Seanad Éireann debate -
Wednesday, 23 Jan 1946

Vol. 31 No. 1

Housing (Amendment) Bill, 1945—Second Stage.

Question proposed: "That the Bill be now read a Second Time."

Minister for Local Government and Public Health (Mr. MacEntee)

This Bill, as the House will understand, is a continuing Bill, relating to building grants payable to private persons or public utility societies for the building of houses in rural areas. Ordinarily, this Bill, which deals with building grants payable to private persons or public utility societies, would be concerned merely to prolong the operation of certain provisions of the Principal Act, that is, the Housing (Financial and Miscellaneous Provisions) Act, 1932, but on this occasion it includes also an important provision which is designed to assist the campaign now in progress to combat the scourge of tuberculosis. I shall deal later with that provision of the Bill, which is contained principally in Section 3, but perhaps I should first deal with what might be called the more normal provisions of a measure of this kind. In Clause 2 it is proposed to extend, for another two years, from 1st April last, the time for the completion of new houses in rural areas and the reconstruction of existing houses owned by small farmers and agricultural labourers, under the system of grants established by Section 5 of the Principal Act. Normally, I may say that this section—Clause 2 of the definition Section—is all that would appear in a Bill of this description, but the House may wish to have some figures relating to the activities which have been carried on under the provisions of the Principal Act which it is now proposed to extend by Section 2. The total number of new houses built by private persons and societies of the kind to which I have referred in rural areas since the passing of the Housing Act, 1932, is about 23,200, and, of these, 5,196 have been built since 1st April, 1940. The number reconstructed since the 1932 Act came into operation is 30,696, of which 6,341 were reconstructed since 1st April, 1940. Of the total number of 23,202 new houses completed for private persons or public utility societies, in rural areas, no less than 3,540 were for agricultural labourers and 9,791 for farmers with a valuation under £15; 2,186 for farmers with a valuation from £15 to £25, and 7,685 houses for other persons—residing, of course, in rural areas. Of the 30,696 reconstructed houses, 27,963 were reconstructed by farmers with a valuation not exceeding £25, and 2,733 houses were reconstructed by agricultural labourers.

These particulars, as I have indicated to the House, relate to the provisions of the Act of 1932 which it is proposed to continue as a temporary measure for another two years. At the end of that period—indeed, long before that, I hope—I shall be putting before the Oireachtas a new Bill to deal with the housing problem generally, not alone in the light of financial conditions but of economic conditions as they may be expected to stabilise themselves in the post-war years. The experience which has been derived from the operation of the existing Housing Acts has shown that it is necessary to introduce a new measure in order to remove certain disabilities and to ensure that decisions can be taken with regard to this matter of housing, and, accordingly, we must press forward. This Bill, as I have already said, is merely a continuing Bill—a Bill in connection with which I cannot, I think, at this stage, go into the whole question of housing.

I come now to Section 3—what might be regarded as a novel section in the Bill—which deals with people undergoing treatment for pulmonary tuberculosis, in cases where the accommodation in the home is inadequate for the proper segregation of the patient from other members of the family. The section provides that on the certification of the appropriate medical officer of health the local authority may, and, if required by the Minister, shall, make to the owner or occupiers of the house a grant towards the cost of the provision of an additional room in or attached to the house. A grant of the full cost may be made by the local authority, and two-thirds of the grant or £100, whichever is the less, will be recouped to the local authority by the Minister for Finance. Where the Minister—in this case, the Minister for Local Government and Public Health —is of opinion that the provision of a hut or chalet within the curtilage of a house would serve the same purpose, Section 4 enables the provisions of Section 3 to be applied accordingly.

Section 3 of the Bill, therefore, as members of the House will understand, may be regarded as a further step in the campaign against tuberculosis. The Tuberculosis (Establishment of Sanatoria) Act, which was passed last year, provided for additional sanatorium accommodation for patients who require institutional treatment, but only for those cases. Further provision is required to deal with the cases of persons who, although suffering from the disease, do not require active treatment in sanatoria. One cannot say with certainty how many persons in this country are suffering from tuberculosis. It is known that 22,879 persons received treatment under the various local authority schemes in 1944. No doubt, there are many others who are being treated by private practitioners, and also there is a large number of people who, unfortunately, unknown to themselves, are suffering from the disease.

Tuberculosis, as I need not tell the House, is an infectious disease, and, therefore, the first measure to be taken to combat it is to limit the spread of infection. This is a matter of primary importance. The incidence of tuberculosis infection and disease is, therefore, higher amongst persons who come into daily or, perhaps, hourly contact with infected patients in their own homes. We have to recognise that fact, if the disease is to be prevented from increasing. We have all known or heard of cases of families in which two, three, or four members had died from tuberculosis, and it is that kind of thing which has given rise to the delusion—I think I may call it so— that tuberculosis is "in the family", as the saying goes; but I think it can be stated definitely now that tuberculosis is not hereditary and, therefore, is not "in the family".

The reason why several members of the same family may die from tuberculosis is that, in their own homes, they have been constantly exposed to infection and cross infection, from one another. Section 3 of this Bill aims at reducing this exposure to infection. When discussing this particular provision of the Bill, I hope Senators will keep in mind the fact that it is not necessary that every person who has contracted tuberculosis should be treated in an institution. Very many sufferers do not require active sanatorium treatment. What they need is food, rest and fresh air. But if we are to counteract the influence of persons who already suffer from the disease as a source of infection it is essential that the conditions of the home in which these persons live shall be such as will permit of segregated accommodation. If this accommodation can be provided domiciliary treatment—that is by visits and treatment in the patient's home by the tuberculosis medical officer—will meet the case and the persons concerned will make satisfactory progress without any sanatorium treatment, at least in the vast majority of cases. During the last year over 8,000 persons suffering from tuberculosis received institutional treatment. It is probable that a considerable number of these did not, in fact, require such treatment but because their home conditions did not permit of segregated accommodation being provided for them it was deemed prudent to have them admitted into sanatoria in order to protect the other members of the family. If segregation can be secured, say, for 1,000 such persons as is anticipated in this Bill, it must follow that the pressure on the bed accommodation in existing tuberculosis institutions will be greatly relieved.

When addressing the House on the Tuberculosis (Establishment of Sanatoria) Act, 1945, the Parliamentary Secretary, Dr. Ward, informed the House that we had instituted an inquiry to determine the extent of overcrowding amongst persons who were known to be suffering from this disease. The results of that investigation have been analysed and we believe that about 1,000 persons will benefit by this new provision. In these 1,000 cases we shall be attacking infection at the source, but more than that, not only will better provision be made, but there will be a considerable number of other individuals who, by the operation of this measure, will be protected against infection. The grants under this Bill will be made in the first instance by the local authority concerned, but towards the amount of the grants the Minister for Finance, as I have indicated in paragraph (g) of sub-section (1) of Section 3, will make a generous contribution. A grant will be given only in the case of a house where the conditions admit of an extension of the living accommodation and where the county medical officer of health or the superintendent medical officer of health, as the case may be, certifies (1) that a member of the household is suffering from pulmonary tuberculosis, and (2) is undergoing treatment, and (3) that the existing accommodation is inadequate for his proper segregation from the other members of the family. I should like to emphasise that persons in respect of whom applications for assistance under Section 3 of this Bill are made must be actually undergoing treatment and, of course, must be persons who cannot provide this proper accommodation out of their own resources.

Section 4 permits the Minister to sanction a grant for a hut, chalet or similar building in lieu of a room provided for by Section 3, where he is of opinion that such alternative is necessary. The Exchequer contribution will be forthcoming in these cases even where it is thought better that the hut or chalet detached from the dwelling-house should be provided. The Bill also provides in sub-section (4) of Section 3 that for a period of seven years the valuation of the building consisting of and including the house shall not be increased by reason of the addition of the extra room or chalet. I am sure I do not need to say anything more to recommend Section 3 to the House. We believe that it will prove to be a very important ally in fighting tuberculosis. I should like to emphasise this, that it does not by any means represent all that is being done or that is in preparation in that connection. Next week it is hoped to circulate a White Paper giving a much more comprehensive view of the measures we are taking to deal with the disease. I can assure the House that the Government's plans for tackling this white scourge are of the most progressive kind. When Senators have had an opportunity to study them as outlined in the White Paper they may think it a more suitable occasion to debate the whole question at length.

