Committee on Finance. - Health Bill, 1947—Second Stage.

I move that the Bill be now read a Second Time.

This Bill provides for a large measure of codification of the law in relation to health administration: it is also the first step in the task of general modernisation and expansion of the law and administration in relation to health services. I have no doubt that this latter task will involve the submission of a number of other measures to the Oireachtas as time goes on, but the present Bill contains what I hope will prove to be that measure of reform which is at once most urgent and most practicable.

I do not think it necessary to dwell in any detail on the codification aspects of the Bill: the explanatory memorandum circulated to Deputies sets out the general heads of the statutory responsibilities which have devolved on the Minister for Health in pursuance of the recent Transfer of Functions Order which was made following the establishment of a separate Department of Health in pursuance of the Ministers and Secretaries (Amendment) Act, 1946. The Transfer of Functions Order has been laid before both Houses of the Oireachtas, and Deputies who have examined it must have been struck by the great number of Acts and portions of enactments which had to be cited to give effect to the transfer. There are 46 complete Acts mentioned in Part I of the First Schedule to the Order, and numerous sections of some 14 other Acts are set out in Part II of that Schedule, while there are 21 adaptations of provisions which fall to be exercised severally by the Minister for Local Government or the Minister for Health, according to their respective functions. This gives a fair picture of the voluminous and diverse enactments which have become the responsibility of the Minister for Health.

Now, if Deputies look at the First Schedule of the Bill, dealing with repeals, they will find that some 26 enactments are being repealed in whole or in part. These repeals are possible because the provisions of the present Bill re-enact or replace them in modernised—and, I hope, in improved —form. The result will be that the lists of statutory functions which proved such an arduous and complex task to prepare in connection with their transfer to the Department of Health will be greatly abbreviated and simplified by the provisions of this Bill. The law on the matters with which the Bill deals will in future be available for reference in a readily accessible and modernised form.

As indicated in the explanatory memorandum, the Bill, when enacted, together with the Mental Treatment Act, 1945, the Parts of the Public Assistance Act, 1939, appropriate to the Minister for Health and certain self-contained Acts, will comprise a consolidated series of statutory enactments in relation to most of the Minister's functions and the relevant responsibilities of local authorities. There will remain the need for a separate codification of the food and drugs legislation—although we anticipate that also to a certain extent by special provisions in this Bill.

That is all I need say at this stage on what I might term the legal mechanism of the Bill in relation to the existing law.

I have indicated at the beginning of my remarks that the second objective is the modernisation and reform of the health services. To explain how far we aim at carrying this objective into effect in the present measure, it may be well for me, without going into the detail that is reserved for Committee Stage, to review the proposals in the Bill, Part by Part. Deputies will, I am sure, also expect me to indicate the more important changes which have been made in the proposals which have previously been before the Dáil in the appropriate Parts of the Public Health Bill, 1945.

I might say here, before proceeding to survey the provisions of the Bill and apropos of my references to the Public Health Bill, that, before the consideration of this measure became my responsibility and following very lengthy debates in the Dáil, a large number of amendments had been circulated for consideration on Report Stage of the Public Health Bill. The Ministerial amendments included among these had received very careful consideration and Deputies who participated in the debates and who have studied those amendments will, I am sure, appreciate that they were designed to go a long way to meet a number of the matters which had been the subject of controversy.

In the present Bill, all the relevant amendments then proposed have been incorporated, except where the provisions in question have been otherwise altered, modified or omitted. That fact in itself will, I am sure, help to expedite the consideration of the present measure and procure a moderately harmonious discussion of its contents. I say "moderately" because my proposals are not necessarily perfect and I do not claim to be infallible, but neither should other parties claim either perfection or infallibility for any criticisms or counter-proposals which they may have to make.

As regards Part I, I would draw attention to the new definition of a "health authority". The Public Health Bill contained definitions of a "county authority", "health authority" and "sanitary authority" and it was intended that a health authority might be either a county authority or a sanitary authority. For all the purposes of this Bill, the administrative authority will be the health authority which means the council of a county or the corporation of a county borough. The intention is to rationalise and simplify the administration by making all local functions under the Bill the responsibility of a county or city authority. This in effect means that the numerous urban sanitary authorities who will retain responsibility for sanitary services supervised by the Minister for Local Government will have no responsibility for health services supervised by me.

Part II deals with institutions. Effect has been given to the Report amendments which were put down to meet the criticism of Deputies in regard to the powers sought by the Minister to order the provision or discontinuance of an institution. As agreed on Committee Stage, a local inquiry will have to be held in relation to the desirability of the Minister acting in this manner in any particular case before any Order is made.

This Part of the Bill contains provision for the transfer to health authorities of district institutions maintained by the public assistance authority. I do not anticipate that this provision will be utilised except in restricted classes of cases until further legislation, to be explained beforehand in a White Paper, is introduced to alter radically the public assistance basis of institutional administration. In the meantime, the powers sought may be utilised to bring particular infectious disease institutions under the control of the health authority, e.g., fever hospitals at present managed by the public assistance authorities.

There was some discussion, in debate on the corresponding provisions of the Public Health Bill, in regard to the magnitude of the institutional building programme. A figure of £24,000,000 was mentioned for hospitals and reference was made to a further long-term liability of about £10,000,000 for dealing with institutions other than hospitals, for example, county homes. I should like Deputies to be clear that this Bill does not involve, as a matter of course or in itself, the implementation of that large programme. That is a long-term programme which was initiated when the Hospitals Act was passed in 1933. Hospital construction proceeded for some five years up to the outbreak of the war. It is being resumed now and will be accelerated according as funds and materials are available; but it is not provided in this Bill that any particular institution will be built. To give effect to the provisions of this Bill, certain transfers of institutions will be necessary; if they are modern ones, so much the better, if they are not, we must set about improving or replacing them as part of the general construction programme.

The provisions for transfer of any institutions maintained by sanitary authorities are consequential on the removal from those authorities of any responsibility for health functions. The institutions actually maintained by them are relatively few and trivial— scabies treatment centres, disinfestation stations and other centres of that kind.

I now come to Part III of the Bill, which deals with the mother and child service. I have had the provisions on this matter brought forward into one of the initial Parts of the Bill because I regard it as the most important item of reform for which the Bill provides. These provisions are the basis for a comprehensive service for mothers before, during and after childbirth, and for children up to the age of 16 years. It will be observed that, so far as the Minister is concerned, the provisions are enabling provisions. The Minister may make regulations applicable to every health authority or every health authority of a particular class or a particular health authority as to the manner in which, and the extent to which, they are to exercise their powers in regard to: Attendance to the health of mothers; attendance to health of children who are not pupils of schools, and attendance to health of pupils of schools.

Then there is an obligation to submit children to medical inspection unless a registered medical practitioner certifies that the child is unable to attend the inspection owing to illness, or that he has examined the child and will be responsible for any treatment up to the date of the next inspection. Provisions are also included in regard to the affording of facilities for medical inspection of children in schools. I have no doubt that the co-operation of the school authorities will be forthcoming in practically every case. The law has, however, to provide for all cases, to enable the comprehensive nature of the service to be maintained and, for this purpose, school managers are required to give all reasonable facilities on receipt of the prescribed notices, and subject to the consultation which the health authorities are required to have with them.

The purpose of the prior consultation is to enable the inspection to be carried out with the minimum inconvenience to the authorities of the school, but I think that in practice it will be possible to arrange, with the consent of all concerned, for regular inspections at stated times in such a manner as to require very little discussion or preparation prior to particular inspections.

As regards the need for a service such as is proposed here, most Deputies will be aware that both the present maternity and child welfare service and the school medical service are inadequate; that the whole-time public health staff is unable to cope with the demands of a full service, and that there is not proper continuity of attention to the health of children before they attend school and afterwards. It is proposed to establish an integrated service whereby the defects in the present schemes will be remedied and a greatly expanded and modernised service will be provided which will include ante-natal care of mothers, facilities for obstetrical attention and post-natal supervision, and a full medical service for children from birth until the age of 16 years.

In this respect, I propose to pay particular attention to the preventive aspect of the new service. Thus, in addition to medical treatment, the new service will include provision for the early detection and diagnosis of defects in children, their immunisation against preventable disease, care of nutrition, physical development and the promotion of sound healthy habits. It is my aim to use this service to promote a healthy growing generation.

I have given considerable thought to the means by which this service will be implemented, and I am satisfied that it is very desirable that the district medical officers (or the dispensary doctors, as they are commonly called) should be associated with the new service. The service will, of course, deal with various specialised ailments, but it is essentially a basic general medical service such as those doctors are already performing to the best of their ability and resources in their ordinary medical practice, official or otherwise. Some months ago I met representatives of the Medical Association, following which it has been arranged to accord sanction to proposals for increased salary scales for the dispensary doctors up to certain limits indicated to them. Those increases are based on the admitted need for stepping up the remuneration of dispensary doctors in respect of their existing duties. I told their representatives at the same time that I hoped, when this Bill was passed, to be in a position to discuss with them the terms on which they would assume responsibility for increased duties which, in effect, meant this service which I am now discussing.

As I have already indicated, the proposals in the Bill are enabling provisions, as far as the Minister is concerned. The local authority is required to implement them according as regulations thereon are brought into force by the Minister. Furthermore, while most anxious to implement this service, we can only do so with the implements at our disposal, improving those implements, of course, as rapidly as we can. To ascertain precisely what facilities will be at our disposal immediately and what new facilities should be provided, a comprehensive national dispensary survey is being conducted at present. A conference of all the county medical officers of health has also been convened to discuss various public health matters, and the proposed mother and child service is an important item on the agenda.

With the aid of these negotiations and conferences I hope to attain a workable and agreed basis for the co-operation of the dispensary doctors with the whole-time county health staff in the operation of the service. The chief medical officer in each county and his assistants will be expected to supervise the service, to check up on child health and on infantile and maternal mortality, to constitute in brief the headquarters staff which will direct the implementation of the scheme, inspect it in its operation, assess its results and be answerable therefor to the health authorities and to the Minister. The present schemes are inadequate and unsatisfactory, precisely because a small health staff is required to get around every school in the county and to provide for followup treatment without any clear coordination of their machinery with the functions of the institutional and dispensary medical officers who treat the general maladies of the people. The matter is obviously one in which the co-operation of all sections of the medical profession is essential.

