I think the Minister is rather fortunate inasmuch as his Department is not one that could be to any great extent approached from a Party standpoint. There have been, of course, some comparisons drawn between the Minister and his predecessor. Personally I do not think such comparisons are either necessary or desirable.
Every fair-minded person will agree that the Minister has made a tremendous effort to get the work of his Department well under way. Every fair-minded person will also agree that the Minister's predecessor, during the short time he was Minister for Health, did make a very significant effort in connection with the work of his Department and did approach the problems of that Department with a very considerable amount of zeal.
I would regard the main functions of a Minister for Health as being, first, to prolong human life; and, secondly, to alleviate human suffering. So far as the prolongation of human life is concerned, an instance was brought to my notice in the past week which may seem to be depressing, but only to members of this House. A gentleman in County Carlow lived to be over 100 years. He was approached to give his reasons for his long span of existence on this earth and he promptly replied that it was due to hard work and no politics. I am sure that would be bad news for Deputies. We can only hope that, perhaps, the old gentleman's mind was beginning to fail.
I feel that in regard to the first and most important function of the Minister, to preserve and improve the health of our people, there is no question more important than diet. It has been said that many people dig their graves with their teeth. That is, perhaps, a silly occupation for intelligent people, yet it may be true. There is no doubt, however, that what is known as malnutrition exists on a very wide scale throughout all sections of the community. There is no doubt that deficiencies in diet prevail, not only amongst the very poor, where it is understandable, but amongst people who are not so poor. I firmly believe that in this country the consumption of wholesome foods, and particularly wholesome home-grown foods, is not encouraged to the extent which is necessary and desirable.
Somebody has said that the three greatest destroyers of human life are the bottle, the frying pan and the teapot. By the bottle I mean, of course, excessive use of intoxicating liquor. By the frying pan I mean too much fried foods of all kinds. Lastly, there is the excessive consumption of tea. I do not know how true that definition may be, but I would say that there are three foodstuffs which the people of this country do not use to the extent which is absolutely necessary and desirable. The first is oaten porridge, a home-grown food. Last year we farmers were chasing the Minister —we chased him out of the country— looking for a price for our oats, while the majority of the people practically do not use oats as a food at all. That is an extraordinary state of affairs, yet it is true. Then, of course, there is the need for an increased consumption of home-grown vegetables. We do not use a sufficient quantity of vegetables in our food to sustain health and to provide for all the needs of the human body. Lastly, of course, there is the all-important food—milk— which, I think, is not used in sufficient quantities, particularly by children and mothers.
In this connection, I wonder would it fall to the Minister's Department to do something to encourage the use of these very necessary foods. I wonder would it be possible for the Minister or his Department to organise, say, an ideal food exhibition, setting out the ideal types of food for our people, the foods which are both economic and desirable when cooked in the most palatable and attractive way. There is no use in saying to people that they must use more of a certain type of vegetables if those vegetables, when prepared, are unpalatable, or that they must use more porridge, if it is not properly prepared and cooked. One has only to visit the hotels in this city to see the different ways in which porridge is cooked. In one hotel you will get porridge which is so palatable that you are inclined to call for a second helping. In another, you will get a sort of mixture that is nothing more than scalded oats. I do not know whether the suggestion I have made of a food exhibition setting forth the best types of food could be carried out. Publicity and propaganda in this respect might do a good deal to encourage, first of all, good cooking and, secondly, increase the consumption of those very essential home-grown foods. Most people will acknowledge that deficiencies in diet are mainly responsible for various ailments of children and of adults also. Whatever steps the Minister may take, I think there is need for publicity and propaganda in regard to diet.
There are very considerable sections of our people whose income is so low that they cannot completely solve this problem for themselves. Owing to inadequate housing accommodation and inadequate cooking appliances, they may not be able to provide themselves with what is the best possible diet or they may not have the money to purchase the necessary foods. Nevertheless, a great deal can be done, because the best foods for our people are by no means the most expensive foods. The first essential unit in any organiation to fight disease is a well run and well organised dispensary district in charge of a competent and properly treated medical officer. I quite agree with all Deputies who have said that our dispensary buildings and equipment to a large extent are antiquated and inadequate. That is particularly true in the rural areas. Something very drastic must be done to improve dispensary buildings and the equipment in them.