Mr. Baxter

It would be inappropriate to suggest that this Bill should receive anything but the unanimous support of the House. As to its general terms, I think continuing conditions have been operating here for a number of years. I want, however, to comment on Section 3, not in a very critical manner, but to lay emphasis on the fact that this aspect of Ministerial policy, which seeks to impose an additional burden on local rates, is one which is not finding favour with ratepayers generally. There can be no quarrel with the policy of the Government, or with the policy of the community, in the battle against tuberculosis. We must be altogether at one on that, as the State, in the name of the community, is obliged to do its utmost to eradicate this dreadful disease, but there are other methods by which that could be achieved which, I think, would do more than the thin end of the wedge the Minister has inserted in the Bill. I am not going to contest the wisdom of the insertion of that section now. Perhaps it must be given a trial. But I confess that, even on the Minister's own statement, I am not too optimistic that it is going to achieve its end. I accept the Minister's view, and also that of the Parliamentary Secretary, that tuberculosis is not hereditary, but if it is not passed on from parents to children, it is passed on from one generation to another in houses that are, probably, the greatest source of infection. I am not quite clear what exactly the Minister means to do regarding the operation of Section 3. Does the Minister suggest that he is going to have a patient, who has contracted tuberculosis, possibly within the walls of that home, treated in an additional building that is to be erected? I wonder what we are going to achieve by that. That is an aspect of the operations of Section 3 which I should like to have taken into account. I do not desire now to go into a lengthy consideration of this problem. We did that with the Minister's Parliamentary Secretary and, as the Minister said, we shall have an opportunity of doing so again. Speaking with some experience, my view is that, while this disease is not passed on from parents to children, it is passed on from one generation to another and the living organism is present in many of the homes of the country. I do not think that we shall achieve very much by the section which the Minister has inserted to enable what I may describe as home treatment to be provided for persons suffering from this disease. There are circumstances in which this might be a suitable remedy. I should like, however, that county medical officers of health, when giving advice about patients being treated in out-buildings of their own homes, take into account the history of the families concerned. I know quite a number of homes in which the disease has been passed on from one generation to another and I do not think that we shall get rid of it in those homes by the erection of an additional building, while the old building still stands.

I dissent from the proposal that the cost of this treatment should be, to any extent, a charge on the ratepayers. The battle against tuberculosis is a national struggle in which the whole community is involved. I do not think that the Minister should impose the burden which he proposes to impose by this Bill on the ratepayers. On a number of occasions, the Minister has been very generous to people in the local areas at the expense of the ratepayers and, in this Bill, he is taking power to impose further burdens upon them. These burdens are mounting up to an almost unbearable extent and this proposal is one which will not be received with satisfaction even by the Minister's strongest supporters. I assent to the view that the House must accept this measure.

Mr. Kingsmill Moore

It is rather difficult to know whether to approach this Bill from the point of view of housing or from the point of view of public health. This measure is called a Housing Bill but, obviously, the portion of it which deals with housing is almost automatic in its operation and no discussion is necessary in regard to it. But that portion of it which, although contained in a Housing Bill, deals really with the problem of public health—Sections 3 and 4—does raise certain questions which it would be worth while for this House to consider in some detail and with some seriousness. Everybody here is in sympathy with the object of those sections—and nobody more than I am myself. It may, however, be questioned whether the sections to which I have referred are not conceived rather too narrowly and, from the point of view of their operation, somewhat erroneously.

The object of those sections is, apparently, to have provided a permanent room, attached to the house in which the patient is resident, or, in certain circumstances, a chalet. The ownership of the room or chalet will be in the person who owned the original house. This provision is intended, as expressed, merely to provide for the proper segregation of the sufferer from tuberculosis. If it is intended merely for the purpose of segregation, then it is easy to see that segregation in this way will be almost impossible. It will be easy to excuse delay—perhaps, necessary delay—in sending a person to an institution. It will be easy to lose sight of the fact that the proper method of preventing the spread of infection is really by training in the use of the sputum flask and the handkerchief. Emphasis is here laid on the provision of a permanent room or hut which will be available to the sufferer. That may be, eventually, unnecessary either because the person who has been suffering from tuberculosis gets well, as a result of the provision of this hut or otherwise, or because he dies. Then, you have a room attached to the cottage, which is of advantage to the cottage, but which, from the point of view of public health, has ceased to justify its original function. I suggest that the emphasis should be laid not on the making of grants to provide rooms for sufferers, but on giving the widest possible powers to local authorities to provide free of charge to sufferers something in the nature of chalets or garden shelters which can be rapidly put up and rapidly taken down, which can be put at the disposal of the sufferer within a few hours, or at latest within a few days, of the time when his disease is diagnosed, and which, when they have done their work or have, unfortunately, failed to do their work, can be taken away, disinfected and used for the treatment of other sufferers.

May I explain a little bit more clearly what I mean? The scheme envisaged in the Bill is that a room should be added to an existing house or that a chalet should be built in the garden attached to an existing house. It is set out that this is to be done for the proper segregation of the sufferer from the other members of the household. Anybody who knows anything about rural, or even urban, conditions knows perfectly well that it will be almost impossible to prevent children from going in and out of that room and that this method will not be effective either for the preservation of the children's health or for securing rest and fresh air for the actual sufferer. What is needed in a case like that is training for the sufferer in the use of the sputum flask and the handkerchief, because, if those are used properly, approximately 95 per cent. of the danger of infection disappears. I am aware that, in addition to infection from sputum, there is a danger of droplet infection, but we are not dealing with nasal pharyngeal infection, and sputum, in the case of this disease, is, probably, the primary method of conveying the infection. If there is a certain amount of droplet infection, a proper use of the handkerchief, in the event of coughing or sneezing, will deal with it. In the case of the ordinary man, to ensure that he makes proper use of the flask or handkerchief, it is, probably, necessary he should have a short period of training in an institution. Persons of naturally cleanly habits may be instructed by word of mouth but, in the case of persons who may not; naturally, be of disciplined or cleanly habits, a certain amount of training in an institution is necessary.

I am rather afraid that, if we pass this measure in the form in which it is, we may be masking the measures which are necessary. We may be inducing a person to adopt a room when he knows that institutional treatment is desirable and we may not be preventing infection by providing the extra room. It is possible that these rooms will become nurseries of infection, because they will become impregnated, unless the occupant is well trained, with the germs of tuberculosis and children going in and out will be likely to pick them up.

The scheme which I urge on the Minister—and which I urge in a cooperative manner and which I think might be added on to this measure— is power for every local authority to provide something in the nature of a garden hut or shelter for a man as soon as his disease has been diagnosed. Again I do not wish it to be conceived as a substitute for treatment in an institution. I concede that its greatest use will be as auxiliary to treatment in an institution. It is inevitably the case that, whether a sufferer is poor or rich, after his disease has been diagnosed, a period of greater or lesser duration must elapse before he can get into an institution, before a bed is ready for him, and it is most important that during that period certain elementary precautions for his own health should be taken.

Under the scheme I recommend, it would be possible to have an open-air shelter to allow of an open-air life provided within 24 hours. He then goes to an institution where he is trained in the manner of living, in the regular exercise, in rest hours and in the hygienic precautions necessary for a cure of the disease, and after being there for a short time—six months, nine months, or perhaps a year—he will, we hope, be given what is technically known as a clean bill; that is to say, his sputum is no longer positive, and, on examination of his lungs, no crepitation or sounds are found which indicate that the disease is then active. It is, in fact, quiescent—it is not cured. It is necessary for that man, for a period of six months or a year at least, to continue living in conditions as near as possible to those provided for him in the sanatorium, and here again comes into use the temporary shelter which can be provided by the local authority. He goes out of the sanatorium and he has this shelter at his disposal, and, in the course of the next six months or a year, his lung hardens and he is enabled to take up his regular life. The shelter or chalet is then available for use for the next sufferer after having been disinfected.

This is no chimerical scheme. I myself know of one such shelter which, in 1912, was instrumental in completing the cure of a person suffering from tuberculosis. It cost £15 and it remained, after having served its function, in the place in which it had been put up. In 1941, when another person in the neighbourhood had the beginnings of the disease, it was bought for the large sum of £2 and set up in another place. A child was put into it and was also cured. That is an example of one shelter used after an interval of over 30 years. When its use for the first patient was at an end after a year, it remained there for 29 years. If it had been at the disposal of a local authority, it might have been carrying out its curative work during all those 29 years.

It is some scheme of that nature—I am not attempting to go into details; I am merely envisaging it largely— which I think would be of more advantage, as well as being infinitely cheaper, than the scheme set out in the Bill. It may be that to a certain degree local authorities already have power to provide these buildings—I am informed that one local authority, whether it has the power or not, has taken it on itself to adopt a scheme something like this—but I suggest— and, if necessary, I shall bring in an amendment to that effect—that local authorities be enabled, as an alternative to providing a permanent room or permanent chalet which is to pass into the ownership of the sufferer, to make themselves the proprietors of a considerable number of these small portable shelters, which they can give without any charge to sufferers for as long as they are needed and which they can take away for the use of other people when their use in a particular case is at an end. If that authority exists it could, I think, be amplified, and, if I may use the phrase, put more into prominence in this Bill. I fear that the money expended in the manner proposed will not be as well expended as it would be if expended in the manner I suggest, and I urge that serious consideration should be given to the relative merits of the scheme and the necessity for the particular provisions before the House.