There is one other aspect of the service to which I wish to refer before passing away from it, and that is, the objections which have been voiced to the compulsory examination of children. I must say that I am not very much impressed by these objections. My experience of any beneficial service affecting health, or social welfare generally, which is made available, is that it is criticised by the people more on the score of its inadequacy than on the fact that they are compelled in some way or another to avail themselves of it. The people of this country for the past 150 years and, in particular, since they were made the proprietors of their own holdings, have been anxious to improve their status and their houses and property and to educate their children above the standards which existed in former times. There is also a growing degree of enlightenment on the need of greater attentioto health.

Medical treatment, including specialist treatment, is intelligently and insistently sought for by the vast majority of the people. But just as we need compulsory school attendance for the children of those who value education least but require it most so do we need compulsory ascertainment of disease and defects in relation to the children whose parents are least keenly aware of the need for medical attention. An ill-educated child may become a menace to the community in his later years, but the danger is much less than that of an infected child who may infect his companions and there is the added possibility that unless his condition is diagnosed and treated he will grow up, if he grows up at all, a burden on the community through some kind of constitutional infirmity.

It is, therefore, the people who are not sufficiently well aware of the need for medical attention whose children are likely to be most in need of inspection and who may have to be required by some procedure, other than mere invitation, to present themselves for inspection. But I do not anticipate that compulsion, if you can call it compulsion, will amount to absolute dragooning. As I say, the number of people likely to present difficulty will probably be very small, and side by side with the clinical aspects of the service there will, in due course, be a domiciliary nursing service which will be available for giving advice to expectant and nursing mothers and the mothers of young children. That will, I hope, still further reduce the numbers who fail to appreciate the value of the service. I hope that the domiciliary visitors will prove a very valuable medium of health propaganda and that their peaceful persuasion will prove in most cases an effective alternative to compulsion—in other words, that they will be able to coax the lazy ones on with something more gentle than a stick.

I need not stress the advantages of the service from the personal, public health, social or national aspects: these are self-evident. But to put the matter on its most material level, there is grave economic wastage from the loss of young lives and from the undue proportion of children who grow into adolescence and adult life with their economic potential diminished or destroyed by avoidable infirmities. There is the economic waste of the children who are reared and then lost through death, and there is the further economic waste of chronically infirm persons who have to be supported by their relations or by the State or both. In the matter of mental defects, in the absence of a comprehensive scheme to ascertain them and deal with them, backward children are allowed to remain or recede into idiots when early training of a specialist kind would advance them, never perhaps to normally adult mentality, but would at least make them amenable to progressive improvement.

For families who do not wish to participate in the scheme generally applicable and who may have some preferences for private treatment of their children's ailments and some objection against compulsion based on more than mere aversion, inspection of the children is not compulsory if such people can satisfy the health authority that they are providing adequately for their children through the employment of private practitioners.

Furthermore, treatment of the children following the ascertainment of defects is not compulsory for any class. But the public conscience has reached a stage at which the health authority must at any rate take cognisance of defects in children who are not otherwise medically provided for and bring these defects to the notice of the parents in the interests of the individual children and of the coming generation generally. The parent then becomes the arbiter of the child's destiny and he is free to determine whether a recommended course of treatment will or will not be availed of—with this exception that where a case of infectious disease is ascertained on inspection the health authority has a further obligation, by virtue of their responsibility for the public health, to safeguard the rest of the community.

This brings me to the next Part of the Bill. Part IV deals with infectious disease and infestation. The provisions on this matter in the original Bill were debated at considerable length and following detailed consideration of the provisions on Committee Stage amendments were prepared for introduction on Report which were intended to modify considerably the major points of contention. These amendments have been incorporated in the present Bill.

They include the guarantee that infectious disease regulations will not prescribe compulsory surgical treatment. I may say that I have had considerable doubts as to the wisdom of accepting this amendment even though it is provided in the definition section that "surgical treatment" does not include hypodermic injection, inoculation or other processes of immunisation or the taking of blood or other specimens for examination or test. Take the case of a child who may have to be compulsorily isolated for treatment of diphtheria. Most Deputies will be aware that the operation of tracheotomy is often necessary in such cases to preserve the child's life. If consent is not forthcoming, then, under this provision, the child must be either allowed to die or the surgeon will have to break the law. Consent is usually required at present as a matter of course. But it is a very different matter to provide by law that consent is essential.

I put it to Deputies to consider this matter and to let me have their views. In my opinion the idea that surgical treatment of an unnecessary or illegal or immoral nature would ever be undertaken by responsible medical officers in this country is entirely fanciful. The suggestion is a slur on the profession. And if, which God forbid, concentration camp conditions were ever to develop here, the mere prohibition in an Act of Parliament would not deter those responsible from indulging in activities which, as far as I can see, must have occurred to the minds of Deputies from a too close proximity to a time in which conditions abroad were abnormal and which we hope will never again recur.

If, therefore, I have a general expression of willingness from Deputies to delete this proviso against compulsory surgical treatment I shall move an amendment to that effect on Committee Stage. Otherwise the provision will have to stand.

Another amendment of the Public Health Bill embodied in the present Bill is the modification of the provisions in relation to the duty of parents to keep children from school and the giving of lodging in dwellings and the use of public conveyances. These provisions were formerly applicable to persons who were probable sources of infection. They will now apply only to persons who actually have any of the infectious diseases to which the provisions are applicable.

Another, and I think a very proper amendment is the provision that, before a person who is a probable source of infection is detained or isolated, he must be actually inspected medically. Previously it was, I think, contemplated that it might be necessary to get after, for instance, a group of itinerants and detain them without individual medical inspection. We will take the chance that our service will be sufficiently effective to permit of individual inspection. A further safeguard of personal freedom which I have had included will ensure that the practicability of detention at home will be considered before a person is compulsorily isolated in a hospital or other place.

I do not wish at this stage to go over the detailed provisions in relation to compulsory isolation and treatment. I shall be prepared to discuss them in detail on Committee Stage, but I wish to say now that there may perhaps have been a certain delicacy or reticence as to the matters for which the provisions are primarily intended, a delicacy natural enough but capable of giving rise to considerable misunderstanding. I now say that one of the first and most important conditions which these provisions are intended to counter is the spread of venereal disease contracted from prostitutes soliciting in the streets. That statement is not, I think, capable of any misunderstanding. It is not the business of the State or the health authorities to enforce the codes of public morality which are infringed by these conditions but so long as these conditions exist it is, I submit, the duty of the State to ensure as far as possible that the resulting spread of disease will be countered and as far as possible eliminated.

Venereal disease, like some of the more natural diseases of children to which I have referred earlier, is a process of physical and mental rot which may pursue the unfortunate individual throughout his life. But, worse still, it can produce another generation of unfortunate innocent children who may be congenital syphilitics. Many unmarried mothers are found to be infected. Successful treatment of such cases is surely an objective which would justify the procedure proposed.

I have felt obliged to state the position thus briefly and plainly, in the hope that the discussion which will follow and any consideration of these provisions on Committee Stage will advert to the terrible consequences of letting this menace go unchecked.

Another serious infectious disease to which the provisions of detention and isolation will be applicable is typhoid. Typhoid carriers may be of two kinds, persistent and intermittent. To treat them so as to eradicate the sources of infection is often a lengthy and tedious business. Those people may not be aware of any illness or discomfort and in fact their condition is not dangerous to themselves but here again they represent a class which, all unwittingly, is a menace to the community, and it is for this reason that their detention for treatment and cure is proposed.

Section 39 contains a revised set of provisions in regard to the maintenance of the dependents of persons suffering from infectious disease. I should mention that "infectious disease" there, of course, includes tuberculosis. The former provisions contemplated that the full cost of maintenance should be met from the rates. I went into this matter personally and, after consultation with the Minister for Finance, I have included a provision for half the cost being met by way of State Grant. Side by side with this new provision I propose to take power to regulate the rates of allowances where necessary. Such rates may be fixed either too high or too low, and it is to achieve some uniformity in the rates which will be applicable over the country as a whole that I am seeking this permissive power of regulation. The section is being tightened in other respects, as many Deputies very properly considered that, as formerly drafted, these provisions might be open to abuse.

I have made other modifications in this Part of the Bill in the respects mentioned in the Explanatory Memorandum, including giving persons an option not to undergo immunisation (except in the case of serious epidemics). I anticipate that immunisation schemes will be very fully availed of when an effective service is in operation, and in that event the people who opt out, some of them, such as Christian Scientists, on conscientious grounds, will be a danger only to themselves.

I have had the requirement that a medical officer should notify infestation deleted, while extending the provisions to articles of clothing, etc., as well as to persons.

The sections about precautions to be taken in relation to schools and public conveyances are also being omitted. These are matters of administrative detail which can be provided for in regulations.

I think that Section 110 of the former Bill was not discussed in any detail in the Dáil but there were numerous amendments down in relation to it. It proposed to take very wide powers of regulation and control of the uses to which institutions might be put. I am absolutely in favour of a system of rationalisation of institutions by reference to their specialised functions and regionalisation of many of them by reference to appropriate areas of the country, but such a process could not be effectively undertaken without including the voluntary hospitals in it. I hope in the more comprehensive proposals which I shall publish in a White Paper to outline a scheme of this nature which would be contingent on full negotiation and agreement with all the interests concerned. Meanwhile, the section which replaces that section in the present Bill, viz., Section 40, is related only to the treatment of infectious disease in institutions. It has been found by experience to be absolutely necessary to prevent the spread of infection or cross-infection. For instance, it would defeat the whole policy of segregating infectious disease cases if we were to allow open tubercular cases to be treated in the same wards as non-tubercular patients. It is to remedy such conditions that the present provisions of the section are designed and limited.

I may briefly describe the purposes of Part V of the Bill as being for the protection of the public from danger to health arising from careless or unsafe preparation of food and to standardise foods which are especially important to the public health. The powers sought replace and supplement existing powers which have been found to be inadequate.

