As there is an amount of statistics in this, I propose to read the statement on the main Estimate.
The Estimate for the Department of Local Government and Public Health in the present year makes a provision for a net expenditure of £1,229,829. Grants for housing amount to £702,765 and for health services to £360,790, making a total of £1,063,555 for the social services included in this Vote. There is a net increase of £18,487 in the Vote as compared with the financial year 1940-41.
It is customary in moving the Estimates for the Department to examine the statistical evidence concerning the present state of public health. It is a matter of special interest that further progress was achieved during the year 1940. In the past ten years a great deal has been done in improving public health services, raising the standard of sanitary administration, providing new homes in replacement of insanitary and overcrowded dwellings, and removing bad environmental conditions. The results which have been achieved have had a considerable influence on the maintenance of health, and in bringing about a general improvement in the welfare of the community. There has been a gratifying reduction in mortality from the principal notifiable and preventable infectious diseases. The vital statistics for the year 1940 are at present, however, only provisional and may be subject to slight modifications, but they reflect a continued improvement in public health. The total number of deaths attributed to the principal notifiable and preventable infectious diseases in that year was 279 which was a reduction of 106 as compared with the number of deaths in 1939 (385). The corresponding number of deaths for 1937 and 1938 was respectively 542 and 487. The mortality from these diseases in 1940 was the lowest on record.
The principal notifiable and preventable infectious diseases are typhoid, typhus, scarlet fever, diphtheria and puerperal sepsis. The number of deaths from typhoid was 29 in 1940, the lowest number on record for the country from that disease. In 1939 there were 56 deaths from typhoid, while the average annual number of such deaths for the decennial period 1930-39 was 68. The number of notifications of typhoid fever received in 1940 was 253 which was a definite decrease in comparison with the previous year when the number of cases notified was 385. It is worthy of note that there was only one case of the disease notified from Cork and Waterford Cities during 1940, and that no cases arose in 50 out of a total of 61 urban districts and in 115 out of a total of 162 rural areas. The incidence of typhoid fever is to a certain extent a reflex of the standard of general sanitation in the country, and the fall in the incidence of the disease is due in large measure to the provision of adequate and pure water supplies throughout the country generally during the past ten years.
When submitting last year's Estimate, I was in a position to state that the year 1938 was the first year in which there had been no outbreak of typhus fever in this country since the Infectious Diseases (Notification) Act, 1889, came into operation. The disease has been of infrequent occurrence in recent years and in 1940 it broke out in two counties with fatal results in two cases. Ten cases of the disease were notified from four different districts in one county, and were traced to a band of itinerants who had moved rapidly from place to place before the disease was definitely diagnosed. A single case of the disease was reported in another county. The circumstances of these outbreaks were such that a serious epidemic might have developed if it had not been for the alertness and efficiency of the local medical services and the promptitude with which precautions for preventing the spread of infection were taken.
Deaths from diphtheria have been a source of anxiety for a considerable number of years past. In the returns for 1940 a substantial reduction in the mortality rate is shown. 178 deaths attributable to diphtheria occurred in that year as compared with 245 deaths in 1939, and with an average annual number of 342 deaths for the ten year period 1930-39. The rate for 1940 approximates to a reduction of 50 per cent. on the average for that decennial period. The total number of cases of diphtheria notified in 1940 was 1,891, of which 808 occurred in the four county boroughs, 321 in urban districts and 762 in rural districts. The number of cases, viz. 1,891, represents a reduction on the total notifications in 1939, which were 2,097.
There was no case of diphtheria reported during 1940 from 29 out of the 61 urban districts, and from 53 out of the 162 rural districts, as compared with 14 urban districts and 47 rural districts in 1939. The latest returns in regard to approved schemes of immunisation against diphtheria available are those for the year 1939. These schemes operated in the four county boroughs, in 12 urban districts and 14 county health districts, and resulted in the immunisation of 22,593 children in that year. Further discussions have taken place with the representatives of the medical profession in regard to the rate of remuneration payable for immunisation work against diphtheria and for other additional duties, and it is expected that agreement will shortly be reached. A more widespread and effective combat against this disease can then be organised.