Mr. Duffy

The general intent of this Bill is approved by everybody and the only comment I should like to make is in respect of the provision in Section 3. I have the feeling that, if a local authority adds a room to a house, that room will become merely one of the common rooms of the household and not a room for isolating a person afflicted in a particular way. I assume, of course, that local authorities will provide the additional rooms only in the case of small houses. I know it is intended that their activities will be restricted to the needs of people who cannot afford to provide the accommodation for themselves. These people, in the main, live in two-roomed or three-roomed houses, and the additional room will, in my opinion, become one of the ordinary rooms of the household.

The Minister is probably aware that, in places like Peamount and also in Papworth in Britain and in other sanatoria, you find a large number of these chalets, wooden constructions, away from the main building. People who are able to walk around and probably to work a certain number of hours in the day live, or, at least, sleep in these chalets, and I imagine that the best approach is that of providing some simple structure detached from the house which will be used as a sleeping room for a person affected. I do not imagine we contemplate a living room because, if a person is confined permanently to his bed, very likely he will be removed to an institution. Therefore, the person we have in mind, I take it, is the person who, during the day, goes around doing whatever work he is allowed to do— perhaps doing very much more than he is able to do. What we are trying to do is to provide sleeping accommodation which will isolate him from other members of his family, and particularly children, and I therefore agree with the view expressed by Senator Kingsmill Moore that the best approach is the provision of a chalet, a hut, which is reasonably comfortable and has accommodation sufficient for sleeping purposes.

One of the things one remarks about Peamount or Papworth is the fact that there is no front door to these huts. There is a half door, and, in the middle of winter, you find the place wide open. I was very much struck when I first saw the chalets in Papworth, where the buildings are on a rather high elevation, to find, in the month of February, that they had no front doors. I was told by the doctors, however, that that was a desirable feature, that one of the things needed above all was plenty of pure, fresh air.

The one reservation I have about this scheme is that we are authorising the expenditure of approximately £150,000 to deal with a problem which is not merely a problem of infection. People contract tuberculosis without having had contact with affected persons, and the reason why they are prone to contract it is due to the fact that they are insufficiently nourished. Often they have not got sufficient protective clothing. I would suggest to the Minister that he has a special function in this matter, apart altogether from his colleagues in the Government. He is the Minister for Public Health, and if he is to deal with this problem of public health then he has to face the fact that inside the Government he must be stern in getting endorsement for a policy that will enable every man and woman in this country to be properly nourished, properly fed and properly clothed. We get, therefore, to the position where we have to consider the mass of the people who are afflicted by a disease of this kind through the effects of poverty. None of us here, I think, will cavil at the expenditure of this sum of £150,000 if, as the Minister has suggested, it is going to save the lives of a large number of people by isolation. We all gladly subscribe to the view which he has expressed. I merely want to draw his attention, in passing, to what I believe to be the kernel of the whole problem, which is not just that of taking the person who is stricken down with tuberculosis, but rather dealing with his social conditions so that he will escape the scourges of the disease. In the long run, I believe that would prove to be the cheaper policy of the two. Having said that, I want to say that I welcome the Bill as a small instalment towards the social progress which we must have if we are to fight tuberculosis at all.

Mr. Honan

On every side of the House we join with the Minister and those concerned in the promotion of this good work of attacking the great scourge of tuberculosis. It has often struck me that in this matter we, more or less, start mid-way in the campaign instead of acting on the policy that prevention is better than cure. The efforts towards prevention could, I think, be started with great advantage in the primary schools of the country, and be continued in the secondary schools. In the primary schools, some time might be allotted each day to enable the teachers to give lectures to the pupils. This instruction might be supplemented by other methods. The pupils might be warned of the dangers of expectoration in the schools, in their homes or elsewhere. I think that would be a good start to make in the campaign against the terrible scourge of tuberculosis. It has been suggested that chalets should be provided for those affected by this disease. I am afraid that would not meet with the entire approval of affected persons or of their families. Those of us who live in the country are well aware that people have a great dread of it becoming known that such a disease exists in their families. Notwithstanding the points that have been made by previous speakers, I am afraid that the idea of providing huts or chalets would not meet with approval. An addition to the house for the accommodation of an affected member of a family would, I think, meet more with their approval. The reason why I say that is that the erection of a chalet some distance from the house would indicate to the whole country that some person affected with tuberculosis resided there, whereas an addition to the house itself would not. I would suggest, however, that there should be a separate entrance to whatever addition is built to a house.

There is another suggestion I would like to make, and it is that the house in which an affected person has been reared should be fumigated, and that, if necessary, the plastering on the walls should be removed. The walls might be replastered and every care taken to see that all danger of infection was removed. Those of us who come from the country are well aware that people do not like to admit that any member of their family died from tuberculosis. Although some member may have died from the disease, the family will give a hundred reasons other than the real one, as being the cause of death. Therefore, I am more strongly in favour of an addition being made to a house with, as I have said, a separate entrance to it, than of the erection of chalets which, as I have said, would indicate to the whole country that some one in that house was suffering from tuberculosis. I do not think the erection of these chalets would meet with approval in the country at all. I imagine that those members of the House who are familiar with conditions in the country will agree with me on that. I hope that the Minister will be able to find the happy medium. I have the feeling that the views I have expressed, as to the manner in which persons affected with this disease should be treated, will meet with general approval in the country.

Liam Ó Buachalla

Is maith liom a thabhairt faoi deara go bhfuil an Seanad ar aon intinn i dtaobh buntáistí an Bhille seo agus go bhfuil fáilte roimhe. Bíonn cuid mhaith cainte ann ó am go ham i dtaobh seirbhísí sóisialta ach an té a bhfuil spéis sna cúrsaí sin aige ní fhéadfadh sé gan admháil go gcuireann an tseirbhís atá i gceist sa mBille seo mórchuid soilgheasa sóisialta ar fáil.

Ba mhaith linn an tuarascáil a thug an tAire dúinn ar thoradh Achta na dTighthe ó 1932 i leith. Ní fhéadfaimis gan bheith brodúil as Acht ar tógadh 23,200 tithe nua agus gur hatógadh 30,696 cinn eile ó tugadh an tAcht isteach i 1932. Is scéal mór é sin, go háirithe nuair a chuimhníos duine gur faoin tuaith a tógadh iad sin uilig. Níl mé ag iarraidh a rá go bhfuil an scéal sásúil go hiomlán. Níl fhios agam cé mhéad tithe a theastaíos le go mbeidh an ganntan uile ar ceal, ach gan aimhreas ar bith is mór an méid atá déanta agus is mór é a thairbhe i saol na tuaithe.

Bhí brath agam roinnt ceisteanna a phlé i dtaobh tógála tithe sa tsaol atá anois ann. Ach ós rud é gur luaigh an tAire go bhfuil sé fhéin eolasach ar na deacrachta agus go n-admhaíonn sé go mb'fhéidir go mbeidh air Bille nua faoi thithe a thabhairt isteach ar ball, níl call an cheist a phlé anois díreach.

Rinneadh tagairt d'ailt a 3 agus a 4. Is maith leis an Seanad go hiomlán na hailt seo bheith ann cé go bhfuil sé soiléir go mha mhaith le cuid de na Seanadóirí mion-athraithe a dhéanamh orthu. I mo thaobh féin de, léiríonn na hailt seo dom go bhfuil fogha eile á thabhairt faoi ghalra na hEitinne, atá chomh fada sin ina chrádh mór ar an tír, a cheansú. An socrú seo atá á dhéanamh le cuidiú le daoine na seomraí breise agus na chalets a chur suas, tá sé le moladh go mór. Ní leor é seo, ar ndóigh— rud atá ráite cheana—leis an mí-ádh a chosc. Tá a lán rudaí eile le déanamh againn sul a mbeimid i ndon a rá go bhfuil an cath á riar go hiomlán ar an ngalra. Caithfear breis aire a thabhairt do scéal an bhainne ar fud na tíre. Tá súil agam go mbeidh toradh sásúil ar imeachta an Choiste atá ag scrúdú cúrsaí bainne i mBaile Átha Cliath faoi láthair. Ach tá súil agam freisin nach do Bhaile Átha Cliath amháin a déanfar beart de thoradh an Choiste seo. Níl baile mór ar fud na tíre nach gá cúrsaí réire agus glaine an bhainne a scrúdú ann.