The need for the powers sought in this Part is evident. While many food establishments in this country maintain an adequate standard of cleanliness, I am sure that all Deputies will agree that there are also many which leave much to be desired. It is necessary that public health administrators should be able to stop the dangerous and careless practices which often give rise to illness and epidemics and from the point of view of nutrition to control the extravagant claims sometimes made for very useless compositions. Standardisation of foods will only affect economically those at present dealing in sub-standard products. I am sure that the control will be welcomed by the honest manufacturers, traders and caterers as eliminating an unfair economic advantage at present enjoyed by those who do not incur the expense of taking proper public health precautions.

The form of the regulations made under this Part will be settled after full consultation with the trade and other interests concerned. It is hoped that, with their help, a code of food laws will be evolved which will be capable of harmonious and efficient operation.

Part VI contains somewhat similar powers of control over medical and toilet preparations and certain other articles. Here again the intentions are to prevent danger to health, from the use of certain preparations and articles, and also to control the sale of preparations purporting to have medical or tonic qualities which in fact they do not possess.

The opportunity has been taken to repeal the Rag Flock Act to re-enact and extend its provisions to other filling materials. The intention is to enforce appropriate standards of cleanliness for bedding of all kinds.

The remaining portions of the Bill have, I think, been adequately explained in the memorandum issued with the Bill. I have provided in Part X for the establishment of consultative councils on the lines proposed in the previous Bill and in amendment thereof.

I have omitted the section which defined the health functions of the Minister. They added nothing to his legal powers and, as Minister for Health, I am seeking and will continue to seek from the Oireachtas all the statutory additions to the legal powers already transferred to me which I may consider necessary for the proper implementation of a progressive health policy.

It is with a certain amount of hesitation that I rise to discuss this particular measure. For approximately the 20 years that I have been a member of this House, as a matter of principle I have consistently refrained from undertaking discussion on any legislation introduced by the Department of Local Government and Public Health. I adopted that particular course lest I might be under suspicion of having obtained at any time in my professional capacity information from inside that Department that might in any way be embarrassing to the Minister in charge of the Bill. I think it is entirely unnecessary for me to say that never at any time did I seek to secure, either directly or indirectly, for my own information or the information of colleagues, any information from that Department relating to the business before the Dáil. However, in face of this new Health Bill, having considered the whole situation very carefully, I came to the conclusion that when a Health Bill was being introduced, laying down the legislation that would affect the health of the people in the country for perhaps many decades to come, laying down, by legislation and regulation, the extent to which that Bill would affect the individual persons making up this country, the extent to which it would enter into every home in the land, and the possible extent to which it might interfere with the ordinary rights of people, there was a very peculiar responsibility on any medical man who happened to be a member of Parliament to state his views, as a result of his experiences, to tender the advice that was the natural outcome of those experiences, and to have those views either accepted or rejected just for what they are worth. In approaching this particular Bill in that capacity, merely as a medical Deputy who has had a certain number of years of experience, both as a general practitioner and, later on, as a public health medical officer, I do not claim to speak in any representative capacity whatsoever. I merely speak as an individual medical man expressing my own views, honestly based on my own experiences. The Minister has his own ways and means of getting the considered views of the majority of the members of the profession, whether as a whole or when subdivided into specialised sections such as public health men. I do think it is rather unfortunate that, even in debate, this particular Bill should in any way be related to the late and not lamented Public Health Bill of 1945. I think that it would be wiser just to make a new start, as we are, with this Bill. The other Bill, in my opinion, was a policeman's Bill rather than a medical Bill. It was a Bill that was ruthlessly going to trample on the human rights of people. In the interests of health, the one test that was applied to the Public Health Bill of 1945 was—is this section sound in the interests of national health? If the answer was "Yes", then the Bill said: "Go ahead." That is a very dangerous doctrine; it is a very dangerous road to tread.

If the only test applied to a Public Health Bill is whether it is sound in the interests of national health, I think no Christian would stand for that. We must remember that on the eve of the Great War, both in the West and in the East, we had a peculiar kind of health mentality beginning to exhibit itself and we had members of my profession subscribing to some of the new health doctrines. The new health doctrines that were showing their heads in the East and in the West at that time were the ugly doctrines of the eradication of the unfit, the liquidation of those with transmittable disease, the theory of making it surgically impossible to reproduce the race if there was transmittable disease or transmittable infirmity. If any of those things were submitted to the mere test—"Is this sound from a health point of view, —the answer would be, `Yes'." But would it be right from any human point of view? The answer would most emphatically be "No". In the old Public Health Bill there was too much of the attitude that, provided a thing was defensible on general public health lines, the rights of the individual did not matter. Now that Bill, let me say to the Minister, is dead and buried and I congratulate the Minister on that.

An Ceann Comhairle took the Chair.

The Minister has come in here as a new Minister, heading a new Department, with a completely new Bill which may contain within it some of the sections of the old Bill that were generally acceptable. I congratulate him on that. I do not want to have him embarrassed by any recollections of the old Bill or the House confused by the shadow of the old Bill. This is a completely new Bill, and I have studied it very closely. On the whole, I regard this Bill as a non-controversial Bill. I agree with the Minister in expressing the hope that it is a Bill that can be discussed harmoniously. When I say that this is a non-controversial Bill and that the general principles of the Bill are highly acceptable, I do not mean that it is a Bill that will not require the very closest investigation, the very fullest consideration, and very full criticism in the direction of improving a good Bill in order to make it a better Bill.

This Bill, might I say, like practically every Bill that comes from a Department, represents the desk mentality rather than the mentality of the operative in the field. From the medical point of view, this Bill represents the mentality of the headquarters medical man sitting at a desk and, from beginning to end, there is a strange absence of the mentality of the medical man at the periphery, the operative in the field, the man who comes up against the practical questions and the practical difficulties. A blend of these two mentalities would, and I hope will, produce the ideal type of Bill, the Bill that is easy to work, the Bill that understands human reactions and the ordinary difficulties that arise out of human contacts. It is in that direction that I want to address my remarks. I should like to approach this Bill by dividing it, as it were, into parts, not so many of the sections divided into so many parts as contained in the Bill itself, but rather to approach the discussion of this Bill from different aspects, namely, (1) the provisions in the Bill itself, (2) the effects of the Bill, and (3) the machinery necessary to implement the Bill.

With regard to the provisions in the Bill and the aims and objects of the Bill, I think there should be very general agreement with the aims and objects. It is a Bill that starts out with the object of providing better medical and nursing services for the people as a whole, taking some further steps to prevent the spread, if not to attempt to eradicate, infectious diseases and providing medical advice and, if necessary, medical treatment for expectant mothers, nursing mothers and the child from birth to the age of 16. With regard to some of the provisions and the ways and means suggested, we have, first of all, a great number of elaborate sections dealing with infectious diseases and the powers that are taken to deal with those diseases. You have a continuation of the emergency regulations with regard to the compulsory removal of infectious disease cases to hospitals.

Now, if I were asked, is it advisable or desirable that any or most cases of infectious disease cases should receive treatment in isolation in a fever hospital, unhesitatingly I would answer "Yes". I think every medical man of any experience could answer "Yes". But, if the question is put the other way, namely, is it necessary in the year 1947 to take compulsory powers to have such cases removed to hospital, my answer as one person with one person's experience would be emphatically "No". I am more than 30 years practising medicine, a number of years as a general practitioner and dispensary doctor, some 18 or 19 years as a public health medical officer with medical charge of a county and dealing specifically and in a peculiar way with infectious disease, with some years in between as chief of the Army medical service. During those 30 years I can say truthfully and honestly that never even once did I come across any single case that should be treated in a hospital and that was not treated in a hospital —not even one case. But I can remember very many cases where it required tact and patience and perseverance in order to get the patient to go to hospital or to get the parents to agree to send the child to hospital. I remember one house at a distance that I had to visit no less than seven times and I had to pick up a very highly-respected clergyman and bring him back to the house to add his powers of persuasion to mine. Later on I had to get a retired school teacher to come with me to the house to add his powers of persuasion to mine. That was the most difficult case I ever had. Finally, that child went to the fever hospital with happy and contented parents behind and with a smile on his face and we left that house with the blessings of the family. The powers were there under the emergency regulations. At the very first refusal we could have requisitioned a couple of Civic Guards and we could have had that patient forcibly removed from the home to the fever hospital. The patient would go away in tears, the parents would be left at home in tears and that very atmosphere and experience would seriously jeopardise the prospects of a cure, or, at all events, anything like a smooth and speedy cure.

Here in Ireland, unlike a number of very near countries, the success of the medical profession has been built mainly on the degrees of understanding and the amount of affection between the public and the doctor. The medical man, particularly in rural Ireland, is something more than just a medical attendant; he is a kind of friend, an adviser, a counsellor for the people, and the success of medicine in Ireland has grown out of the amount of respect and confidence that the people have in the medical profession. That is the name we have at home and abroad and I would be sorry to see the practice of medicine being carried out in this country under the shadow of a policeman's baton in any particular field of its activities.

Cases were cited where it was necessary to have compulsory powers. The itinerant class, the mobile tinkers, the people who are in one district to-night and who, like the Arabs, fold their camps and disappear and are in another bailiwick to-morrow, and who have been carrying cases of infectious disease with them, were always a problem. I think even our own public health laws from 1864 met that particular type of case; it met the type of infectious disease that was a menace to the public and had no fixed abode or no particular provision for the safe-guarding of the neighbour. But, if the general rule is based on that particular type of case, then have your compulsory powers with regard to that case but, in my opinion, they are unnecessary and unwise with reference to the general run of cases.

I know the Minister or anybody else may say: "If you do not want these powers you need not use them; they need not be used and what harm are they doing to anybody?" Neither the Minister nor myself is a prophet; neither the Minister nor myself can speak for posterity. The very minute that becomes our health code, there will be younger men coming out of the schools who will be trained in this type of medicine in association with law. They will not be trained along the old principles that the first thing necessary in the practice of medicine is to get the confidence of your patient and your patient's parents.

