James McKenna, Farhat Manzoor and Greta Jones, Candles in the Dark: Medical Ethical Issues in Northern Ireland during the Troubles (London: Nuffield Trust, 2009), pp. v + 149, no price given, paperback, ISBN: 978-1-905030-32-3.

Abstract

This is an important book that will appeal, not only to historians of medicine, but to social historians and those interested in the history of the Troubles in Northern Ireland. The authors have given an insightful account, which at times makes difficult reading, but which, nevertheless, is significant in its contribution to the history of the Troubles, encompassing the period from 1969 until the second ceasefire in 1998. The research conducted for this book is a momentous achievement: the authors conducted oral history interviews with over two hundred people over a three-year period, with the chief objective of trying to find out how difficult it was to conduct medical work in Northern Ireland in the period, and ‘to maintain the medical codes of ethics governing health care’ (p. 2). The interviewees consisted of health professionals, patients, ex-prisoners and medical staff working in prisons. The authors draw attention to the particular problems of oral history in the case of Northern Ireland, but in spite of these, the book as a whole gives a balanced view of the issues of both sides of the Divide, and the oral history accounts are compelling and give a personal insight into the experiences of men and women during the Troubles. Following the introduction and a chapter on the background to the history of the Troubles in Northern Ireland, the main part of the book opens with two chapters that deal with the experiences of health professionals and patients. The first of these examines the effects of the Troubles on the work of general practitioners in Northern Ireland in the period, in particular, focusing on the difficulties that they encountered while trying to go about their daily work, such as unofficial roadblocks and the increased demand on mental health skills. In addition, the chapter examines the effects on patients, such as the difficulties they experienced in travelling to hospital and how their political and religious persuasions may have affected their choice of hospital and/or GP. The next chapter gives an insight into the particular problems that hospital staff and patients had to contend with during the Troubles. Notably, Northern Irish hospitals, such as the Mater Infirmorum, which straddles ‘one of the most fraught community interfaces in Belfast’, witnessed a great deal of civil strife and violence during the Troubles (p. 43). The chapter also addresses the issues of staff and patient security in Northern Irish hospitals in the period, indicating how these factors ‘complicated the lives of medical professionals and intruded directly on the delivery of medical care’ (p. 63). The final two chapters deal with the issue of medical care in prisons during the Troubles. The first of these is largely based on the allegations of prisoners and gives an insight into the effects of the Troubles on both prisoners and prison doctors during the period. The final chapter deals with the topic of ‘Prison Protests’, in particular, focusing on the ‘Dirty Protest’ and the strain it placed on medical services. This chapter was well balanced, and gave adequate focus to the experiences of prison medical staff, the stories of whom are often neglected in broader histories of the Troubles. Doctors working in prisons were targets for assassination on the outside, and the type of work they experienced resulted in consequences for their mental health, with one senior doctor, ‘Dr P’, who nursed most of the hunger strikers, representing a victim of this and committing suicide, arguably as a result of the pressures of his job (pp. 105-6). This book is a significant contribution to the history of Northern Ireland, examining the history of the Troubles from the perspective of those delivering and receiving medical care. The oral history accounts which form the basis of the book will represent a valuable historical resource for future generations of historians.