took the Chair.
PRIVATE DEPUTIES' BUSINESS. - VACCINATION (AMENDMENT) BILL, 1928—SECOND STAGE RESUMED.
Question again proposed: That the Bill be read a Second Time.
When the debate was adjourned the other night. I had said, speaking as a layman and from my experience of having gone through that fell disease called smallpox in this country, and seen a great deal of it in the East, that I was convinced of the efficacy of vaccination. Really I do not see how anybody who has had anything to do, however slightly, with cases of this kind could think otherwise. I think it is only because we have had such wonderful immunity for so many years that people here underestimate what a terrible disease smallpox is. During the Middle Ages, all through the eighteenth century, and partly in the nineteenth century, at different periods these countries were devastated. The attacks practically swept certain districts clean, and it was only by the lucky discovery of vaccine by Sir William Jenner that relief was brought to the people suffering from this terrible scourge. Of course, I am quite aware that a great many people think that improved sanitation has had a great deal to do with it. The learned medical Deputies who have spoken have shown that although sanitation has been a great asset in the improved health of these different countries, and has reduced the disease in many ways, still smallpox is not one of these complaints that is affected by sanitation to any great extent. In fact, I know of cases where sanitation could not have entered into the matter.
It has also been stated that certain complaints have been passed on by vaccination. I do not think that has been proved at all. In fact, I think Deputy Sir James Craig denied that it would be possible to do it through vaccine. It might have been possible when the vaccine from one person was used to vaccinate another. I think I understood the Deputy to say that, but under the present system of pure vaccine such a thing is absolutely impossible. Therefore, one can but come to the conclusion that if any of these cases did arise, the disease must have been in the child, perhaps in a very highly developed state, wanting practically nothing to bring it on. That, of course, is a matter that only the doctors know. I know people who were vaccinated and passed immune through epidemics of smallpox that were of a very serious character. I can remember a case where a man who did not believe in vaccination got the disease abroad, and, from being more than usually prepossessing, that person's after-life was a perfect torment. He recovered, but I can only say that his appearance was more of a leper than of a human being for a very considerable number of years. Having seen these things myself, they have thoroughly convinced me that there is a reasonable certainty of immunisation from this terrible disease by vaccination. There may be cases now and then where it may fail, but that must be always the way. Taken as a whole, I contend that vaccination has been one of the greatest blessings that has ever been vouchsafed to these countries. Let us hope that we will never have epidemics like those we had in past ages.
The people at the ports, of course, are most particular in having foreigners carefully examined, but it lies with the internal Governments to see that the interiors of all countries are kept clear of this disease by rigidly carrying out the rules and regulations that are laid down for the general good. It is said that it is wrong to put compulsion on anyone, to make them do what they do not believe in. We have all to give in on certain things that the large majority of the people believe to be for the good of the country. I think it will be a very bad day, and that we will pay a fearful penalty, if these rules are relaxed in the case of this fell disease. In England they are allowed to maintain a conscientious objection, with the result that in many places the disease breaks out. Of course their arrangements are very good for isolation and for stamping it out, but if vaccination was maintained as strictly as it was in years gone by, I am quite certain there would be none of these cases at all. As a layman, that is my impression, and I hope that the authorities in this country, where we have had no epidemics, and where I hope we never will, will do their best to maintain the law as it stands at present, and not weaken it by giving way to conscientious objectors. I hope that the law will be maintained as it is, and if epidemics break out on the other side of the water we shall have the advantage of not having the conscientious objection clause.
I rise to support the Bill. I have not been convinced that the Bill is not a necessity, even after listening to such an eminent authority upon this subject as Deputy Sir James Craig. Deputy Sir James Craig told us that the disease is a purely air-borne disease, that sanitation has little or no effect upon it, and that by endeavouring to ward off the disease by means of improved sanitation no useful purpose can be served. Now, Deputy Everett stated what, in my opinion, was a very clear truth, when he referred to the sharp differences of medical opinion upon this subject.
Where is it?
I am going to quote, for Deputy Hennessy's benefit, the opinion of a very eminent medical man, the late Sir Edward Chadwick, who maintained that cases of smallpox, typhus, and ordinary epidemics occur in the greatest proportion in common conditions of foul air, stagnation, putrefaction, bad house drainage, filthy street surfaces, and from overcrowding in foul houses. Being an ordinary layman I do not propose to say which of these authorities is correct, but I do propose to have the common sense to accept the opinion of either one or the other, and I accept the authority in this particular instance of Sir Edward Chadwick.
The Deputy has described Sir Edward Chadwick as an eminent authority. Perhaps he would say on what he bases his opinion of his eminence.
Well, I do not profess to regulate the eminence of any men in a profession, but Sir Edward Chadwick has obtained great eminence upon all these questions of sanitation and particularly upon the particular question of the disease we are now discussing. I simply accept what is ordinary every-day common knowledge on this subject, and I put that forward in the light in which Sir Edward Chadwick has been accepted by the great majority of the people in England.
Not by those entitled to judge.
Take your medicine please, although you are a doctor.
It was a pity that Sir Edward Chadwick, for whose opinion I have the very greatest respect, did not go a little further and tell us what are the causes of small-pox, what brings these impurities into the air which create the germ from which small-pox originates, whether it springs up spontaneously, or from what source it emerges. If what Sir Edward Chadwick has said is true it is perfectly clear that germs will appear from putrefaction, bad drainage, and other things of that nature. I would go even further and would say that impure water plays a very important part in the creation of small-pox. It is a most extraordinary thing that where investigations have been made as to the origin of small-pox, in almost every instance it can be traced by one method or another to impurities in water. I will give you an instance of that. At Ebbw Vale, in South Wales, where many cases of small-pox have occurred and where it is a somewhat recurrent disease, it was found, when an endeavour was made to trace the origin, that the water supply was very dangerously polluted. It has also been found in many other instances that scarcity of water leads to small-pox. I am sure that before this debate closes we will have the benefit of the views of some of the medical men on this question and I hope that they will endeavour to tell the House, from their intimate knowledge of the subject, what the real origin of small-pox is, or if the origin can be traced. If they can show that the opinion of Sir Edward Chadwick is untrue it is up to them to do so, but until they do that, that view cannot reasonably be accepted.