The public health man of the future, educated in this newly suggested code, will rely on the police, will rely on the law, rather than on his own tact, his own powers of persuasion and his own powers to induce respect and confidence. I think it will lead to a gradual deterioration in the professional outlook of members of our profession in the future. I do not think that there is any indication that any such steps are necessary or desirable.

We had a lot made about a situation in Connemara. We had reference to a mobile group somewhere in Connacht. We had one or two episodes of that kind and we had, of course, the departmental view. I would be inclined to ask the question: was every possible power used or every possible influence used before the legal order had to be put in force, and, the legal order being enforced and having set authorities going compulsorily to remove cases to hospital, was there an immediate benefit? Was there a resultant loss?

If the general powers asked for here are necessary or defensible in certain zones or areas, I suggest to the Minister that he should make these powers adoptive; if any administrative body wants to adopt legal compulsion behind the medical work of the county, let them adopt it the same as all adoptive Acts are applied to certain areas, but do not apply them to the country generally.

What I say with regard to infectious diseases applies with greater force to school medical attendance. The School Medical Attendance Acts have been in operation in this country in different counties from 15 to 20 years. They have been operating very smoothly. I have had 17 or 18 years' experience in one county and it might be of interest to recite briefly my experience. When I took over public health work in County Meath I took over duty in the midst of a hectic political storm. Anyone who was not a political supporter more or less thought I was going there as a political agent, and it was their business to embarrass me in my duties to the greatest extent they could because they thought I was there to carry out a political job, to be the spearhead of a political Party.

Everyone was pulled into that, school managers and school teachers. I went to schools for school medical inspection and never found as much as a mouse on the floor. I had certain legal weapons behind me with regard to school attendance. I did not use one of them; I merely went to the next school. That school might be empty and the next school half-full, but if I found any children in a school I did my job and these children got glasses or got their teeth removed and, where that was required, they got diseased tonsils removed. In the schools where the boycott was on the children were trying to read with their squints and with the books up against their eyes. Every second week they had a swollen jaw from a rotten tooth and they were snuffling and sniffling with their adenoids and tonsils.

Then they began to see the value of school medical inspection. There were no compulsory powers used, although there was a law with regard to school attendance. The news was passed from one school to the next, and the result is apparent from a report that I have for the year before the war began, the last normal year and the last year a report was issued. The attendance at school medical inspections all over that county is considerably above the average attendance and is 99 per cent. of the pupils on the roll. That was brought about merely by cooperation between parents, teachers and medical men. Remember, my results are in no way exceptional. Do not think they are. An exceptional case is where there is any avoidance of school medical inspection.

Practically in every county in Ireland, parents, teachers and even children value the services they are getting through school medical attention. There may be one or two areas where the service is not being fully availed of. Why blame the children or why blame the parents? Very often these services break down from want of tact on behalf of some of the personnel of the machinery working the service. It may be the medical officer, it may be the nurse, it may be somebody else who is tactless and turns people against it. I heard with a certain amount of amazement the Parliamentary Secretary on a former occasion stating that the reason that compulsory powers were taken was because—I do not pretend to quote his exact words— there was a great number of children avoiding school medical inspection or absent on the day of school medical inspection and that in most cases it was those who wanted medical inspection most who were absent. I did not query or contradict the Parliamentary Secretary, but I do not think that over the last 18 years there has been a single annual report produced by any school medical inspector in any county in Ireland which I have not read and studied. I cannot just remember any single report that indicated that there was any studied or deliberate avoidance of medical inspection. I attend conferences of my colleagues in the public health services every couple of months, and I never heard anything of the kind suggested.

I believe that school medical inspection is going on very satisfactorily and very harmoniously, that confidence is growing in that service and that parents, teachers and managers are looking more and more to the value of that service. That being so, even in the backward counties, the utilisation of that service is increasing year by year, and I think it is a grave blunder to associate it with any form of compulsion now. If the thing is a failure then by all means let the courts come to the assistance of the service. If it were going backwards—and I know there is no evidence of that—I think it is desk enthusiasm for getting the work done that is at the back of these compulsory provisions. Without a linking up between the desk mentality and the field mentality, you would not have compulsory powers. If there is a particular area where compulsory powers are required, then deal with that area.

Again, the Minister or anybody might say: "If you do not want the powers you need not use them." I do not think that is an answer and the Minister will not be very long presiding over his present Department when he will agree with me that it is not an answer. Say that you pass the Bill with these compulsory powers providing that children must attend school medical inspection, and that I fix a school medical inspection for a certain day at a certain school where there are 230 children on the rolls and that 204 children attend that medical inspection. When the returns come up at the end of the month I shall probably be asked: "Of the 26 children absent, in how many cases have you got a certificate that they have been adequately inspected elsewhere?" I reply: "Six." What is the next letter that will come? "What steps do you propose to take in regard to the other 20?" I reply: "None." The next month, in reply to a similar query, I reply: "None." A point is then reached when I get the Act hurled at my head and I am told I am not making use of the provisions there to assist them. That is done through the manager.

I am talking with knowledge and with sincerity. I am talking from the absolute conviction that the advice I am giving is in the best interests of Irish medicine and Irish youth. Compulsion and medicine are completely incompatible. Compulsion and the Irish character are completely incompatible. Compulsion is not required. If there is an area where there is a case built up for acquiring these compulsory powers, then again I say let these powers be adoptive and give any particular council, any manager or any county medical officer who applies, leave to operate these powers but do not be shoving policemen on to those who are doing their work quite successfully as it is.

There is another side in connection with this unnatural association between medicine and law. I think it is a side of which the Department over which the Minister presides is never conscious and that is administration. We shall take the case I have been discussing. Take these 26 absentees from that particular school this week and 26 absentees from another school next week. We reach a point when the Department has goaded the unfortunate medical officer down the country into taking legal action in accordance with the provisions of this Bill. There are 52 prosecutions in all. It is not just simply a case of rambling into the courthouse on a fine morning, saying that so-and-so's child was absent from school medical inspection and then sitting down to hear what the Bench has to say about it. You are put there and you are asked in accordance with the Act: "Are you in a position to give evidence that this child's parents got due and adequate notice of the date of the medical inspection? Have you a mental photograph of every case? Have you ever made a mistake in your records by leaving any case out or have you ever made a mistake in a name?" You are called into court and you have to remain there while prosecutions for brawls, drunks and unlighted vehicles are dealt with. I had an experience of going to court in connection with the Housing and Miscellaneous Provisions Act and again with the Milk and Dairies Act—only once, thanks be to goodness, in each case. I learned a lesson. I was like a travelling clown going from one courthouse to another in County Meath. In connection with the milk and dairies case, I appeared in five different courts before the case was heard. Then I was asked to prove the bacteriologist's certificate as to the condition of the milk. Had I anybody from the laboratory to prove that it was the sample I had sent up and that that was its condition?

The Minister's Department knows that, in that particular case, there was an appeal to the High Court. I do not know how many nights I sat up in the Four Courts after the courts had closed, in conference with junior barristers and senior barristers and solicitors, while that case was pending —I am sure seven or eight nights—and the case finally never came to court. I was in another housing case that went for two years from court to court and was then settled at a cost of £700 or £800. These Bills very lightly suggest court action and lay down penalties, but I should like the Minister to get a couple of legal men sitting down with him to give him a picture of what is entailed in one prosecution under any of these clauses. My experience is that life is too short for that kind of thing, and, when the machine is running smoothly and running well, the wise pilot will not fiddle with it.

I give the Minister one last example of health and law. There is a regulation which prohibits the sale of mussels for human consumption, if the mussels are taken from a certain belt of the coast. Mussels are taken from that belt of the coast in cart-loads, hundreds of tons every week, and it is in my administrative area. It is in contravention of the regulations; it is illegal; but they go to Sheffield and Leeds and are sold there for human consumption, and the British health authorities objected. I was told to take action in accordance with the regulations. There is nothing illegal in any man picking up a mussel and putting it on a cart, and I cannot stop him picking mussels and putting them on carts. The railway company, when I tried to get them to stop carrying the mussels, said: "Under such-and-such an Act, we are bound to carry anything tendered to us for carriage." They carried them, and, when I got legal opinion, I found that I would have to sit on top of a sack of mussels in Mornington and keep sitting on that sack until it reached Sheffield and until I saw the bag of mussels under me being sold for human consumption.

That is an Act of 1868.

Those are the difficulties which arise, and there is a tendency inside the Department of Local Government, which I hope will not be transmitted to the Ministry of Health, lightly to invoke legal powers and to think: "Everything is rosy now; we have the law behind us." But remember that the unfortunate instrument they have is not a legal man. He is a medical man and every one of us is terrified of law, hates the courts and does not want the law to be brought to his assistance in his profession at all. So much for some of the provisions.

One thing I regret very much is that we should have a Health Bill in 1947, when we are aspiring to make this island an aerial link between East and West, bringing the Far East within a few days, if not a few hours, and the Western Continent within six or seven hours of our shores—that is our aim and ambition, our desire and our intention—in which we choose to repeal the Vaccination Acts. I could understand a layman doing that, a layman who had been badly advised; I cannot understand any medical man doing it. I am not going to assert dogmatically what the properties of vaccination are, but vaccination is, if not a guarantee, a protection against smallpox, and to remove that protection from our people at a time when we are bringing the East right up against our shores —and smallpox, as the Minister knows, is mainly a disease of the East —is a step which it is difficult to understand.

The retreat is covered up in the White Paper by saying that, in the event of an outbreak of smallpox, powers will be taken to vaccinate. Did the Minister get medical advice supporting him in that view? Did he ever come up against even a suggested case of smallpox and try to vaccinate, with all the machinery of the Army available, with transport, with unlimited helpers, unlimited doctors and unlimited nurses? On one occasion, there was a report of a case landing at Haulbowline and that meant that every person who had had contact with Haulbowline had to be vaccinated, and speedily vaccinated.

The news arrived within six or eight hours and the scatter of people was as far as from Haulbowline to Nenagh. People had to be hunted all around the place to be vaccinated.

