That is not my information. I understand that four years ago provision was made to build the Coombe Maternity Hospital but the present Minister gloried in the fact that because he thought there were not sufficient reserves in the Hospitals Trust Fund, he must postpone the building of that hospital until such time as ready cash was available. Now he finds himself in a position to give the sanction, four years later than need have been, for the erection of the hospital. I think one can carry fiduciary caution to excess when the lives of mothers and infants are at stake. I think it is worth taking a risk to build such a hospital in the presence of a situation in which the maternal mortality and infant mortality rate is at a figure much higher than world averages would suggest is justified.
I should like to ask the Minister to tell us why is the rate of maternal mortality higher in this country than in Great Britain or Northern Ireland? To what distressing fact is that due? We have access to all the same drugs as they have access to and it is common knowledge that the antibiotics have contributed very greatly to the disappearance of what used be known in the bad old days as puerperal fever associated with childbirth. I understand that modern research has greatly reduced the conditions in which infant mortality was high in the past and that all these instruments of care and prevention are available to us. Is it that we lack accommodation in hospitals for mothers who require hospital care, or what is it that creates this relatively high maternal mortality in our midst? I do not think the Minister should be content merely to register the fact of a high maternal mortality rate, without telling the House what his advisers tell him is the cause of it so that we can deliberate the best means of correcting that situation.
I am glad and happy to recall that at this hour we now have a number of superfluous sanatoria. I want to go on record expressly as stating that one of the proudest boasts the Government of which I was a member have to make is that in this short term we have superfluous sanatoria. It is a grave public disservice for people to suggest that because we now have superfluous sanatorium accommodation, it is evidence that we built improvidently when we did. If we accept that proposition, I think we shall fall into mortal error in our future health policy. I well remember when that scheme of sanatorium construction was embarked upon, our aim and object was to create a situation, in the shortest possible time, in which many of the sanatoria constructed would become superfluous.
We gravely weighed the cost, and we felt that perhaps it would take a 20 year period to realise that objective. Happily, in the years that have ensued, we had the benefit, as a nation, not only of the improved sanatoria accommodation provided, but also of the world progress made in the discovery of new drugs useful in T.B. therapeusis and these combined factors reduced the period in which our prime objective was achieved. Now it can be a matter of pride and satisfaction to us that that outlay of £10,000,000 has meant that instead of burying 91 per 100,000 of our population each year, we have to deplore only the funerals of 18.
I only hope we may soon have a similar tale to tell in regard to maternal and infant mortality. I assure the Minister that if his exertions in respect to the Coombe Hospital are as effective as ours were in respect to the sanatoria, he will never have to withstand derision on whichever side of the House he may then be sitting for that he was courageous in providing hospital accommodation to reduce the incidence of maternal and infantile death with which he was confronted during his period of office.
I should like to ask the Minister does he intend making any statement, in the course of this debate, designed to put an end to the disedifying row between himself and the Irish Medical Association. I do not assign the blame exclusively to the Minister, but I have to say that any of us who has had any experience of Ministerial responsibility knows that if, in dealing with any group or organisation in the country, a situation of deadlock supervenes, the primary duty of the Minister responsible for that section of Government work is to break the deadlock. It does not follow from that, that he should be asked to give any preliminary undertaking or guarantee. His duty to break the deadlock is to hold himself ready to meet the parties concerned whenever they seek to meet him, but if he contributes to the creation and maintenance of the deadlock by saying that, unless certain prior conditions are complied with, he will not meet them or will not talk to them at all, then he becomes himself principally responsible for the maintenance of a highly undesirable situation.
Apart from those of us who have had Ministerial experience, everyone who has had any experience in negotiations at all knows that even at the level of ordinary labour relations, if a trade union makes what appear to be unreasonable demands, or even if its members embark upon what appears to be a wholly unreasonable course of conduct, nothing is more fatal or more conducive to the promotion of industrial unrest and upheaval, than for one or other party to such dispute to say: "Unless some preliminary concession is made, we will not talk at all."
No harm can ever be done by meeting, by talking, and by exchanging views. That may involve a great deal of trouble; it may involve a great deal of patience; and — and here is what I think is the real stumbling block — it may involve a certain degree of humility on the part of the person who is a public servant. A wise public servant is prepared to combine all these virtues for the public good. In so far as the vanity of the Minister forbids him to meet the Irish Medical Association without demanding certain preliminary hostages, the whole country is being kept in an uproar, essential services are being seriously interfered with and an extremely disedifying spectacle is being provided for every section of the community by a Minister whose vanity will not allow him to admit that, in the past, his own petulance may have contributed to a situation which is now highly dangerous and certainly gravely inimical to the public good.