Ar an gcaoi chéanna, ní mór féachaint chuige go mbeidh na scoltacha go léir chomh compórtach teolaí agus is féidir. Tá mórán déanta ar na scoltacha cheana agus ní fada, dar liom, go mbí an scéal go hiomlán ina cheart. Ach, thairis sin, is dóigh liom gur ceann de na cúiseanna is mó atá ann go bhfuil an eitinn chomh coitianta imeasc daoine óga, go dtagann an oiread sin díobh fliuch ar scoil, agus gan deis feiliúnach ann le iad a thiormú agus gan an deis acu ar dheoch te fháil go tráthúil. Ní shílim gur uireasa éadaí is údar don trioblóid. Mholas féin cheana, nuair a bhí an cheist seo á phlé againn go gcuirfí clóca ruibéir ar fáil do gach páiste scoile—iad a bheith le fáil in aisce, nó ar chostas beag.

Ceapfaí ar óráid an tSeanadóra Ó Dubhthaigh gur ar na daoine bochta amháin a thagann an eitinn. Níl me ag rá go bhfuil a ndóthain den bhiadh cheart á fháil ag gach duine bocht. Ach ní mór cuimhneamh air go mbíonn an eitinn ar go leor leor daoine nach daoine bochta iad. Is galar é an eitinn nach n-aithníonn an saibhear thar an daibhear. Is é an fáth a ndéanaim tagairt don phointe seo nár mhaith liom, má bhíonn stigma i gceist, go gceapfaí go ngabhann an eitinn leis an mbochtanas.

Is maith liom an réiteach atá déanta maidir leis an seomra breise, nó chalet, a cur ar fáil. Is maith liom go bhfuil an rogha ann, cé go bhfuil a lán le rá ar shon na tuairime a nochtaigh an Seanadóir Ó Hónáin i bhfábhar an tseomra. Ní mór cuimhneamh nach é gach teach a fheileann sé seomra breise a chur leis. Caithfear aoirde na talún, deis na gréine, fascadh, dréineáil, agus rudaí eile a chur san áireamh. Má scrúdaítear an cheist go cúramach, sílim go n-aontófar gur réiteach sásúil é an rogha a bheith ann go mbeidh comhairle an dochtúra chontae le fáil ag na daoine ar an gceist.

Ní shílim go bhfuil aon bhrí sa tuairim go mbeadh na seomraí féin dainséarach toisc go mbeadh bítheoga an ghalra sna ballaí. Tá muinín mhóragam ar molta na ndochtúirí agus as an gcéimíocht, maidir le fumigants. Más fíor go mbeidh na seomraí nua chomh dainséarach toisc gur chomhnaigh othair eitinne iontu nach mbeadh sé chomh maith a rá guráiteacha an-dáinséaracha na hóspidéil eitinne fhéin?

Is ceist achrannach í cinnte; cé ar a thiocfas an t-airgead i gcóir na nithe atá beartaithe sa mBille seo. Ach má bhíonn ar mhuintir tuaithe an t-airgead a sholáthair ní mheasaim go luighfe an bhróg orthu chomh trom agus deirtear. Sa gcéad dul síos, ní bheidh an costas an-mhór. Ach ag an am céanna nach gnáthach dona húdaráis áitiúla aisíocaíocht rathúil d'fháil ón Rialtas féin i gcás scéimeanna den tsaghas seo!

Bitear ag caint ar bhochtanas na tuaithe. Níl muintir na tuaithe chomh saibhir deisiúil agus ba mhaith linn iad a bheith ach ní mheasaim, má bhíonn ar an tuaith an t-airgead atá riachtanach faoin mBille seo a sholáthar, go mbeidh siad chomh bocht san nach mbeidh ar a gcumas é a chur ar fáil ná ní mheasaim go mbeidh muintir na tuaithe mí-shasta é sholáthair.

Professor Fearon

Like the previous speakers, I recognise and welcome most heartily the humanity and consideration that have gone into the construction of this Bill. But, just in connection with Section 3, there is a point which I would be grateful for the opportunity of emphasising or submitting and that is: why restrict this concession of the additional room to cases of pulmonary tuberculosis? It seems to me that for two reasons that should not be done. One is that there are many other illnesses that can be just as incapacitating, just as grievous, and just as likely to benefit by the provision of an additional apartment as pulmonary tuberculosis. Secondly, there is the practical one, that directly we mention pulmonary tuberculosis in this Assembly we seem to resolve ourselves into a committee to discuss the entire history of the disease and all its manifestations. The point I would respectfully submit to the Minister is that under Section 3, if a member of a household is suffering from some condition for which he is undergoing treatment and if the existing accommodation is inadequate, we should let him have this additional room and leave out the tuberculosis part of it altogether.

Another reason why that is advisable is because there is this question of the stigma attaching to a building that has an additional room built on to it for the purpose of the treatment of tuberculosis. This may seem fanciful, but it was raised in connection with the chalet system. I have the impression that a house which has one of these accessory rooms will be marked for the rest of the life of that house. Just as during the great plague days, when a cross was painted over the door, the people know that the plague had been in the house, and just as at the present time certain houses are pointed out as cancer houses, certain houses will be pointed out as tuberculosis houses when one of these accessory rooms has been constructed. That is a practical danger which I think we might get over by allowing the additional accommodation to be constructed for other conditions as well as tuberculosis. Then, if a certain house had a part of it extended for the benefit of some resident, it would not necessarily be for the treatment of pulmonary tuberculosis at all. It might be for a chronic heart or many other conditions of that sort which have not got that unfortunate superstition attached to them that tubercular conditions have in the eyes of many people. Possibly that might be better presented when the Bill comes before us in Committee; but I submit it to the Minister as a possible way out of what I believe is a real difficulty. With regard to the question of chalet treatment, I think there is a great deal to be said for that where the right type of chalet can be got. Apart from that, I welcome this very interesting scheme—I will not call it experiment, because I think it is more likely to succeed than a great many of our scientific experiments. I think it indicates a very substantial contribution to the battle against our national enemy.

Mr. Seán O'Donovan

I think that but for the insertion of Sections 3 and 4 this Bill would have been passed by the Seanad long before now so far as the Second Reading is concerned. So many Senators have contributed to the debate and so many opinions have been expressed that I have made up my mind to express a few opinions also, some of them contradictory of what has been expressed so far. In that respect, I should especially like to refer to Senator Fearon's remarks with regard to the addition of a room to a house marking it out as a plague spot. I think that is a very unfortunate thing to mention amongst, we will say, a learned body of representatives of the community like we are here. It is a pity that, instead of emphasising such a possibility or mentioning the superstition attaching to it, we should not devote ourselves to giving the opposite point of view and insisting that it is by a greater knowledge amongst the general public of the means of infection that we will get a proper approach to the final eradication or near eradication of the scourge of tuberculosis.

We should remember that the cause of tuberculosis is the tubercle bacillus. If we can keep that away from us, we will not get tuberculosis. We will not get it from a neglected cold or any of these other things that we hear referred to. You must get the specific infection into your body in order to get tuberculosis. The medical profession tell us that it is not handed down, and we have to believe that. But it is handed round, as the Red Cross Society point out in their propaganda. Therefore, when a member of a family is infected with the tubercle bacillus, there is a danger of his propagating it amongst other members of the family.

The object of this Bill is to try to provide a system of isolation of the infected individual from his neighbours so that he will not hand round the infection. The disease cannot be contracted by others if it is not handed round. I think it would be far better to try to emphasise these things rather than to say—I am sure the Senator really did not mean it—that because there is an additional room put on to a house it will be marked out as a place to be avoided.

To my mind, the two greatest scourges we have in this country are tuberculosis and cancer. Unfortunately, we cannot do anything to prevent the living death which people have to suffer when they are affected with cancer; but we can do a lot to prevent people suffering from the living death of tuberculosis. I assume that this is more or less of an emergency measure to deal with a transitional period until we have a satisfactory system of hospitalisation for infected patients. Possibly the greatest benefit will be derived from the facilities for rehabilitation afterwards. A patient who has been cured or in whose case the infection has been arrested will not be a danger to others. When that patient goes home he can use that additional room for isolation purposes and thus remove the danger of the flaring up again of the infection.

Some speakers seem to have forgotten the fact, when speaking of Section 3, that there is Section 4 in the Bill also. Section 4 provides for an isolation hut or chalet. Senator Kingsmill Moore suggested that it should be owned by the local authority and transferred afterwards. I would be delighted if that could be provided for, and I think it could. Again, it is necessary to emphasise that, once it is disinfected there is no danger, as otherwise people would not allow a hut to come to their house or garden if it had been used by somebody else, even though it was for the same disease. The tubercle bacilli can be destroyed by disinfection or by the lapse of time. Any tubercle bacillus will not live long outside the body where it cannot reproduce itself. It will not live more than six months. Therefore, if the building has been shut for six months, it naturally disinfects itself.

