There were just one or two other matters to which, in reply to criticisms on the Estimate for the Department of Local Government and Public Health, I should like to refer. One was the question of the treatment of tuberculosis. Deputy Dr. Rowlette and others asked a number of questions about the subject. I would refer Deputies to the Annual Report for 1933-34 of the Department of Local Government and Public Health in which, on page 93, a tabular statement sets out the incidence of tuberculosis and the rate of mortality of people from tuberculosis. At the end of the table there is a paragraph to this effect:
"As compared with the years 1912-14, the reduction in mortality from tuberculosis for all age periods together is 44 per cent. The greatest decrease—65 per cent. less than in 1912-14 — occurred at ages under five. The decrease in other age groups, as compared with 1912-14 was: five to ten years, 63 per cent.; 10 to 15 years, 61 per cent.; 20 to 25 years, 26 per cent.; and 25 to 35 years, 38 per cent.
The highest tuberculosis mortality rate in 1933 per 1,000 of the population were as follows:—Dublin County Borough, 1.80; Cork County Borough, 1.62; Louth County, 1.50; Dublin County, 1.48. The lowest rates were as follows:—Cavan County, 0.73; Monaghan County, 0.78; Roscommon County, 0.80; Waterford County, 0.81.
As set out in my opening statement, in the last period for which we have figures there has not been any change over the previous year.
The Department have a policy on the question of tuberculosis treatment and the officials have been examining the subject in consultation with the members of the Hospitals Commission for some months past. They have not elaborated in detail the plan that is being worked out between the Department and the Hospitals Commission, but Deputies might be interested if I gave them a rough outline of what is in mind. It may be useful from the point of view of getting criticism. I know that not every medical authority or medical expert on tuberculosis in the country is satisfied that everything that could be done is being done. I have heard criticism from time to time and have heard that people are dissatisfied, but unquestionably in the last 20 years very big advances have been made, and there has been a great improvement and a great reduction in the rate of mortality from tuberculosis. The treatment of people suffering from tuberculosis in the various sanatoria established all over the country has, in all probability, materially helped in the big improvement that is evident. This is a very rough outline of what is being discussed at present as the basis of a plan for dealing with tuberculosis:—
A person who is suspected or suspects himself of being affected by tubercular disease of some kind visits a central or branch tuberculosis dispensary. After examination, the tuberculosis officer classifies the patient as (a) early or moderately-advanced pulmonary T.B. case capable of cure or improvement; (b) surgical T.B. case of similar class; (c) observation case; (d) clearly advanced or chronic case for which no improvement can be expected; or (e) non-tuberculosis case.
The T.B. officer recommends cases classified as (a) and (c) for admission to a chest hospital where accurate diagnosis is made by X-Ray and observation, and any necessary surgical intervention is carried out. The patients are then drafted, according to their classification, either to a central sanatorium, where the most up-to-date treatment is available, or to the local tuberculosis institution for advanced and chronic cases. Cases needing major surgical operations from time to time are transferred from the sanatorium to the chest hospital when the operation is necessary.
The class at (b) are to be dealt with at an orthopædic centre, or, where minor surgery only is called for, they may first be admitted to a county hospital for the purpose, and subsequently transferred to the orthopædic centre, which is to be associated with an orthopædic school or instructional centre.
It will, therefore, be necessary for every applicant for treatment, whether for a first or subsequent course, to be drafted through a chest hospital for classification unless his clinical and physical symptoms are such as indicate that he has reached the chronic or hopelessly advanced stage of the disease.
The advance case hospitals at present used as local sanatoria are to provide bed accommodation for both pulmonary and surgical cases in the advanced stages.
The units required for the new tuberculosis schemes will be as follows:—(a) For each county and other district, central and branch tuberculosis dispensaries may be required; (b) a central chest hospital in Dublin, and a wing or block in regional hospitals so located as to serve conveniently groups of counties, etc.; (c) central sanatoria fully equipped to provide the most up-to-date treatment for early and moderately-advanced cases of pulmonary tuberculosis; these institutions to be so located as to serve conveniently groups of counties; (d) a central orthopædic centre or group of co-ordinated institutions to deal with surgical cases of tuberculosis—county hospitals to be utilised for minor surgery in such cases; (e) advanced case hospitals.
These proposals would probably require for efficient operation legislation to secure compulsory notification of all types of tuberculosis with power of compulsory removal to an institution and the retention therein of all tuberculous patients in an infective stage.
