The principal difference in this Vote as compared with last year is in the increased amount required in connection with some of the public health services. These differences are principally:—Medical treatment of school children, £7,300; Gaeltacht school meals, £6,352; treatment of tuberculosis, £17,500; grants in connection with minor drainage schemes, £8,000. In addition there is a new heading included for the purpose of providing Irish-speaking nursing probationers in general nursing and midwifery. The total of the increase comes to about £40,000. The net increase in the Estimate is about £32,700. The reorganisation of the public health services is proceeding satisfactorily.
County medical officers of health have been appointed in 17 out of the 27 counties, and in Dublin County an appointment is at present under consideration by the local authorities. I should like this progress to be greater, but I want to be fully satisfied in urging the completion of the scheme that there is a sufficient number of suitable applicants coming forward possessing the requisite high, technical and administrative ability for the organisation of health measures. In the counties in which county medical officers of health are functioning the measures which have been taken are already gaining momentum, and there has been an immediate and gratifying appreciation of the functions and work of the county medical officers of health which is a testimony alike to the capacity of the men appointed to fill the positions and to the desire of the local authorities to see defects in our public health system remedied.
While on this subject, I may refer to the first Public Health Conference held by the Department last year. Practically every public health authority in the country sent delegates, and the gathering that assembled in the Mansion House was fully representative of both medical and administrative experience. The interest which the conference aroused and the practical nature of the discussions were most gratifying, and there can be no doubt that assemblies of this kind serve a most useful purpose in promoting an understanding of public health matters, not only amongst those engaged in public health administration, but amongst the population generally. I had intended to deal with housing and child welfare in June, but I have not yet abandoned the idea of dealing with the subjects this year. County institutions continued to be improved and rendered more efficient for the treatment of all classes of disease. Capital expenditure up to £60,000 was incurred for the purpose during the year. On the provision of water supplies and sewerage schemes there was an expenditure of £180,000 of which approximately one-half was in rural centres.
It is satisfactory to be able to record a further decline in the incidence of infectious diseases. The number of deaths in 1929 resulting from scarlatina was the lowest since 1918, being 62 as compared with 79 in 1928 and an aver-of 85 for the ten years covering the periods from 1919 to 1928 inclusive. Enteric fever or typhoid, has fallen in recent years, and the number of deaths registered in 1929 is the lowest on record, being 88 as compared with 94 in the preceding year, and 124, the average annual number for the decennial period 1919—1928. The prevalence of enteric fever in an area is to a certain extent an indication of a backward state of sanitary administration in the district, whether in regard to the provision of an adequate pure water supply, the lack of an efficient sewerage system or the general want of cleanliness. As our public health services progress local authorities will come to recognise in time that expenditure on the establishment of an efficient sanitation is real economy, and is amply repaid by the decreased outlay in controlling outbreaks of typhoid fever, not to speak of the saving effected in human life and suffering.
We have, however, to record an increased number of deaths from diphtheria. In 1929 the number was 79 more than in the preceding years. From a scrutiny of notifications received from counties, in 1930 the disease was more prevalent in the Counties of Tipperary, S.R.; Cork, Galway and Limerick, Louth and Wexford. The immunisation campaigns to which I referred last year have been carried out in Cork, Louth, Galway and Wexford. Striking results have already been obtained in reducing the mortality from the disease in the northern area of County Louth, where 1,500 children under six years of age were inoculated with toxin-anti-toxin during the Autumn of 1928 and 1929. The number of persons affected with diphtheria in that area fell from 84 in 1928 to 37 in 1929, and to 10 in 1930. It is hoped that equally favourable results will ensue from the other areas where immunisation is being carried out.
The mortality amongst infants for the year 1929 is somewhat higher than for the previous year, being 70 per 1,000 births as compared with 68 for 1928. Additional deaths in 1929 were chiefly due to pneumonia and bronchopneumonia as a result of influenza in epidemic form, and both urban and rural areas were equally affected. The death rate compared favourably with that in neighbouring countries, England and Wales showing 74 per 1,000 births; Scotland 87 and Northern Ireland 86. Statistics for 1930 which are to hand but are not yet checked in the Registrar-General's Office show that the mortality for 1930 has gone back and is even lower than the mortality amongst infants for 1928.
Maternity and Child Welfare schemes are being operated by 84 voluntary associations and 23 local authorities. The activity carried on by the nursing associations is the provision of a health visitor who is fully trained in medical and surgical nursing.
The provision of medical treatment for school children is developing satisfactorily. The service has greatly impressed the public mind, and is attaining rapid popularity wherever it has been initiated. Schemes have now become well established in Cork and Dublin County Boroughs, Clonmel Borough, and in the Counties of Cork, Kildare, Louth and Offaly, and are in process of development in Limerick and Waterford County Boroughs and in the Counties of Carlow, Cavan, Monaghan, Roscommon, Westmeath, Wicklow and Wexford Counties.
The examination of the most recent figures in respect of school medical inspection in the two county boroughs and four counties in which the service is well established, shows that in the course of a year's work 47,795 school children were examined. Of these 22,562 were found suffering from dental defects, 9,260 from enlarged tonsils and adenoids and 6,956 from eye trouble. The records of the cases treated are not yet complete, but the percentage is likely to be satisfactory. For one county the returns for last year show that the percentage of cases notified to parents of the poorer classes that underwent treatment was:
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For enlarged tonsils and adenoids
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70%
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For dental caries
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65%
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Eye trouble
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54%
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Improvement in the numbers treated will follow rapidly as parents observe the good results in cases where steps are taken to have defects remedied.