Deputy Sir James Craig painted for us a wonderful picture of the dangers that might arise from contact due to intercourse between England and this country. I hope I am not misquoting Deputy Sir James Craig, but it was, I think, one of the medical Deputies who drew a picture of the danger existing through intercourse between England and ourselves. I cannot accept that as having the weight with which it was urged upon the House. I do not think that there is a great element of danger. What has happened in countries where there has been absolutely compulsory vaccination? Has it warded off small-pox or has it not? Has it been the complete agent of immunity that Deputy Sir James Craig told us of? Let us see for ourselves what has really happened where they have had compulsory vaccination. There is a certain area that has been called the land of inexorable vaccination, and that is Brazil. Brazil has compulsory vaccination from one end to the other.
The Deputy is going far enough away.
The disease does not spare any particular area in the world. I am endeavouring to put very salient facts before the House, and perhaps the Minister will be able to refute them. In Brazil a child cannot enter any school, primary, secondary or otherwise, without being vaccinated. No person can enter the public service without being vaccinated. People cannot even enter private service without vaccination; you cannot take on a domestic servant unless she has been vaccinated. So that you will see, as far as vaccination is concerned, that that country deals with it in a very drastic way. In the year 1925-6 in Rio de Janeiro 652,703 persons were vaccinated, and in that year there were 2,187 deaths from small-pox. Where does the complete immunity that Deputy Sir James Craig has claimed for vaccination come in in face of a startling fact of that nature? I am endeavouring to follow the logic of facts, and I have had the advantage of being trained in the same school of logic, I believe, as Deputy Sir James Craig himself was, so that perhaps I might have some little glimmering of knowledge on the subject. Of these 2,187 who died from small-pox, 1,326 were under twenty years of age. I do not wish to suggest anything of a non-professional character, but, after all, there is an underlying element that this does bring grist to the mill somewhere. In the area I have referred to where they have compulsory vaccination for small-pox there were almost 50 per cent. of fatalities, and if the medical men are able to get over that I will be exceedingly interested to hear them. Deputy Sir James Craig made one very fatal admission. He said that if small-pox is to be warded off and if vaccination is to be effective it should be repeated at periods of seven years, or not later than twelve years.
I happen to be one of those who was vaccinated in his early days. I have escaped small-pox, even though I have travelled from one end of England to the other, where they have no compulsory vaccination. I have lived on both sides of the Channel, and never contracted that disease. I want to say to medical Deputies that 90 per cent. of the people of this country, after the seven-year period has elapsed, according to the statement of Deputy Sir James Craig——
The statement I made was that there was not a single death under 12 years of age in the case of people who had been vaccinated— that is taking the figures of the English epidemic for 1926.
Not a single case?
No.
I think Deputy Sir James Craig stated, after Deputy Dr. Ryan had mentioned the seven years, that after seven years—if I am not mistaken—the effects of vaccination passed. My recollection is that Deputy Sir James Craig did admit that.
I am sure Deputy Sir James Craig will give me credit for this, that I do not mean to be discourteous to him. I am sure the Deputy will appreciate this fact, because I think it is pretty universally admitted by members of the medical profession that vaccination has no effect after the seven-year period. The value of vaccination passes away after that period. Therefore, 90 per cent. of the people of this country are open to contract small-pox if what the medical men tell us is true. What has prevented them from contracting small-pox? I think plain common-sense will tell any man the reason is this: that vaccination has not got the merits which the medical profession claim for it. Why do I take up such a rigid opposition of this Bill? My answer is, because of practical experience. I claim to have a greater responsibility as a family man than any member here. That may be regarded as a startling claim, but I have a serious responsibility in that respect. I can tell the House that one of my own children, a rather delicate lad, was brought to the doctor against the wishes of his mother to be vaccinated. On the first occasion the vaccine did not act, nor did it act when he was brought back the second time. He was brought back despite the protestations of his mother. On the third time it did act, and although Deputy Sir James Craig and other medical men in the House have said that they never knew of a case where ill effects arose from vaccination, I can tell the House that, following vaccination in the case of that child, his body was covered practically from head to foot with a scaly substance. That is one of the reasons why I stand up here against the attitude taken in this House by members of the medical profession. I say the members of the medical profession have not been logical in their attitude by opposing Deputy Everett's Bill. If this question goes to a division. I will vote in support of the Deputy's Bill.
I found it very hard to observe the rules of order while my colleague, Deputy J.J. Byrne, was speaking. At almost every sentence I felt inclined to interrupt and contradict him. Speaking on this matter from the point of view of the ordinary lay woman, I say if this conscience clause is passed it will give two classes of mothers in this country a very good excuse for not getting their children vaccinated—(1) those who are too foolishly fond of their children and say they do not want them vaccinated, that vaccination would hurt them; and (2) careless mothers who allow their children to remain unvaccinated. These classes will be conscientious objectors if there is any loophole through which they can avoid the law. I think the House would be criminally guilty if they allowed this conscience clause to pass, thus leaving the young children of the present day, as well as the unborn children of the future, open to such a terrible disease as small-pox. Those of us whose memories go back to the eighties can recall the number of pretty, prepossessing people, as Deputy Wolfe described them, who were hopelessly disfigured by this dire and fell disease. I can remember, in the County Cork, seeing men go around who were afflicted with blindness from the effects of smallpox. I am not concerned with what has happened in Brazil, or with the opinions of Sir Edward Chadwick. What I am concerned with is Ireland, and with what is occurring in our own country, and the fact is that this country has been immune from small-pox since the vaccination laws had to be rigidly adhered to. I am far more concerned with the opinions of Deputy Sir James Craig than with the opinions of Sir Edward Chadwick. Deputies should realise that there is a terrible responsibility placed upon them before they vote for the conscience clause.