The number of deaths arising from scarlet fever in 1940 was 35, constituting the lowest figure yet recorded. In 1939 the number of deaths from the same cause was 43, while the average annual number in the ten years, 1930-39, was 88. The mortality in 1940, therefore, represented a decrease of 60 per cent. on the average annual number of deaths for the decennial period above-mentioned. The number of cases notified in 1940 was 2,465, which is a substantial reduction on the number, 2,779, reported in 1939.
Influenza is not a notifiable disease, but influenzal pneumonia is. As is generally recognised, the incidence of influenza varies considerably from year to year. The most serious outbreak during the last decade was in 1937, when 2,772 deaths attributable to that cause occurred. In 1940 the number of deaths was 804. The number of cases of influenzal pneumonia notified in 1940 was 250, as compared with 208 in 1939. The number of deaths due to cancer in 1940 was 3,573, being a reduction of 165 on the number for 1939. The incidence of cancer does not fluctuate very much, but has shown an upward trend for a considerable period. The investigations of the Provisional Cancer Council which was set up to investigate and report on certain aspects of the causes and incidence of this disease have had to be suspended owing to present conditions as it was not practicable to make investigations of the system of treatment in other countries or to obtain full information thereon.
For some years past there has been a gradual improvement in the death rates attributable to puerperal sepsis and to accidents of childbirth and pregnancy. The predominant factor contributing to the mortality of mothers in childbirth is puerperal sepsis. It is noteworthy that since 1936 there has been a continuous decrease in the annual number of deaths due to that cause. The returns for 1940 show 35 deaths due to puerperal sepsis as compared with 38 in 1939 and 46 in 1938. The average annual number for the ten-year period, 1930-39, was 74. The figure for last year, therefore, represents a reduction of about 53 per cent. on the decennial record. In 1940 no case of the disease occurred in Limerick City, and only one case each was reported from Cork and Waterford Cities. No case occurred in 48 out of the 61 urban districts or in 122 out of 162 rural districts.
Infant mortality still continues at a high rate. The death rate in 1940 is practically the same as in 1939, the total deaths in 1940 amounting to 3,698. The rates for the four county boroughs are still very high, being per 1,000 births as follows:—Dublin, 92; Cork, 94; Limerick, 74, and Waterford, 107. The rate for Waterford in 1939 was 73, and the increase in 1940 was due to abnormal mortality from diarrhoea and enteritis.
The counties in which the provisional infant death rates per 1,000 births were highest were Waterford, 88; Dublin, 84; Carlow, 78; Kilkenny, 73, and Kildare 70. These rates compare very unfavourably with the corresponding rates per 1,000 births in certain counties on the western seaboard. In these counties the provisional death rates per 1,000 births were Mayo, 37; Clare, 46; Kerry, 49; Donegal, 49, and Sligo, 50.
In the four county boroughs where the death rate is highest, maternity and child welfare clinics have been established which afford medical advice and nursing services. In Dublin the attendances at clinics were as follows:—mothers, 32,315; infants, 15,721, and children, 29,380. In addition to the work done at welfare clinics in Dublin, there is a well organised system of visitation of mothers and children in their homes.
The following extracts from the report of the medical officer for maternity and child welfare relate to the position in 1939:—
"Thirteen welfare clinics are held weekly in the city at different centres, usually in slum areas. Mothers, pre-natal and post-natal, are seen and advised, as well as infants and children up to five years of age. Defects discovered are dealt with by recommending the case to the special department of the different hospitals.
"A short talk is given at each clinic by one of the health visitors. This talk is on some subject of mother-craft. Experience shows that the mothers are availing of this service in a much better way than they used formerly. A medical officer is in attendance at each of these clinics to assist and advise. The clinic in the Pembroke district is held in the open air during the summer months. In July, 1939, a new combined welfare clinic and dining hall was opened on the north side of the city at St. Joseph's Mansions, Killarney Street. This is unique in that it is actually built into the block of flats and serves a very dense slum area."
The number of deaths due to measles in 1940 is returned at 67, which compares favourably with the number for 1939, which was 84. The mortality for 1940 is the lowest on record. This disease is compulsorily notifiable only in a few districts, but steps are being taken to ensure that at least the first case occurring in a family will be notified in future.