I fancy that, if this were simply a Housing Bill, without these Sections 3 and 4, we would have had much less discussion on it. It will require a lot of care and supervision to see that the added room or hut is suitably isolated and is not frequented by other members of the family. Unless there is a proper sense of responsibility and a proper sense of the danger of infection, the hut or chalet in the garden can be just a handy playground for children. I presume such a building would be used almost entirely as a sleeping compartment, so that the patient may be isolated from other members of the household and avoid sleeping in the same room or the same bed with children or adults not infected with the disease. Everyone will agree that, where others sleep in the same room, whether in the same bed or not, as a person with pulmonary tuberculosis, there is always the danger of infection from the sputum. Care must be taken that that danger is avoided and also that the hut or chalet be not used by other members of the family. They must understand the danger and realise that the infection will be passed round if everyone, including the patient, is not careful. The sputum holders or handkerchiefs are good in their own way, but the patient affected must be kept as isolated as possible from the other members of the family, so that the danger of passing the tubercle bacillus will be greatly reduced.

I have been struck by the possibility of extending the provisions of this Bill to other forms of tuberculosis than pulmonary tuberculosis. The section only applies to people who are suffering from pulmonary tuberculosis, to those in danger of coughing up sputum; but there are other forms of infection from the tubercle bacillus, in which the bacilli can be transmitted to other members of the family. It is rather unfortunate that this is confined to cases of pulmonary tuberculosis. Of course, that is the greater danger and concerns the greater number of people, as it is also the more serious. I suppose that, if we went any further, the expense would be far greater. I view the insertion of these Sections 3 and 4 as being more or less of a transitory or emergency measure, to tide us over the period during which we have not sufficient sanatoria hospital treatment available for the affected members of the community.

I must disagree with what Senator Baxter said. His point was that the central authority should defray all the expense in connection with this or any other scheme which tends to raise the local rates. Senator Baxter and others would be very perturbed if the central authority were to usurp all the powers of the local authorities. These are powers which must be exercised by the local authority and, if they handed them over, they would be handing over to this octopus, the Department of Local Government, the sole control of the lives of the people. That is the very reverse of what they will argue in other cases. It would mean they were in favour of centralising all authority, legislative and executive. That would not be good for the people. Our present system provides for the execution of these schemes through the local authorities and, naturally, they must defray part of the expense. We cannot have them carried out by the local authority, but have the central authority pay the piper. We cannot have it both ways. Therefore, in the case of expenditure which is subsidised by the central authority, the local authority must bear its share, to the extent to which it is satisfied to help in carrying out this legislation, which, generally, we are glad to see being introduced.

Mr. P.J. O'Reilly

When I saw this Section 3 first, I was very dissatisfied with it, as it seemed to introduce a very new principle, a principle that is objectionable from many standpoints. I would deal now with one standpoint, that is, that such a building must necessarily be of a temporary character. As Senator Moore pointed out, the disease either takes away the person infected or the person is cured. Then this special building automatically becomes a white elephant. People generally have very strong objections to it being known that a member of the family has been suffering from this disease. It is taken to be a reflection on the family generally and the existence of a permanent building there will mark for all time the fact that one member of the family has been suffering from this disease. Senator O'Donovan suggested that that should not be the attitude but, unfortunately, it is the attitude and that is the general experience.

I welcome Section 4 very heartily, as being the proper method of dealing with this particular trouble. I would suggest that Section 4 really should have been included in the Public Health Bill, which is to come before us shortly. In County Tipperary, we have Section 4 already in operation, inasmuch as we have erected four of these temporary huts, on the suggestion of the county medical officer. There is a very fine design, which is available to anybody. This temporary hut can be erected at a reasonable cost. If the cost of timber and other materials had not shot up to the present level, I think the structure could be made at a total cost of £25 or £30. The last one we had made came to about £40 in all. The structure is essentially a temporary one and can be moved as soon as it is no longer required and taken to other places, after disinfection. As Senator O'Donovan has said, these buildings can be used over and over again.

I do not like Section 3 but I heartily welcome Section 4 and consider it the proper method of dealing with this matter. The question might be asked as to where we got the money to construct these huts. The answer is that, up to a stage, it was contributed on a voluntary basis by local people and, at a later stage, when money became available in considerable quantities to the Irish Red Cross Society, the society was good enough to contribute a sum of approximately £200 towards the construction of these shelters. That covered not merely the cost of the shelters but a lot of expenses which the tuberculosis committee had incurred. I wonder whether this type of work could not be done on some organised voluntary basis. Personally, I detest this subsidising out of public funds for private people. There will be no initiative left after a short time and we will become a nation of beggars. We should try to secure co-operation. It should be preached from the hilltops that co-operation is the only way to make this nation one that can hold its head up before the rest of the world.

Senator Honan referred to the schools and what they might do. I fully agree with what he suggests. If there was more propaganda done through the schools generally, a lot of the danger from this infection would be removed. I suggest that the Minister might approach the Department of Education in order to see that as much co-operation as possible will be given, on the largest possible scale. If this propaganda were carried out on an organised basis, a lot of the danger associated with this disease would pass away. That is another reason why we should not attach a permanent building to ordinary houses.

Senator Duffy struck the nail on the head, as it were. Knowing the gambling instincts in our Irish nature, he suggested that the additional room might be used, not for the purpose for which it would be constructed, but for some other purpose. Very likely it might be used as a kind of store room at some future time, and quite conceivably it might be used as a dance room because, as we all know, there is at the moment a craze for dancing. Eventually the primary use of the building might be lost sight of and there would be a structure that would not actually be required for the purpose for which it was erected and it would be simply a testimonial to the fact that this disease existed in that particular spot at some time.

There are technical instruction classes held in rural districts and, if the Department of Education were anxious to do it, I am sure they would be able to devise a plan under which they would supply the materials necessary for the construction of huts. In other words, they might be prepared to advance money towards the construction of these huts on the understanding that it will be refunded. It is important that the work should be done in that way, because it will bring home in a very definite manner to those engaged in making the structures the object they are intended to achieve. It would, in my opinion, be the best type of propaganda to show people the great need there is for the prevention of infection.

I am a member of the Tuberculosis Care Committee in Tipperary and I take a great interest in the work that is done there to help to check the spread of the disease. I have been in close touch with the county medical officer of health for many years. I may say that a relative of mine died from tuberculosis and, when one is personally acquainted with the dangers of the disease, one is inclined to take a much keener interest in whatever efforts may be made to check it.

I do not like the idea of permanent buildings. I do not like it from the standpoint I have mentioned. Senator Fearon raised the point that the additional room should not be limited to cases of pulmonary tuberculosis. That raises a very general question and, if allowed, it might involve the erection and subsidising of thousands of buildings. It often struck me that every house should have one room set apart for the calamities of life, whether an infectious or any other type of disease, but that is raising a big question relating to the design of houses and, of course, affecting their cost.

I would like to repeat that since we in Tipperary are working this scheme on a voluntary basis we can, if Section 4 is approved, go ahead and see that these huts are provided in larger numbers than heretofore.

Mr. Quirke

I rise to support the Bill. I believe it fills a long-felt need and it will be accepted in the country as a definite attempt to cope with tuberculosis.

Listening to the various speakers, I felt it reflects much credit on the House that so many Senators have made what I might call an intensive study of tuberculosis. It was quite evident, listening to Senators, that they have gone into this matter very intensively. One or two, in particular, seem to have made a study of it and their remarks were really extraordinary, coming as they did from what we may regard as laymen. Of course, Senator O'Donovan has an advantage over most of us, in view of his veterinary studies and experience. The speech he delivered threw a good deal of light on this important subject.

I was sorry to hear Senator Kingsmill Moore—who made an excellent speech and who convinced most people that he knew nearly as much as most doctors about this disease—suggesting that it might be possible, in certain cases, that people would avail of the provisions in the Bill to get an extra room that they might not be entitled to get. I think that is a reflection on the medical profession in this country.

Mr. Kingsmill Moore

I do not think I said that.

Mr. Quirke

I regard that suggestion as a reflection on the members of a very honourable profession. Surely, it must be evident to anybody who reads the Bill that a person could not avail of that provision without first receiving a certificate from the doctor? Senator Kingsmill Moore seems very much surprised, but I think I am quite correct in saying that most people here interpreted his speech in the way I have indicated.

Mr. Kingsmill Moore

I have not been correctly interpreted. I do not think I said what the Senator has suggested.

Mr. Quirke

If the Senator says he did not suggest that, I am very pleased. I would be rather surprised if Senator Kingsmill Moore, or anybody else for that matter, suggested that a doctor would issue a certificate to any man if he was not suffering from tuberculosis.

Mr. Kingsmill Moore

I did not intend to convey anything of the kind.

Mr. Quirke

Like Senator Fearon, I was surprised to find the debate developing into the type of debate which might be expected from a board of doctors, or from other people with high technical qualifications. Like most Senators, I have my own opinion as to whether the extra room or a chalet would be the best thing for the treatment of this disease. I am prepared to say that matters of that kind should be left to people who are fully qualified to consider the desirability of providing extra accommodation for people suffering from tuberculosis. At the same time, it was interesting to hear the various arguments put up by Senators.