Deputy J.J. Byrne spoke as a family man. I speak as a family woman, and I may mention here that my family runs into two figures. Every one of my children has been vaccinated. The process gave them no pain. I was there myself when the children were vaccinated. They did not even cry during the process. After the vaccination they were ill for a couple of days. But what are the trifling effects that a child may suffer after vaccination compared with the terrible effects that children may suffer from this dire malady of small-pox? I have read some of the objections that in the early days were put up against vaccination. Deputy Byrne's theories seem as ridiculous as many of the objections that were put up when Dr. Jenner first discovered the effects of vaccination. It was prophesied that vaccination would brutalise the children; it was averred that the vaccinated children became ox-faced; that abscesses broke out to indicate the spread of horns, and that the countenance of the person affected became gradually transmuted into the visage of a cow, and the voice into the bellowing of bulls. There seems to be about just as much sense and logic in some of the arguments which the anti-vaccinationists have put up in this House as there were in the objections I have just mentioned. I appeal to Deputies to think of their responsibilities to the children of this country and to oppose this measure of Deputy Everett's. Like Deputy Sir James Craig, I also regard Deputy Everett as a pleasant comrade in this House, and I am sorry to have to oppose him, but my responsibilities are far too great, and I therefore appeal to the House to reject this measure.
Unlike Deputy Byrne, who has made up his mind in this matter, I confess I have not decided how I will vote. I have listened with great interest to the discussion, and particularly to the views of the members of the medical profession. I would like, when other Deputies who are in the medical profession follow, that they would elaborate a little bit more some of the points raised. I have tried to get as much information as I could in the last few days on this matter. There is one thing I am not clear about. It is suggested that because of the manner in which this lymph is brought about there is a danger, and that it has happened, that syphilis has been transferred from one person to another. I have also heard, and I would like to get confirmation of it, that if calf lymph is used it is impossible to transfer syphilis from the calf as it is a purely human disease. I would like to have that confirmed by some member of the medical profession in the House. The reason I took particular interest in this is, that I was rather impressed by what Deputy Sir James Craig said, that the introduction of glycerine into the lymph kills all germs. I know from what I have discovered that glycerine does not kill the germ of syphilis, and therefore I would like to have it confirmed by some member of the medical profession that it is a fact that lymph taken from a calf cannot bring about the transfer of the germs of syphilis. That would do away with one of the difficulties I have. Deputy Byrne gave us at great length a history of Brazil. I must say that I was not impressed with his references to Brazil. He left out what should be one of the main points of his argument. He did not tell us whether those people who died from small-pox in Brazil were citizens of Brazil, or had just come in to the country, and who happened to get the disease. It is generally accepted by those who believe in it that vaccination brings about immunity for a period of five or seven years.
I have heard it said that children under the age of seven years are more likely, if coming in contact in any way with the disease, to contract small-pox than older persons. That does not agree with the theory that they are immune for a period of from five to seven years. I am sure the Minister for Local Government and Public Health, who is responsible in this matter—and it is not a political question, as it concerns people of all shades of opinion— in his opposition to this conscience clause, will have got advice from the medical profession at his disposal, and that he will be able to give us some enlightenment to counter the eminent authorities quoted here in favour of the conscience clause. I would like to hear from the medical men who will follow in this debate some definite medical opinion. Are they satisfied as medical men to advise this House, composed mainly of lay people, that vaccination is necessary and essential as a preventive of small-pox? I am not at all impressed by people who say that mothers are afraid of inflicting pain on their children. I know of other operations that have to be performed and that inflict more pain on children of a younger age than that at which children are vaccinated. I would be glad it medical men would enlighten us if this is necessary as to why it is necessary. I do not ask them, like Deputy Byrne, to state what is the cause of this, that or the other, because there are many diseases the cause of which cannot be explained. It is generally accepted in the medical world that vaccination is a means of helping people to withstand small-pox when it breaks out. I would like a more elaborate discussion on the subject from the medical point of view, so that those of us who have not made up our minds as to how we will vote on this Bill will feel when we are going to vote that we are doing the right thing.
This Bill is of a very mild form. It leaves it optional to people to have their children vaccinated, and it leaves it optional for elders to be vaccinated. Vaccination is a question of vital importance, as far as the national health is concerned. I do not think it is reasonable or fair that there should be a law in any country that would inflict punishment on a child and that the parents would have no control in the matter. A child is brought under the law immediately by an Act of the Government, and is sent to a doctor to be inoculated with a virus of some kind, a virus that is foreign to the body of that child. From the views that have been put before us by the Deputy doctors. I can scarcely conceive that the members of this Dáil will for one moment give any serious consideration to the points on which they tried to establish their case. They have not established that children remain immune for six months after vaccination. Under such circumstances why should we accept the statements of the doctors? Why should we continue to ask the people of this country to send their children to doctors to have such punishment inflicted on them? There is no reason why we should do it. I think this should be a matter for the mothers and fathers of the children to decide.
A child is sent to a doctor and it is vaccinated, and when brought home it immediately becomes extremely ill. If the child is healthy and strong that virus enters into its body directly, and the blood of that child kills the virus and it has no effect. In the case of a child whose health is not up to the proper standard after inoculation by this virus, which is foreign to its body, it becomes seriously ill. In many cases day after day the mother is in consultation with the doctor as to why the child suffers. The doctor has to prescribe an antidote against the virus with which he has inoculated the child in order to preserve the life of that child. There is no doubt that the health of children has been impaired by this inoculation. In the case of a delicate child who has been vaccinated the volume of blood is not able to resist for any length of time. I am sure that the Deputy doctors who have spoken on this matter will admit that in 99 cases out of a 100 it means certain death in such circumstances.
Why should we expose our children, if they are delicate, to death? Why should we expose our children to the risk of sickly lives by the infliction of this punishment, if it is not going to be effective after six or twelve months or after three, four, five or six years? The limit the doctors are prepared to say this inoculation will keep the children immune from small-pox is seven years. That is the farthest they will go. Further, they are not prepared to guarantee that the child is immune from catching small-pox for any period. It is all-important that the fathers and mothers should be the sole directors in this matter and that their views should be the sole consideration. They should not be compelled to inflict upon their children this punishment. It is a punishment on the parents, in the first place, and a punishment on the children, in the second place. On the evidence of most doctors of the world, this vaccination serves no useful purpose. The doctor-Deputies who spoke here would not put the period of immunity at more than seven years. These are the facts from themselves, and they have not been and will not be refuted.
The Deputy doctor on my left here spoke of the procuring of the lymph from the calf. He told us how it was tried and tested before being distributed to the dispensary doctors. He did not say upon what that lymph was tried. It is very strange that if the lymph is pure it has got to be tried and tested. Upon what is it tried and tested? Is it upon a dog? Is it tested upon a cat? Having tried and tested it upon a dog or cat, is it fair to send that very substance through the country and have it tried upon the children of the country? I do not think that is reasonable or just.
