I move that the Bill be now read a Second Time. The main purpose of this Bill is to make further and better provision in relation to the health of the people. It is now evident that a need exists to advance public health at a rate in keeping with the general advance in the social and economic life of the people of this country, and by adequate safeguards to forestall or prevent dangers to health which would certainly arise if proper protection were not afforded. Good health means much more than mere freedom from disease; therefore, it is necessary to approach the question of health in a positive manner, and to take measures not only to improve the general wellbeing of the people but also their power of resistance to disease. The means are at hand, being principally the application of the scientific knowledge of nutrition, and of the inculcation of habits and practices which make for satisfactory hygienic conditions, improved physical development, and an equable balance between the spiritual and material aspects of life.
The existing public health legislation contains little provision for positive effort towards health as distinct from preventive measures. The only laws bearing on the subject are those relating to maternity and child welfare, school meals, and medical inspection of school children. The supply of free milk and footwear for necessitous children also represents a considerable advance in the same direction. A definite effort towards improving the general health of the nation is now due, and this Bill contains provisions framed for that purpose. The advance in medical knowledge, especially as regards the modes of transmission of infectious diseases, has brought with it a fuller realisation of the importance to the community of a healthy and cleanly condition in each of its members. It is, therefore, in the best interests of public health that we should insist on the provision of the sanitary facilities which are likely to improve health or prevent infection, and make it as easy as possible for individuals to use these facilities. Even when this has been done, there will still be recalcitrant persons who will refuse to avail of the facilities provided, and in the interests of the general community some measure of compulsion must be made available for dealing with such cases. There is nothing new in giving compulsory powers for such control of infectious diseases as may be necessary to safeguard human life.
One of the most interesting features of Irish history during the past hundred years has been the organisation of local government administration. If we trace its development back to the grand jury days, when in each county local government was administered by the gentlemen of the grand jury, we find that public health measures in their day were very primitive. In 1838 owing to the appalling social conditions of that period the poor law system was introduced, and its administration was entrusted to boards of guardians, partly elective and partly ex-officio, under the supervision of the central authority. In the succeeding 40 years, that is, up to 1878, very little was done for the improvement of the public health. Such laws as were passed affecting local government were entrusted to either the grand jury or the boards of guardians. Except in the larger cities and towns which were governed by corporations or town commissioners, the boards of guardians were the health authority. They were entrusted with the making of sewers, the provision of burial grounds, the construction of waterworks, the provision of dwellings for labourers, and the administration of the laws relating to the sanitation of dwellings, and abatement of nuisances. The Public Health Act of 1878 gave very extended powers for the control of infectious diseases, the improvement of public health and the installation of more modern systems of sanitation. The larger towns became urban sanitary districts and public health functions in those areas were exercised by the urban authority, but otherwise the boards of guardians remained the sanitary authority until 1898 when their functions as such became vested in rural district councils.
The county councils which were established in 1898 were given all the fiscal powers of the Grand Jury in relation to matters affecting local government, but these did not include any control of public health. It was not until 1908, when the Tuberculosis (Prevention) Ireland Act was passed, that county councils became vested with public health functions. They were then made responsible for the prevention and treatment of tuberculosis. These powers were extended in 1917 in connection with the arrangements for the treatment of venereal disease, and in 1919 they were made responsible for the establishment in their areas of schemes for the medical treatment of school children.
At the date of the foundation of this State we had rural district councils and county councils influencing and controlling different aspects of public health or preventive medicine in rural areas, and urban sanitary authorities in urban areas.
The system of administration was unwieldy, uncoordinated and largely inefficient. In 1925 public health administration in the rural areas was placed under boards of health and public assistance, and on the introduction of county management in 1940 their functions as rural sanitary authorities vested in the county councils. Their public assistance functions outside the City and County of Dublin also vested in the county councils, except in joint public assistance districts where the administration of public assistance has been entrusted to joint boards of public assistance. Sanitary functions relating to certain infectious diseases in urban areas other than county boroughs were exercisable by the urban authorities. The position in that respect would be improved by entrusting the responsibility for the control of infectious diseases in the entire county to a single authority, and hence the Bill provides that the full powers shall be exercisable by the county council.
Our present system of county health administration came into being in the year 1925. The Local Government Act of that year empowered county councils to appoint county medical officers of health. It took considerable time to get the new organisation working, but for several years past we have had in every county an organised public health unit directed by a whole-time medical officer. We may congratulate ourselves on possessing this organisation, as few countries are so well equipped to deal with dangers to public health. It is the duty of the county medical officer of health to advise the local authority on all matters affecting the health of the district. He is responsible for the control of infectious diseases and for keeping the local authority informed as to conditions injurious to health in their area, or to any influences affecting or threatening to affect public health in their area. He must exercise general supervision of the veterinary and sanitary staffs of the local authority as regards inspections of slaughterhouses, dairies, cowsheds and other premises in his area where food is prepared, stored or otherwise dealt with. He has also various duties, mostly of a supervisory nature, in relation to the special health services administered by the local authority. We have, therefore, in being a great health machine, and it only remains for us to perfect it still further to ensure that the best results possible can be obtained.