I strongly advise him, in lieu of a pilgrimage to some penitential place, to charge himself with the task of exercising the virtue of humility, and announce that in the cause of goodwill, he wants to meet the Irish Medical Association and discuss their problems, and even if they do not agree, they may possibly, in the course of such discussions, create a volume of goodwill upon which they can subsequently draw for a resolution of their misunderstandings.
Deputy de Valera and Deputy Esmonde spoke of the desirability of assisting persons who suffer from the two principal killing diseases mentioned in the Minister's statement, heart disease and cancer. Both Deputies pointed out, with, I think, unanswerable force, that any sufferer from cardiac trouble must inevitably have his condition greatly exacerbated by the anxiety of financial stringency consequent on his sickness. As Deputy de Valera pointed out, the incidence of this disease is peculiarly high amongst the white-collar worker and the professional man.
It is a fact — I do not think there is any doubt about it — that a great many young professional men recognise, on the threshold of their careers, particularly if they are contemplating matrimony, that a very necessary charge upon their current income is an insurance premium against incapacity resulting from illness. I know several young professional men who, when they marry, undertake to pay a premium when they are young and vigorous and healthy which ensures that if they should be smitten with illness and unable to carry on their practice for any protracted period, their income is maintained.
I often wonder if a Department such as the Department of Health could not with advantage discuss with the actuaries of some of the great insurance companies, particularly the insurance companies who specialise in this type of insurance, whether some scheme could be devised by way of some annual appropriation to build up a fund that would meet such a charge as Deputy de Valera and Deputy Esmonde envisage.
I do not want to underestimate the difficulty of such a plan. If you want to provide adequate protection, sufficiently effective to relieve the anxiety of people smitten with heart trouble, it is necessary to provide allowances in some degree commensurate with their ordinary income. Otherwise the fact that the income and way of life enjoyed by the family has been disrupted gives rise to the very problems we hope to allay in the case of the sick person. Therefore, the problem is one of complexity.
The suggestion is worth considering if we know the incidence of deaths from heart diseases, and we do. From that, I imagine statisticians could readily advise as to the probable annual occurrence of these heart conditions. Actuaries could then tell with reasonable accuracy what charge would provide a premium to protect the income of people likely to be smitten in this way. I do not say more than that I think that is a matter that might profitably be investigated. When it was so determined, we could then profitably consider whether such a premium should not be made available from the Exchequer by way of the creation of a fund for this purpose or whether some plan should not be worked out whereby it should be partially voluntary and partially State-aided.
In the meantime, it is hard for people who are young and healthy ever to envisage the possibility of crippling illness. However, for most people, particularly for the person whose family depends entirely on his personal exertions, it does seem that an attempt ought to be made to help in some way or another to make provision against heart disease, in view of its high incidence and its commonness now as a death-dealing disease in our society.
As Deputy Crotty stated, in the last analysis, we all have to die of something. While that is true, a great deal could be done to protect families from disease and the premature death of the breadwinner if we could reduce the causes and exacerbations of such a condition as heart disease, one of which doubtless is financial stringency created by the disease itself.
I do not want to criticise the Minister unduly for his insistence that people who can afford it ought to pay for the inoculation of their children against infantile paralysis. In theory, he is right. I brought my child and I had him inoculated against infantile paralysis. I do not think I paid anything. Perhaps that inoculation was not against infantile paralysis because I also had him inoculated against tuberculosis. I think it was the B.C.G. that I got for nothing. I discovered to my surprise I could not get it done at my own expense. That seemed rather to be erring in the other direction. I applied to the pediatrician who at that time was looking after my son's health. He told me he was not in a position to do it and that I had better repair to Rialto. I did so. The preliminary tests were carried out and the necessary inoculation was provided. When I asked the charge, I was told there was none. I left Rialto triumphant, having paid nothing.
The other inoculation was provided by my son's physician. The B.C.G. was the inoculation he got free of charge. I suggest that even if there is a public service available free of cost, a great many people would continue to get the job done privately because they would prefer to get it done that way or because it is more convenient to get it done that way. Many children get their B.C.G. injections at school. It is more convenient to get it done by the doctor attending at the school than to bring them to a centre.
