After this rather unpleasant interlude, I take up again the discussion of the Estimate submitted by the Minister for Local Government and Public Health. In this matter I find myself in more agreement with the Minister than was the case in certain recent debates. The Minister mentioned that schemes of medical inspection have now been established all over the country. Perhaps I should say that in the last Departmental Report that was issued it was indicated that schemes of school medical inspection have now been regarded as normally applicable all through the country. The Minister stated again yesterday that 80 per cent. of the school-children came within the ambit of those schemes. I notice that his statement yesterday—he said over 80 per cent.—differs very little from the statement applying to the years 1933-4. The figure then was 80, and it is now over 80. It would appear that during the last two years there has not been any encroachment on the remaining 20 per cent. who are apparently still not subjected to a school inspection. When one asks what that means —that the children are within the ambit of school inspection—one finds that it does not mean that 80 per cent. of the children are, in fact, inspected. In the year 1933-4 there were 114,087 children inspected out of a total school roll of 414,000. That was stated to be 26 per cent. The figures given by the Minister yesterday of the number inspected are practically the same as they were two years ago, so that we find that practically only one in four of the children who come within the ambit of the scheme are, in fact, inspected during the year. That means, presumably, that a child is inspected only once in four years. Although we are told school inspection has become part of the normal experience of the school-children of the country, one can hardly say that a thing that happens only once in four years is part of the normal experience. I suggest to the Minister that if school inspection is to be really effective in checking the beginning of disease, each school-child must be inspected not less frequently than once every year. School inspectors must at least be quadrupled in numbers before the system can be considered efficient. It is possible if the system was well established on a sufficient basis that less frequent inspection would be needed. But inspection at four years' interval is not adequate.
In the Report of the Department special attention is drawn to the insanitary conditions of many of the schools throughout the country. It was stated that defects in sanitation were general in rural schools. That is a condition that has persisted as far back as my memory goes. It is surely time that steps were taken to render these schools safe, at any rate, for the children who attend them for hours at a time. According to the Minister's Report there are defects in the sanitation, but one might surely go further and say that many of these schools are a positive danger. I do not know with what Department the responsibility rests for the sanitary condition of these schools, whether it is the Minister's Department or the Department of Education that is responsible. But whichever Department is responsible the House would be behind that Department in any effective steps it might take to render these schools safe. I do not suggest that they should be rendered luxurious but simply safe.
Again attention is drawn to the great necessity for playgrounds in connection with rural schools. There, also, the House would be behind the Minister in any steps he takes to secure that the children were given safe places to play, and not to compel them to play on the public roads to their own great danger and to the annoyance of other users of the roads.
I congratulate the Minister on a step to which I think he did not refer in his statement yesterday, but which was announced in the Press this week. That is that he is giving special consideration to the problem of the defective child, and is having investigation made as to what number of such children are in the country in order to from the basis of some scheme. That step is long overdue. I am not blaming the Minister for not taking steps before, but I am glad he is doing so now. It is over 30 years since an enumeration was made of the mentally defective children in the country, and from that day very little has been done in the matter. The enumeration of 30 years ago is long out of date so that the steps the Minister is now taking are most effective.
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.
It seems disconcerting to find that puerperal mortality in connection with childbirth is still on the increase. There is remarkable difference between the rate of puerperal mortality in urban areas and rural areas. In urban areas the mortality is 3.7 per 1,000 births. In rural areas it is 5.25 per 1,000, nearly 50 per cent. greater in rural areas than in urban areas. That certainly is surprising. Infant mortality is much less in rural areas than in urban, and the general health is better, but in this one particular item the mortality is much higher in the rural areas. That must surely be due to some lack of providing adequate attention for the mother at the time of childbirth. It cannot be due to anything inherent in the people in the country and it must be due to lack of completely adequate medical service.
I was glad to hear the Minister state that regulations are framed to put the Milk and Dairies Act into effect and that he hopes soon to be able to name the day when the Act will come into operation. We know that this legislation was long overdue before it was carried through the House, and that the hopes of many people centred round it. I hope there may be very considerable improvement in public health, particularly in regard to tuberculosis, by reason of that legislation for which the Minister and his Parliamentary Secretary are responsible. The question is urgent and, therefore, I hope that, while I recognise that it requires time to frame the regulations, not a moment will be lost in bringing this Act into force. The Minister referred to the great assistance in many of his social schemes rendered by the people of the country. It is pleasant to know that the Department and the local authorities throughout the country recognise that the people are very willing and anxious to give help, when properly guided, in connection with schemes dealing with the health of the people.