There is one other matter which strikes me in regard to our dispensary service, that is, that apart from medical work, the amount of clerical work thrown upon the dispensary doctor is excessive. There is a considerable amount of work such as keeping accounts, filling forms, compiling registers, which in the ordinary course of events, doctors should not have to perform. At any rate, that work should be simplified to the greatest possible extent and whatever method can be found to simplify account keeping should be instituted.
There is another matter which might receive attention. Dispensary doctors are called upon to compound and supply the various medicines which they prescribe. I have often wondered if it would not be a more efficient method to have that work contracted out to the local chemists who, perhaps, are better equipped to discharge that function. In that case, the dispensary doctor would prescribe and the prescription would be taken by the applicant to the local chemist where he would receive the medicine free, as at the dispensary. I do not know if that would add to the cost, but it would certainly be more expeditious and possibly more efficient, and it would save a good deal of crowding up of dispensaries with jars, bottles and all the equipment which is necessary for the compounding and storing of medicines.
A great deal has been said about the necessity for extending free medical treatment to all sections of our people. I quite agree that the problem of ensuring that no person shall suffer from lack of medical treatment because of a lack of means must be met. At the same time, no one would like the entire population of this country to be absolutely dependent upon a medical service which would be of the same nature as the Civil Service. No one would like our entire medical profession to become a branch of the Civil Service. There must always remain to a very considerable degree medical and hospital treatment for which people will pay a reasonable fee. The question arises what, in the circumstances, it would be reasonable to expect. People below a certain income level and, in the case of farmers, below a certain valuation, should receive medical and hospital treatment free or almost free. People above those levels but below certain other levels might receive medical and hospital treatment partly free; perhaps they would pay 50 per cent. of the cost. People on the higher income levels would pay, perhaps, almost the entire cost.
Such a system could be devised to meet the situation, but there ought to be a definite limit so that everybody will know exactly where he stands. As Deputies and members of county councils know, there was a certain amount of uncertainty as to the people to whom free treatment should be afforded and as to those who should be required to contribute. As we know, much of the time of local representatives is occupied in dealing with this problem. The limits of income and valuation should be very clearly and definitely stated. Those under a certain limit should be entitled to free treatment if they require it, and those over that and up to another limit should receive 50 per cent. free treatment, and those over that again, perhaps, should pay the full amount. That is something which ought to be cleared up definitely and as soon as possible.
As I say, I do not quite agree that everybody should receive absolutely free medical treatment or that everybody should be absolutely dependent upon the Minister for Health for the state of his health. Some time ago I was listening to the B.B.C., when somebody in a very melancholy voice said:—
"If the Conservative Party get in we may have to give back our hair and our teeth,"
thereby indicating that there was a general association over there of the people's health requirements with a particular Party. That idea should not be allowed to develop here. I do not think that we would be a very independent, democratic country if everybody were dependent on the Minister for Health for his hair, teeth, glasses, and so on.
As far as the provision of suitable institutional treatment and institutional accommodation is concerned, the Minister deserves to be congratulated on having made a very far-reaching, all-out drive to secure an increase in the number of hospital beds for tubercular patients. Somebody in opposition to the Government asked were these hospital beds all new beds. It does not matter so much whether they are all new or not. The important thing is that they were provided. In the county in which I am a member of the local authority, last year we had only ten beds for tubercular patients. As a result of reorganisation and readjustment proposed by the Minister, we will now have 50 additional beds. Those beds are not new beds, but they were made available through a little bit of organisation and readjustment as between the county and the adjoining county. That is the kind of work that a Minister for Health can do and should do, and it is the kind of work that the present Minister for Health is doing.