A contrast of the public health position which existed half a century ago with the organisation of trained, skilled, well-equipped personnel which is now available, shows how great is the advance that has been achieved. A few examples illustrative of the improvements brought about by the public health services may be of interest at this stage. In the year 1881, 1,406 cases of typhus occurred in the City of Cork. This number was only an indication of the situation throughout the country. Within recent years, apart from a few endemic areas in one or two counties, the disease has become almost non-existent in this country, and with the further steps which are about to be taken, I can assure the House that before long it will have completely vanished. How great were the epidemics of typhus in by-gone years can be seen when I say that in the epidemic of 1815-1817, in Dublin alone over 70,000 cases occurred, and the total number of deaths for the entire country was estimated at 44,000. For a great number of years we have not had a case of smallpox in this country, so that it is now possible to abandon compulsory vaccination, the measure mainly responsible for banishing this disease from our midst. Amongst the recent triumphs of preventive medicine must also be included the progressive and gradual decline of typhoid or enteric fever.
As I have explained to the House, public health has now reached a point when something more than the mere eradication of infectious disease is necessary. A point has been reached when it has become essential to pursue disease, and I am confident that the public health authorities and their staffs will welcome the additional powers for that purpose which the Bill contains.
Before dealing with the various matters of detail I would like to direct special attention to what is probably the most important feature of the Bill, and that is the advance which will follow the implementation of the powers asked for in Sections 85, 86 and 87. I have noted with some amusement the efforts of various Press commentators on this Bill. While they considered at length what were relatively minor provisions, the major purpose and intention, in fact, what might be described as the real basis of the measure, was completely overlooked. The three sections mentioned contain the necessary legal provision for the new maternity and child health services which it is proposed to establish in this country.
As the House is aware, we already have facilities for maternity and child welfare, and a school medical service. The maternity and child welfare schemes, which are administered by sanitary authorities, have been shown by experience to have many defects. The assistance given is limited almost completely to medical advice and where necessary, the supply of free food supplements. There is not sufficient continuity between the examination of the mother before the birth of her child, attendance at the birth and the care of the mother and child after the birth. Again, a serious defect is that the service is not sufficiently backed up by facilities for treatment; nor is there provision for follow up to ensure that, in fact, every mother and child receives the necessary treatment, and finally there is the defect that the scheme only applies to children up to five years of age.
The school medical service also cannot be regarded as satisfactory. Recent developments in the organisation of school medical work show clearly that two main types of service are necessary, one a simple inspection and treatment service, the other a more specialised inspection related to such aspects as nutrition, child-guidance, and other specialities. We have not been able to provide fully for either the one or the other. The facilities for treatment in most of our school medical services are inadequate. Again, examinations are not carried out often enough, and there is lack of continuity between the maternity and child welfare service and the school medical service.
A further important consideration in relation to the school medical service is the inability of officers to carry out what may be described as a complete examination of the children of school-going age. By complete I do not mean clinically complete, but rather complete in the sense that each child receives an examination regularly as part of a regular and complete schedule. This is not altogether due to an insufficient staff, but can be attributed in part to the fact that careless parents warned in advance of the day of examination, not only refuse to allow their children to be examined, but wilfully withhold them from attending school on the day on which the officers attend. If I felt assured that this refusal to allow children to be medically examined was due to any conscientious motive, or a desire to protect the individual liberty of the subject against what was looked upon as an unwarrantable encroachment, I would insist that all deference should be paid to such an ideal and direct the officers of the service to respect such a wish. Or, if I felt that, in fact, the examinations carried out by the medical officers of the local authorities were unnecessary because the parents of those children who did not attend, or who refused examination, had provided alternative medical attention, again I would respect their motives. But when I realise that from one end of Ireland to the other, always and everywhere, when an opportunity for an examination of children is refused, it is precisely the class or group or individual, whose children most need it, who refuse it. Theoretical arguments against compulsory examination do not carry much weight when considered in the light of realities. If there are verminous children in the school, it is those children whose parents will not permit them to be examined lest the condition should become known. If there are malnourished children in the school, or children with skin infections, it is again precisely those children who will not be submitted for examination, and I ask, are we to subject the clean, healthy child to the constant risk and danger of disease because of the carelessness and prejudices of the inconsiderate few?
The responsibility for the health, care and welfare, of the children of this country is a big responsibility—a much greater charge than most Deputies realise. It is a responsibility which concerns not only the life, health and happiness of the present generation of children, but it concerns the future of our race.
I am not submitting these proposals in the spirit of an impetuous reformer, striving by laws, regulations, or orders, to dragoon people into some foolish scheme conceived as a passing whim. I am simply appealing to the ordinary common sense of the members of this House, appealing on what are sound principles of public health and sociology, for the opportunity to promote the better lives and happiness of expectant and nursing mothers and children up to the age of 16 years.
The problem of child and maternal health has been studied in this country. Not only has it been studied in relation to what has been done elsewhere, but it has been studied specifically in relation to our own conditions. It has been studied, not as a text book exercise, but through research, inquiry and the experience of those in closest touch with the problem. Having given close attention and earnest thought to the matter, I have now decided to co-ordinate the maternity and child welfare schemes into a unified free service, which will give continuous care to the mother and child during the ante-natal period, during birth, and until the child reaches the age of 16 years. The powers to establish this service are contained in Sections 85, 86 and 87 of the Bill, and of the 113 sections in the Bill I regard these three as being by far the most important.