I think it was Senator Honan who suggested that an extra room to a house would be more desirable than a chalet, and he suggested that a door be constructed so as to cut off access to the sick room. You could argue that matter for a considerable time. In my opinion that again would be a matter for the doctor. It is quite understandable that if a person was in an advanced stage of tuberculosis he or she would be in contact with some other member of the household, or some nurse or other person who might be engaged to look after the patient, and if the door were on the outside and the weather were bad it would make things difficult. Senator O'Donovan suggested that if proper care were taken, there would not be any disadvantage in having the door connected with the rest of the house.

Senator O'Reilly objected to the subsidising of this or any other scheme. If we were not prepared to subsidise it, I am quite sure that the Senator would say that no money should be spared in order to eliminate this disease and that we certainly should subsidise people to enable them to build these houses. We are used to that type of argument here. I agree that we should not, as Senator O'Reilly says, shout it from the hilltops and create a situation where a child going to school would ask other children: "How do you think I am looking"? or where children would be inclined to think that they were doomed before having an opportunity to start out in life—that they were certain to die from tuberculosis. That is the great danger and we should do everything in our power to prevent that impression from spreading.

I am prepared to admit that this disease has been, as it were, a sort of nightmare to lots of people, including myself, although I believe I am past the age when I could be attacked by a germ of that kind. I have known hundreds of people, in fact I know several people in this House, who have been cured of tuberculosis. I believe we should create the impression amongst the people that, even if one has tuberculosis, it is really not a sentence of death. I know personally hundreds of people who have been cured. Some of them I might wish to get rid of in some other way but I should not like them to suffer that kind of death anyway. The trouble is largely psychological. I think money should be spent on that type of propaganda, that where people have been permanently cured that fact should be made known to the public, of course with the permission of the people who had been cured. That would really do more good than taking chances in the other direction, by spreading the conviction amongst people that they were certain to die because that is what it amounts to.

With regard to the preference which some Senators have expressed for the chalet as against an additional room, I cannot see any great difficulty arising there. It is really a matter of taste or a matter of getting advice from the doctor. If a patient were really bad, it might be necessary to isolate him but I do not agree at all with the argument against the building of an extra room or with the suggestion that it will be always known as the plague room. There are several other enactments under which extra rooms can be provided. There are what are known as reconstruction grants which have been availed of all over the country and it is quite a common thing to see extra rooms added to houses in various parts of the country. It is not suggested under this Bill that the extra room will look any different from any other room. If that system is adopted, it will just mean an addition to the end of the house and I do not believe that any notice is going to be taken of it. In the years to come, if somebody happens to die in that house after five or six years' illness, or if he happens to recover, I do not believe that anybody in the district will associate that fact in any way with the extra room. I believe that in any statements we make, we should try to get into people's minds the idea that tuberculosis is not the scourge it was supposed to be some time ago and that with modern treatment people can be and have been cured. We should try to instil the idea into the minds of young people who may get tuberculosis that if they take proper care of themselves and if the disease is treated in a proper way there is every prospect of a cure. I welcome the Bill and I hope it will be followed by other measures aiming at complete elimination of this disease.

Mr. Foran

I welcome this Bill as far as it goes, but I am much more impressed by the statement of the Minister that this is a prelude to a broadside on the national scourge of this country than by some of the other statements which we have heard. To the extent that it is only a prelude, I agree with the Bill, but there are a few points I should like to put to the Minister. One is, how is he going to provide an extra room for the great number of tenement dwellers in Dublin or other big cities throughout the country? I can only assume that in view of the confined and restricted space available to such people, institutional treatment will be arranged in their case. If not, I do not see how a chalet or an additional room can be provided in tenement houses which are already overcrowded. I am not at all enamoured either of the extra room or the chalet. I do not know that it is going to do patients very much good to have them isolated and singled out as persons suffering from a plague or scourge, people who are to be avoided to a certain extent. Because of that, I sincerely hope that the Minister will carry out the promise that he has already given here, that there will be a more intensive and perhaps more effective attack on this scourge. Senator Quirke, after making an attack on everyone else for their alleged want of knowledge of tubercle bacilli, proceeded to inform us that we should go and tell our children who are all right that tuberculosis is no longer a menace.

Mr. Quirke

I said nothing of the kind.

Mr. Foran

That is the impression I got from what the Senator said to Senator Moore. In my opinion we should rather over-emphasise, if anything, the danger of tuberculosis. To-day our people are leaving themselves open to infection by this scourge judging by the kind of pastimes they indulge in. They are leaving themselves open to become receptacles for tuberculosis germs. One has only to go along the principal thoroughfares of our cities on a fine summer's day to see queues crowding into picture houses. Are we to tell those people that that is a healthy kind of recreation for them? I say emphatically "no". The risks that they are running in such crowded atmospheres, when they should be out enjoying the sunshine, should be pointed out to them. Again, we have overcrowded dance halls with heated, fetid atmospheres. The frequenting of such places is not calculated to prevent the development of tuberculosis. That is the answer to what Senator Quirke told us in regard to telling people that tuberculosis is not a serious matter. The Irish Red Cross Society has done excellent work with the scare posters sent round the country bringing home emphatically to the people the menace this disease represents, how easily it is contracted and how easily it can be avoided and possibly cured by taking proper care. I hope that the lines advocated by Senator Quirke will not be adopted generally throughout the country because we know that they are wrong lines and that their adoption may mean an increase in tuberculosis.

Senator O'Reilly talked about Government and State intervention in health and social matters. He actually told us that we were becoming a nation of bankrupts. On the other hand he advocated that more voluntary effort should be encouraged by the State. Is anything more calculated to pauperise our people than treatment of that kind? Every thinking person knows that the first duty of the State is to provide proper housing and health facilities for the citizens. A healthy citizen is a valuable citizen; an unhealthy citizen is an encumbrance. Money spent on ensuring the health of the people is a gain for the nation generally. When we have the more comprehensive plan of the Government before us we will be in a better position to judge. As I said, I am not at all enamoured of the provisions of this Bill. I do not think it will do a whole lot towards arresting the spread of tuberculosis. I do not think it will do a whole lot towards curing it. I do hope that the Minister, when he is concluding, will tell us how it is proposed to provide an additional room or chalet for tenements in our cities.

Mr. MacEntee

I trust the Senator understands that I do not intend to try to do that.

Mr. O'Dea

I am very sorry that this scheme was not inaugurated very many years ago, because if it had been I do not believe that there would be any necessity for the regional sanatoria that we are contemplating erecting. A very short time ago I was speaking to an expert on tuberculosis and he said that there should be more treatment of the patients in their own homes than there is at the present time. He said that if that were done the present sanatoria would be quite sufficient. I said I thought there was great danger in keeping them in the houses, but his reply was: "No; if they are properly instructed and their people are properly instructed there is no danger whatever of the spread of the disease." He did say that there was a certain danger from people sleeping in the same bed, but not so much from associating in the same house. This idea of the extra room is the very thing that is required to provide for people who are stricken down by this disease, and who are quite capable of being treated in their own homes. I believe that several types of tuberculosis will not spread except in certain ways, and that patients suffering from those forms of the disease can be treated in their own homes.

Senator Baxter spoke about the cost to the local authorities. I see here that two-thirds of the cost of £200 will come out of the central fund, so the extra expense to the local authorities will be very small, and I think they will be glad to pay that extra cost. Senator O Buachalla pointed out that it is not so much the poor who get the disease as the well-to-do people. When the well-to-do people see those chalets or rooms erected for the poor, they will erect those chalets or rooms for themselves out of their own funds, without any cost whatever to the country. I believe the disease is being conquered. I believe that nothing will help so much to conquer it as the provisions of Sections 3 and 4 of the Bill. I certainly welcome it very heartily.

Mrs. Concannon

Last night, the Minister made a very suggestive and very interesting speech, from which I should like to quote one line: "It is the public, the taxpayers and ratepayers, who call the tune, and naturally they pay the piper." To my mind, that ought to be in letters of gold in the frieze of this and the other House. When any question of public expenditure comes up we should regard ourselves—if not exactly as calling the tune—as speaking for those who call the tune, and regard it as our duty to see that every penny which our action enables the Government or the local authorities to expend should be spent to the best advantage.