In this matter of hospitalisation, I happen to be actively associated, not with one county, but with two. In the County of Carlow—I am a member of the county council—a fight has been going on there for many years for a decent general hospital. In the pre-war period there was a great difference of opinion amongst the members of the then board of health as to where the hospital should be built. There were various disputes in regard to plans, and in one way or another the whole matter of providing a hospital was delayed until the outbreak of war. Since then a proposal has been made to link up County Carlow and County Kildare and establish a regional hospital for the two counties. The unfortunate thing, however, is that if one looks at the map one will find that the Counties Carlow and Kildare represent a very long, narrow strip of territory, stretching almost from the City of Dublin to the County Waterford, and so it is hardly the kind of area which one would contemplate for a regional hospital. While Carlow was quite willing to fall in with the views of the Minister and to provide, as far as possible, for a regional hospital, the County Kildare has apparently refused to co-operate. The proposal of the Minister was that the south end of Kildare would go with Carlow and that this would ensure that a proper hospital would be provided for that area. That does not seem to be possible now unless the Minister can bring pressure to bear on the County Kildare to fall in with that very sensible arrangement. I know that Deputy Allen would not tolerate any pressure being brought to bear on any county, so that if we are to recognise the sovereign independence of each county, I suppose Carlow will have to be content with a hospital suitable only for that small county.
On this question, I am not so much opposed to small district hospitals as some Deputies. I am not so enthusiastic as some Deputies seem to be for large-sized regional hospitals. I believe that the smaller hospital can serve the needs of the people quite efficiently, a hospital at any rate which is capable of providing for one resident surgeon. I think that in many areas throughout the country, such as Carlow or such as East Wicklow, a 60-bed or 70-bed hospital could be provided with a resident surgeon. We are frequently told that, owing to modern means of transport, there should be no difficulty in conveying patients over long distances to a regional hospital. The same argument could be used in the reverse way, namely, that there does not seem to be any reason why, with modern means of transport, one specialist should not be able to attend two or three of the smaller hospitals.
There is one point, however, which I think must be strongly stressed, and that is that, whatever decision is taken in regard to the erection of hospitals, county boundaries, to a certain extent, must be overlooked. It is necessary, first of all, that a decent hospital should be provided in a fair-sized town so that it will be able to provide for the needs of a big centre of population and, secondly, provide the amenities which are essential to a first-class decent hospital. The town of Carlow happens to be on the corner of the county. There does not seem to be any reason why a ten-mile radius, adjoining the county, should not be served by that hospital. That seems to be logical and reasonable.
I am not only a member of the Carlow County Council, but I am also a representative for the County Wicklow. I am, therefore, very deeply interested in the question of hospitalisation in County Wicklow. We have, in West Wicklow, a small district hospital which has rendered very efficient service to the people of that area over a very considerable period. It is a matter of first priority in County Wicklow that that hospital be enlarged and improved. Plans for its enlargement and improvement have been under consideration for a very long period. I think that the local representatives in Wicklow, and in other counties, are getting tired of all this eternal planning, of maps being drawn and of plans and sketches being sent down with engineers and architects following each other, revising those plans from year to year and changing and altering them. Everything is being done on paper, but nothing is being done in actual fact. We have in Baltinglass a small hospital. It was formerly the fever annexe to the old Baltinglass workhouse. The engineers and architects have been planning extensions on paper for a long period of years. I think that the Minister should insist on his Department, and on all concerned, getting down to the work of providing the necessary accommodation that is required there. When the Baltinglass hospital has been completed, there is no reason why the work of providing a decent hospital in Wicklow should not proceed as rapidly as possible. It is not the mortar, the cement or the steel that is going to provide the hospital treatment for the people, but rather a well-trained staff with doctors and surgeons. They are the backbone of any hospital service, and they must be given reasonable accommodation and reasonable facilities. Nothing more should be asked and nothing more is required.
A lot has been said about the county homes. I think that the Minister has visited many of them. I am not sure if he visited the county home in Wicklow. It is a well-run institution. As far as Carlow is concerned, the patients in the county home are housed in an old military hospital. It was probably built by the British away back about 1798 or maybe later. It is being made to serve the needs of the poor, the aged and the infirm. It is not a suitable building for the purpose. The only redeeming feature about the whole institution is the magnificent service which is given there by the nursing staff, the members of a religious order, who are in charge.
I think the great reform which is needed in regard to county homes is a breaking up of those institutions into their component parts. It is wrong at the present time to crowd into one institution different types of patients or inmates. There is a great need for a suitable home for the aged and infirm. Such a home should not be too large and it should be confined to that particular type of person. There is no sense in crowding together the aged and infirm, mentally defective children and maternity cases. These are the types of people who are at the moment being catered for in the county homes. The breaking up of those institutions is a very necessary step in getting away from the old tradition of the workhouse, where poor and destitute persons were crowded in regardless of age or sex or the particular type of affliction from which they suffered. It does not solve the problem of the county home merely to change its name from workhouse to county home or to christen it with the name of some saint. The only solution is to start out now and let us have for the aged and infirm a separate type of institution.