The service will be based upon the family doctor. Its background will be one of prevention. Briefly, it is proposed to develop a free ante-natal and maternity service for every woman who desires to avail of it. The service throughout the provinces will be provided through the district medical officer, and will be organised on a county basis. It will have no relation to or any connection with the public assistance organisation. The doctor will be assisted by a midwife who will receive a salary and will give her services free. Ultimately, an obstetrical consultant service will be made available, not only to advise ante-natally in those cases liable to give trouble, but to assist in a specialised manner in the care of cases which require a consultant.
A free service, on the same basis as that given to the mother, will be provided for each child from birth until it reaches the age of 16 years. During infancy a special system of visitation will be carried out by the district midwives under the supervision of the doctor, and regular help will be given to mothers by advice, weighing of infants, and encouragement to breast feed. Experience has shown that the majority of deformities, defects, and disabilities occurring in childhood are in existence before the child reaches the age of 5 years. Unfortunately, it has been during this age that children receive least attention, and it is precisely to this age group that I intend this service to devote special attention. Therefore, for children of this age arrangements will be made for regular domiciliary inspection and treatment of defects by the district medical officers, and, not only will treatment of defects by the district medical officers, and, not only will specialised care they will have the assistance of both the public health officers, and of ophthalmologists, orthopaedists, and other medical specialists. Children will also be subject to regular examination, as school children, by the district medical officer, who will treat free of charge any defects or illness he may find. Again the district medical officer will have the backing of consultants of various kinds for those conditions for which specialised treatment is required.
Recent development in school medical work has seen the institution of care of a different type. This is based upon the newer knowledge of nutrition, of psychiatry, and of developments in physical culture. This aspect of school work will be the charge of the whole-time officers of the local authority who at present carry out school medical inspection work.
For the fuller operation of the service it is also proposed to have a fully trained whole-time nurse appointed in each district throughout the State. The value of such assistance will be at once appreciated when it is realised that, in addition to general nursing duties in relation to school children, she will also carry out follow-up work in those cases who will be discovered to have disease, or who are receiving treatment as a result of school inspection. She will also play a large part in the education of children in the school in a healthy way of life, good habits, and cleanliness, and she will impart an elementary knowledge of nutrition and food values.
Before leaving the subject of the mother and her child, let me say a few words on the subject of infant mortality. We in Ireland have rather an indifferent reputation as compared with other countries in this respect, yet it is not fully deserved, and is due to circumstances which have been hitherto beyond our control but which are rapidly ameliorating. Our infant mortality rate for 1944 was 79. This is too high. It could be brought down to a much lower figure. By infant mortality I mean the number of deaths occurring each year per thousand live births. When it is realised that each year hundreds of children all over the country die from what are clearly preventable causes, it should be at once apparent to the House that every assistance must be granted to enable us to remedy the position. I have said that our infant mortality figures, which have averaged 72 for the ten years 1935 to 1944, do not truly reflect the position, and would indicate that throughout Ireland infants die at an excessive rate. I wish to make it very clear that that is not the position. While we have black spots which are largely responsible for maintaining a high average rate of infant mortality, the fact is worth nothing that for the last ten years the average infant mortality rate for County Mayo has been 43; for County Monaghan 47; and for County Leitrim 47; figures which, under the circumstances, are comparable with those in any other country, and no one will say that these are the richest counties in Ireland. On the other hand, Dublin County Borough has had a ten years' average of 104, Waterford 95, Cork 89 and Limerick 83. This matter is being given considerable study and in Dublin at present, efforts to reorganise the care of infants are being made, but no amount of theorising, of discussing the why and wherefore will fill the empty cots and cradles in the hundreds of homes where babies have died. We must regroup our forces, take additional powers, spend more money, and by hard work and attention to every minute detail, and by aiming at the highest standards, continue the fight until success is achieved.
I will now review the several parts of the Bill. Part II defines the general duty of the Minister in regard to public health and provides for the establishment of consultative councils to give to the Minister advice and assistance in connection with matters affecting or incidental to the health of the people.
Part III deals with the provision of institutions by health authorities. Since the passing of the Act of 1878, every sanitary authority had power to provide for the use of the inhabitants of their district, hospitals or temporary places for the reception of the sick or convalescent, and to charge for the maintenance of patients admitted to these hospitals or places. The power so granted was not used except to a very limited extent, and the general hospital system of the country became dependent on the development of poor law and voluntary institutions. Even when county boards of health replaced rural district councils in pursuance of the Local Government Act of 1925, these larger bodies with increased financial resources did not undertake the work of supplementing the existing hospital accommodation. The provisions of Part III of the Bill are designed to coordinate the powers of local authorities in regard to the provision of institutions under the Public Health Acts. It must be our aim to bring the public hospitals, and the fever hospitals maintained by the public assistance authority, more into line with public health administration, and the time has come when the principal sanitary authorities should be prepared to meet their obligations in this respect. The term "institution", for the purpose of the Bill means a hospital, sanatorium, maternity home, convalescent home, preventorium, clinic, health centre, first-aid station, dispensary or any similar institution, while the term "health authority" includes county authorities and sanitary authorities.