The school medical officers gladly acknowledge the whole-hearted cooperation and support which they receive from school managers and teachers. The sanitary conditions in a number of schools have called for attention and improvements have been effected in many instances. Managers have shown themselves anxious to fall in with the views of the school medical officers for the purpose of securing better hygienic conditions in the schools. It is often possible, on skilled advice, to provide, at a moderate expenditure, far more satisfactory lighting and ventilation, and to arrange for more suitable sanitary accommodation in connection with the school premises.
During the past financial year school meals schemes were established in Cootehill and Fermoy Urban Districts and Waterford County Borough, whilst 7 more urban district councils have provided in their estimates for 1931/32 for the cost of bringing schemes into operation.
The population of the county boroughs and of the urban districts in which school meals schemes are now in operation, or are to function in the forthcoming financial year, represents over 81 per cent. of the total urban population of the country. In Dublin County Borough, where meals are supplied, a daily average of 6,931 children received meals during the year ending 31st March, 1930, at a total cost of £11,603. The total number of schools participating in the year ending 31st March, 1930, in all the urban areas where schemes were in force was 163, as against 146 in the previous year, while the average daily number of children receiving meals was 16,828, as compared with 16,366 in the previous year.
The Education (Provision of Meals) (Amendment) Act, 1930, which became law on the 23rd December, 1930, enables the Commissioners of a town to be a local authority for the purpose of providing school meals. The authorities concerned were duly notified of the provisions of the Act on 13th January last, and the establishment of schemes suggested in districts where needed.
The Town Commissioners for Ballyshannon, Edenderry and Mullingar have already taken the necessary steps for bringing school meals schemes into operation.
As regards school meals for children attending National Schools, in the Gaeltacht schemes have been inaugurated by the boards of health. The total number of schools dealt with under the Gaeltacht School Meals Act was 329, and the number of children, 18,420. In Cork in five out of eight schools in the area a scheme has been introduced; in Galway 99 schools are being dealt with and 56 in Kerry. The adoption of arrangements under the Act in the case of Donegal and Mayo is deferred until the present financial year.
Approved schemes for the welfare of the blind are now in operation in all counties and county boroughs, except Cork and Mayo Counties and Limerick County Borough. Steps are, however, being taken to bring the standard scheme prepared by this Department into operation in Mayo County in the coming year. In Galway County, where a partial scheme has been in operation, the standard scheme will be brought into force in the coming year. The adoption of schemes in Cork County and Limerick County Borough is at present under consideration.
In the areas in which approved schemes were in operation during the year ending 31st March, 1930, blind persons to the number of 1,100 were afforded assistance in their own homes, whilst 212 were maintained in the approved institutions for the blind. The total number of blind registered under the schemes of the local authorities was 1,358 in that year.
Deputies will observe that there is a large increase in the provision made under the head of tuberculosis as compared with previous years. Tuberculosis schemes are now in force in every county and county borough, with the exception of County Longford. In several of the counties the schemes have been largely developed by providing for the treatment of persons in local sanatoria. Moderately advanced and advanced cases of the disease constitute a large majority of cases coming under the notice of tuberculosis officers. Most of these cases suffering from pulmonary tuberculosis are definitely infective, and if their home conditions do not permit of satisfactory isolation, or if suitable precautions are not observed, their presence in the same is a constant menace to the health of other members of the household, and especially of children. Hence the necessity for facilities for the segregation and treatment of such cases in institutions. It has been ascertained by experience that patients of this class will not readily undertake the long journey to a centralised institution situated far from their homes, or that if they do they will leave the institution after a comparatively short stay. On the other hand, they will avail of a sanatorium within convenient reach of their friends.
During the last 18 months local institutions have been opened or enlarged at Grianán an Chláir, Ennis; St. Brigid's Sanatorium, Portlaoighise; St. Teresa's Sanatorium, Ballinrobe; St. Patrick's Sanatorium, Collooney; Grianán Charmáin, Enniscorthy; Crooksling Sanatorium, Brittas; Woodlands Sanatorium, Galway; Glenties District Hospital, Carndonagh District Hospital, Donegal District Hospital. Local sanatoria or tuberculosis hospitals are now available for the residents of 15 counties and two county boroughs. In Kerry, Kildare and Meath it is anticipated that similar institutions will be in operation during the forthcoming financial year. In addition, in several other areas active steps are being taken with a view to securing premises suitable for conversion into sanatoria. Notwithstanding the extension of facilities for the local treatment of tuberculosis patients there has been no appreciable decrease in admissions to Peamount and Newcastle Sanatoria. The number of cases dealt with under approved tuberculosis schemes has increased from 15,719 in 1928 to 18,217 in 1930, an increase of nearly 16 per cent.
It is gratifying to record that the downward trend of mortality from tuberculosis previously observed has continued at an increasing rate during the year 1929, as evidenced by the returns supplied by the Registrar-General. These disclose that the mortality from all forms of the disease in that year represented the lowest rate yet registered in this country, 1.32 per 1,000 of the population. The actual number of deaths from the disease was 172 less than the previous year. The improvement is altogether accounted for by the reduction in the incidence of pulmonary tuberculosis, which was responsible for 190 deaths less than in 1928. The decrease in mortality was confined entirely to rural areas, where a reduction of 215 deaths took place, whereas in urban areas there was an increase of 43.
