I gave notice to-day that I would raise on the Motion for the Adjournment the question of the enforcement of the vaccination laws in the County Wexford. I do so for the purpose of giving the Minister for Local Government and Public Health and members of the House some idea of the situation that exists in the County Wexford in connection with this matter. At the outset I would like the House to know that I am not going to argue the question from the anti-vaccination point of view. Rather, I propose to argue it from the point of view of the expense that will fall on the ratepayers of Wexford if the Minister insists on the County Wexford Board of Health putting the vaccination laws into force. I might state that the vaccination laws have been in abeyance in the County Wexford for the last twenty years. As a result of that there is a very large number of defaulters in the county at the present time. From the medical returns supplied to the Board of Health recently it appears that at the present time there are 17,000 vaccination defaulters in the county. Personally I am inclined to think that the number is much larger. I should imagine it is nearer to 20,000. My information is that it will cost 1/- to serve a notice on each defaulter. Taking the number of defaulters at 17,000 that will entail an expenditure of £850. The doctor's fee in each case I am informed is 2/-. That will amount to £1,700. If there are to be prosecutions in Wexford, which I believe there will because we have had them before, and I am certain we will have them again, then estimating the cost of them on the cost of the prosecutions previously carried out in the town of New Ross, the ratepayers of the County Wexford will be asked to pay something like £5 per case. If we take the number at say five per cent. of the total who refuse to carry out the vaccination laws, and put the cost down at £5 per head the amount involved will be £4,250. I am doubtful whether in most of those cases after spending all that money, the vaccination laws will be carried out. I daresay that the position in Wexford is probably different to that in any other county.
QUESTION ON ADJOURNMENT.—ENFORCEMENT OF VACCINATION LAWS IN COUNTY WEXFORD.
Not at all. It is the same in Kilkenny.
Mr. JORDAN
I am glad to know that I am not alone in this. I am arguing the case purely from the ratepayers' point of view. We in the County Wexford are hearing every day that the ratepayers are overburdened and that they cannot pay the present rates any longer. If this Act is going to be enforced in Wexford then the rates in the county are going to go up very considerably. At the present moment the greatest difficulty is experienced in getting in the rates. If this additional burden is placed on the ratepayers they will find their position an impossible one. The present position is that the Minister for Local Government and Public Health has issued a threat of mandamus against the County Wexford Board of Health unless they agree to put the Act in force. The position that we on the Board of Health find ourselves in is that we are not prepared to shoulder this burden and, on the other hand, we do not want to saddle the ratepayers of the county with the cost that will be entailed by the enforcement of the vaccination laws. That is the position in Wexford at the moment. In reply to the question which I had on the Order Paper to-day the Minister stated that he had no intention of amending the Act to allow conscientious objectors to go free. In view of that answer I do not know what sort of position we are going to be put in in the County Wexford, and I am anxious to know what the Minister has to say on the matter.
Would the Deputy just develop the point as to who is going to bear the expense of an outbreak of smallpox if that occurs in the County Wexford?
Mr. JORDAN
The fact remains that for the past twenty years the vaccination laws in Wexford have been in abeyance and no case of smallpox has broken out. You cannot say that you will be involved in the cost of an outbreak of smallpox until it occurs, but we know definitely that if the vaccination laws are put in force we will certainly incur costs.
I should like to support what the Deputy has said. I think the Department should not take up this non possumus attitude. This is a very exceptional case and a reasonable time should be given in order to get these different parts of the county in which the Act has not been enforced into line with other parts of the country. The Minister for Finance is very ruthless in collecting income tax, but I doubt if he would demand that 25 years' arrears of income tax should be collected in one year. He would be prepared, I am sure, to make some concession. That is really what it amounts to, as far as the ratepayers of County Wexford are concerned. They are expected to pay for a situation which has been in existence for twenty years. I think the Minister might consider a progressive and gradual improvement in the situation in that respect.