Part IV deals with infectious disease. Under the existing law, sanitary authorities are charged with the administration of provisions for the prevention and control of all infectious diseases except tuberculosis and venereal disease, which are dealt with by the county authorities. It is now proposed that all infectious diseases are to be dealt with by county authorities.
The Minister is empowered to declare by Order that a disease is infectious. It is intended to utilise this power so as to bring tuberculosis and venereal disease into the category of infectious diseases and by that means bring to bear on these diseases the full force of the statutory powers relating to infectious diseases. Attention is drawn to the position which obtained when the Tuberculosis Prevention (Ireland) Act, 1908, was being promoted. The feeling in this country was then so adverse to the disease being made generally notifiable that the Government of the time restricted notification to (a) the stage of pulmonary tuberculosis where the sputum discharged was liable to communicate the disease to other persons, and (b) circumstances in which the patient slept or worked in the same room as non-tuberculous persons or was employed or engaged in handling, preparing or distributing meat, milk, or any other article of human food intended for sale to the public. In 1919, a revised Order was made, extending the compulsory notification to any form of tuberculosis at any stage at which the sputum or other infective discharge from the patient was considered liable to communicate the disease to other persons.
The result of this limited notification was that cases of tuberculosis were not notified until they had reached an advanced stage and the patient did not accordingly come under the notice of the tuberculosis medical officer until there was little chance of recovery or effective treatment. Moreover the infection had often been spread by that time to the patient's household or fellow workers. The position which has resulted could have been largely prevented if full notification had been enforced and the people educated to appreciate the real requirements of the situation. It is not yet too late to provide the necessary safeguards for the protection of the present generation both in their early years and up to the prime of life. For that purpose it is proposed in the Second Schedule of the Bill to empower compulsory notification of all forms of tuberculosis and compulsory removal to hospital of infective cases where necessary. I would like to stress the fact that the making of an Order declaring tuberculosis an infectious disease will apply the provisions of Section 34 of the Bill to persons suffering from that disease. Under that section the health authority of the area in which such a person resides shall make reasonable and proper provision for his maintenance or that of his dependents.
This provision is likely to have far-reaching effects in aiding the campaign against tuberculosis. As we know, the cure of that disease is most easily effected if the person attacked seeks medical advice and treatment in its first onset or in its earliest stage. Breadwinners are too often deterred from seeking early treatment by fear of loss of employment and the consequent suffering to the family or other dependents. If the patient is assured of reasonable financial assistance to meet his needs, he can seek medical advice without delay and concentrate on obtaining the best results from the treatment afforded to him, thereby increasing considerably the likelihood of a complete cure. Medical officers of sanatoria are familiar with the case of mothers who leave an institution before they can receive any adequate treatment because they are worried as to the lack of care of their children at home. Where the circumstances so require, the health authority may make such provision by defraying the cost of the employment of a person to act as a substitute for the patient during absence or incapacity. The latter course would be useful for instance in the case of a mother of young children who had tuberculosis, as it would be possible for the county authority, if the circumstances so required, to arrange for a suitable person to carry on the care of the children, and perform here other duties while the mother is undergoing institutional treatment. Similarly, it is conceivable that the supply of an agricultural worker might be the best and most economic means of securing the reasonable maintenance of the dependents of a farmer patient who could not himself afford to pay a farm labourer to look after the farm during his absence in hospital, or his incapacity for work.
In view of the service rendered to the community by the hospitalisation of persons who are probable or actual sources of infection, it seems fitting that where hardships are incurred by such persons or their dependents on account of giving up employment or occupation, reasonable and proper financial assistance should where necessary be made available to meet such hardships. If any dispute arises as to the nature or amount of the provision (if any) to be made for the maintenance of any such persons or his dependents the matters is to be decided by the Minister.
In regard to cases of venereal disease, it is necessary to have available compulsory power to deal with patients who refuse to avail of treatment and who, if allowed to remain in an infective condition, are liable to spread infection to innocent persons. Under the existing law, if a person can prove that he has contracted an infectious disease by reason of the failure of another person to comply with the provision of the Public Health Acts, he can recover from the other person compensation for the damage he has suffered. Difficulty, however, usually arises in proving that the disease was contracted on account of the defendant's failure, seeing that any other cause of infection must be eliminated with reasonable certainty by the complainant. The clause inserted in Part IV of the Bill should remove this difficulty.
I would now draw attention to the proposed repeal of the Vaccination Acts. It is no longer proposed to enforce vaccination against smallpox except at times or in districts where the risk of that disease is regarded as serious. Smallpox has for a long period been absent from this country, the last case on record being an imported case discovered at Cobh in 1923, whilst the last death occurred in 1907.
Other notable matters to be included in regulations are compulsory cleansing or disinfestation of persons and the examination of persons suspected of being probable sources of infection. Power is also taken to extend to aircraft coming into or leaving the State, and to their passengers and crews, the precautions against the introduction into this country of infectious diseases which are at present applicable to vessels arriving from abroad.