I am inclined to agree with Deputy Dr. Ryan, the ex-Minister, when he said that a good many of the people who are housed in mental and county homes could be catered for in their own homes if some assistance were given to their relatives. We have heard of what was described as the three-tier home— that is, the home in which there are three generations. Some people may say that it is highly undesirable that the grandfather should live with his children and grandchildren. I do not think there is anything radically wrong in that, or that there is anything unnatural about such a proposition, if the necessary provision is made for the accommodation of the separate families, the older and the younger generations. If some of the money spent on county homes were devoted to providing additional rooms in houses throughout the country for old people it might, perhaps, meet the problem better than by resorting to the county home.
Again, it might be desirable to provide something like colonies of small dwellings for aged people who have not near relatives or who may have no relatives at all. Those old people could have the comfort and privacy of a little home of their own and they could have the supervision and the assistance normally provided in an institution. There is one thing I will ask the Minister not to do, and that is not to build new county homes on the model of existing institutions. He should break new ground in that particular direction.
In addition to the old people I have mentioned who will be found in those county homes, there are such types as mentally defective or physically defective children. The problem of those children is one which urgently needs attention. It would be no harm if some Deputy were to pay a tribute to the institutions which are in existence for the care of such children. It would be no harm if somebody would pay a tribute to the splendid work done mainly by nursing sisters, religious orders, in those homes. Perhaps there is nothing more depressing to anyone who is not upheld by a strong faith and by hope and charity than the care of children who are physically or mentally defective. It is really very depressing, yet there are people who, without pay or reward, devote their lives to the care of those children. I think this House would be lacking in its duty if a tribute were not paid to the splendid institutions which look after those children. Those institutions are inadequate to provide for all our needs. They have to be enlarged or new homes may have to be provided.
The solution of this matter will not be found in the provision of new county homes or the enlargement of existing ones. It is a specialised work which people who have made this a life study must undertake. A great deal has been done by those people. I will instance the Deaf and Dumb Institution at Cabra and the admirable training that is given children there. Those in charge of that institution equip the children, notwithstanding their physical defects, so as to enable them to make a living in the world. In the same way, mentally defective children can receive a great deal of help and assistance in fighting the battle of life. I do not think the atmosphere of any county home is a suitable place to provide that training.
I asked the Minister last week a question about the provision of dental treatment in our rural areas. I am particularly concerned with the dental treatment of children. In most counties they have a dental surgeon whose duty it is to attend to the treatment of dispensary cases and of children who have been inspected in the schools and who are found to require dental treatment, but in the rural areas there is no equipment for the provision of that service. Last week I suggested that something in the nature of a mobile unit should be provided for the dental surgeon so that he could travel from place to place with his equipment and provide an efficient service. I did not know at that time but I have since discovered that there is a type of trailer manufactured for the provision of dental treatment. The trailer is equipped with a dental chair, an electric drill, pliers and other instruments that a dentist uses and this can be hauled behind any fairly large-size car. The advantage of such a travelling unit can be easily understood. A number of children in rural schools are bound to have defective teeth. With such a travelling unit the visiting dental surgeon would have his equipment available just the same as in the surgeries in the cities and towns. Advantage should be taken of that system in every county. I do not know how much the Minister can do in this matter. It might fall to him merely to advise, if Deputy Allen prefers the county councils should adopt the scheme. It might also fall to him to provide the necessary capital for the purchase of these travelling units. One person who brought this to my notice commented on the fact that the lack of proper equipment defeated the whole purpose of dental inspection in the schools because the children were more or less frightened since the dental surgeon could not do his work as efficiently as he might do it in his own surgery.
I may have mentioned some depressing things in the course of this discussion. I would like to close upon a brighter note. When the Minister has done as much as possible to improve the health of our people, he might then consider the desirability of brightening up our hospital morgues. I do not see any reason why these places should present such an appearance of bleak austerity. It would surely not be an insurmountable obstacle to provide a few flowers to brighten these places.