A letter appeared in the "Morning Post" on yesterday from Sir Edward Rogers in connection with smallpox. He started the letter by saying, "Seven million pounds sterling will be the price the nation will have to pay during the year 1928-9 for dealing with smallpox, if the present rate of increase of the disease is continued." He gives figures to show that in 1920-21 the actual number of cases was 226. They have increased rapidly, until this year the number of cases is 15,000. If they increase at the same rate for the next couple of years, the number of cases of smallpox occurring in England will be at least 50,000. The cost of an epidemic of smallpox would be tremendous. This method of vaccination is undoubtedly the only means of protection against smallpox. Vaccination is in the nature of an insurance. If a man pays £5 or £6 a year to protect his house in case of fire, he is not at all anxious that his house should go on fire. If at the end of twenty years he has escaped an outbreak of fire, he is not prepared to stop payment on account of his insurance policy. I say, therefore, that vaccination is in the nature of an insurance. I say, furthermore— I am sure others will agree with me— that not only is vaccination necessary but re-vaccination is necessary. If I have time, I will allude to that aspect of the question in a moment.
We are not going into the question of the merits of vaccination now.
Sir James CRAIG
How many minutes will I be allowed?
About three minutes more.
There would be no use in my attempting to develop my argument in that time. All I would like to say is that it would be the greatest possible disaster to public health in the Saorstát if vaccination were allowed to fall into abeyance. I was talking to a very distinguished County Wexford medical man yesterday and he said he would like to be able to tell those Wexford cranks what he thought of them. He said he would describe them as nothing but criminal lunatics and that they should be treated as such.
Is that man a resident of County Wexford still?
I am not interested, personally, in the matter, but I would like to give as much weight as my position can give to it. So far as smallpox is concerned, they will be very sorry in County Wexford if this were allowed to occur. If an outbreak occurs not only will they be burdened with the cost of hospitals and nurses, but everyone who is in contact with a case will have to be kept apart for sixteen days at least. That will be a tremendous cost to the country. If they do not look upon this in the nature of an insurance, I cannot say anything more for them.
I do not like to contradict Deputy Craig because he has much more experience of medical matters than I have, but I think if an epidemic of smallpox were to occur in this country at the present time there is no county that would escape so well as Wexford. The people there know that they are not vaccinated, and if small-pox were to break out they would go immediately and have it done, while people in other counties who have been vaccinated would believe that they were immune, but they are not, because vaccination done in childhood does not prevent smallpox in later years. Unless we go into this matter properly and, as they do in Germany, have it done every seven years, vaccination is no preventive of smallpox. Therefore, I think the people of Wexford have shown a little more sense in this matter than some of the lunatics that are trying to enforce it. As far as the gentleman Deputy Craig referred to is concerned, I am afraid common sense is not all on his side. The big grievance they have in Wexford is that in England there is a conscientious objection clause; a person can object conscientiously to having his child vaccinated, but here there is no such clause. That was how this agitation was started twenty years ago to have a conscientious clause inserted in the Irish Act. It was not inserted. Deputy Craig will remember a man called Edward Jenner who, in the year 1791, discovered vaccination. He vaccinated his own child, two years old, and a few years afterwards he injected the child with smallpox to prove that he was right.
The people of Wexford are not like Edward Jenner, they are not prepared to see their children suffer. They have a conscientious objection to vaccination and want to see a conscientious objection clause introduced in Ireland. If it were introduced I believe they would be quite satisfied. I do not know what the numbers are but I think the figures given by Deputy Jordan—17,000—is a very big proportion of the population. I know the figure is very high and I know that there is great dissatisfaction. What is more, I know that there is nothing political or what you might call anti-Government in the thing. I think the people on all sides object to vaccination. The peculiar thing about it is this: If a man is summoned for not getting his child vaccinated and goes to jail for a week the child is absolved. How can a week in jail for the father prevent the child getting small-pox?