Did the Minister read of the Glasgow epidemic quite recently? With all the ample machinery that is available to the British Health Department for vaccinating in advance of the case, the Glasgow contacts had reached the south of Wales. The epidemic had reached the south of Wales well in advance of the vaccinators. It is nonsense to talk of vaccinating in face of an outbreak of smallpox. You cannot keep in advance of the outbreak. Take a case landing at Rineanna. He has been a little seedy on the plane and when he gets off the plane, he proceeds to Limerick by bus, has a meal in Limerick and goes to Dublin by motor. He stays, say, in the Shelbourne and then goes up north. This is all done very easily within three days. On the third day, having been seedy all the time, the rash comes, and remember that in this country we have not seen smallpox, or very few of us have not seen smallpox, and the first stage of smallpox is not going to be diagnosed just as quickly as a broken leg. Let us say that even three days elapse and that then it is found to be smallpox. Where are your contacts? How are you going to get after them? What became of the 25 people in the bus from Rineanna to Limerick? What became of the people in the hotel in Limerick? What of the people who travelled up, the people in the Shelbourne, the people at the races that evening or at the theatre or pictures that night? And you will vaccinate ahead of the epidemic !

It may be defensible on any other grounds to drop vaccination this year in this Bill, but it is not defensible on health grounds. There is an objection to vaccination—it is historical and political. It was compulsory under the British Government, and we in this country were out to break every British law we could, and that was one of the laws which it was popular to break. There was a provision in England for conscientious objectors, which did not apply to us, and consequently it was easy enough to arouse indignation against that law, the breaking of which was one of the things adopted in a major struggle by the Sinn Féin organisation.

There was a reason for it at the time —not a health reason but a political reason and a national reason. I do not think that that should be transmitted down along the line. It is bad health policy. In association with the dropping of vaccination, you have a Bill which is making provision for immunisation against other infectious diseases. In my very humble opinion, we are inclined to go too fast in that direction. I believe in letting the test be done on the big fellow and, when it is successful, apply it to the little fellow. I believe that general immunisation against infectious disease is only in the phase of trial. The Minister will not forget that, 15 years ago, immunisation against diphtheria was taken up as a new protective. It was urged over the radio and elsewhere. Immunisation against diphtheria was being done then with the one-shot method. Since then, we have learned that we might as well have been squirting it through a window. It was so much labour lost. Let all that experimenting, or most of it, be done in a country with greater population, more disease and far more finance than we have. When a thing is proven sound, then adopt it here compulsorily or as Departmental policy.

Immunisation against diphtheria has reached a very high degree of efficiency and success. I am all for it. But, remember, big proprietary firms have waded into medicine. They have immense publicity and immense wealth behind that publicity. They are able, to a certain extent, to command the support even of medical journals. There is power pressure behind proprietary articles and preventives which are being put on the medical market now-adays. My advice is to be cautious and conservative in this matter before we generally apply it with any degree of national policy or compulsion behind it.

There is one other point on that question of immunisation. Immunisation in the city is one thing, because the population, as they grow up and move about in trams and buses and go to picture-houses, have a degree of acquired immunity, so that no harm whatever is done by immunising a minority within a city. Remember, however, that immunised children or an immunised group inside any population can be carriers of disease without throwing out any symptoms. An unimmunised person who gets the germ throws out symptoms, gets sick and is removed from the general public, whereas the immunised person can carry around the germs without throwing out any symptoms. A vast weight of medical opinion here and elsewhere considers it a mistake to immunise a minority inside a majority community. I admit freely that, if we stick it out and keep immunising year after year, in the course of time—perhaps 20 years—we shall have wiped out diphtheria. But what is the price we shall pay in the years between? I had no immunisation in County Meath up to the year of suggested evacuation. I had an average of only nine cases of diphtheria per annum—all children. Because evacuation from Dublin was threatened and immunised Dublin children would come down on top of the Meath children as so many carriers, I had to immunise 13,000 odd children in Meath. What are my diphtheria rates since? An average of in or about 50 a year—and the bulk of these adults. That shows that it is not all easy weather. There are pros and cons in all these matters. That is why I suggest that the desk mentality and the field mentality should be brought more into contact before legislative proposals are introduced.

This Bill has one very welcome provision. That relates to the establishment of a health advisory council. It was not necessary to introduce a Bill in order to have a consultative council. I think that the consultative council, or a consultative council, should have been operating on this Bill before it reached this point. When a Bill is in draft, the Ministerial colours are, to a great extent, nailed to the mast. To get a Bill altered at this stage is difficult and the effort may appear to be controversial.

With regard to the other provisions, I strongly urge the Minister to withdraw those which are bringing in an element of legal compulsion to the practice of medicine. If there is a particularly strong case in any administrative area which must be met, then meet it in that particular area by making the powers here adoptive where there is a special call but do not apply them elsewhere. With regard to the effects of this Bill, I wonder if they have been fully considered. A kind of legislative precedent is universally recognised, that, when any legislation undertaken by an Assembly interferes violently with vested interests or interferes with the material position of individuals, that legislation will bear on its face provision for compensating the individuals. Take the medical profession. The whole Dáil may not be very excited about this matter but the Dáil has a sense of fair play. The medical profession in this country can be roughly divided into three classes. In the first class, are those who rely entirely, or mainly, on private practice. There are very few of those outside the city.

The next big class are the dispensary medical officers, who in the main rely for their livelihood on private practice. Then you have the clinical hospital men and the specialist group. What do we propose to do in this Bill, if it is ever carried out in its fullness —and the Bill is not worth while taking seriously unless it is intended to implement it, and implement it early? There is too much of a tendency to put an attractive sample in a Ministerial shop window and to have empty shelves behind in the shop; and I fear, from some remarks made by the Minister in introducing this Bill, that this is going to be one of those shams, that we will not see it materialise in our lifetime to anything like its fullness. I am devoting myself to this Bill in the hope that it is seriously intended and will be put into operation.

Take the private practitioner outside the City of Dublin. What are you going to do under this Bill? Every expectant mother, every nursing mother, is to get free medical attention; every child from birth to the age of 16 will get free medical attention. A couple of weeks ago, we introduced another Bill, dealing with national health, so as to raise the income level to £500, and under which every family with an income of less than £500 may get free medical benefits. There are experienced medical Deputies opposite who will agree with me that any doctor in general practice makes anything from 70 to 80 per cent. of his income out of children, that the decent parents send lightly for a doctor when the child is sick, but the parent himself must be very ill before he will spend money on himself in feeing a doctor.

If the Bill is implemented and if the people avail of it, the treatment of every type of illness and ailment, in every child in Ireland up to the age of 16, will be free, for every expectant mother and for every nursing mother also. That income will be taken from the present income of the private practitioner. Alongside of that, you have this National Health Insurance Bill to which I referred. Are you not wiping that man financially out of existence? Has there been any discussion, any agreement as to how you will compensate that man for robbing him of his livelihood? Deputies in other Parties understand the importance of the principle I am talking about in association with doctors. Labour men and others have always secured, as far as they could, that when legislation was going through this House which would deprive men of their livelihood there would be a court of one kind or another established to arbitrate, so that reasonable compensation would be provided. What is the proposal in this Bill with regard to this? That type of private practitioner, if the Bill is ever worked in its fullness, will be completely wiped out.

The next group affected is the most numerous group of medical men in the country, the dispensary doctor. Let no Deputy think that any dispensary doctor in rural Ireland has ever taken up the appointment because of the salary. The salary paid to any doctor in rural Ireland does not run his car, does not pay for the maintenance, running costs and renewal of a car. It merely gives him rolling stock so as to put him into a district where the main end of his livelihood must be secured from practice. You take every patient, expectant mother, nursing mother, every child suffering from any ailment up to the age of 16, and you put them on the non-fee basis. Is there any discussion with regard to compensation? I know the Minister said in introducing the Bill that he intends to do it in steps, by nibbles, by bits, but remember once this Bill goes through, it is the law. Then any man in a job may be told: "Very well, that is the law and these are the duties you have to carry out, and anything you get for those duties is going to be given to you gratuitously, whatever the Minister for Finance will sanction."

Has the matter been taken up with the Department of Finance? We had the Most Rev. Dr. Dignan's scheme scoffed out of this House some years ago. Why? Because it was thoroughly unsound, the Minister told us, until it was associated directly with its cost, until the financial cost of it was laid down. In this Bill, do we hear a hint of the cost, or have we any picture of it? Has the Minister any idea of the cost or any idea as to how much of it will be sanctioned by the Minister for Finance? Has it been discussed and thrashed out yet with the Minister for Finance? If it has not, then I say that the medical profession is being very unfairly treated. They are being walked into a rat-trap in blinkers. The British attempted legislation along these lines, but on a much bigger scale. How did they do it? Did they say: "Live horse and you will get hay"? Did they say: "Walk into my parlour," like the spider to the fly? For two years before they came to the House of Commons with the legislation, they had been in constant session with representatives of the profession who would be affected, adversely or otherwise, by the proposed legislation. To a very great extent, the legislation was framed with the knowledge of how it affected the various people concerned. Fairly ample provision was made for dealing with them and since its introduction the provisions for compensation were increased by 50 per cent. Here we have the Bill, and we are asked to make it law and make it mandatory on every doctor in the country and then leave the profession to the tender mercies of the Minister for Finance, and the Minister for Health will say: "Too bad, boys, I did my best; I am sympathetic, but the lad around the corner will not give." That is very consoling to a man who has lost his livelihood.

Before we get through the Committee Stage, the Minister must be more expansive than he was in his opening speech. He must let the people affected by the Bill know what they will get by way of compensation for the damage done to them by the Bill. He must let representatives of the taxpayers—and a great many of them are also representatives of the ratepayers —know what this Bill in fullness will cost (a) the taxpayer, and (b) the ratepayer.

The next portion of the Bill is the machinery. What is the proposed machinery to carry out this particular Bill in its fullness? I know the Minister does not for a moment think that the Bill can be fully operated over the existing dispensary districts by the existing dispensary men, no matter what pay is given.