A person who is infective, or in charge of an infective person, must take reasonable precautions to prevent others from being infected either by himself or by a person under his care. It is disturbing to observe how lightly people violate the elementary rules for preventing the spread of infection by permitting children suffering from whooping cough, measles, scarlet fever, chicken-pox, mumps, ringworm, scabies, etc., to attend schools or mingle with other children. Again, persons suffering from tuberculosis, often fail to take the simplest precautions to prevent the disease being conveyed to other members of their families or households.
A person who lets apartments as lodgings must not do so in respect of a room or other place which he knows to have been occupied by a person who was a probable source of infection, until the necessary disinfection and disinfestation of such room or place has been carried out. The same prohibition applies to the selling or letting of dwellings which have been exposed to infection. Restrictions are also placed on the use of public conveyances by any persons who are a probable source of infection with diseases to be specified.
Experience of the operation of the powers conferred by the Public Health Acts for the compulsory removal to hospital of persons suffering from dangerous infectious diseases and for the isolation of contacts has shown that the procedure prescribed for that purpose is cumbersome and unsatisfactory. The power of compulsory removal cannot be enforced if the patient or the contact refuses to go to the hospital or place of isolation, and is willing to pay the penalty provided for the offence which in the case of a patient is a fine not exceeding £10, and in the case of a contact a fine, not exceeding £5. This remedy is of very little use against the classes of the population who are likely to resist the adoption of reasonable precautions against the spread of infectious disease. This was clearly demonstrated a few years ago in connection with an outbreak of typhus fever in a northwestern county which was traced to a party of itinerants travelling through that area. Unsuccessful efforts were made to induce members of this party who were contacts with cases of the disease to allow themselves to be disinfested, and to be isolated for a period so as to preclude the infection being carried to other localities. Before the necessary procedure could be carried out the itinerants had disappeared.
In view of the grave danger arising from a contingency of this kind, it was decided to provide the necessary machinery for dealing with such cases. For this purpose the Emergency Powers (No. 46) Order, 1940, was made by the Government on the 27th August, 1940. This Order empowers the Minister to issue a warrant for the detention and isolation of any person who is considered to be a probable source of infection with any disease until a specified medical officer shall certify that such person is no longer a probable source of infection. The Order has been used in a considerable number of cases and has proved of immense value to county medical officers of health in dealing with outbreaks of serious infectious disease, especially of typhus fever. It is proposed to incorporate the same principle in this part of the Bill with the amendment that the chief medical officer of the county, county borough, or port sanitary district concerned, shall be substituted for the Minister in regard to the issue of an Order directing the detention of a person who is deemed to be a probable source of infection. This alteration will enable the Order to be made more quickly and will ensure that it can be acted on more promptly. Moreover, provision is being made in the Bill for giving to the patient, or, in the case of a child, to his parents, a right of appeal to the Minister against detention. This new provision should therefore be a distinct improvement on the Emergency Powers Order which will be revoked when the alternative arrangements become available.
The new provisions in Part IV render unnecessary various clauses of the Public Health and associated Acts under which sanitary authorities are authorised to provide facilities for cleansing and disinfection in connection with the prevention or control of infectious disease, and these are being repealed.
Parts V and VI of the Bill deal respectively with drainage and water supply. As regards Part V, there has been considerable difficulty in inducing owners of premises in an area where a new drainage system has been installed by a sanitary authority, to connect their premises to that system. It is considered that when a sanitary authority provides a systeme of public drainage on modern lines in their district, the standard of drainage required for premises in that district should be raised, and, where practicable, drainage by means of cess pools or similar arrangements should no longer be permitted. No provision is made in the existing law for such improvement and the powers of the sanitary authority are therefore confined to cases in which even the absolute minimum of drainage does not exist. The Bill introduces a new procedure in accordance with modern requirements under which owners of premises can be required to provide drainage systems which are satisfactory having regard to the standard of the area in which these premises are situated. This procedure is set out in Sections 40 to 45 of the Bill. Section 40 empowers the sanitary authority to require within a specified period after the coming into force of a drainage Order the due execution of specified drainage works for the drainage in a satisfactory manner of any separate premises, or of two or more separate premises.
The sanitary authority is empowered to make such portion of the drainage system which passes through land of which the owner is not an owner of premises required to be drained, or to make portion of the system where the total length of the drain exceeds 100 feet in case of any separate premises, or in case of two or more premises, any excess length as may be determined under Section 43 (4) of the Bill. In case of default the sanitary authority may execute the necessary work and recover the appropriate expenses. Where any doubt, dispute or question arises, an appeal lies to the Minister, who may either confirm the Order of the sanitary authority, with or without amendment, or subject to such amendments as he thinks proper, or he may annul the Order if the circumstance of the case would warrant the adoption of that course.