I am prepared to accept the general opinion of 90 per cent. of the population of this country that this matter of vaccination against small-pox is really a bogey. It is a bogey that goes a long way to inflict punishment on many children. It is through that bogey that 75 per cent. of the children in this country are vaccinated. It is this way: the parents will say, "It is just a little bit better to have the child vaccinated lest it be said later, in the event of the child contracting this disease, that it was my fault. I will save myself in that respect." I do not think that the doctor-Deputies, when speaking on this matter here, should have disclosed their identities as doctors. Everybody knows pretty well what weight the opinion of a doctor carries in country districts. In rural areas, most of the people regard the doctor as a sort of deity in some respects. In general, the doctor's opinion is accepted as being something final; it is accepted as having been based on favourable evidence and it is felt that in everything he says he must be right. That is why I submit that the medical Deputies in this House should not have disclosed their identities when speaking on this Bill. They are here as Deputies and not as doctors. Giving their views as doctors on a Bill of this kind, will have a very detrimental effect upon the population of the country.
There is another matter in connection with vaccination and that is the punishment to the child. That is why this matter of vaccination should not be continued any longer. Again, the mother or the parent of the child brings that child to the hospital or dispensary. The child is inoculated with the virus. The mother sees that the child immediately cries and she gasps. The first opportunity she gets she extracts that substance from the body of her child. That is because the natural instincts of that mother tell her that it is wrong to have any foreign sulbstance introduced into the body. I have seen instances in the matter of travel where a peculiar situation arose in connection with vaccination. There are first, second and third-class passengers on the boats. The first-class passenger was supposed to be immune from small-pox when he got into another country. The second-class passenger was supposed also to be immune from small-pox when going into another country. Why was it that the third-class passenger was not considered safe or immune from small-pox when he got to another country? I have seen these passengers on the boats and I have seen the third-class passengers inoculated. I have seen young men suffering from the hardship and pain inflicted on them by this vaccination and I have seen them sick for days. Directly many of these men got the opportunity, they had the substance extracted from the arm. When the substance was in a part of the body which they were not able to reach themselves, I have seen them get other young men to extract it.
I do not think it is right for this House to have a division on this Bill. It is a question whether the father or mother should be compelled to have their children vaccinated with some foreign substance that is going to do them no good whatsoever, in the opinion of the principal doctors of the world. No doctor will guarantee that the vaccinated person will be immune from small-pox within six months after the vaccination. There are a number of large families in my district, and not one of the children has been vaccinated. I know families with 6, 10 or 12 children and none of them has been vaccinated. These children have remained immune from every disease for the last 20 years. I make that statement of my own personal knowledge. I can prove that no doctor has visited the homes of those unvaccinated persons for 20 years to treat them for any disease, such as the 'flu or diphtheria or measles. I can prove that none of these children has ever contracted measles. They are the healthiest children in the district. I know families who have been unvaccinated and they did not have a doctor in the home, except in the case of accidents. I am aware of vaccinated children who have suffered from diphtheria, measles and other diseases, that are never known amongst those who have not been vaccinated. It was only last Good Friday I met with a case of a family of five children unvaccinated in a district in which there was an outbreak of measles. Not one of that family contracted the measles. That is a clear indication that the blood of unvaccinated persons offers a better resistance to disease than is offered in the case of those who have been vaccinated.
It is in vain to try to persuade such people that the introduction into their bodies of calf lymph or any other lymph, is going to be of any benefit to them or to make them immune from this disease. This House should do nothing to impose such a barbarous operation on the children. I do not think it is quite fair that men who have no practical experience of families and people who have not practical experience of the conditions that obtain universally, should vote against this Bill. This is a very mild Bill. I expect that the law with regard to vaccination will, in fact, be ultimately abolished altogether. Having regard to the opinions of so many people, I think the Bill is a reasonable and just one. It gives the option to people who want their children vaccinated to have them vaccinated. It gives the right to adults, if they want to be vaccinated, to be vaccinated. I put it now here to the Deputies: which of us here in our senses will submit ourselves to a dispensary doctor and say, "I want to be vaccinated"? We will not, because we have come to the use of reason, and we have no belief in the substance they are going to put into our bodies. I know of one of the most up-to-date countries in Europe, and in that country it is an offence to have vaccination carried out.
What country?
The Netherlands. It is one of the most modern countries, and it is in close proximity to us. In that country no vaccination is allowed to be carried out, and it is in that country that science and modern intellect have gone a long way to serve the interests of Europe and the world in general. A good deal has been done by that country.
What is the country?
ACTING-CHAIRMAN
The Deputy referred to the Netherlands.
That country has been foremost in science, and the Government of that country has decided that vaccination operations are not to be carried out. In fairness to the people of our country who have a conscientious objection, they should not be compelled to do what they do not want to do, and Deputies should not be asked to vote for the infliction of punishment on the people of the country which they would not care to have inflicted on themselves.
On a point of explanation, when I was speaking to the House about the two thousand odd people who contracted small-pox in Brazil, it appears there was a considerable element of doubt in the House as to whether or not these people had been vaccinated. Every person who contracted the small-pox had been a vaccinated person. I wish to make that point perfectly clear to Deputies when they are making up their minds to vote for or against the Bill.
My opposition to this Bill is very strong and earnest, and, in reply to a question by Deputy Briscoe, it is fully informed and supported by the best medical advice that I can get. I know of no scrap of medical advice that has come to me from this country that would be in favour of this particular Bill. Every responsible medical body in the country—the Royal Academy of Music——
Musical comedy!
Music when the operation is being performed.
I am sorry. I should have said the Royal Academy of Medicine, the Royal College of Physicians and the Irish Medical Association have all passed very forcible resolutions dealing with this particular question. Irish medical opinion is very strongly in support of the present vaccination laws. A terrible lot of nonsense has been spoken about this matter in support of the Bill. On the part of Deputy Everett and, I think, Deputy O'Kelly, no evidence has been brought forward in connection with the matter. One or two attempts have been made to drag points across the discussion.