The estimate that I have heard is that this Bill will require from 300 to 500 extra doctors, and 1,000 nurses. I do not know what the salaries given will be but certainly at a low figure the cost will be £500,000 a year. On a 50-50 basis £250,000 would come from the rates and £250,000 from taxes. That figure may be an under-estimate or an over-estimate, but there should be an estimate somewhere. If I am grossly wrong let us have an estimate. That is the salary side of it. What about the institution side? Where are these grand child-welfare and maternity clinics going to be held in each dispensary district? Does the Minister suggest that 2 per cent. of our existing dispensaries could be utilised for such a purpose? He knows and will agree with me that, in nearly 100 per cent. of our depôt dispensaries, or in the majority of our dispensaries, neither he nor I would use them to amputate a puppy's tail. New premises will be required in practically every dispensary district. Let us say that the cost will be from £1,000 to £2,000. What is the estimated cost for buildings where an institution is required under the Bill? Will any man with a sense of responsibility say that we are not entitled to get this information? I am asking for an estimate because nobody would think of pinning the Minister to any firm figure.

This Bill, when working in its fullness, will require so much extra money per annum for increased salaries for the people remaining in the service, for new salaries for the extra ones that will have to be called in, and new salaries for nurses. Can we have an estimate of the amount for increases in salaries for medical people, for nurses, for lecturers and supervisors, and an estimate of the number of persons of each class required, an estimate of the annual cost of the new services, an estimate of the premises required, an estimate of what the cost of the new buildings will be, an estimate of the compensation that will be paid to people who are either liquidated or seriously injured in their livelihood as a result of this Bill? I think everyone is alive now to the fact that this Bill is really built around the nurses. The nurse is the foundation figure in it. The provision of even one nurse for every dispensary district in the country is a matter of finding 500 or 600 nurses. I estimate that in every dispensary district, when you take the schools and the maternity and child welfare schemes into account, two nurses will be required for each district. That means approximately 1,000. You cannot get them by going into Wool-worth's and you do not pick nurses off hawthorn bushes. Every doctor in the House knows that since the end of the war, it has been virtually impossible to get the services of nurses at any price. On account of the tragedy that rolled over Europe, and the amount of human damage done as well as the number of wrecks that were left, the reaction to replace all that by better health measures has meant that nurses have at last come into their own. In this country they were all the time the most downtrodden class of ladies that ever practised a profession. They were underpaid and badly treated. They had impossible service hours, but the last couple of years have brought a change so that there is a complete dearth of nurses now. How are 1,000 nurses going to be procured?

Has the Minister any suggestion to make as to when this Bill, if passed next week, will be implemented? There is no appointed day and there is no estimated price for anything. There are no proposals before the House as to where the workmen and workwomen are to come from. I agree absolutely with the aims of the Bill, and with its provisions, subject to this slight reservation that I would like to see the compulsory powers go or kept only in an adoptive manner, every county being left to please itself as to whether it will have them or not. I also want to know from the Minister how he is going to provide in the Bill for the damage done to the individual in his income, and what is his mental time-table with regard to putting this Bill into operation. Finally, what does he think will be the cost of the Bill when it is put into operation?

In spite of what Deputy O'Higgins has said, I am prepared to welcome the Bill, and particularly the Minister's approach to the matters that he proposes to deal with in it. I am pleased that he has consulted with and is prepared to consult with the members of the medical profession. The fact that he is prepared to do that is to my mind proof that he does not intend to do any of the things that Deputy O'Higgins fears he might do. I am sure the Minister will consult with the members of the profession before he puts any of the controversial provisions of the Bill into operation. I am also pleased, in spite of the objections which Deputy O'Higgins has raised to it, that he is introducing the mother and child service. That will require examination because the nurses mentioned by Deputy O'Higgins will have to be provided. I agree that they cannot be provided overnight.

The Minister will be wise enough to see that the nurses are specially trained for that work and that he will put the scheme into operation only when he feels that it can be efficiently carried out. The mother and child service will be a great boon to the general body of the people throughout the country and will be welcomed by them. It will be a great help to dispensary doctors and other doctors in getting at early cases of tuberculosis, deformities, such as club foot, and other diseases like that. It will also help to improve the general health of the community, particularly as this service will be continued until the child reaches the age of 16.

There is one type of case that will be particularly difficult to trace, that is, cases of mental deficiency. I find from my experience in a country district that I have been visiting houses for several years without knowing that mental deficients lived there. These things are considered a slur on the family by the people in general and I do not think that inspection at schools, and such like, will get at that trouble. The Minister in his capacity as Minister for Social Welfare should introduce legislation whereby children suffering from mental deficiency would get some benefit from the State. People might then be induced to come forward and disclose to us the extent of that problem. If some inducement is not offered to the parents of mentally defective children I fear that it will take a long time for us to discover the true extent of the problem. It is most distressing to go into houses to discover such cases. It is only when the parents are getting old and when the son who is to get the place is getting married that I have succeeded in finding out some such cases. Unless there is some inducement to the parents of such children in the form of a grant, gratuity or weekly allowance, we will never get at the problem as it really is.

I do not agree with Deputy O'Higgins when he says that the provisions asked for in this Bill in connection with infectious diseases are too drastic. I am perfectly satisfied that those powers will not be asked for and that doctors, as I know them, will never call in Guards or the legal profession to cope with any problem that arises. There is one thing, however, that we propose to tackle under this Bill, and I am glad we are doing it, that is, venereal disease. I could conceive that in such circumstances we might have to invoke the provisions of this Bill. Otherwise, I think the profession could be relied upon to deal tactfully and there would be no danger of coercion being introduced by the medical profession. Deputy O'Higgins feared that because such provisions might be on the Statute Book at some future date the medical profession might abuse these provisions. I would be sorry to think that the medical profession would ever degenerate to the extent that Deputy O'Higgins envisaged. I am quite sure he was not serious when he suggested that there was any likelihood of the medical profession degenerating to that extent, that they would become mindful of the law rather than strive to alleviate suffering and relieve distress. I believe that nurses and doctors can be relied upon, as the Minister has said, to use persuasive powers rather than coercion.

There was a point raised by Deputy O'Higgins which I think is well worthy of consideration by the Minister in regard to the increased duties that will be imposed upon dispensary doctors and dispensary midwives. I quite agree that the great percentage of income of doctors in rural districts is derived from their private practice rather than from the very meagre salary that is being paid to them at the present time, but I am sure the Minister will continue to consult with the medical profession and, when any controversial problem like this will arise, will be prepared to meet the members of the profession and to discuss any problem with them. By so doing he will ensure the full co-operation of all sections of the medical profession in any efforts he may undertake to improve the health of the people generally.

An Leas-Cheann Comhairle took the Chair.

Dr. Lynch

I had no intention of intervening in the debate until I heard Deputy O'Higgins, in relation to the proposed abolition of compulsory vaccination against smallpox, referring to the mysterious gentleman who arrived from the air at Rineanna and who proceeded to—I think it was Cruise's Hotel he mentioned—took a train or bus to Dublin, stayed in the Shelbourne and then proceeded to the north and in the course of his peregrinations infected some thousands of people with smallpox.

Dr. O'Higgins also said that he was opposed to forced hospitalisation of infectious cases generally. He made no reference, however, to the fact that a man who was suffering from, say, open tuberculosis, who boarded a bus in Cork and who came to Dublin could infect a number of people in the course of his journey. I am, I must say, altogether in favour of powers being given to the responsible medical authorities where the occasion requires it, forcibly to hospitalise, if necessary, certain types of infectious diseases. Deputy O'Higgins referred to cases where he had to go back five or six times, where he had to get the parish priest to persuade the parents to allow an infectious case to go to hospital. I am by no means in favour of that because, by the time the doctor has gone five or six times to inspect the case and to persuade the parents and to persuade the parish priest to persuade the parents, a number of persons in the district can be infected. I think the power proposed in the Bill is very necessary and will not be abused by a responsible medical man.

I am not quite so happy about the proposals regarding ante-natal care and the responsibility for looking after the various cases of illness in children under 16 and the responsibility of looking after maternity cases. I am not quite so sure what the Minister proposes in that respect. What I gather is that the district medical officer would be responsible for looking after every case of maternity which would occur in his district notwithstanding the means of the people. I think the medical profession as a whole will oppose that because while it is well recognised that the patient has a right to choose her own doctor, there is also a well recognised right on the doctor's part, if necessary, to choose his patient. As far as I gathered from the Bill it would be obligatory on the district medical officer to attend every case in the disrict which required his attention. I think the medical profession generally will oppose that very strongly. I do not think it is right that the district medical officer should be responsible for attending to all children under the age of 16 in his district irrespective of the income or the financial position of the parents. That is not right at all. There are certain families in every district who, by right, should contribute to the support of practitioners who have to live by private practice and I do not think it should be asked of the district medical officer to attend the dependents of these people.

Reference was made to ante-natal care. Ante-natal care, as understood in medical circles, is a matter of comparatively recent growth. There are men in dispensary districts who have been practising for 25 and 30 years who have not been trained in what is known as "ante-natal care". How does the Minister expect these men to assume responsibility for a subject in which they have not been trained?

I must say that I welcome the Bill. We dispensary doctors generally and, I think, the medical service generally have been functioning under a medical service which I think was introduced some 70 or 80 years ago, and which is completely out of date. Speaking for myself and, I think, speaking for the medical profession generally, we welcome this measure, but we hope that before the Bill is passed the Minister will again consult with the representative members of the profession.

Deputy O'Higgins, speaking on behalf of our Party, welcomed this Bill in principle. He then criticised severely the machinery of the Bill. To that I would like to join my voice. While Deputy O'Higgins gave qualified approval to what is in this Bill, I for my part would rather see this Bill covering a far wider range of things. There are things that it does not, in fact, include, but it is late in the day now.

Deputy O'Higgins has questioned the wisdom of taking compulsory powers with regard to infectious diseases. I join with him in an appeal to the Minister on that ground. I think anybody who knows this country knows that if you want to kill any proposal, even a very good proposal, a sound proposal, a wise proposal— if you want to kill itab initio—the way to do it is to take compulsory measures to carry it out. Deputy O'Higgins has quoted from his own experience. I have been looking through reports which he has here— one is the Ninth Annual Medical Report on County Meath, and the other is the fifteenth. They bear out everything that he has said as to what took place there under his administration as an officer of public health. My own experience in my native county bears that out.