If the Minister has reason to apprehend a serious increase in the incidence of the disease, he will put himself in an impossible position if he sticks his heels in the ground and says that although 70 per cent. of people under 25 are eligible for free inoculation, he will insist that the remainder will pay 7/6 up to a maximum of £1 for one family. The resulting economy must be microscopic. If there were a strenuous campaign even for a limited time, it would be very beneficial. If it were said that for the next two years anybody who wanted to be inoculated against infantile paralysis could have it for free and that at the end of that time the matter would have to be reviewed the Minister would be in a very much stronger position in insisting on the nominal charge from those who could afford it, while continuing to provide it free for those whose financial circumstances make it difficult for them to pay for it.
If it is desirable — and from the Minister's statement it looks as though this year might be a dangerous year— I urge on him at least for a limited period accompanied by suitable publicity to announce that there will be free inoculation against infantile paralysis and that those who do not avail of it within the limited period specified, say, two years, must face the fact that thereafter they will be expected to make their own arrangements. He will have no reason to regret such a step.
Over and above inoculation of this kind, there is another matter to which the Minister's attention should be turned at once and urgently if we are correct in believing that this is a year, in which the incidence of infantile paralysis may be high. There is running through the centre of this city a canal and, so long as children are children and weather is hot, the children of the city will bathe in that canal as they have nowhere else to bathe. I am assured on the best authority that to allow children to bathe in fresh water which has not been put through some process of chlorination in the summer months is a pregnant source of acute anterior poliomyelitis.
There are two courses open, and I think this must be faced: either to clean up the canal and recognise it as a public bathing centre and take steps to chlorinate the water or to provide alternative bathing accommodation which will be properly chlorinated and supervised and effectively prevent children from bathing in the canal. But there is no use in closing our eyes to what is proximate and full of danger and spending all our time dwelling on remoter remedies for present evils.
Mark you, I think you can carry all this business of prophylactic measures to fantastic extremes. I remember years ago going to the Department of Local Government and Public Health and asking them to collaborate with me in the conversion of a certain part of the river at home into a swimming pool. We had been using the river as a swimming pool for 40 years and apart from one man drowning in it, nobody ever associated any infectious disease with the use of that part of the river but it became necessary to rebuild a weir which had been knocked down in order to restore the river to the user as a swimming pool.
I was told by the Department that it was completely out of the question, that it would be most dangerous and quite unthinkable, that in any case the danger of starting an infectious disease in the area ruled the proposition out from all consideration, and in the hopping and trotting, they succeeded in frustrating the project and to this date nobody can swim in that part of the river because the level is too low and the weir was not rebuilt. The project was never sanctioned and the local authority was not allowed to do it and the ground for the refusal was that being a fresh water river, there was danger of disease.
When you come to a canal in the city, however, into which are thrown dead dogs and cats and buckets and every kind of refuse and superimposed on that a dense concentration of children bathing in restricted areas of the canal, then I think the danger is manifest and substantial and I do not think the Minister for Health is entitled to close his eyes to it. It is one of these tricky, immediate problems that Ministers are very reluctant to face because it demands some practical action and that is something they do not like, but I put it to the Minister that he has a grave responsibility if he is serious— and I have no reason to doubt he is serious — about his apprehension in regard to acute anterior poliomyelitis this year. He has a grave duty first to provide prophylactic inoculation free for a restricted period, with due notice that the period is restricted and he has a duty to intensify the publicity founded on that offer and he has an urgent and clear duty either to clean up the canal and chlorinate its water to make it safe for children to bathe in or provide alternative accommodation for children to bathe in and prohibit use of the canal for that purpose.
I am all in favour of using the canal because in my experience if you attempt to prevent them using the canal, it will become a kind of garden of paradise for them to be entered whenever and however public vigilance can be avoided and I must say I would have great sympathy with the children because bathing in the canal has a certain excitement about it and it is a traditional practice and to be forbidden from doing it on a hot day appears to me to be a great hardship. I do not think it would be impossible by the exercise of reasonable vigilance to make the canal water fit to bathe in.