Deputy Everett said that he avoided bringing in arguments at all, and his plea at the tail-end of his speech was a kind of ad misericordiam appeal to the House. “This is only a little bit of a Bill brought in by a little Private Deputy, and the House ought to let it go through.” He said that if the medical profession would impress on the Medical Department of the Department of Local Government and Public Health the necessity for dealing with other diseases in the same way as they impressed on them the necessity for enforcing the Vaccination Acts, we would not have a large and increasing number of people dying from consumption. If, in approaching the question of vaccination, Deputy Everett informed himself in the same way as on the question of consumption, he has not done very justly by the people in attempting to speak in an authoritative and argumentative way against the present Vaccination Laws.
In so far as consumption is concerned the annual report for the year 1926 shows that from 1916 onwards we had a very steady decrease in the number of deaths from consumption in the country. The returns for 1927 have not been published yet, but it shows a still further decrease in the number of deaths. In 1916 there were 6,471 deaths from tuberculosis of all kinds. The average for the years 1916 to 1925 was 5,375. The total number of deaths in 1926 was 4,362, being 1,013 less than the average for the last ten years.
Has the Minister any information as to how many consumptives left the country and died out of the country—consumptives who went away for a cure?
I have not.
Has the Minister any evidence of the number suffering in various sanatoria and hospitals at the present time?
The Deputy was speaking here of a large and increasing number of persons dying from consumption and within our jurisdiction here. I say the number has consistently decreased from 1916 and perhaps before that year. At any rate, the number that died in 1926 was 1,013 less than the average for the previous ten years. The number of deaths in 1927 was 4,184, or an additional 178 less than in 1926. It represents a decrease in deaths from tuberculosis of all kinds in rural and urban areas in respect of men and women, and if Deputy Everett can make the statement with regard to consumption that he has made in the face of these facts——
Can the Minister give the number suffering in the various hospitals and sanatoria in 1916 and the number in 1926?
I cannot give it now, but I suggest that there was a reduction in the number of people who died from tuberculosis as a result of the measures taken to stamp out the disease in the country. The measures we have taken have stamped out the disease by fully 20 per cent.
It is the only test.
I say that it is not treating a very important matter, the public health of the country, in a reasonable way for Deputies to approach it with a want of facts, and I charge Deputy Everett with approaching it in that way. Deputy O'Kelly said, with regard to the attitude of the Local Government Department:—"I do not think that the Local Government Department can be very serious about this matter, because if they were they would have made a more serious effort in the last four or five years to enforce the Acts where there were deliberate efforts made by local authorities to put them into operation." That suggests that the Department has not assisted local authorities who have statutory obligations to put the Acts into operation, and has not given them proper assistance. I would like to know on what facts Deputy O'Kelly bases that statement, because the actual facts are that from, say, 1910 to 1913 there was a very definite fall in the number of vaccinations. In 1910 there were 62,000 odd vaccinations. In 1911 the number fell to 57,000; in 1912 to 51,000, and in 1913 to 43,000. Except for a rise during the years 1915, 1916 and 1917—a rise about which I have not been able to get any interpretation except that it was brought about as a result of war conditions, the vaccination of men in the country going to the Front, and the influence that would have on the general population in having vaccination carried out —except for that rise and one small rise in 1919, the year when instructions were issued to have vaccination opposed with might and main by the Nationalists of the country, the number of vaccinations fell steadily until the year 1922. In that year 22,000 vaccinations took place, or 38 per cent. of the births. From 1922 there has been a steady rise. In 1923 the number was 39,000; in 1924 it was 48,000; in 1925 it was 50,000; in 1926 it was 50,000, and the number in 1927 was approximately 53,000.
Thus, during the period in which Deputy O'Kelly says that the Department of Local Government was hardly serious about the matter, steps were taken to get the vaccination laws effectively enforced because of the medical foundation upon which the law was based, and the thorough belief of the Department that public health interests demanded that, and also because of the danger that lay at our doors owing to the epidemic in Great Britain. The number of vaccinations that took place, as compared with births, rose from 38 per cent. in 1922 to 90 per cent. in 1927. It is unfair, also, in dealing with the matter that a Deputy would attempt to prejudice the discussion by saying that the Department was not serious in the matter, whereas the facts, in so far as I give them, show that the efforts of the Department to have the vaccination laws properly carried out have been very successful, and that we are getting back to the normal position. I think that before Deputy O'Kelly made that suggestion he should have had the facts behind him. In dealing generally with this matter we have not had any evidence put before us, good, bad, or indifferent. One Irish doctor has been mentioned, Dr. Russell. I do not know anything about him, but you have been told that his advice is that the vaccination laws have been a failure here. We naturally ask on what grounds are they supposed to have been a failure? Is it because there is practically no small-pox here to be dealt with? I submit that the fact that we have practically no small-pox in this country is very strong evidence upon which we can base reasonable arguments that the laws have been successfully carried out. I certainly would like to hear the facts upon which the allegation is made that the vaccination laws have not been successful here.
To argue whether the law has been successful or not, Deputy J.J. Byrne asks us to go to Brazil. He asks: what has been the experience in countries where these laws have been enforced? We need not go as far as Brazil to study that matter in a systematic way. I have here a statement of the mortality from small-pox among the civil population in Prussia, and also among the military population there since 1825. It is in chart form. In the ten years from 1825 to 1834 the number of deaths per hundred thousand among the military population in Prussia from small-pox was greater in six years out of the ten than it was among the civil population. When vaccination was introduced into the Prussian Army in 1834—it was not introduced in respect of the civil population until 1875—the deaths from small-pox among the military population fell to practically nothing. In the year 1831 there were 75 deaths per hundred thousand among the military population from small-pox. and the figure for the year 1832 was 66.7, and for 1833 it was 75.0. For twenty-six years, from 1845 to 1870, the number of deaths from small-pox among the Prussian military population was only on four occasions as high as 0.8 per hundred thousand. The mortality amongst the civilian population would represent an average figure of 20, as against 0.8. When, in 1874, vaccination was introduced in respect of the civil population in Prussia death from small-pox was practically wiped out among that population. The deathrate in 1896 was 0.02; in 1897 it was 0.03; and in 1898 it was 0.04. Among the military population, only on two occasions, between the years 1874 and 1901, was there a figure that was not 0.0. I am told that people object very much to figures. I did not intend to refer to the German position, except for the fact that we have been challenged to consider what has happened in countries where vaccination has been imposed. I would rely on the facts as they reflected upon the true effects of any particular operation as disclosed over a long period of time among the Prussian people rather than take them from Brazil to-day.