We are always told in regard to these measures when they are being introduced that they will never be drastically put into operation whereas, in practice, everyone of us knows that the moment an Act is put into operation the officers of the Department concerned see to it that every one of these things will, in fact, be put into operation and, in so far as they can, have them carried out. I think the suggestion of Deputy Dr. O'Higgins that these compulsory proposals should be made adoptive was a wise one. The county manager and the county council, in any given case, when it was discovered that public health officers were being frustrated in carrying out the proposals of the Bill for the benefit of the people, could adopt them and make them compulsory in that county.

The next matter—it is one that is on moral grounds—that gives me the most serious consideration, is the results of the Bill on the medical profession. I hold no brief for the medical profession at all. I approach this purely on moral grounds. Those Deputies who have taken any interest at all in the proposals that have developed in England under Lord Woolton and Lord Beveridge will know that one of the big questions which was kept continuously under review and representation was the question of making reparation to those who were being penalised by the operation of the Act, namely, the medical profession. It is two, three or four years ago since this matter began to be considered in detail and I forget what the actual sum of money was, but it was colossal. Our sum, of course, would not be anything approaching that. But if we are demanding certain things in the interests of public health and the well-being of the community we have got to bear the consequences. Speaking for myself, knowing what has happened on various occasions in the past, I am not going to be a party to and vote for this Bill until ample provision is made for doctors who are going to be penalised. Is this House recklessly going to pass a Bill purporting to be a Public Health Bill when at the same time we are going to do irreparable damage to men whose parents provided the money to educate them and who have spent all these years in the public service on a mere borderline income, serving the public night and day? Anybody coming from rural Ireland will know of the enormous sacrifices that these people have made in the cause of the sick and, particularly of the sick poor. It is not necessary to go into specific cases. One could not find words to describe the work they have done and the sacrifices they have made, practically without fee or reward, in the interests of the sick poor. Now when a Public Health Bill is brought in, there is nothing specific in it as to what sum of money will be given to these men to provide for them in their old age. Many of them are over 60 years of age. They have trudged on foot over the bogs and the highways carrying a bag of maternity instruments for the last seven years since petrol rationing began. They have even gone seven miles on foot and seven miles back in rain and snow. They have seriously injured their health during those years in serving the public. At the end, we have this Bill here under which many of them will be thrown on the roadside.

I ask that this Bill should not be proceeded with until such time as an actuarial examination has been made as to the actual cost of making reasonable provision for these men, not ample provision, because these men have never been amply or justly paid for the services they have rendered to the community. We could have nothing but the profoundest admiration for the services they have rendered. I would not like to be a party now to throwing them on the roadside without provision being made for them. We should have a detailed statement on that matter.

I should like to know whether the consultative council mentioned in the Bill has been formed. Has it advised the Minister on the various aspects of the Bill? Has it advised him on the sum of money which would be reasonably adequate to provide for these men who will be deprived of their livelihood? The families of many of them are at an age when their education is expensive. They have children ranging from 12 to 20 years of age. They require special provision to enable them to provide for their children in the way they would be expected to do. We had a Public Health Bill which was discussed for many months. Now a new Bill has been introduced and, apparently, no detailed examination has been made into a vital matter of this kind. I certainly will not accept the proposal to make representations to the Department of Finance in this matter. I want to have the matter put in black and white, because anybody who has any experience of the Department of Finance knows what would happen. Are we to hand over the destiny of these people to the gentlemen of the Department of Finance? I think it is only necessary to mention that to the Minister. He has a reputation for being a decent, honourable man and, if he is, he is in honour bound to see that specific proposals are put before the House and embodied in this Bill making provision for anyone who is displaced as a result of it.

As to the proposed abolition of vaccination, as a layman I wonder where this hare-brained proposal came from or who suggested it. The reference made by Deputy O'Higgins to this matter is sufficient not only to alarm the House, but the country at a time when we are doing our utmost to attract people from the ends of the earth to this country. I do not wish to make any reflection—far from it—on the medical profession, but everybody knows that there are not six doctors in this country who have seen a case of smallpox. A young doctor friend of mine who after he was qualified went out East, when coming back through the Suez Canal, found that one of the people on board had been taken ill. As the person was coming from the East he suspected it might be a case of small-pox. In fact it turned out to be a case of smallpox. Let us assume that a visitor arriving at Rineanna or Collinstown was developing smallpox and went down to a country district where the dispensary doctor had not any experience of the disease. If he was called in to attend that person, he might not have the faintest idea of what he was suffering from because he had never actually seen a case of smallpox. The result might be that we would have an alarming outbreak of that disease. I heartily agree with Deputy O'Higgins when he speaks about how it could be spread over the whole country. Vaccination was a very wise precaution even before we had any aerial terminus here. It did no harm and it eliminated smallpox in this country. Now that we have this added danger, it would be sheer madness not to enforce it. Have we got so soft and tender-hearted that we are afraid to send a child to a dispensary to have it vaccinated in case it might cry? We are getting too soft about these things. If we are to take our place in the world a lot of this softness will have to go.

As I said, we approve of this Bill. I should, however, like to see its scope widened. If I were in charge of it, I would have dealt with other matters which are highly necessary. I will not enumerate them now. There are, however, three matters about which I am concerned. I agree with Deputy O'Higgins that compulsory powers should be adoptive. Secondly, I am gravely concerned that this House should remove any injustice which is being done to the medical profession. In my view, no money we could give them would recompense them for the services they rendered to the poor of Ireland. Thirdly, this proposal not to enforce vaccination should be dropped. I do not know whether the Minister is acting on his own initiative or whether some collection of kind-hearted old ladies came to him and said: "Put an end to this abominable and atrocious thing—vaccination." Let us put an end to this nonsense and let us ensure that this country will not be smitten by a plague of smallpox from the north to the south that will have established itself before we know what it is and that will cause irreparable damage to the health of the community.

Listening to the last Deputy, one would get a completely distorted view of what this Bill proposes to do. The Deputy started off by making a comparison between this Bill and the Act passed in England. He does not appear to realise that in England the whole health service has been nationalised. This Bill does not seek to do that. When the Deputy spoke of the compensation he was demanding for the doctors here, he forgot, or probably does not know, that the system in England is quite different from the system prevailing here.

In England, prior to the nationalisation of health services, doctors had what is called a panel practice. That practice had a certain number of patients, as many as the doctor could get in up to a certain number, and the doctor had a right, if he wished to change from the area or to retire, to sell his panel practice and that had a value based on the income of that particular doctor. Deputy McMenamin is confusing a panel practitioner with a dispensary doctor.

I am not doing anything of the kind.

The Deputy did confuse them. We are trying to increase medical services generally to the whole population, with particular reference to those under a certain income and, instead of our doctors being put out of business—which resulted in the very strenuous appeal that they should be pensioned properly—they will be put into positions where they will have increased work to do, increased incomes, and where there will be, for the first time since we had a Government of our own, the possibility of increased employment for doctors. The same applies to nurses.

This Bill has been welcomed by Deputy O'Higgins, who obviously spoke for the Opposition and who has a great deal of knowledge of what is contemplated in the Bill. Evidently he gave it very close study. But there is again a certain confusion. On the one hand, Deputies over there are demanding compulsory vaccination, without recognising that if you have that it must be applied to every individual every seven years. It is well known that if you vaccinate a person and there is an epidemic of smallpox, unless you get re-vaccinated every seven years you are not immune. That does not appear to be understood by the Deputies who spoke.

Again, while they are demanding compulsion in that respect, they are opposing compulsion in other respects. Deputies associated with the medical profession on this side of the House have welcomed compulsion in the treatment of infectious diseases in the manner envisaged in the Bill. There are people here who have some knowledge of general requirements in connection with medical services, particularly those who have had years of service on local authorities, where we are associated with hospitals and local requirements generally.

Deputy O'Higgins seemed to feel, by the way he spoke, that this Bill was merely being introduced and would then be shelved. He illustrated that by the shop window packed with copies of the Bill, and the shelves all empty. Then he went on to say that this Bill, if it were properly applied, would mean that the dispensaries would not be sufficiently large or well equipped to cope with the requirements that would be put upon them now under this measure. Is it not obvious that the whole idea behind the Bill is to do that very thing, and that the State will provide, in conjunction with the local authorities, the requirements which arise from it, in the sense of money requirements?

I do not understand how one can welcome a Bill and then pick holes in it, based on arguments which, on examination, are not well founded. Deputy O'Higgins pointed out with great emphasis that because dispensary doctors up to the present made their living mainly from the private incomes they received, they will now be deprived of that. That was one of the objections he had. Later on he pointed out that an imposition would be put on the people through increased rates as a result of this Bill coming into operation. Surely, his approach should not be, as far as the public are concerned, that two and two make four when, in fact, it is a case of two minus two, meaning nothing. This is the position. The people who hitherto had to pay, those of them under a certain income, will now pay a proportion of the rates which will have to be increased as a result of the medical services.

In Dublin recently, through the Dublin Corporation, we decided that persons with low incomes could not afford to pay for hospital treatment and we put 2/6 in the £ on the rates of Dublin in order that certified persons should qualify for free treatment in hospitals because, if they had to pay out of their low incomes, their homes would suffer. But nobody says these people who, although they are paying their share, if you like, through even a small increase in the rates, are not getting security for that in the sense that they will get hospital treatment generally as distinct from what it used to be.

There are other dangerous infectious diseases besides smallpox, and Deputy Lynch pointed out that the same amount of danger applies, in connection with what he described as open tuberculosis, as in the case of small-pox. It is as infectious and you only need to have the same gentleman to whom Deputy O'Higgins referred arriving at Rineanna and spreading his infectious disease. We have to take cognisance of the fact that our health services up to the present have not been the best and we must agree that this is a step in the right direction. If as a result of this Bill, infectious diseases and their effects will be eliminated, we shall have a much more healthy nation than in the past.

Deputy McMenamin, in the course of his remarks, appealed to the Minister three times, not only to insert a provision in the Bill to provide compensation for persons displaced in the medical profession but also to obtain a certificate from the Minister for Finance to that effect. The Deputy further asked that the amount of the compensation should be specified in the Bill. No medical man who spoke on this Bill made such a request. I say that the Bill is a measure of which we can be proud. I was abroad recently in two different countries and I discussed with certain people, some of whom were medical doctors, the developments taking place. Strange to relate, everything that happens in this country in regard to medical legislation is watched closely in medical circles abroad. What is contemplated in this country is examined by these medical men, admired and approved of.

