taken every step it can to hide it, it is clear that many of the Death Certificates for the children of Tuam are works of fiction. To compound the difficulties of unearthing the truth, the original obligatory Medical Certificates appear to have vanished, all of them. All that remains is a short description of the cause of death on the face of the Death Certificates. The Medical Certificates, required to be produced, before a Death Certificates could be issued, are nowhere to be found.
What the documentation tells us about the medical attention to children in the Tuam home is that there was an absence of proper or adequate care. That Dr Costello's role was largely one of certifying their deaths. That his Medical Certificates, were frequently signed in batches sometimes a considerable time after the children had died and their bodies disposed of. In part, it is the absence of some illnesses among the 796 certified as dying in the home, which betrays Dr Costello. Even after all these years an independent epidemiological study of those deaths will help in giving us a clearer picture and one more likely than not of an even greater horror than that exposed to date. Such a study would neither be costly nor take a great deal of time.
The 'explanation' offered by the State that the death rate among 'illegitimate' children was that they were prone to congenital debility and malformation, simply because their mothers were unmarried is truly appalling. It is no more than a philosophical hair's breadth away from the Nazi attachment to and practice of eugenics and the slaughter of those born with a mental or physical handicap, then being pursued in Nazi Germany. If we are to give any credence to the State's official view, we would have to accept that there was something in the DNA of these children, which set them apart from the offspring of married Irish women.
There is no doubt of course that unmarried mothers were stigmatised and suffered a great deal. What the Department Report does not say, is that it itself, had under its own legislation deemed unmarried mothers to be 'offenders' and specifically excluded them from any form of State relief if they refused to enter Magdalene laundries as slave labour, under the provisions of the Local Government (Temporary Provisions) Act 1923. That under that legislation it offered mothers a choice, imprisonment and slavery under a religious order, or starvation. That Act was not finally repealed until the year 2000, the first year of the third millennium
In the first days of media activity over the Tuam mass grave in June 2014, then Taoiseach Enda Kenny said that the State had treated these children as a sub-species; he was being far more accurate than he possibly understood. The children of Tuam were treated as an identifiable group, their 'illegitimacy' setting them apart and according to the State making them more likely to be malformed or congenital idiots with a horrific death-rate being nothing that should cause alarm. Whisper it if you will; sub-humans, Jews, idiots, gypsies, homosexuals, non-humans or to quote Enda Kenny; a sub-species. Tuam was created as a repository for such undesirables. In Germany, similar institutions designed to cleanse society were called concentration camps. Tuam is indeed an Irish Holocaust and it is not the only one.
Those who whimper and quibble about the use of the word holocaust are free to do so, as are those who wish to exercise proprietorial control over its use. Nothing they can say will alter the reality of Tuam.
As of today’s date the coroner for North Galway Dr Val Costello, has given no public indication that he will convene an Inquest into a single death at the Tuam Home. Where a coroner has failed to hold an Inquest, the Irish Attorney General has the sole power (and this writer believes the duty), to appoint another coroner to do so. In correspondence with the Attorney's office going back some three-and-a-half years, I have received each time, a negative response. It is an indisputable fact that requests for an Inquest made to the local coroner from those who can be reasonably presumed to have infant family members lying in a cesspit; even when sent by registered post; have not received even the basic courtesy of a reply.
In the interim, the Minister for Children and Youth Affairs, Katherine Zappone has attempted to seize jurisdiction over the mass grave, to the point that she claims that it's future will be (at her instigation), decided by Government. . She claims powers she does not have and is essentially attempting through a mixture of ‘consultative’ bluster and obfuscation to bury the Tuam children for all time, without any hope of justice She announced by way of statement from her office on July 17th, “As I prepare to make a recommendation to Government on the future of children’s remains and the site of the former Mother and Baby Home in Tuam...... This is clearly delusional. Only the local coroner or another appointed by the Attorney General has decision-making powers over the mass-grave. There is something Trump-like in the manner in which she presses on, though she is apparently doing so with the blessing and encouragement of the members of the present Government.
In October 2002 the late Harold Pinter, speaking at the 'No War on Iraq Liaison Group' meeting in Westminster Hall, recalled Cromwell's exhortation to his troops prior to their bloody assault on Drogheda. The General said;
'Kill all the women and rape all the men'.
To which a Roundhead Trooper replied;’
Excuse me General; shouldn't that be the other way round?
At that point a loyal voice from the ranks called out:
The General knows what he is doing!
In fairness, the Minister has spent time and public money attempting to procure a claque which she hopes will raise its voice to deny the wishes of the Tuam families, as well as the clear requirements of Irish law and basic humanity. .However, she and the forces within Government and the State generally will succeed in perpetuating the crimes against the children of Tuam, only if we let them.
We know that the ugly face of Tuam and other such institutions was seen in appalling detail in documentation that came into the hands the HSE and Government in 2011. They suppressed that information. In 2014, the grotesque nature of Tuam became widely known and was attended by the usual public hand-wringing. Since then, Government and the State through its various agencies has exerted itself only to hide, obscure, deny (and lie) and even possibly destroy the evidence that should direct the public policy of a civilised country.
Returning once again to Dr Rowlette, we have to ask ourselves, if we have ever reached the status of a ‘civilised country' or, if this is simply something to which we still aspire, it is clear, we cannot rely on those in positions of power to deliver it.
Kevin Higgins, July 2018