The institution of a proper sewerage system is largely dependent upon the connection of premises to a public water supply. The explanatory memorandum circulated with the Bill indicated the defects in the existing law. The Bill introduces a modern procedure for the provision of a water supply applicable to all buildings and empowers the sanitary authority to make a provisional water supply order requiring the connection of a building, in a specified manner and within a specified period, with a public water supply. The owner or occupier of a building and the owner or occupier of land through which the water pipes are intended to pass, may lodge an objection with the Minister in regard to the order, and he may confirm the order without amendment or with such amendments as he thinks proper, or annul the order. Where the order is confirmed, the sanitary authority may make that portion of the water supply system which is more than 100 feet from the building, or, in the case of several buildings, which is more than the total length of pipes in the water supply system represented by 100 feet multiplied by the number of such buildings, while the owner or owners of the buildings will be responsible for making the balance of the system which lies nearest to the buildings. If that portion of the system is not made by the owner or owners, the sanitary authority may do that work and apportion the cost as between the owners. A right of appeal to the Minister is provided for in the case of any dispute as to the portion of the system and the apportionment of the cost, to be made by the sanitary authority.
Recently we had a discussion in the House as to the feasibility of providing a piped water supply to rural dwellings. In pointing out the impracticability of such a proposal, I directed the attention of the House to the availability through our spring wells of a pure and wholesome water supply in many rural areas. I expressed the hope that local authorities would direct their attention to the proper construction of these wells so as to protect this source of domestic water supply from contamination. In the hope that local authorities may do something practical in the matter, provision is being made in Section 54 of the Bill to enable local authorities to spend money, or make a grant of money, to any person for the provision, improvement or maintenance of any water supply other than a public water supply.
Difficulty is at times experienced in arranging for repairs to water pipes which pass through lands owned by a person not the owner of the building to which the water pipes are connected; and power is taken in the Bill to enable a sanitary authority at the request and at the cost of the owner of the building, to enter on the land and carry out the necessary repairs to the pipes.
Part VII of the Bill contains provisions for the control of temporary dwellings and camping. Power exists at present under Section 20 of the Local Government Act, 1925, to make by-laws for the prevention of nuisances in tents, vans, sheds, or similar structures, or on barges, lighters, boats, or other vessels on any inland water used for human habitation. This section has not proved effective, and, in any event, is not sufficient to deal with the problems which are expected to arise in the near future from holiday camping. The framers of that section had mainly in mind itinerant tinkers and people of that kind whose squatting on the road margins and lands often gives rise to a nuisance owing to their nomadic way of life. The danger to health and morals, and to life and limb, by these squatters on the roadside and in other public places, has so often been referred to by public representatives that I need not delay the House by further reference to it. Suffice to say that the powers sought in the Bill are calculated to deal satisfactorily with the matter.
We may now also expect a great increase in motor caravans, camping in tents for pleasure, and semi-permanent holiday rest camps. Further, there is reason to believe that vessels of the house-boat type may be stationed on coastal and inland waters to cater for tourists. While no objection to this development is being made there is nevertheless serious danger of injury to the health, and to the amenities of our countryside, unless steps are taken to regulate camping and to prevent abuses. Part VII is designed to enable the sanitary authorities to do this in an effective way without unduly interfering with the enjoyment of healthy pleasure.
The term "temporary dwelling" includes tents, vans, sheds, huts and similar structures and vessels on inland waters used for human habitation or constructed or adopted for such use. The power of a sanitary authority to make bye-laws in respect of the use of temporary dwellings in their sanitary district is re-enacted and such bye-laws may relate to habitable condition and cleanliness, the control of infectious diseases, prevention of injury to the amenities of the locality by reason of filth, refuse, and noise, the securing of orderly and decent behaviour by occupants of temporary dwellings, and the prevention of nuisances. Power is taken for a sanitary authority to prohibit temporary dwellings in any part of their sanitary district where they consider that such dwellings would be prejudicial to public health or the amenities of the locality, or would interfere unreasonably with traffic on any road.
This power would be mainly used for the prevention of danger of road accidents by encampments or parked vehicles on road margins, and for the preservation of the amenities of pleasure resorts or beautiful landscapes. There is a right of appeal to the Minister for any person aggrieved by the prohibitions. If a temporary dwelling is in such a condition as to be injurious to health whether by reason of the absence of proper sanitary conveniences, overcrowding or other cause, it may be dealt with as a nuisance within the meaning of the Public Health (Ireland) Act, 1878, and a court before which proceedings are brought by the sanitary authority against the occupier of the site of that dwelling may make an order prohibiting the retention of the temporary dwelling at that place or within such area as may be specified in the order. Provision is included in Section 60 of the Bill for dealing with permanent or semi-permanent holiday camps or camping grounds. Under that section the Minister may by Order provide that the section shall come into force in a specified sanitary district or part of a sanitary district on a specified day. The arrangements provide for the grant by a sanitary authority of a licence to an occupier of land in their district authorising the use of such land for camping during a specified period of 12 months. This licence may be granted subject to specified conditions dealing with the maximum number of dwellings to be kept on the land at the same time, their nature and size, the distances between any two dwellings, their distance from the public road, their sanitation, the orderly and decent behaviour of their inhabitants, the maintenance of healthy conditions and preservation of amenities and the employment of a warden to supervise the dwellings. It will be illegal for a person without such a licence to use land for camping on more than 14 consecutive days or more than 30 days within 12 consecutive months. Exceptions are made for persons engaged in seasonal farming operations and in respect of camping on land occupied in connection with a dwelling in the vicinity by the occupier or members of his household. In connection with the conditions for the obtaining of a licence it seems to be quite proper to require, from persons who are making their land available for campers as a profit-making enterprise, a reasonable standard of amenity and convenience.