This seems to me to be a question as between chalets and rooms. There is a great deal to be said on both sides, and the Bill provides that either a chalet or a room may be provided, according to the circumstances. Presumably, the circumstances will be determined by local conditions. Chalets could not be provided universally. There would not be space for chalets everywhere, even apart from the question of the slums to which Senator Foran referred. Even in the smallish towns, like Galway, if there was a question of providing chalets there would not be a proper place to put them. Therefore, the choice must be determined by local circumstance, and the fact that the Bill sanctions both would seem to meet that situation. I think there is a great deal in what Senator Kingsmill Moore said, that the local authorities should have power to provide those movable chalets. At first sight, it would seem that in that way more people would derive advantage from the spending of this particular money, but the local circumstances must be taken into consideration, and must determine the issue. Whatever rooms or chalets are provided, I expect the Minister will see to it that they will embody the very best results of the anti-tuberculosis planning, that is to say, that they will have the proper kind of glass in the windows, the proper kind of aspect and so on. In that way, those rooms or chalets would provide a means of health training. The people would learn the proper kind of houses to build or get built for themselves. They would learn how to keep them properly and treat them properly. That is all part of the intensive course of education which must underlie our campaign against tuberculosis.

I am very glad that the House has given such attention to this particular aspect of the Bill. Our fight against the menace of tuberculosis is one of the greatest fights we have to face. It is forced on everybody's notice. We cannot take it lightly, but we must regard it hopefully. We must remember that it can be faced and can be fought, and we hope that we are on the right way towards solving the problem. I was told by a nurse who lived in Holland— she was speaking of conditions before the war—that tuberculosis raged to an appalling extent in that country, but such measures were taken to combat it that it became almost negligible. More than isolation is required. Isolation of persons who are not getting institutional treatment is just one aspect of the question. It is an important aspect. How their families are to treat those patients, and how they can be trained in ordinary healthy habits of life, must also form part of the fight. I am very glad that the question has arisen under a Housing Bill, because the provision of proper housing is one of the means by which we must attack this problem. We must also attack it by training our women to do their job well, and to cook the food properly. Of course, unemployment has a great deal to do with the problem too.

Mr. MacEntee

Senator Baxter is a most intriguing speaker, and a very disarming one.

Mr. Hayes

Might we hear what the Minister is saying?

Mr. MacEntee

I am very sorry; if the Senator cannot hear, I am afraid my vocal organs cannot carry.

Mr. Hayes

I should like very much to hear the description of Senator Baxter.

Mr. MacEntee

It was a very flattering one.

Mr. Baxter

For once.

Mr. MacEntee

I said he is a very intriguing not to say disarming speaker. I never had a measure before this House that the Senator did not get up and open his speech by a most pacific announcement that he did not quarrel with any of the proposals. Unfortunately, however, his pacific temper does not always endure to the end of his oration, and, in this particular instance, having told us that he was warmly in favour of the Bill and, in particular, in connection with Sections 3 and 4, he went on to say, firstly, that he dissented from the Bill in the matter of its cost of operation being made a charge on the ratepayers; secondly, that the Bill, in his opinion, would not achieve its purpose; and he wound up finally by going back to his first cause of criticism of the Bill: that is to say, that he dissented from it from the point of view that the cost of operating any part of Sections 3 and 4 of the Bill should be a charge on the ratepayers. Now, I know that that is not a new point of view from the Senator. I have often heard him putting forward that point of view—so often that I have been reminded of a story concerned with a local authority election, one of the candidates for which died before the day of the poll. The deceased man's name appeared on the ballot paper, however, and when this became known, his friends were worried as to what they should do about it. One man thought that it would be better to vote for him on account of the Party to which he belonged; another man thought that it would be better to vote for him on account of his wife, but another man said: "Well, we might as well vote for him, because he cannot raise the rates on us now."

Mr. Sweetman

Certainly, no doubt the Minister always can and does.

Mr. MacEntee

No, he is not dead but perhaps the opposition to the Minister might be extremist.

Mr. Hayes

Far from it.

Mr. MacEntee

However, Senator Baxter put one or two questions to me which, although I am not particularly concerned with the public health aspects of this Bill, I shall try to answer. He asked, in effect: "Why should we treat, in his own home, a person who is suffering from tuberculosis?" Well, the answer to that is that there is a large body of public opinion and of medical opinion in favour of the view that if proper treatment can be given, in the earlier stages of the disease, in the affected person's own home, that is the best way to deal with the disease. Do not forget also, in that connection—now that we are talking about sanatoria—that there is a certain prejudice in this country against going to a sanatorium and getting treatment there.

Mr. Sweetman

That prejudice should be killed.

Mr. MacEntee

I am not saying that there is any justification for that, but we must remember that that taboo applies to almost every aspect of the treatment of this particular disease. The second suggestion of Senator Baxter—to my mind, at any rate— rather indicated that he takes a very poor view of the way in which the medical officers of health, who are responsible for administering the various anti-tuberculosis schemes, administer their duties.

Mr. Baxter

Nothing of the kind.

Mr. MacEntee

Now, what I have to say applies also to some of the statements for which Senator Kingsmill Moore made himself responsible. It is a fundamental condition attaching to the provision of these additional rooms that the county medical officer of health will certify that the person concerned is not only suffering from tuberculosis, but that he is undergoing treatment and that the existing accommodation is inadequate for the proper segregation of the patient from the other members of the household, and also that the local authority will certify that the house concerned is suitable for being provided with an extra room. If Senator Sweetman will look at paragraph (d) of Section 3 he will see that a local authority shall not make a grant unless and until it is certified that the house is suitable for being provided with an extra room. However, let me get back. First of all, the proposal to build an additional room can only be given effect to on the certificate of the county medical officer of health; and, secondly, it can only be given effect to in respect of a house which is suitable for the provision of an extra room to that house. Thirdly, it can only be given effect to where the medical officer of health certifies that the person concerned is undergoing treatment there. Now, are we to believe that the medical officers of health, who are charged particularly with this matter of the prevention and cure of tuberculosis, are going to issue certificates in respect of houses in regard to which these conditions cannot be fulfilled? That is what Senator Baxter implied in his statement. Perhaps he did not do so consciously, but that is the clear deduction to be made from what he said: that the county medical officers of health would go along and ask for the erection of such rooms attached to houses which the Senator described as, and I think Senator Kingsmill Moore adopted the phrase afterwards—no, I am sorry; Senator Kingsmill Moore coined the phrase on his own—houses in which tuberculosis existed as a living organism, and the suggestion was that it existed as a living organism in many of the houses of this country.

Now, first of all, I think we may take it that the medical officer of health will only permit this room to be erected in a part adjoining the premises; and, secondly, as he is treating the patient, and assuming that the local authority has to spend a considerable sum of money, he will also see that all those steps which can be taken to disinfect the house, and leave it safe structurally, will be taken. We may also assume that, since he has to visit the patient from time to time, he will see that the precautions which are necessary will be observed, since he is visiting the patient in a domiciliary capacity.

Senator Kingsmill Moore said that Section 3 and 4 of the Bill raise certain questions. He said that the Bill might be conceived to be too narrow, and perhaps he had in mind the fears that Senator Fearon had in mind in connection with these particular sections. If so, I shall wait to dispose of the particular arguments that Senator Fearon had in mind, but Senator Kingsmill Moore said that he thought this had been conceived too narrowly and that, perhaps, it might be thought that the ownership of the room would be vested in the original owner of the house. Now, that is true, and I admit that that might be an objection, but so far as the majority of rural houses in this country are concerned — the occupiers of which cannot provide such accommodation — the owner of such homes is already the local authority. I am quite prepared to admit that there may be a considerable number of exceptions to that position, but, in general, a very large number of the people for whom additional accommodation will be provided under this Bill, will be already living in houses belonging to local authorities, and perhaps this has a bearing on the objection that Senator Baxter has to this Bill. He was so obsessed with the idea of voting for the dead man, because that would not raise the rates, that he overlooked the fact that by the expenditure of something up to £50, the local authority would make itself owner of property worth £150.

Mr. Hayes

That is intriguing.

Mr. MacEntee

It would be a case of cutting off your nose to spite your face, when you come to the stage where a representative of a local authority would condemn a Bill of this sort on grounds such as the Senator adopted.

Mr. Baxter

That argument will not make much impression on local authorities.

Mr. MacEntee

Let me get back to what Senator Kingsmill Moore said. The Senator stated that it was easy to overlook the fact that segregation was impossible, that it was easy to overlook the question of sending a person to a sanatorium, and easy to overlook this position, that a person should observe a certain régime and take precautions. I am paraphrasing what the Senator said, and I do not think I am misrepresenting him. Under the development of our public health services, as we now envisage them, the main preoccupation of which will be the prevention and cure of tuberculosis, I cannot conceive that they will overlook the fact that in the home complete segregation is impossible, or will encourage to remain in the home a person who could only be adequately dealt with in a sanatorium. I think it is not possible for a medical officer of health to make that mistake. Similarly, I think we may reassure ourselves as to the possibility of a tuberculosis officer of health refraining from sending to a sanatorium a person who ought to be there, if he could get accommodation. We are dealing with a problem for which, at the present time, we have not sufficient accommodation, and it may be that by segregating sufferers, while we may not be able to save them, we make it easier for other members of the family. That is a consideration in the objections urged against the Bill. The third point was the need for observing a certain régime and taking precautions. I do not think the Senator has considered the implications of the principal paragraph of sub-section (1) of the section where the county medical officer of health must certify that a person is not only suffering from tuberculosis, but is undergoing treatment. We may be reasonably assured that the medical officer ensures that the patient carries out the treatment he prescribes. We may take it that persons who avail of the accommodation will observe the precautions which are necessary if they are to cure themselves. It seems to me that people who, despite all the prejudice, avail of the opportunities presented by the Bill, will be those in respect of whom the educational campaigns now being carried on by various bodies have been effective, and that they will be the more intelligent section of the population who wish to be cured.