I suggest to the House that the experiences among the German population are much more to be relied upon than the experiences in Brazil, even if we had the systematic setting out of the position in regard to Brazil that we have in regard to Germany. There has been an outbreak of small-pox lasting from 1917 up to date in Britain, and it is still increasing because it is not a fact, as Deputy Connolly suggested in one of his loose remarks, that the British people are able to deal with it, even after an expenditure of something like £10,000,000. The epidemic is increasing almost weekly in Great Britain so that there is no sign at present even after that very lavish expenditure of money and after a number of deaths that they are succeeding in dealing with it. We have the very striking fact that out of the great number of cases that have occurred in England, not one single vaccinated child under twelve years of age has contracted the disease, while in the case of children under fifteen years of age there have been only eight. In the case of unvaccinated children, approximately out of 10,000 cases, 4,000 cases have been of children under fifteen years of age. These are the real experiences occurring among people-highly organised from a public health point of view. They are highly organised for the purpose of collecting and estimating facts and we must be very much impressed by them. With regard to the general medical opinion on vaccination and its effect on the prevention of small-pox, the matter was investigated for quite a number of years, from 1889 to 1896, by a Royal Commission in Great Britain. I want to read its findings here. They are not the findings of a commission consisting of medical people. They are the findings of a general commission and most of the evidence given before it was by people who opposed vaccination.
What is the date of the report?
The Commission sat from 1889 to 1896 and reported, I presume, about 1896. Its conclusions were:—
"We think:—
"1. That it diminishes the liability to be attacked by the disease.
"2. That it modifies the character of the disease, and renders it (a) less fatal, and (b) of a milder or less severe type.
"3. That the protection it affords against attacks of the disease is greatest during the years immediately succeeding the operation of vaccination. It is impossible to fix with precision the length of this period of highest protection. Though not in all cases the same, if a period is to be fixed, it might, we think, fairly be said to cover in general a period of nine or ten years.
"4. That after the lapse of the period of highest protective potency the efficacy of vaccination to protect against attack rapdily diminishes, but that it is still considerable in the next quinquennium, and possibly never altogether ceases.
"5. That its power to modify the character of the disease is also greatest in the period in which its power to protect from attack is greatest, but that its power to modify the disease does not diminish as rapidly as its protective influence against attacks, and its efficacy during the later periods of life to modify the disease is still very considerable.
"6. That re-vaccination restores the protection which lapse of time has diminished, but the evidence shows that this protection again diminishes, and that, to ensure the highest degree of protection which vaccination can give, the operation should be at intervals repeated.
"7. That the beneficial effects of vaccination are most experienced by those in whose case it has been most thorough. We think it may fairly be concluded that where the vaccine matter is inserted in three or four places, it is more effectual than where introduced into one or two places only, and that if the vaccination marks are of an area of half a square inch, they indicate a better state of protection than if their area be at all considerably below this."
That is the complete statement of their recommendations. These are the findings on medical grounds that are the basis of our present Vaccination Acts. I suggest that since the making of that report all our experience has been that the present Vaccination Acts are justified, and that such modification as there has been in England has brought upon England the really very disastrous situation in which they now find themselves. Since 1917 approximately £10,000,000 has been expended, without talking of the dislocation to a certain extent of trade and family life that a visitation of this disease brings. It is argued here that children ought not to be vaccinated until they come to the use of reason, and that they then should be allowed to say whether they should be vaccinated or not. Medical evidence is clear that small-pox, just as measles and whooping-cough, is a disease of childhood. I am not competent to say definitely, but I do suggest that it is still in England at the present time a disease of childhood, and that the 4,000 odd unvaccinated children who contracted the disease out of 10,000 cases, in 1926, were the real spear-head of the disease amongst the British population at the time. We have endeavoured by the enforcement of the Vaccination Acts since we took control of the matter to cover the weak spot, that is, to cover the childhood position so that the childhood position in this country would not be the spear-head for the entry of small-pox here.
We ought to realise the danger there is in Great Britain at the present moment and the danger there is to us, because it has been explained by medical speakers here. I think it is absurd that Deputy Connolly should object to Deputies here speaking on the matter as doctors. He wants to stifle the doctors. Medical statistics have shown that the period of incubation of this disease is from eleven to fourteen days, and that a person may leave not only England but New York apparently perfectly free from the disease and the disease may show itself after his arrival here. We have taken steps in the matter of old clothing coming into the country to see that small-pox is not brought in in that way, but there is no protection that we can devise that would prevent a person coming over from England here without any apparent signs of disease and developing the symptoms of the disease three or four days afterwards. We are not able to raise any protection against it. Our population is not as immune as we should like to see it in the event of the disease coming over here from Great Britain. If we look at the figures from 1910 onwards we will see that we must have at present about a quarter of a million persons between six and eighteen years of age who are unvaccinated. I consider that we are in a dangerous condition from the point of view of public health if an outbreak did take place. Only a very small percentage of the medical profession here have any experience of the disease. We were very fortunate in connection with the last eleven cases that appeared here that the infection never spread from the house in which it showed itself, because of the vigorous medical steps taken. But only a small percentage of the medical profession have had experience of small-pox, and a rapid outbreak might easily occur in any area which we might find it difficult to cope with.
We should not therefore discuss this matter in a light vein. It is a very serious matter, and we ought not to allow ourselves to be carried away by the appeals of Deputies who claim that children suffer pain and hardship by being vaccinated. I doubt very much if medical Deputies will bear that out. To hear people speaking like that one would imagine they never saw a child getting its face washed. It is unreasonable to attempt to appeal to people's feelings by talking about the pain that children undergo. There is, I am sure, no Deputy who, if his child was suffering from diphtheria, would not get it inoculated right away. All the facts and all medical evidence go to show that vaccination can safeguard our people from the losses and disabilities that the people in Great Britain are suffering at present. Then people say, "What is the use of vaccination except you re-vaccinate later on?" The child population of the country is the spear-head of the people from the point of view of small-pox and the present vaccination law, if effectively carried out. will safeguard that. If it be found that that is not sufficient safeguard against the spread of small-pox, then we can deal with the question of re-vaccination. But the fact that we are free from small-pox is no reason why we should take down our guard now.