I have been urging Ministers for Local Government and Public Health to do this for the past 20 years. Why they do not do it is a mystery to me but nobody ever seemed to be sufficiently interested in it. If the Minister cares to consult the records of the Custom House, he will find somewhere that pretty steadily over the past 20 years I have been battering at the doors of various Ministers, mainly Ministers for Local Government. On one occasion I think I was battering at the door of the Minister for Local Government when the present Minister for Health was sitting on the other side and urging him to stimulate the Corporation of Dublin or C.I.E. — whatever the appropriate authority was — to put the canal in a fit condition for children to bathe in.
Our prime concern should be to ensure that children's lives are not put in peril as a result of doing what they might reasonably be expected to do. I often thought that an action would lie against whoever owned the canal if a child bathed in it and developed acute anterior poliomyelitis and could directly attribute that to the water of the canal. I think there was a very well-known case of a claim for negligence — Cooke v. the Midland and Great Western Railway — and I wish that somebody would take an action of that kind against the company and mulct them in damages. If they did, if we could launch a successful action against the Minister or C.I.E. or somebody of that kind and establish their liability, within 48 hours, this problem would be cleared up.
I do not want the Minister to think that I am suggesting he is a heartless or unscrupulous person — I do not— but until something like that happens, Ministers and their advisers are inclined to close their eyes to the fact that some children die and some are crippled for life as a result of infection picked up in such a way. That fact ought to be a very much more stringent spur upon them to take remedial action than the danger of a successful action being launched against them is or would be.
I heard Deputy Crotty speak today with great satisfaction of the reforms in Kilkenny and I am delighted to hear about them because county homes are on my conscience. I never pass a county home without feeling that we are all gravely to blame because if Kilkenny has achieved this reform, it is one that is not reproduced in many counties in Ireland. I think the county home is a gloomy place and I hope we shall yet see the day when all the county homes will be closed up. We must have a county hospital for the sick but I want to put it to the Minister, as I put it to many of his predecessors, that our forebears were very much better advised in these matters than we are. We have taken over from the old British poor law a bad system, and it is being carried on simply through inertia.
There was a system which obtained here and in Great Britain in the 18th and 17th Centuries. In Great Britain it was a survival of an earlier time, the old charities of pre-Reformation days, and that possibly was true here up to the time of the Poor Law.
That system was that you sought to establish in the parish where old people became indigent or unable to look after themselves a limited number of small homes closely analogous to the homes where they lived and, instead of sending them 20, 30, or 40 miles away from their own parish and herding them together in one big impersonal workhouse, they were established in small dwellings, sometimes in the shape of little flats in one large building or else in one of a row of cottages. Almost invariably you found that in the group of cottages or apartments there would be one department reserved for a matron who would help to look after the old people who could no longer look after themselves.
The difference between accommodating people in those circumstances in their own parish — where they will see their neighbours, where they will meet people with whom they an have a chat, where they are able to move about and see familiar places or, if they are unable to get about themselves, can get a neighbour to wheel them in a chair around the town and can see their neighbours and visit the market on market day and maintain their ordinary life — and the horror of seeing old friends, as I have seen them, taken away from their homes and dumped in a bed in a county home where they do not know a living creature, is radical, dramatic and, I think, compelling.
I would urge the Minister not to spend another shilling on perpetuating county homes for the indigent poor but rather seek to empty every county home in the country into parochial centres which I do not think cost any money at all to operate because, with very little supervision, the people can look after the homes themselves. I think you will find that the charities to which I have referred, the old charities, would have it to tell that even if there is an old person who is unable to look after himself or herself the neighbours will give a hand and that life is quite possible on that basis. If you have a matron who will exercise general supervision and give exceptional help in individual cases the scheme works perfectly well.
Despite the reforms of which Deputy Crotty spoke, I hope in our day to see every county home in Ireland closed down. I recognise that you must have hospitals for the chronically sick who require constant medical attention and nursing. We made a considerable mistake, as Deputy O'Higgins mentioned, 30 years ago when we embarked on this vast scheme of building county hospitals everywhere. We would be much better off with cottage hospitals which would have provided for the chronically sick a very similar service in their own neighbourhood to that which I now suggest for the indigent poor. I hope the Minister will express his view on that where he comes to deal with this general question of county homes. All I am afraid of is that we shall find ourselves in a position effectively to grapple with this problem and that in a desire for prompt and early reform we shall pour millions of money into these detestable barracks of county homes and that then we shall be married to this system for ever more.