The Senator advocated the provision of chalets which may be taken down. Senator P.J. O'Reilly took the same line, being strongly in favour of temporary chalets. The point about that is that local authorities for a considerable period have been in a position to provide chalets of this nature under their tuberculosis schemes. Under these schemes I think the Exchequer would be bound to reimburse them 50 per cent. of the cost of chalets. Whatever may be the prejudice against erecting an additional room, there seems to be a much more firmly rooted prejudice against the erection of chalets. In that connection the number of chalets erected from time to time has been very disappointing. Section 4 in this Bill represents a triumph of hope over experience, because we felt when drafting the Bill originally, that we might save paper and not bother about chalets at all. However, they are there. The erection of huts or chalets does come within the scope of the Bill, whether temporary or otherwise, when erected by local authorities. I should like to say regarding the suggestion to provide temporary chalets that it is all very well to suggest that they would cost £25. They cost £25 to pre-fabricate, but how much would they cost ultimately to erect and to take down when finished, or to keep in repair? At the end I think it would be found that the advantage, from the monetary point of view, in favour of temporary chalets would be much less than in the case of annexes.

The only other point in Senator Kingsmill Moore's speech to which I should like to refer is the concluding portion, where he suggested that instead of inducing persons to take a room we should try to get them to take precautions, or provide them with sanatorium accommodation to the extent to which that is possible. I should like to assure the Senator that it is not a question of inducing persons to take a room. There would be no coercion beyond the ordinary amount of persuasion that a medical man would be entitled to use in respect of a patient to get him to take the steps necessary, in this case not only to cure himself but to prevent other members of the family becoming infected. We do not propose to operate this measure in such a way that, by inducing a person to allow a room to be built on the premises, we will dissuade a person from going to a sanatorium, who otherwise ought to go there.

Senator Duffy expressed a point of view which received a certain amount of concurrence when he suggested that, if the local authority adds a room to a dwelling, the extra room will be used as another bedroom and not as segregated accommodation. I do not think that there is much substance in that point, unless we are prepared to do— do—what I am not prepared to do— allege that, in most families where there are sufferers from this disease, there is such a degree of callousness and indifference not only to the fate of the sufferer but to the fate of the other members of the family that, if this opportunity of having segregated accommodation is provided, it will not be availed of. We cannot cure people of this disease despite themselves. There must be very intense personal co-operation on the part of the sufferer if this disease is to be cured. What we can do and what we are trying to do under this Bill is: if people, overcoming all the prejudices to which reference has been made, come and ask us to provide them with the accommodation which is necessary to prevent their infecting other members of the family, we can, when we have done that, put the onus on the sufferer himself and, in greater measure, on the other members of the family, particularly the heads of the family, to see that that room is used for the purpose for which it was provided, so that the other members of the family may be saved from the infection which has stricken one of their number down. I think that that is a complete answer to the fear expressed. The only foundation for that fear would be that the families were so indifferent regarding the fate of the sufferer and their own fate that they would not take what is the most elementary and easiest precaution to prevent the spread of the disease and facilitate the cure of the patient.

Apart from that factor, which, I think, will be a very powerful and general one, there are other safeguards. We are not asking local authorities to provide those rooms, even on the certificate of the medical officer of health, unless they are satisfied that they will be used for the purpose for which they are provided. In providing the rooms, the local authority will, doubtless, attach certain conditions as to their use and will ensure that they are reserved for the purpose for which they were provided. With the tuberculosis officer visiting the house frequently, examining the patient and treating him, he should be able to satisfy himself that the room is being used solely for accommodating the patient and is not being availed of for the general use of the family. That would apply in the case of houses which do not belong to the local authority. There is the further consideration, which I have already mentioned, that, in many cases, the local authority itself will be the owner of the premises to which the room has been added.

Senator Fearon asked me why we restricted the provisions of this measure to pulmonary tuberculosis. The reason is that this Bill is of a dual nature. Sections 3 and 4, it can be contended—and I have so decided—properly belong to a Housing Bill. We did not want to have provisions relating to housing accommodation for human beings spread over a number of dissociated statutes. The Bill has also a public health aspect. That matter was referred to by Senator Kingsmill-Moore, or some other Senator, who thought that this measure might more properly be described as a Public Health Bill. There is something to be said for that contention but we have come down on the other side for reasons I have mentioned. We want to keep those housing measures closely associated with one another with a view to having them codified later and made available in handy form to anybody who wants to consult them. We have not lost sight of the fact that the measure has a public health aspect and that it is the public health activity of preventing the spread of the infection that we are mainly, if not wholly, concerned with here.

Most of the diseases which Senator Fearon mentioned—diseases to which, he suggested, a provision of this sort might be applied—are, I understand, not infectious. As I have said, the principal purpose of this Bill is to enable members of a household one of whom is suffering from tuberculosis—a highly infective disease—to segregate themselves from the infected person during the day as much as possible and completely at night. In the case of heart disease or cancer, I do not think that we could put up that argument to the man who controls the purse-strings, who would have to be satisfied before we commenced to provide for diseases other than those covered by this Bill. I do not say that, at some future date, the provisions of this measure may not be expanded, but it is better to make a beginning upon a narrow ground.

Senator Fearon also feared that the stigma attaching to the building of the proposed accessory accommodation would be such that few people would avail themselves of the provisions of this measure. Senator O'Reilly said that, even in those cases where the additional building had been erected, it would be a white elephant and a hallmark which would prevent other people from availing themselves of the accommodation, even if the original patient had been cured. I hope that that will not be the position. Most of us who remember the terms in which consumption or tuberculosis was referred to when we were young are sensible of the fact that people generally are taking a much more rational and intelligent view in relation to the disease than was then taken. They no longer regard it as incurable. All sort of educative agencies are carrying on campaigns with a view to convincing people that if the disease is taken in time, or if it is properly treated even though it is not taken in its very early stages, the chances of cure are very great, but that, if neglected, the inevitable fatality will ensue. Whatever about the unintelligent section, this campaign is bearing fruit with the intelligent section of the community.

Despite what we have heard about the stigma and the taboo, I have no doubt that intelligent families will avail themselves of the provisions of this Bill and that, by force of their example, prejudices will gradually be broken down until the provisions are generally availed of. I go further and say that, when the fruits of the segregation are known, when sufferers undergo a cure in these circumstances, it will do a great deal to disabuse the minds of the people of a superstition that, as there are houses which are known as cancer houses, there are houses which are tuberculosis or consumption houses. I may say that I do not anticipate that we shall have a spate of applications for this additional accommodation the moment the Bill is passed, but we do believe that for a period of years—for one year, two years, three years or four years—as this campaign goes on, the benefits of this Bill will be more and more generally recognised and will be availed of to a very great extent indeed.

Senator Foran welcomed the Bill and then asked me in what way we were going to add an extra room or a chalet to a slum tenement. I can answer the Senator very briefly. We do not propose to add an extra room or a chalet to slum tenements. We propose, if we can, in God's good time, to abolish them altogether and that is what we are trying to do.

Mr. Foran

When?

Mr. MacEntee

As quickly as we can. Senator Mrs. Concannon also suggested that there was a good deal in what Senator Kingsmill Moore said, that local authorities should have power to provide chalets. I think I have dealt with the points raised by the Senator in the course of what I said in reference to Senator Kingsmill Moore's points.

Mr. Kingsmill Moore

I should be obliged if the Minister would give me the reference to the section which empowers local authorities to provide these chalets free.

Mr. MacEntee

There is no statutory authority, but they can be provided under a tuberculosis scheme which can be approved of by the Department.

Mr. Kingsmill Moore

I suggest that if it were put into a statute it might be more widely known.

Mr. MacEntee

When the Tuberculosis Acts were first introduced there were a great many inducements and exhortations to local authorities to provide these temporary chalets, and while some of them did so, apparently, as I have said, the prejudice then was too strong against them and they were not too successful.

Question put and agreed to.

Committee Stage ordered for Wednesday, January 30th.

Business suspended at 5.45 p.m. and resumed at 7 p.m.