The position, as Deputy Jordan has pointed out, is a very peculiar one so far as Wexford is concerned. The number unvaccinated is very high, but 17,000 is certainly large. The people there have a decided objection to vaccination because of the fact that some children who were vaccinated as far back as twenty years ago are still showing signs of that vaccination. Deputy Craig talked about small-pox and the danger there is if people are not vaccinated. As far as I am concerned, I am perfectly satisfied that if the towns and cities of Ireland are looked after in a proper manner by the Public Health authorities—if sanitation is attended to—there will be no such thing as small-pox in this country. There are big numbers of people in Wexford who have not their children vaccinated. The Minister knows and a great many people in this House know, that the anti-vaccination propaganda at one time was synonymous with our fight against the British Government. A great many of the arrears of vaccination were due to that, apart altogether from a conscientious objection. The Minister should bear that in mind before he enforces his mandamus. I think the situation as far as Wexford is concerned should be carefully examined. Certainly it is going to cost the ratepayers a great amount of money, if the calculation made by Deputy Jordan is correct. It would mean more than 2d. in the pound. Wexford is an agricultural county and the farmers there, as in other parts of the State, are not in a good position at the moment. So that I think the least the Minister should do would be to reconsider the whole position as far as Wexford is concerned. County Wexford as far as vaccination is concerned is in a state of chaos. The matter has gone beyond the control of the County Board of Health. It was a legacy handed over to them from the different Boards of Guardians at the time of amalgamation, and apart altogether from the question of the people's consciences it is not fair that they should be asked to clear up the mess that was created in the days of the old Boards of Guardians.
rose.
AN CEAN COMHAIRLE
This is a question on the adjournment, and the tendency is to restrict rather than to extend debate. This is a question dealing with the County Wexford, and if any other Wexford Deputy rises I will hear him.
It deals with Cork also.
I rise to protest against the action of the Ministry in trying to enforce vaccination at the present time. During the past 25 years this question has been left in abeyance, and now we are told that there are 17,000 who are not vaccinated. If this thing is enforced I do not believe that more than 5 per cent. would be vaccinated through the action of the Minister. The majority of them are opposed to vaccination for conscientious and other reasons. If they are prosecuted at the cost of £5 each case, it will mean £85,000. That is a burden that the people could not bear. I think the least the Minister might do is to postpone the enforcement of this Vaccination Act until the coming summer.
I cannot hold out any hope to the County Board of Health in Wexford that I will not do everything possible to enforce the Vaccination Laws in the county, and in every other county in the Saorstát. I do not know what Deputy Corish means by saying that if we pay attention to sanitation and all that kind of thing we need have no fear of small-pox.
On a point of explanation, I said if the different local authorities in their areas—I did not say the Ministry of Local Government.
There is no small-pox in the country.
There was no small-pox in some of the counties in England five or six years ago, and what is the position there now? The public bodies in the different counties have made statements in regard to the expense they are under, and the hopelessness they feel in fighting small-pox. If a small outbreak of small-pox occurred in Ireland at the present time it might easily lead to conditions that would be very serious, and might spread very rapidly throughout the country. On 23rd January, 1926, the "Daily Mail" reported that an epidemic of small-pox was sweeping over the northern part of the parish of Durham and all efforts of the medical authorities to stem it had failed. The report gives the number of cases notified in the county in each of the quarters of the previous year. In the first quarter it was 16, the next 79, then 152, and then 729. That was in 1925. There has not been a week since in which Durham has not recorded extra cases of small-pox, both in its urban and rural areas. Deputy Craig quoted some figures with regard to, I suppose, Britain as a whole.
They referred to a mild form of chicken-pox, as stated in the "Daily Mail."
I was referring to small-pox in Monmouthshire, where the outbreak is not as great as in Durham and has cost the ratepayers £10,000 in capital expenditure and equipment, while the maintenance of 200 beds for six months will mean another £13,000. Of the 773 cases reported 173 cases were left on their hands. It is a mild form, Deputy de Loughrey says, but the position with regard to small-pox is that while you have light forms of small-pox in different parts of the world with the exception of one case in Switzerland, it is never associated with the more virulent type. It has been found in Detroit, where a mild form of small-pox existed for a number of years, that it developed into the virulent type and, as far as we can be advised by medical men to-day, we have no assurance that the mild form when existing in any particular area is not going to develop into the virulent form. In Detroit there were only 17 deaths among the 4,631 cases reported from 1915 to 1923, giving a case mortality of 3.7 per 1,000; in 1924 there were 163 deaths among 1,610 cases; 124 of these cases were of the virulent type, all but one with fatal issue. We have the responsibility of carrying out the vaccination laws. On an occasion like this raising a matter in this form gives no one a fair opportunity of dealing with it. It has not been suggested, in any kind of logical way, that the medical basis upon which our vaccination laws are framed is unsound and that is the first thing that ought to be argued here before we are asked to relax in the administration of the vaccination laws.