I should not depart from this subject, on which I have spoken harshly of county homes as county homes, without expressly stating that the rigours and horrors of these establishments are to my mind incalculably relieved by the superb devotion of the nuns who operate them. I remember visiting Roscommon County Home when things were much worse than they are today and marvelling at the old Mother Rectress who had spent the greater part of her life there looking after the people. I said to her one day: "How do you spend your life in this kind of work?" One of the distressing features of it is that those who are most difficult to nurse are often the least appreciative of the nursing. Her answer was: "If you did not see Christ in each one of them you could not do it for a day." These devoted women with high vocations have made conditions in these institutions as nearly tolerable as it is possible to make them but the plain fact is they are horrible. We ought to be able to get rid of them. If they had not been wished upon us by the English Poor Law, our mentality would never have evolved them. The time is overdue when we should take steps to escape from that deplorable tradition and establish something which would be more in keeping with our attitude to such a problem.
Now I am going to make a suggestion to the Minister which I hope will not come under the general censure expressed yesterday by the Minister for Justice about well-intentioned people who make fatuous suggestions without due regard to cost. There are in this country a whole number of homes for old people — some of them for old men, some of them for old ladies. One distressing feature that they have in common is that they are all hard up. They like to provide the best food they can for the inmates. They like to provide a fire in winter and to provide as much comfort as their funds will allow.
Almost invariably one thing falls into arrear for want of money and that is interior decoration. In the old days people used to think that interior decoration mattered very little. We are all familiar with the usual Government provision of dark brown paint because that lasted longer than any other paint and if there was to be any white on the walls it was put at a level where no human hand or eye would ordinarily reach it. I understand it is pretty generally accepted now that part of efficient therapeusis in a hospital is a suitable colour scheme and I am prepared to accept that as certainly true but I think it is also part of the essential task of preventing old lonely people from subsiding into incurable melancholia that their surroundings should be made reasonably cheerful and gay.
I agree with some Deputy here today — I think it was Deputy Faulkner —who said that the voluntary element in social services of this kind was very precious and should at all costs be preserved. These homes for old people are largely the result of voluntary effort by religious. They make collections and people preach charity sermons for them and we hear appeals on the radio for them and they scrape along as best they can. Would the Minister consider it an extravagant proposal to suggest that, where there are approved homes of this kind operated by charity, capital grants should be made available for the purpose of interior decoration? I do not think that is an extravagant proposal and I think it would be a very profitable way in which to bring together State obligations to old people and voluntary effort on their behalf. It would pay a rich dividend in increased comfort and happiness for the people who are constrained to live in these homes and would certainly greatly relieve the burden of the religious and other persons who operate them.
It is a long time since I directed the attention of Ministers for Health in this House to the vital need in rural Ireland for what used to be called the Jubliee nurse and is now being replaced by the dispensary nurse. The number of Jubilee nurses is growing less and less but the number of district nurses does not seem to be increasing. I wonder is there anything we can do about that. I suppose it is that the demand for nurses is so high that it is relatively hard to get nurses to undertake that laborious kind of work. However, I can say from personal knowledge that in rural Ireland the labours of a dispensary doctor could be greatly lightened if he had the assistance of a nurse and, what is even more important, the fruits of a dispensary doctor's work in rural Ireland could be doubled and trebled if he had the assistance of a dispensary nurse. I do not think it is unreasonable to suggest that the Minister should direct the attention of the local authorities, if it be their responsibility, to the fact that if they would exert themselves to recruit district nurses, the results of their dispensary doctors' activities would be greatly enhanced.
I wish to say a word now in furtherance of my suggestion that we should provide some assistance for the interior decoration of old people's homes and of hospitals. Would it be unreasonable to suggest that some annual grant should be made to the society that provides radios for the blind? There are a large number of people confined to their rooms because they are blind, and even those who make their way out and get themselves trained to earn a living, when they come home in the evening — and they cannot very well do anything else but come home, with their affliction — they are obliged to clasp their hands and sit and depend on the charity of their neighbours to read the newspapers to them or provide some entertainment that will relieve the tedium of hours passed in darkness.
I am told that the voluntary society which provide radios for the blind have a very long list of people waiting and they are prevented from providing radios because they have not got the money which they seek to raise by public subscription and so forth. I agree that these needs are much better provided by the charitable subscriptions of neighbours.