The several medical inspection schemes which are in operation in every county and county borough continue to progress. There were 135,404 children examined in 1939, constituting 35 per cent. of the total average school attendance. The number of defects ascertained were as follows:—Dental, 63,258; diseased tonsils, etc., nose and the throat, 25,857; eye defects, 24,146. The numbers treated were: Dental, 50,448; diseased tonsils, etc., nose and throat, 7,766; eye defects, 19,456.
The examination of school children affords a great opportunity for an investigation of the prevalence of malnutrition amongst school children. The following extracts from reports of county medical officers of health for three counties indicate the results of such investigations:—
"Out of the total children examined this year, 278 were regarded as suffering from malnutrition, representing a rate of 3.6, while for the previous year there was 5.3 per cent..... In the majority of cases seen by me the cause of this condition was poverty, and in some others the subnutrition was attributable to defects such as enlarged tonsils, etc."
Another report says:—
"The percentage of slight malnutrition among the school-children was 10.8, being a small reduction on the figure found during the 1938 inspections. The number of children manifesting signs of pronounced malnutrition was only two out of a total of 4,249 examined. This represents a percentage of only .04 as compared with .33 in 1938 and the position may therefore be regarded as satisfactory. When children in rural areas of this country are found to be markedly malnourished it is usually because of parental ineptitude and neglect."
A further report says:—
"There were 42 cases of definite malnutrition requiring treatment found and these were referred for medical advice.... A special form has been printed for the purpose of advising parents as to the amount of rest, the proper clothing, the proper type of diet and the values of various foods suitable for children and this is circulated among the parents of children whose nutrition is less than average standard."
School meals are provided in four county boroughs, 41 urban areas and seven towns. In these districts for the year ended the 31st March, 1940, the average weekly number of children in receipt of meals was about 160,000. The total number of meals provided was approximately 5,205,000. School meals are also provided in rural areas of the Gaeltacht by the boards of health for the counties of Donegal, Galway, Kerry, Mayo and West Cork. The total number of meals provided in the last financial year was approximately 2,800,000.
The arrangements for the supply of free milk, for which a sum of £90,000 is provided in this Estimate, were continued during the year in urban and rural areas, with the exception of two urban districts. The allowances are limited to children under five years whose parents or guardians are in receipt of assistance or are unable to provide from their own resources an adequate supply of milk for children of this age. The value of this scheme continues to be highly reported upon by county medical officers of health.
The scale of allowances is as follows:—one eligible child in family, one pint; two eligible children in family, one and a half pints; three or more eligible children in family, two pints. The general supervision of the schemes is entrusted to the medical superintendent or county medical officers of health. The premises of milk contractors are visited frequently by veterinary inspectors to ensure that the methods of milk production are satisfactory and samples are sent for examination as to quality and purity.
Local authorities are encouraged to give a preference to milk sold under a special designation. In Dublin County Borough only highest grade milk has been supplied during the past year (298,420 gallons were distributed during 1939/40) whilst in Dublin County highest grade and standard milk are provided. In Limerick City highest grade, standard milk, and pasteurised milk are supplied. In Dun Laoghaire Borough pasteurised milk and in Carlow Urban District standard milk are provided. Difficulty continues to be experienced in some districts in securing registered suppliers and it was again necessary to authorise the distribution of dried milk powder in such districts.
Schemes for the treatment of tuberculosis are in operation in each county and county borough. Local sanatoria have been provided in three county boroughs and in 17 counties. Treatment for children is provided in five open-air institutions in which there are also facilities for the general education of such children. On the unrevised figures the death rate from tuberculosis in 1940 increased to 1.22 per 1,000 of the population as compared with 1.13 for 1939.
During the year further progress was made in the installation of water supplies and sewerage schemes in urban areas and in towns in county health districts. Forty-one schemes were undertaken at a total expenditure of £200,000, of which about £80,000 was met out of the Employment Schemes Vote. Some delays occurred in deliveries of pipes, plant, etc., but they did not seriously interfere with the programme of works. Twenty urban authorities undertook works for the provision or improvement of parks, playgrounds and fair greens. The schemes undertaken were mainly small works, but they nevertheless represented useful additions to the amenities of the towns concerned.