At present a sanitary authority can only provide baths and wash-houses within their district, but the Bill extends that power to the establishment of these facilities outside their district, subject to the consent of the local sanitary authority. If that consent is refused or withheld for a period of three months there is right of appeal to the Minister.
The Bill also authorises the provision of life guards at bathing places and the provision of instruction in swimming and saving persons from drowning. This provision should reduce the considerable loss of life from drowning which annually occurs in a country like this where rivers and lakes are so numerous. Moreover, these facilities will enable a higher standard of personal cleanliness to be generally observed.
The objects of Part IX have been summarised in the explanatory memorandum which accompanied the Bill, as follows:—
(a) The protection of the public from food which is actually dangerous or injurious;
(b) The prevention of the exploitation of the public by manufacturers of inferior articles of food for which nutritive qualities are falsely claimed and also of malnutrition caused by the use of such foods;
(c) A general improvement in the nutritive qualities of the food available.
The second section in this part of the Bill is an extension of a similar provision contained in the Public Health (Regulations as to Food) Act, 1907, which is being repealed as a consolidatory measure and re-enacted in an extended form in the Bill. Authorisation is given therein for the making of regulations providing for the prevention of danger to the public from the manufacture, preparation, importation, storage, distribution, or exposure for sale, of food intended for sale for human consumption. The word "food" also includes drink. These regulations would deal with the wholesomeness and cleanliness of materials used in the preparation or manufacture of these commodities. They would also control the manner in which such articles are stored, exposed for sale and distributed. Too often one witnesses the danger of contamination to which food is exposed, especially food which is intended to be eaten without being cooked. Bread, a food in general use, is carried on uncovered trays on top of vans exposed to the dust of the road and is distributed in a very unhygienic manner. Confectionery and sweets, favoured by children, are exhibited in shop windows subject to defilement by flies and other insects; fruit and lettuce are deposited outside shops open to contamination from various sources; and ice-cream is carried unprotected on vehicles through the streets. Meat may also be seen arranged on slabs outside victuallers' stalls handled by every intending purchaser. The regulations will prescribe that suitable protection against contamination shall be afforded to such commodities.
The remainder of Part IX deals with the standardisation and control of articles of human food and drink. The necessity for these provisions is easily demonstrated. Standardisation will protect the manufacturer of an honest and genuine product from the competition of unscrupulous rivals who may profit by imitating the appearance, but not the quality, of his products. It will enhance the prestige and appreciation of Irish products by guaranteeing to purchasers that they will obtain a product of standard quality, and it will be clear to businessmen that quality will be the factor finally determining the sale. In this respect Irish goods will be in competition with those from other countries where such a practice is already in operation.
It is well known that statements published in modern advertising of a product are not always related to the actual value of the product. In the case of food this may have serious consequences. The presence on the label, or wrapper, of an accurate description of the article, will ensure that purchasers are not misled by advertisement. Since the bulk of the people who buy food in this country have small incomes and cannot afford to make mistakes in spending their weekly wages, anything which assists them to make a wise choice must be regarded as being of tremendous economic and social value.
The advertisements for baby foods, many of which make exaggerated claims, have been the cause of numbers of Irish children being fed on poor quality, low-grade cereals, with resulting ill-effects, and there is no means of informing the public of the real quality of such foods. Moreover, there has been lately a tendency to claim that certain health foods contain vitamins or some other particular constituents. Without a responsible authority to determine a standard in regard to these constituents the public have no protection. Genuine fruit extracts, syrups, and cordials, are widely and properly recommended to supplements the vitamin content of children's diet. Substitutes, however, have been sold with claims, expressed or implied, by pictures of fruit on the wrappers, or other devices, that they contain extracts from fresh fruits when, in reality, they contain little more than chemical flavourings. This is a fraud on the public which cannot but have and adverse effect on the health of the young children to whom such drinks are supplied.
The ever-increasing variety of modern foodstuffs, however, makes it difficult to prescribe legal fixed standards in every case. Moreover, such a fixed standard must naturally be the lowest that can be permitted, and there might be a tendency for manufacturers to work down to that standard rather than seek an improvement in the absence of commercial advantage. In order, therefore, to encourage an improvement in these foodstuffs it is proposed, either in addition to or in substitution for such fixed minimum standards, to allow producers of particular foods to fix their own standards of quality, and to announce them publicly on the wrapper or container of their products. Each such producer will fix his standard by submitting samples of his product to the Department, which will have them examined and will certify the result. The certificate must be printed on the container in which the product is sold, and the producer must not sell any of that product inferior in quality to the sample certified. This procedure, while ensuring the benefits of publicity to the producer of a superior product, will serve to protect the public and encourage an improvement in the nutritive value of the food concerned.