Deputy McMenamin also referred to the terrible epidemic of smallpox which was going to overtake this country because compulsory vaccination is not provided for in this Bill. In fact, according to him, it has been deleted. Both he and Deputy O'Higgins referred to the fact that compulsory vaccination exists at present in England, except in so far as those who object to it on conscientious grounds are concerned. Well, there are outbreaks of smallpox in England as there are elsewhere and there is the same trouble in looking for contacts in order to try to eradicate it. If we are sensible people, we shall apply sensible measures which we know will be effective. I was in France in the last month and on my arrival I was told that there had been an outbreak of smallpox. I went immediately to the nearest doctor and I had myself vaccinated.

Effectively, I hope.

Deputy Morrissey apparently does not know that one can easily ascertain whether one is effectively vaccinated, on the fourth day after vaccination. For his information, may I inform him that every doctor knows on the fourth day after the vaccination, whether the vaccination has taken or not. If it has taken the doctor is able to certify that that person will be immune from the disease for a period of seven years. I hope Deputy Morrissey is now satisfied that I am effectively vaccinated.

I should like the Minister to take note of the fact that at present we have a very easy and rapid method of communication between this country and other parts of the world. It may happen therefore that a person may have been in contact with infected sources in a foreign country, some short time before setting out for this country, and may on arrival here be a danger. I think the Minister should consider ways and means by which the officers of his Department can keep themselves informed of what is happening in other countries, with particular reference to outbreaks of small-pox, so that steps will be taken to ensure that a person proposing to travel by aeroplane to this country from an area in which there has been an outbreak of small-pox, will not be allowed to board the plane unless he has been properly vaccinated before departure. To that extent I agree that precautions should be taken but, as I say, let us be sensible. If we are going to insist on compulsory vaccination, let us go the whole hog and insist that everybody, including Deputy Blowick and myself, will be vaccinated and be able to present a certificate of immunity for the next seven years.

Why pick on me?

It will apply to every Deputy and everybody in the State. I must say that I have not heard any objection of any consequence in medical circles with which I have had contact —private practitioners and boards of hospitals—to this Bill. I have heard, on the contrary, many compliments paid to the measures which are proposed. I do not know to what extent the Minister will consult with the medical profession as a whole, but I did speak on this matter to one very eminent medical gentleman in the City of Dublin. I asked what he thought about the proposal in the Bill for the setting up of a medical consultative council and he told me, notwithstanding all the row there had been about this question, that in providing for a medical consultative council we are opening the way for a lot of trouble. "It is well known," he said, "that you will never get medical men to agree about anything and I pity the Minister, if he is setting up such a body."

What kind of a pariah dog was he?

He was one of the leading medical authorities in the City of Dublin, a professor in one of our universities.

I suppose he is a professor of ethics?

No, he is a professor of medicine, not a surgeon.

There is a black sheep in every fold.

I do not think he is a black sheep. I do not wish to canvass the name of any outside doctor in this House, but I shall give his name to the Deputy outside the House if he wishes, and I think the Deputy will admit that he is not a black sheep, that he is very white. There are differences of opinion frequently amongst members of the medical profession. I sit on the boards of hospitals in this city and I find medical men at great variance with other medical men. I discovered recently that surgeons have a different outlook from that held by men who are physicians, on matters connected with hospitals. I used to think of all of them as doctors but now I realise that physicians and surgeons are very wide apart in their outlook on almost everything. I do not know whether Deputy Dr. O'Higgins will contradict that.

I am surprised at the attitude of those who have been making comparisons between what has happened in England, as a result of the nationalisation of the medical service, and this Bill. There are two entirely different situations concerned. As I stated earlier, we are not forcing our doctors here to give up panel practices. The doctors here are going to get more work and better pay as a result of this measure. There will be a much bigger outlet for the products of our universities and we shall also improve the working conditions of our nurses and ensure that we shall have within the country the number necessary to staff our institutions.

Everyone knows that in recent times it has been very difficult to find staffs for our ordinary hospitals. I hope that the Minister for Health will, in consultation with the Minister for Local Government, endeavour to bring about a situation under which it will be much easier in future for hospitals to provide more attractive remuneration for nurses. I hope that there will also be some review of the system under which what are called probationer nurses are taken into our hospitals, with a view to having them released from the obligation to pay fees. You will get many excellent girls who are anxious to be trained as nurses whose parents can afford to pay a fee of 50 guineas but there is an equally good type of girl whose parents would find it very difficult to pay such a fee. I hope that fees in such cases will be entirely abolished, that the remuneration will be on a basis commensurate with the standing of the nurse in the community and that we will live to see the day—although Deputy O'Higgins seems to think we will all be dead by the time the Bill comes into full operation—when we will be able to see the beginnings of the successful working of this Bill and its effect upon the health of the nation.

I am in full agreement with many of the sections in the Bill. Such a measure as this is welcome, and indeed overdue, but I do not agree with the attitude taken up by Deputy Briscoe. He says that Deputy O'Higgins welcomes the Bill and that he cannot understand his doing so, while, at the same time, he picks holes in it.

The particular holes he picked.

What, in the name of goodness, are 138 of us T.D.s meeting here for, if it is not to pick holes in proposed legislation? Surely Deputy Briscoe does not imagine that a group of experts in any of the various Government Departments can produce a perfect piece of legislation and be so far-seeing as to provide against all the contingencies which may arise down the years?

I agree with the Deputy on that, but I do not agree with Deputy O'Higgins in the holes he picked in the Bill.

I can understand that.

I am encouraged by that. It would be disastrous if there were agreement between us.

During my four years in this House, I notice—and the sooner we get away from it, the better—that all the constructive criticism has to come from Fine Gael, Clann na Talmhan, Labour or the Independents, and that, with one notable exception, every Fianna Fáil Deputy, no matter what the Government introduce, opens his remarks with the old parrot cry: "I welcome it."

Did I not make some constructive criticism?

I must pay Deputy Briscoe this compliment, that he spoke more like a medical man on this Bill than his two colleagues, Deputies Brennan and Lynch. I do not mean that as an attack on Deputy Briscoe— I say it honestly, and I mean it. I, as a layman, with many of the lay Deputies, was waiting to hear their criticism of the Bill. We had first the Minister, and then Deputy O'Higgins, and then followed Deputies Brennan and Lynch. I frankly admit that this is a highly technical Bill and I was delighted that we had four medical men to explain its knotty points to us lay-men who are not fully acquainted with medical matters. But what happened? Deputy O'Higgins gave us a fine exposition of the Bill, of 75 per cent. of which he approved. He pointed out certain difficulties and certain objectionable features in a very interesting speech.

I had expected that the two Fianna Fáil Deputies would have made a contribution which would have helped us along the road and helped us to do our duty as an Opposition, so that this legislation as it finally emerges would be as nearly perfect as it is possible for us mortals to make it. But having heard them, I candidly feel that I was in the same position as that in which I was before they spoke. I knew as much about the Health Bill when they finished as I knew before, and in fact they rather confused me.

Deputy Lynch said he welcomed the provisions in the Bill with regard to ante-natal care. I cannot see a single provision made for that. The only provision in that respect is that in which the Minister takes ample power to himself to make Orders in future, but we do not know what these Orders will be. Perhaps I have not taken proper stock of the various sections, but I cannot see a single word about it, so that the Deputy is welcoming nothing, or at least merely welcoming a provision by which the Minister takes power to make regulations and Orders in the future.

I think the Deputy must have misheard Deputy Lynch. I think Deputy Lynch indicated that he was not in agreement with the proposals relating to ante-natal care. I may be wrong—I may have misheard him myself—but I understood him to say that he was not quite in agreement on that point.

If I have misquoted the Deputy, I am sorry, but I understood the Deputy to say that he welcomed these powers. I do not want to take up the position of accusing a man of meaning something he did not mean. One point in Deputy O'Higgins's speech of which I took particular notice is, that we must take into account the rapid means of travel now developing in the form of air services, and the possibility that people who may be in the first stages of the disease, who may have incubated the diseaseen route, may land at an airport, without outward symptoms of the disease. Even to a dense layman, that is a very real and very apparent danger, and while I should not like to be a scaremonger, it would be foolish for us to stick our heads in the sand, ostrich-like, and disregard these things. We must take them into account, because a person may land at Shannon airport without any signs of a deadly, infectious disease and, in his subsequent movements, may leave the seeds of death behind him. It is up to the medical men in the Department to take that into account and to see that some precautionary measures to deal with it will be available.

Did I not say the same thing?

Deputy Lynch asked about the man in the bus who spreads tuberculosis germs, but if tuberculosis were such an easily conveyed disease there would be no Irishman or woman alive to-day, in fact, nobody in any country in the world.

He referred to a particular type of tuberculosis.

The principal causes of the spread of tuberculosis in rural districts are under-nourishment, bad housing and many other things which should have been rectified long ago. We put a measure through the House some time ago providing for the erection of regional sanatoria in order to cope with that disease, but in no county that I know of is there at the moment ample accommodation to deal with tuberculosis. The regional sanatoria are going up very slowly, and lots of tuberculosis sufferers will be in their graves by the time they have been provided, and, even taking into account the many serious difficulties which the Department have had to contend with in the matter of shortage of various materials, I say that better steps could have been taken to counteract the disease.

A broad result of this Bill will be a steep increase in the rates in all counties and neither in the Minister's opening statement nor in the Bill is there any indication of any provision for easing the burden on ratepayers. Some account should be taken of that position because we can no longer close our eyes to the fact that rates are becoming an almost intolerable burden in many counties. They have reached breaking point, and I am afraid that, in the matter of piling burdens on the ratepayers, we will soon reach a position in which the ratepayers cannot or will not pay. That will mean a complete collapse of our local institutions, and it would be better to take that aspect into account before anything serious happens.

Debate adjourned.
The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Friday, May 2nd, 1947.