There was a very considerable reduction in the number of houses built by local authorities in 1940 as compared with previous years. The total number is not likely to exceed 3,405. For the previous three years the numbers of houses completed by local bodies were 5,383 in 1939/40, 6,932 in 1938/39, and 4,890 in 1937/38. The number of new houses built by private persons and public utility societies in 1940/41 in rural areas was 2,175. The number of houses reconstructed was 2,768. Private building in rural areas, taking into consideration the conditions prevailing, was maintained at a good level and it is intended to introduce very soon a Bill extending up to the 1st April, 1942, the period for the payment of grants for houses built in rural areas in accordance with existing regulations.
Of the new houses built by local bodies in the last financial year, about 1,555 were provided in urban areas and 1,850 in rural areas. The total number of houses provided to date by the local bodies is approximately 25,484 in urban areas and 18,462 in rural areas. The reduction in the number of houses built by local bodies has been disappointing, but more particularly so in the case of the four county boroughs where it was expected greater progress would have been made. In Dublin City, several contracts were entered into during the year, but the number of houses completed fell to a very low level. The number is not likely to exceed 800. Under the provisions of Section 6 of the Unemployment Relief Works Act, 1940, the corporation were authorised to make arrangements with holders of existing stock for an exchange into new stock equal in nominal value, and to withdraw from the Stock Redemption Fund an amount equal to the nominal value of the exchanged stock in the manner authorised by the Act. These arrangements were duly carried out and resulted in moneys to the extent of approximately £500,000 being made available for the financing of housing schemes. At the end of February, 1941, there were in course of construction 1,896 dwellings, consisting of 1,618 houses and 278 flats.
In Cork City, there was also a falling-off in the number of houses built last year compared with the previous year. It is estimated that the number built in Cork will not exceed 190. In Limerick, the number of houses built is estimated at 130 and in Waterford, at 100. Only in Waterford did the amount built in 1940 exceed the number built in the previous year.
Building operations are in progress in four county boroughs, 12 other urban areas and in 18 counties. The number of houses in course of construction is approximately 3,210 in urban areas and 1,300 in rural areas. Outside the county boroughs urban authorities have been somewhat reluctant to proceed with further schemes owing to the increase in building costs. In rural areas housing conditions have been vastly improved by the number of new cottages already provided by boards of health and by private persons and public utility societies, and proposals of an urgent nature for the clearance of bad housing conditions in non-municipal towns need only be considered in present conditions.
Only in respect of certain materials have difficulties been experienced in the completion of housing contracts. The main difficulty is stated to be in regard to glass and to some extent timber. In some areas the supply of timber is reported to be adequate for another 12 months. The rationing of petrol has to some extent affected haulage necessary for building activities. Every effort is being made to ensure that reasonable supplies are forthcoming to ensure the continuance of housing contracts, where alternative fuel for motor vehicles cannot be used.
During the year 8,220 allotments were provided for unemployed persons. These were let as follows:—6,265 to persons in receipt of unemployment assistance or unemployment benefit; 336 to persons in receipt of home assistance; 338 to persons employed on employment schemes; 1,231 to persons in temporary employment and whose means did not exceed the prescribed amount.
The allotments were generally plots of ? acre and were let at a nominal rent of 1/- for the season. In special cases where the applicants had large families allotments of ¼ acre were provided and a rent of 2/- per plot was charged.
The Department of Agriculture provided free of cost implements (spades, shovels and spraying machines) for the use of the allotment holders and seeds, manures and spraying materials were also supplied free of charge. The services of instructors were made available during the planting and potato spraying periods. The instructors' reports indicated that the allotments were generally well cultivated.
For the present season a special appeal was addressed to local authorities throughout the country requesting their co-operation in making available ample facilities for the cultivation of allotments. Up to the present, schemes embracing some 14,300 plots have been approved and it is estimated that a further 1,700 plots will be provided, making a total of 16,000 for the year. In rural areas, the boards of health are providing tracts of land for cultivation in allotments, and there is every prospect that a substantial contribution to food production will be made by allotment holders.