The regulations to be made under Part IX will prescribe a standard for the composition of foods which require a degree of control, and will set out the procedure in connection with the certification by the Minister of the results of the examination of samples of food submitted to him by the manufacturer or importer.
The only existing power at present for a health authority to expend money on educational publicity is contained in Section 14 of the Tuberculosis Prevention (Ireland) Act, 1903, and relates only to tuberculosis. The dissemination to the public of information and advice on health matters is of great importance in modern public health administration, and Section 83 of the Bill accordingly, authorises expenditure from the rates for educating the public in regard to matters relating to health, by means of advertisements, notices, pamphlets, lectures, etc., subject to direction by the Minister, where deemed necessary, as to the manner in which that power is to be exercised.
It may be deemed desirable from time to time for two or more health authorities to take joint action in the performance of any of their functions under the Public Health Acts as for instance in the provision of institutions, and the necessary authority for that purpose is conferred in Section 84 of the Bill, which also contains a saving in respect of the continuance of joint maintenance by health authorities of any institution which has been so maintained before the commencement of the section. Under the existing law such co-operation can only be achieved by the establishment of a united district under Section 12 of the Public Health (Ireland) Act, 1878, and that requires a provisional Order confirmed by the Oireachtas.
Section 89 provides for the placing of restrictions on the importation, manufacture, or sale of certain articles, and greater control is necessary in respect of certain appliances and substances which are frequently advertised and the use of which may involve the risk of serious injury to health or body. There is also need for greater protection of the public in regard to certain medical preparations which are extensively advertised as possessing curative, restorative, protective, or tonic properties. The public have no guide as to the extent to which these claims are justified, and accordingly there is considerable exploitation of persons suffering from ailments, infirmities, or defects for which the preparations claim to be a remedy. There are few members of the House who have not at some time felt the power of modern propaganda. There are few amongst us who would not resent it if we were told that the actions of our daily lives were not really the result of our free will, but were largely affected by whatever advertising inducements caught our eye. While there is no doubt that modern advertising can be regarded as a reasonable part of legitimate trade, and as it is frequently said that an advertised and patented article must live up to its claims, still there is a form of trade which often deviates ethically in that it tends to exercise far too great an influence through advertising. I refer to the matter of patent and proprietary medicines. I freely admit that there are preparations which as a result of years of advertising have come to be well known, and when kept in the family medicine cupboard are useful home helps for the slight domestic mishaps which occasionally occur. I do not deny that some patent or proprietary products, on psychological or even on clinical grounds, have justified their existence. But I am equally certain that there are many drug products sold to the public as a result of high pressure advertising which are fraudulent.
In most civilised states throughout the world steps have been taken to control this trade, whether by special taxation or otherwise, and it will not be denied that the time has come to control it here. After all, the enormous sums spent on advertising these articles can only come from the pockets of those who purchase them and it should not be necessary for the purchaser to pay an excessive price solely for the pleasure of reading an excessive amount of advertising matter lauding these patent preparations. Accordingly it is proposed, by regulations, to license these preparations, to prohibit the sale of those products which are not of the nature and constitution claimed, and to control the advertisement of medical preparations.
It will probably come as a surprise to Deputies that under the existing law human remains may be buried in a place which is not a recognised burial-ground. There can be no records kept of such a burial, and it is not subject to the conditions which public health and public decency require. Section 92 of the Bill is intended to provide the necessary control in regard to the burial of bodies of deceased persons, and prescribes that such burials shall only be permitted in places recognised as burial grounds.
Whilst in certain burial grounds not controlled by sanitary authorities the proprietors undertake, for a consideration, to keep graves in order, either in perpetuity or for a specified time, the sanitary authorities have no such power as regards burial grounds under their control. As this practice is desirable from many points of view, the necessary power for that purpose is conferred on sanitary authorities by Section 93 of the Bill.
Under the existing law there is no definite power save under Section 15 of the Coroners (Amendment) Act, 1927, or for police purposes, to permit the exhumation of bodies except from burial grounds under the control of sanitary authorities. It is necessary to control such exhumation where required from other burial grounds so as to secure that it may be carried out with due care and decency and in such a manner as not to endanger public health. Section 94 of the Bill provides, accordingly, that licences may be granted by the Minister for that purpose, and prohibits unauthorised exhumations.
Under the existing law the determination of the area of charge for some of the expenditure incurred by a rural sanitary authority (known as special expenses) requires in each case an Order of the Minister. In recent years many county councils have shown a preference for all special expenses being charged to the whole of the county health district as in the case of their general expenses. The present system involves the making of separate Orders in every case. Under Section 99 of the Bill, it is proposed that all such expenses, shall be general expenses unless the county council apply to the Minister for an Order fixing a special area of charge.
The review I have made of the provisions of the Bill will, I trust, help Deputies to a full understanding of our problems. I may add that as a result of this measure 14 existing Acts are being repealed, together with portions of 11 other Acts. The Bill, therefore, effects a very substantial advance in regard to the co-ordination of the public health code, and many additional measures have been included so as to bring its provisions up to date. It is hoped in due course to proceed with further consolidatory and progressive legislation and thus provide a comprehensive, unified and efficient public health code.
