I am very glad that this has been left to an open vote of the House. I intend to make an appeal to country Deputies to support, by their votes, the amendment of Deputy O'Kelly that 50 per cent. should be allotted to the county hospitals. Deputy Dr. Hennessy made an appeal that the question should be looked upon in a larger way, that we should consider the Dublin hospitals as the national hospitals and forget the county hospitals and our duties to our constituents in these counties. I would like to say a word as to the position of the county hospitals, especially that in my own constituency, which has developed considerably in the last few years. The hospital we have in Galway is no longer a county hospital in the ordinary sense of that term. It is a provincial hospital. We have patients coming there from Clare, Mayo and Roscommon, and it has now taken the place that the hospitals in Dublin formerly occupied, as far as these patients are concerned. Apart from the fact that we have patients from other counties, we are now in the position that practically all cases are treated in the county hospital. I remember when I started to practise in 1919 and 1920, the most serious cases had to be sent to Dublin. Nothing except acute abdominal work or urgent operations were performed in Galway at that time.
I received a list within the last few days showing the number of operations carried out there in the past year. I find that the number of major operations done in the Central Hospital was 1.100. The position now is that the Central Hospital in Galway is doing the work formerly done for the country patients by the Dublin hospitals. We have a general surgical and medical hospital, a fever hospital and a maternity hospital combined. It is the largest hospital, of course, in Connacht. It is also the clinical centre for Galway University Medical School. The point was made by Deputy Dr. Hennessy that the hospitals in Dublin are utilised for the training of the future medical practitioners of the country. The Galway hospital now does that work for the Galway Medical School. The staff includes three surgeons, two physicians, a pathologist, a gynaecologist and obstetrician, an eye and ear surgeon, and a house physician. An immense amount of money has been spent on perfecting this hospital. I have here also a list of the voluntary contributions made to the hospital for the last few years. Picking out some at random—in 1925 the amount was £1,096, in 1924 it was £808, and in 1930, £33. They utilised these contributions in installing x-ray plant, a pathological department, and other necessaries for a modern hospital.
This hospital of which I am speaking applied to the Hospitals Committee to be admitted amongst the voluntary hospitals which will be getting three-fourths and which up to this were getting the total amount of the money available. As far as I can hear, they have been refused admission into the scheme. To-day a sheet of paper was handed to me, signed by the Treasurer of the Associated Hospitals Committee. It contains a number of arguments as to why the money should not be devoted in any other ratio than 25 per cent. for the country hospitals, and the remainder for Dublin hospitals. The first reason they give is that the city hospitals are national institutions, that they cater for the sick poor from every county and district in the Saorstát. That is no use as far as Connacht is concerned. We in Connacht are very badly treated under this scheme. Cork, Limerick and Waterford have got their share, but the Cinderella province, Connacht, as usual, has been completely left out. The first statement, "that the hospitals we represent are national institutions which cater for the sick poor of every county in the Saorstát," is not true as far as Connacht is concerned. The next statement is "that these national hospitals, not having the security of the rates behind them, require to be endowed, in whole or in part, owing to inevitable loss of public subscriptions." With that also I cannot agree. Any patients who are now sent to Dublin from country districts are paid for at the rate of £2 per week, the same rate at which they are paid for in the Central Hospital at Galway or any other hospital. I cannot agree that the Dublin hospitals are doing anything for the country people for nothing. Anybody who is aware of the conditions in the hospitals here knows that if a poor person in the West of Ireland requires treatment he must be paid for by the board of health; he will not be accepted free of charge in a city hospital. The city hospitals get a big number of paying patients. I have even heard it said that they know how to charge fairly well. The third reason given is "that the moneys received and to be received from the sweepstakes will not be more than sufficient to carry out our proposals." I believe that the hospitals in Dublin are now in a position—and they certainly will be in a better position by the time the last of the sweepstakes is over—to carry out any proposals that they may have had in mind. When this sweepstake was originated, as Deputy Sir James Craig knows, it was never thought or dreamt of by any of these hospitals that they would get as much money as they have now got. To say that the money they will receive from nine sweepstakes will not be sufficient to carry out their proposals is simply stating something that is not correct. They have more money than ever they thought they would get, and whatever proposals they originally had when they started with the sweepstakes, I am sure, have already been carried out, or they have already sufficient money on hands to carry them through. The fourth reason given against our proposal is "that the reduction of the percentage to be received by the national voluntary hospitals to fifty per cent. will not be at all adequate to provide any reasonable endowments for these hospitals, whereas the sum represented by 50 per cent. of the Hospitals Fund will be largely in excess of what the county hospitals can possibly require." The people who presented this document evidently have very little knowledge of the country districts in Ireland.