We are here in the happy position that since perhaps 1908 we have had only 11 cases of small-pox, and owing to the vigilance of our Public Health Authorities these cases have been dealt with without the infection, to the extent of creating disease, extending to a second person, but Britain, during last year, if we except Spain and Russia, for which we have no particulars, has had 90 per cent. of the small-pox that existed in Europe. Living as we are with our ports in constant communication with Great Britain, we must certainly regard seriously the presence of this extensive and dangerous outbreak of small-pox in Britain and we would, in the Department of Local Government, be neglecting very serious duties to the county if we did not point out the danger or left anything undone to secure that the vaccination laws were administered to the greatest possible extent.
It has been said that the administration of the laws in Wexford would cost a considerable amount and figures have been quoted with regard to New Ross. I do not agree that the vaccination laws have been in abeyance there for 20 years. There has been a certain amount of agitation against vaccination in Wexford for some time past and there are at least 8,000 odd cases in which the dispensary medical officers have not got tired of recording—they may be the most recent cases. The medical officer gets 2/- for every vaccination that is carried out. In every case in which notice has to be served on a person where that person does not get his child vaccinated during the statutory period it costs 1/-. Where there are legal expenses that is another matter. But in January, 1925, the Urban District Council took over the administration of vaccination from the Board of Guardians of New Ross. New Ross has a population of 5,009 and the average yearly number of births is 112. Since 1925 the Board of Public Health has endeavoured to have the vaccination laws administered there and 708 successful primary vaccinations have been done. There have been some legal expenses in the case of 38 defaulters prosecuted recently. The total legal expenses, in connection with vaccination since January, 1925, including the 38 defaulters in New Ross, were £21 14s 7d. So that the cost of having the vaccination laws put into force properly in Wexford is not going to be excessive. There is no reason why, if it is clearly shown that there is a danger in our present circumstances here because of the position with regard to small-pox in Britain, the Wexford people are not going to be as sensible as any other people in the country.
While the point has been raised that people, when they grow up, get over their first vaccination and are inclined to get small-pox, at any rate the childhood period is a dangerous period. It is worth noting in connection with the present outbreak in England and Wales that in 1926 there were 10,141 cases of small-pox. An analysis of the figures shows that complete immunity against the disease was conferred by vaccination under the age of 12 years, and that no infants or young children who had been vaccinated were attacked by small-pox. Indeed, such is the efficacy of infantile vaccination that only 8 children, who have been successfully vaccinated, contracted the disease under the age of 15 years, whereas amongst the unvaccinated children of the same age period the disease developed in 4,840 with fatal results in seven cases. If we are not in the frame of mind that we are prepared to follow France and Germany in having adult vaccination at a particular period, we can be assured that infantile vaccination is going to protect the children of the country up to the age of 12 years practically completely against the danger of small-pox. The cost is very heavy, as I have mentioned in connection with the Monmouth case, and you have costs for medical fees, special nurses, clothing destroyed, and clothing of contracts destroyed. You have the person attacked laid up from 3 to 12 weeks, and the person who is only a contact put into isolation from 12 to 23 days. It is all very well to feel you are not going to have an outbreak simply because you have had only 11 cases considering the number of years since that time. Within the last two years you have had a serious situation brought about in Britain, and we have to realise in the way small-pox is carried that we can very easily find a number of cases springing up in our midst, brought over from England, which only developed when the persons were here in this country. We have a duty to the people to carry out. We are certainly prepared to carry out that duty, and we ought to stop any kind of loose talk. If there is a feeling that there is not a sound medical basis to our present vaccination laws we ought to have the position stated from the medical point of view. Do not let us act blindly in the dark, because someone said anti-vaccination was always connected with the national movement in Ireland.
The Dáil adjourned at 9 p.m. until 3 o'clock on Thursday, 17th November.