I have on a previous occasion referred to the increasing demands of the voluntary hospitals for grants from the Hospitals Trust Fund to meet expenditure in excess of income. In the year 1939 the deficits in the accounts of those hospitals amounted to about £156,058. This was an increase of £40,368 on the amount for the previous year, and an increase of £105,785 on the amount of the deficits for the year 1933. The deficits for the year 1940 have not yet been definitely ascertained but are likely to exceed £180,000. At the rate at which expenditure has been increasing in recent years the provision for endowment would require to be brought up to £6,000,000, which is double that already made. The provision of a permanent endowment fund of £6,000,000 would make a serious encroachment on the amount which it was reckoned would be available for erection and equipment of new hospitals, and may lead to the indefinite postponement of many desirable projects since further substantial additions to the fund cannot be anticipated.
The Hospital Library Council which was set up in 1937 continues to render valuable service in the formation and maintenance of hospital libraries. Most of the hospital libraries are now in their third year and are developing satisfactorily. During the year 1940 two additional hospitals were registered by the council which brings the total number of hospital units served up to 76. Libraries are in operation in 74 of these. The number of books issued during the year was 3,621. The total book stock at the end of the year was 28,207 volumes. During 1940, grants amounting to £5,000 were made to the Medical Research Council out of the Hospitals Trust Fund. The grants paid up to the present amount to £22,500. The council have made a number of grants to research workers —both whole time and part time. In one instance, I understand, research has led to the discovery of a new serum which is likely to have very important results on the treatment of certain types of diphtheria. A statement from the research council on the position is awaited.
Hospital authorities were advised in 1939 and again in 1940 to lay in emergency stocks of medical and surgical supplies and local bodies generally were recommended to purchase reserve supplies of non-perishable articles of food and also accumulate stocks of fuel. This course has been generally followed, and there are at present seven to 12 months' supplies in medical and surgical requirements and reserves of various stocks of food and fuel. Due credit must be given to the official contractors for the manner in which they dealt with greatly increased orders from local authorities when they themselves were finding it difficult to obtain fresh supplies.
During the year the Department continued to exercise the strictest control over increases in the contract prices of commodities permitted under the Emergency Powers (No. 18) Order, 1939. Since the order became operative, applications in respect of more than 1,000 commodities have been investigated and the results communicated to the local authorities concerned. In view of the general fuel position local authorities have been authorised to cut all the turf which they need for their own requirements.
The organisation of parish councils was a notable development which took place during the year. When it was suggested in July last that parish councils should be organised to help in carrying out measures to meet this emergency, there was an immediate response from every part of the country. The work of the parish committees formed under the auspices of Muintir na Tíre had shown that valuable results would ensue from the establishment of such bodies. There are now over 800 parish councils who are taking a special interest in the general welfare of their areas. Some have taken measures to help unemployed persons by providing allotments. Many have taken part in the tillage campaign, and more recently they have been called on to further the movement for the production of more turf. Everyone is agreed that parish councils can fill a useful rôle in the life of the community. There is a wide field for their activity outside the purview of statutory bodies, and if they develop a spirit of co-operation among the people of the parish they should have a very useful existence.
Full particulars of the collection of rates by county councils at the 31st March are not yet available. In the first nine months of the financial year the collection was proportionately much the same as in the previous year. The returns for the last quarter have not yet been received from the county councils.
In 1940, the repayments to the guarantee fund in respect of arrears of annuities were much in excess of draws upon the fund to meet arrears in respect of the current gales and consequently the county councils received last month not only the whole of the balance of the agricultural grant for last financial year but in addition a sum of £136,207, which had previously been held in the guarantee fund owing to non-payment of land annuities. County Meath received repayments of over £25,000; County Kildare over £14,000, and Westmeath over £15,000. In these counties relatively heavier reductions were made from grants in previous years than in other counties. The total sum repaid, viz., £136,207, should reduce substantially the need for temporary borrowing for the financing of local services, which had somewhat increased in the past year.
In conclusion, I would like to express my appreciation of the services rendered by the Corporations of Dublin and Dún Laoghaire when during the Christmas period we had the unhappy experience of aerial bombing. The managers and the air raid precautions staffs of the two corporations, assisted by the Local Security Force, rendered very valuable and efficient service during a critical period.
I should have preferred, if it had been agreed upon, to take the Votes for National Health and Widows and Orphans' Pensions now.