A number of points have been raised about the making up of the lymph and the way in which dispensary doctors administer it. The regulations so far as dispensary doctors are concerned are very explicit. Except in so far as any immediate danger of small-pox may arise, dispensary doctors are to vaccinate only subjects who are in good health, and there are explicit things set out which are to be taken into consideration in deciding whether a person is in good health or not. The vaccine is very carefully prepared. It is not, so far as I know, tried on a cat or a dog. It is subject to the tests that modern science suggests should provide effective tests for discovering the presence of micro-organisms. It is always supplied in fresh condition, and dispensary doctors are ordered not to use but to return, vaccine that they have for longer than seven days. No complaint has been made with regard to the lymph supplied. It is prepared under the closest possible supervision, and I doubt if vaccine lymph is prepared in any other country in the careful way in which it is prepared here.
As to Deputy Briscoe's point. Deputy Sir James Craig, in his speech on the last day, stated that syphilis cannot be carried by calf lymph, because the calf is immune from it—it is not a bovine disease. Talk of that kind is simply spread about in order to raise fears of one kind or another. The Local Government Department, with full medical advice behind its attitude in the matter, is very earnestly opposed to the passing of this Bill, and I appeal to Deputies to recognise that a very serious responsibility from the point of view of public health rests upon them. and that they ought to oppose the Bill very vigorously.
Can the Minister give us any information as to what becomes of the calf from which the lymph is taken—how is it disposed of?
I cannot.
Is there an establishment in the County Dublin where it is taken?
Yes. It is made in Dublin.
The Minister for Local Government and Public Health referred to some remarks made by Deputy O'Kelly. He said that there was a steady fall in the number of cases of vaccination up to 1922, but he did not say whether there was an increase in the number of cases of small-pox. I would be interested to know that. Was there an increase in the number of cases of small-pox in these years? He also said, towards the close of his speech, something that attracted me, and I am sure Deputy Sir James Craig also took notice of it. That was that the doctors in this country had not very much experience of small-pox. I think he was quite right there, and that being the case, I think it might be well if we referred to the countries that have had great experience of small-pox. There will be justification for going to countries with experience of small-pox to find out what the medical opinion on the subject is there, though I noticed that later on there was a disposition to criticise Deputies for going to Brazil and places like that. The Minister went through many figures and quoted the case of Germany. He came nearer home than Brazil. I have a paper here called the "Vaccination Inquirer."
Does the Deputy believe everything in that?
Mr. BOLAND
No; not for a moment. I do not believe anything in any paper. I pick and choose for myself, as most people do. I draw the Minister's attention to one thing: I think he will admit that Germany is one of the countries with the greatest development of vaccination in the world. It is also a country that suits his particular type of mentality. This paper is dated February 1, 1928. Deputy O'Dowd spoke about the immunity from small-pox and other diseases that soldiers enjoyed during the Great War. Germany was not behind in vaccinating her troops. This paper says:—
"The most remarkable figures are those from 1916 to 1921, which revealed no less than 11,951 cases with 1,768 deaths."
I am not saying that these are facts.
Was that in the German Army?
Mr. BOLAND
It was in Germany.
Was it amongst the Russian prisoners?
Could the Deputy give the total population and the percentages?
Mr. BOLAND
I am going to do that. These figures are in tabular form, same as the Minister for Local Government has them. They are only taken from 1896 to 1926, but they are not the full figures for 1926. The period I want to refer to is from 1916 to 1921. Out of 685 cases of small-pox notified there were 93 deaths, and the percentage of foreigners was 27.9, which is very high, I admit. In the following year there were 3,028 cases notified, and of these there were 456 deaths, or 4.7 foreigners.
The foreigners were all dead at that time.
Mr. BOLAND
I do not think so. During that time Germany was full of Russian prisoners who were vaccinated compulsorily, so that I do not think the Deputy is right. In the next year we had a big drop, from 3,000 to 413, and of these 58 died. Perhaps they died from other diseases such as tetanus. There were, as I said, over 3,000 notifications the previous year, which fell to 413 in the following year. Of these 413, 58 died, and the percentage of foreigners is again high, for it amounted to 12.8 per cent. The next year we have an enormous jump from 413 cases notified to 5,021, with 707 deaths, and the percentage of foreigners was only 3.6. I will not weary the House with all these figures. If anyone wants to prove a case by figures he can prove practically anything. I shall now come to England—that is nearer home than Germany. Dr. Garrow, Medical Officer of Health for Chesterfield, has made a report to which I want to refer. I agree with the Minister that medical officers of health in England have more experience of small-pox than our most eminent men here. Everyone will agree that medical men gain more knowledge from practical experience than from books, and everybody will agree that the medical officer at Chesterfield will have as good knowledge of small-pox as our medical authorities here.
I have had experience of two epidemics of small-pox and I re-vaccinated on each occasion.
Mr. BOLAND
I submit that they were very small compared to what occurs in England. Dr. Garrow confines his comparison to the age of 15 and over, for the simple reason, he says, that practically all the cases under 15 are among the unvaccinated—in view of the fact that the conscience clause was in operation in England for 15 years. Of course I see the fly in the ointment here because the seven years come in. The figures he gives are these: up to 15 years of age there were 11,019 cases with 22 deaths, a mortality rate of .20, and amongst those of 15 years and upwards who were presumably vaccinated, 11,524 cases, with 39 deaths, a mortality rate of .33. If the Minister would like plenty more figures I have them here.
Are these from the medical officer of Chesterfield?
Mr. BOLAND
I will hand over the paper if the President wishes. Dr. Garrow submits a table, compounded from Sir Geo. Newman's annual reports from 1922 to 1926 showing that the fatalities were greatest among the vaccinated people. He says:—
"In a total for these years of 11,019 cases, 4,010 occurred among the vaccinated, with 13 deaths—a fatality rate of 0.3 per cent.—and 6,915 occurred amongst the unvaccinated, with 4 deaths. That is, the mortality amongst the vaccinated was five times greater than amongst the unvaccinated."
Is that the same paper which contains this:—"In reply the Minister for Public Health (Dr. Stevenson) supported by Dr. Ryan, of Wexford, made a sweeping provaccinist harangue and brandished all the old exploded dogmas and fallacies in the face of his ignorant and acquiescent audience"?