There are some points that come into this Estimate that were not mentioned in the Minister's statement upon which I would like to make brief comments. I understand it falls to his Department to exercise, either directly or indirectly, control over vehicles for public transport. I would like to say to the Minister that the condition of many of the public vehicles in this country are in a state that is disgraceful and disgusting from the point of view of cleanliness. As far as one can tell there is hardly any control by the police or the public authorities as to the condition of these vehicles as regards cleanliness in relation to health. One rarely, if ever, sees a report of the prosecution of any proprietor of any carrying vehicle for the condition of his vehicle. If the Minister were to travel about as an ordinary citizen in trains and trams and taxicabs, he would find that it was comparatively rarely he got into a vehicle or compartment in which the state of cleanliness was satisfactory. The carrying companies have laws against spitting in their vehicles. I wonder if the records of the Dublin police courts, during the last 30 years, show a single prosecution for this filthy habit. One cannot travel on a public vehicle in Dublin without being offended and disgusted by the condition, as regards health, in which these vehicles are kept. The only exception one could make to that are some of the railway carriages and some of the taxicabs in the city.
In the Minister's Estimate, he includes certain payments for the expenses of the Local Government (Dublin) Tribunal. That is a tribunal whose work has been criticised very largely in various quarters. I wish to make one criticism of it which, I think, has not previously been made in public. It is that, in appointing that Tribunal and selecting its personnel, the Minister did not realise that town planning, as regards the boundaries of Dublin and other areas in the County of Dublin, has any relation to the question of health. I suggest to him that some of the evidence put before that Tribunal shows very clearly that one of the most important aspects from which this question of boundaries must be viewed is that of public health. Evidence to that effect has been put forward, but there is not on that Tribunal anybody who is specially fitted by training, experience or knowledge to form an opinion on such matters. I am not making any criticism whatever of the qualifications of the gentlemen who constitute that Tribunal. So far as their own experience and lines of thought go, I understand no better men could have been selected, from the legal, administrative and engineering points of view. But neither a lawyer nor an administrator nor an engineer is, by his training or experience, fitted to form a sound opinion on evidence put before him from the point of view of health. I am sorry that the work of this Tribunal and the respect which its findings will command have suffered by this oversight on the part of the Minister when it was being appointed.
I do not know whether the work of the Minister in regard to the report of the Hospitals Commission comes under this Estimate or not. I suppose that, technically, if it does not come under any other head, it will come under the head of the Minister's salary. All I should like to say in respect of the work of the Hospitals Commission and the report recently presented to the Minister is that I think everybody who has been interested in this subject has been greatly impressed by the thoroughness, the fairmindedness and the statesmanlike view of the Hospitals Commission, and I ask the Minister to be satisfied that that Commission has made a thorough examination of the problem, so far as it has gone, and that is recommendations to him are deserving of the utmost respect. I ask him further, when he satisfies himself on that Report, to give his decision on the various matters with as little delay as possible. I am sure that the recommendations of the Commission will have his very careful consideration, but I ask him to bear in mind that it has given very thorough and deep study to the problem as it presents itself at the moment.
Deputy O'Dowd spoke of certain matters in regard to the work of the dispensary medical officers in the country. I wish to associate myself with what he has said on these topics. In particular, I think it is unfortunate that any difference of opinion should have arisen between the Minister's Department and the local authorities, on the one hand, and the dispensary medical officers, on the other hand, as to the conditions under which the work of immunisation is to be carried out. That is a work of great importance to the health of the country. If it is to be carried out efficiently, it must have the sympathy of the medical officers. It is not fair to demand of these men that they should do this work as a work of public charity or even as half a work of public charity. It is not fair that they should not receive fair remuneration for the work they undertake in this regard. I hope the Minister will consider this matter with representatives of the dispensary medical officers and that he will come to some agreement which is reasonable, from the point of view of remuneration, and which will secure that this important work will be carried out without hitch and without delay.
While there has been a general tendency to improve the standard of the salaries of dispensary medical officers throughout the country, the system is not by any means entirely satisfactory as yet. There has not been a real approach to a standardisation of the salaries in different parts of the country, so that in some districts the salaries are much worse than they are in others. I deliberately put the matter that way; I do not say that they are better in some districts than they are in others. An unfortunate coincident fact is that they are generally worse in the districts in which private practice is poorest, so that the dispensary medical officer who works in a poor district gets a low salary and very little private practice. I do not think that the system will be sufficiently attractive to secure the best candidates until it has been thoroughly standardised and, in fact, until it is made a State service rather than a service under local control. I think I am not mistaken in suggesting that I am recommending to the Minister another item in the old Sinn Fein policy of 20 years ago. I welcome the reform made within the last few years by the Department in permitting study leave to dispensary medical officers, but the concession is not as valuable as it should be. Study leave should be given dispensary medical officers, not for the sake of the officers, but for the sake of the patients for whose care they are responsible. Their efficiency should be increased by study leave so that they might render better service to the poor people dependent on them. The present arrangement seems to be regarded as something in the form of a concession to the medical officers. If study leave is to improve the efficiency of the service it must go further and a suitable grant must be made to medical officers who take such leave to enable them to do so more frequently. At present they have to take it at their own expense. I suggest that public authorities should make some grant towards the expenses of study leave and therby encourage a concession which in itself should be made more generally efficacious to the public.