They know absolutely nothing about conditions in the ordinary county hospitals, and they know very little of the expense that has already been incurred in Galway to make their hospital a fit and modern institution. I entirely disagree with every statement made by the Associated Hospitals Committee in this circular which was issued to me to-day. Their final statement in favour of the Dublin hospitals is: "It must be borne in mind that most of our large hospitals are teaching institutions which educate the entire medical and nursing professions of the Saorstát. No such claim can be made for county hospitals." That is not correct. In the West of Ireland we have a medical school and university and a hospital that is doing the work that those people claim they are doing for all Ireland. It is not correct to say that they are not doing it as well as the Dublin hospitals are doing it for their own students.
Deputy Dr. Hennessy said that the county hospital is a one-man hospital. That should not be so. That is one of the reasons why we ask that fifty per cent. be allocated for the county hospitals, to enable them to cater for the sick poor and for people who are not wealthy enough to come to Dublin. It is not correct to say that one man can attend to all these people. It shows a very bad state of affairs in the different counties if that is the position. I know that in the county adjoining ours there is only one man acting as physician and surgeon to the whole county in the hospital. I do not see how that man could do eye and ear work, the work of a gynaecologist, and all the other work that has to be done in a modern hospital.
The only Deputy who spoke against this proposal so far was Deputy Sir James Craig. I must say that I disagree with every word of what Deputy Sir James Craig said. Deputy Sir James Craig's statement would lead one to believe that he is out of touch with the conditions prevailing in county hospitals and with what county hospitals have to do. The Deputy said that he would like to see the provision of a small operating theatre. Of what use would a small operating theatre be in a county where there have been 1,100 major operations in one year? Even if there were only 300 operations to be performed a small operating theatre would not be sufficient. At present we have two and they are not sufficient. £5,000 would not go a long way towards the provision of these, because £40,000 has not already done very much. How could it be expected that £5,000 would do for a country hospital what £50,000 is required for for a city hospital? It is not that the numbers of patients are not the same. Why should the people in the West of Ireland have to depend on a grant of £5,000 when other people who can afford to pay their way are not satisfied with £50,000? "A man must be trained specially in the use of the x-ray instruments." We have an x-ray specialist, but in that connection, even with our modern equipment, in hospitals in Galway there have been three or four cases recently of superficial cancer where patients died for want of treatment. These were people who refused to come to Dublin for one reason or another. We want as up-to-date apparatus as any hospital in the city. After all there is a lot of duplication in the Dublin hospitals. You may have in one hospital, say, a certain x-ray plant which may be a very expensive one. It may be for diagnostic purposes alone or for deep therapy. You may have similar plant in other hospitals, when perhaps two would be sufficient. I believe that when this money comes into the different hospitals every one of the hospitals will equip themselves and you will have duplication. The money can be applied to the purchasing of ten, fifteen or twenty very expensive x-ray and therapeutical plants in the city, while the hospitals in the West of Ireland will be without these facilities. If it requires £10,000 or £15,000 to instal a perfectly modern x-ray plant, and, if it can be done here in four or five hospitals, I claim and I hope the country Deputies will support me, that in each county or two or three counties combined, the same plant should be installed.
So far, Deputy Sir James Craig appears to have been the only Deputy to have spoken against this amendment. I imagine from his speech that he does not understand the conditions that we have to put up with in the country, or that he does not understand the difficulty there is, at times, in sending patients to Dublin for treatment, a thing that should not, now, be necessary in the case of what is very often a very commonplace thing. It should not be necessary to send those people up to Dublin at very great expense, when the work might be equally well done in the different county hospitals. I know that Deputy Hogan has referred to the metropolitan mind, and I would like to disabuse, if I possibly could, a number of the Dublin Deputies of the idea that nothing can be done outside of Dublin. This metropolitan outlook is very well developed in the mind of Deputy Sir James Craig.