Mr. BOLAND
I am not a regular reader of this paper. I am giving these figures for what they are worth. I may say I have the chart from 1916 up to date taken from the table here, which I believe must be part of the same statistics as the Minister has referred to.
The Deputy has not checked the figures.
Mr. BOLAND
Naturally, I have not. I will allow the Minister and his Department to do that. I have an interest in this, and a very vital interest in it. It occurs to me that we are vaccinating people in this country, which unlike India, is a country in which small-pox is not endemic. We are vaccinating against small-pox, but we must remember that there are other diseases, such as tuberculosis. I am not going to say what Deputy Everett is alleged to have said, that there was no proper treatment given to tuberculosis. If there is a serum to prevent tuberculosis in after life, why is that not injected into the child? Similarly, why is not tetanus serum injected? In other words, why do you not inject all these things into the unfortunate infant? I am perfectly serious about this. I believe what Deputy J.J. Byrne said. I do not often find myself in agreement with him, but I certainly believe what he has said about his own child. I had an experience myself some time ago, not in the case of my own children—I am taking good care against that. I happened to go to register a child some time ago, and I had to wait rather longer than I thought I would have. But while waiting I was learning something. There happened to be a great number of mothers with children there, where, as I think Deputy Dr. White said, they were waiting as victims. One Deputy. at any rate, used the word "victims," and I think it was Deputy Dr. White.
"Smiling victims."
The word "victims" was certainly used by one of the medical Deputies. I saw some of these victims there, and I heard the stories that the mothers told of other victims. They were all in fear and trembling that the same thing would happen to these victims, and were watching the operations in the case of others. The one reason they gave for bringing their children there was that they were simply terrified by those people who go round brow-beating them. Deputy Everett referred to the fact that there was unfair discrimination against the poor, as there is everywhere else. You are told that you have the law courts. You have indeed, but have you got the money to avail yourself of the law? Poor people love their children just as much as the rich do, and if they feel that something will happen to them they have no choice as to whether they will disobey the law and pay a fine, which, in the case of a man, might mean loss of employment. I think this is what was called "Prussianism in excelsis." If the case for the conscientious clause has not been already made, I think it is going to be made. I do not say that I am going to make a complete case, but I am living in hopes of doing a little towards that, and others will follow.
If I had to choose where an epidemic was threatened, I would be between the devil and the deep sea. I would say that if my children were vaccinated there was a chance that they would get some vile disease from having this stuff pumped into them, but that if they were not vaccinated, there would be a chance of them getting this disease, and I might choose between the two. But I fail to see why I should be called upon to take the risk, where there is not the slightest chance of it, owing to the great improvement in hygiene during the period dealt with by this chart, of having my child contract some loathsome disease. I think parents should not be asked to do so. Some Deputy—I think it was Deputy Briscoe—referred to the possibility of a particular disease being contracted through vaccination. I read another of these pamphlets, which I frankly admit maybe propagandist, but at the same time they, I submit, make a case which has got to be answered. I am sorry that I cannot refer the Minister to it, because I burnt it when I was done with it, but I suppose we all got it. If there happens to be a majority in the House who are naturally ill-informed on the subject, I do not think it would be fair to ask that majority of laymen to take a decision on this subject without first investigating the whole business. I do not want to weary the House with a number of quotations, but I have a suggestion here that there should be inquiries into certain cases. That was for England, and I suggest the least we should do would be to do the same thing here, because I think we will have to admit that the medical men have us more or less by the throat in a case like this, where another class of "The Doctor's Dilemma" prevails—they do not all agree either. I have often put the acid test to doctors; I have asked them if their own children were vaccinated. I got some of them to admit that they had been, but a good many of them said that they had not. In other words, they are in favour of vaccination for other people's children.
I welcome this Bill. It is quite obvious that this is not a Party question, that we are all speaking on it as we think, and therefore I think that before a decision is taken there should be some investigation. As I say, in England a number of people who have been vaccinated have got this disease. Every prisoner of war in Germany was re-vaccinated, and the Russian Army had the same provision, but an enormous number of men died. Of course the number was not as great as would have been the case in other years, due to better camp hygiene, and that also applies to a remark of Deputy O'Dowd's, when he spoke of fatalities from other causes than bullet wounds. But we all admit that during the time between the Boer War and the Great War enormous advances have been made in that direction. I am supporting this Bill, and I make the suggestion—I do not know whether it will be accepted by the proposer or not—not to turn it down without very careful consideration.
When moving the Second Reading of this measure, Deputy Everett said that circulars were sent out by the Dáil Department of Local Government in 1919 saying that the Act might not be enforced, and I think he said that there was a Dáil decree saying that we were not going to enforce the Vaccination Act. I have no recollection whatever of any such document being sent out under my authority at that time, or by the Department. It is quite possible that, with many other pressing matters to deal with at that time, we may have advised against having prosecutions, which is quite a different thing. Certainly I can say that there was no Dáil decree on the matter. I can also say that there was never a document sent out stating that the vaccination laws were not to be enforced. Through the courtesy of Deputy Everett, I have read a pamphlet issued by the Anti-Vaccination League in England. There is the customary intimation on the front page: "Membership, 5/- per annum per member; life member, £5." There is a peculiar strain running through the whole of the references to the various individuals who have opposed vaccination—that Mr. So-and-so was converted on such a date; then we are presented with a picture of all those saved coming along to save others at the cost of 5/- per head or £5, which will secure, I suppose, ultimate salvation. I am not altogether impressed with these various documents with a propagandist origin. I am positively certain that by no stretch of the imagination, and by no use that could be made of official sources, would it be possible to find out how many people died from small-pox who had been vaccinated, or re-vaccinated, as against those who had not been. On examination, I think Deputy Boland will agree with me there. If a man from the Anti-Vaccination League called to a house where a person had died from small-pox and put the question: "Was he vaccinated?" he would probably be told to go about his business.
Mr. BOLAND
That information would be on the medical register of the district.
No; I do not think it would. I move the adjournment of the debate, and I may say that it is my intention to move on Wednesday that the whole time be taken for Government business—for the Budget.
The Dáil adjourned at 2 p.m. until Wednesday at 3 p.m.