Another topic has been mentioned on which I am very anxious to get a statement of the Minister's policy, namely in regard to the circular recently issued dealing with what is called compulsory retirement of officers of local authorities. The circular has been very generally misunderstood by local authorities and also by the Press. Some efforts were made to obtain by parliamentary questions the exact scope of this circular, and the Minister answered quite definitely on certain points but left us in some doubt on other points. He stated definitely on several occasions that the circular was not an Order but was a recommendation. Nevertheless, the local authorities and the Press still regard it as an Order from a Minister. The correction of the misapprehension which was made in this House does not seem to have reached the public authorities up to the present, because one sees in the Press and in other places statements which quite definitely show that the Order is misunderstood. Galway Board of Health on March 14th issued a letter, in which was incorporated a copy of the Minister's circular, stating:
"The Board agrees with the views of the Minister, and issued directions that all officials and employees engaged in pensionable employment under the Board and who have already reached the age of 65 years, or who will reach the age of 65 years within the next six months, shall submit their resignations to the Board or its associated committees in the month of August next so that their retirement will take effect from 1st September next."
I understand that the Board has taken the further step of demanding from some of the officers a certificate of birth showing their age. I do not know what is the Minister's opinion, but that seems to me to be an utterly illegal and impudent procedure. Galway Board of Health is evidently under the impression that it is acting under instructions from the Minister, because it has issued directions that all officers and employees shall retire at the age of 65. Last week the Joint Committee of the Grangegorman and Portrane Mental Hospital, according to a report which appeared in the Irish Times of April 17th, passed the following resolution:—
"That in compliance with the instructions of the Minister for Local Government and Public Health as set forth therein, all established officers aged 65 years and upwards now eligible for full or partial superannuation under the 1890 or 1909 Superannuation Acts be requested to submit their resignations and applications for superannuation at next monthly meeting."
Then follows a list of the groups of officers. That important public committee, which meets almost within earshot of the Minister's office, believed there was an Order, although the Minister told us clearly on two occasions that it was a recommendation. The Grangegorman Committee was somewhat more courteous than other local authorities, because it "requested," while in other places officers were "directed" or "ordered." Despite the Minister's statement the Irish Times, which one would expect to be a well-informed paper, published this week a snappy little article on the proposal for compulsory retirement, in which it stated that the Department had issued an Order directing local authorities to retire compulsorily officers who were 65 years old, so that local authorities and the Press are still of the opinion that the Minister issued instructions in that respect. It is true that a reading of the circular would make it clear to anyone familiar with that form of document that, technically, it was not an Order, but one might not recognise that until the Minister told us in the House that it was an instruction which local authorities were not bound to follow. I propose to read this circular, because I think the form of it is open to considerable criticism, as well as the matter contained in it. It is headed “Circular No. 18/36,” and dated 28th February, 1936, from the Custom House, Dublin, and is headed “Compulsory Retirement.”
"A Chara,
"I am directed by the Minister for Local Government and Public Health to state that he has from time to time received representations that it is not conducive to the public interest that local officers should continue in pensionable employment above the age of 65 years. Cases have come to notice in which disciplinary and other difficulties have arisen by reason of the retention in responsible posts of officers whose faculties have been impaired by age. Where, as is usually the case, the official record of the officer concerned has been meritorious a situation arises which causes embarrassment to both the local authority and the Minister.
The Minister thinks it well to give this intimation of his view that the normal procedure should entail compulsory retirement at the age of 65. Where that age has already been reached or exceeded and there is no obvious loss of efficiency by reason of physical or mental impairment or other cause, the Minister will be prepared, if the local authority so desire, to allow a period of six months to elapse before an officer is required to relinquish his duties. A period of grace subject to the same condition would also apply to officers who reach 65 within the next six months, that is, they need not be retired until 1st September next.
Local authorities would not be precluded, however, from calling on any officer to retire at the age of 60 if they consider his efficiency diminished and that his retirement would be in the public interest. There are certain classes whose duties are such as render an earlier age of compulsory retirement desirable.
All mental hospital officers and servants, except such as have not the care or charge of patients in the usual course of their employment should be retired compulsorily at 60 years. Fire brigade officers would also appear to come within the category of those to whom the retirement at 60 would apply. Please sign and return to this Department the enclosed acknowledgment of the receipt of this circular."
It is then signed by the Secretary of the Department.