That would be for discussion at a later date, of course, but I thought it might be of interest to those who raised the question of tuberculosis and its treatment on the Estimate, and others outside who are interested in this question, to hear what we have in mind, even though what I have said now only gives a rough outline of the plan in mind.
Somebody spoke of the question of reform of county homes. That is a matter in which I am deeply interested myself, and I know that the officials of the Department have been doing all they can to try and improve county homes, and in some cases to carry the reform of county homes so far, you might say, as to blot out the county home as we know it, the old-fashioned institution, altogether. I should like to draw Deputies attention to an institution that has been in existence now for about three years outside Mallow —the Nazareth Home. I invite any Deputy who finds himself in the vicinity of Mallow, and who is interested in this subject, to visit the Nazareth Home and see how the old and infirm people are treated in that institution. That type of institution for the care of the old and infirm is to be commended, and recommended to every local authority which has charge of the old and infirm. I understand that the Meath Board of Health are arranging with the Nazareth Home nuns to set up a similar institution in their county, and I think other counties have discussed the matter also with a view to taking similar action. On the whole, the question of the reform of the county homes has been slow, and I would like to see greater progress made. Even where the boards of health do not wish to introduce this Order, or where for some reason or other there may be difficulties about it, they certainly could pay a visit to these institutions I have mentioned and see how they are run; they could observe the great improvement in the treatment and in the lives and health and appearance of the patients, and that, perhaps, would give them many a headline that would be useful to them even in the old county homes, such as they are, as long as they have to exist.
Deputy Daly of Cork mentioned the subject of waterworks and sewerage schemes, and I think he said, if my memory is not at fault, that there are 60 schemes ready for carrying out in County Cork. I hope that is true, but I am rather inclined to doubt if there would be anything like 60 schemes ready. Anyhow, whatever number of schemes are ready, they will be all welcome. The plans will be welcomed in the Department, where we are anxious and willing to help, not alone the boards of health in County Cork, but boards of health everywhere, to go ahead with their plans and schemes for waterworks and sewerage in every urban area in the country. I am hoping that in this financial year we will have a considerably increased sum available in the way of grants-in-aid for these waterworks and sewerage schemes, and I would invite local authorities, any of them that have been disappointed in the past with regard to grants—I do not think there have been many—again to take up the matter with the Local Government Department, and so far as we can we will assist them in getting their plans through rapidly, and we will assist them also with the usual generous grant for the purpose.
Deputy Rowlette contributed interesting and constructive criticism. He mentioned the subject of the unmarried mother and the illegitimate child. I think he may not be entirely aware of all that has been done already to help to deal with the problem. We have established in recent years special homes in County Cork, County Tipperary and County Westmeath, to deal primarily with the mothers of first-born illegitimate children. The important features in these homes are the ante-natal and maternity departments and individual attention is given to the mothers of the children. One of the lady inspectors is occupied almost wholly in dealing with this matter. I am happy to be in a position to assure Deputy Rowlette and other members of the House that everything that we can do to look after these unfortunate people is being done with all possible speed.
Deputies asked questions about their own counties and what arrangements were being made to deal with hospitalisation in their areas. I have not a complete return here, but I have some notes in relation to institutions in different counties, with the stage of advancement of hospitalisation of different kinds, and perhaps I could refer to some of these for the information of Deputies who asked questions on the matter. As regards works completed, we have Tralee county hospital and Mullingar county hospital. These two hospitals are completed. In the case of Tralee, it has been in operation for some time, and Mullingar will probably be in operation in the next week or two. Works have been completed on district hospitals at Kenmare, Ennistymon, Millstreet, Clifden, and also in the case of Swinford fever hospital. These are works that were financed very largely out of the Sweepstake Funds.
Work is in progress on county hospitals in Mayo, Monaghan, Ennis, Nenagh, Cashel and Mallow; on district hospitals at Ballina, Belmullet, Swinford, New Ross, Gorey, Charleville, Youghal and Midleton; and on fever hospitals at Ballina, Belmullet, Swinford, Abbeyleix and New Ross. Plans have been approved for county hospitals at Kilkenny, Sligo, Portlaoighise, Roscommon and Tullamore; for district hospitals at Killarney, Listowel, and Boyle; and for fever hospitals at Killarney, Listowel, Naas and Boyle. Other works in progress include the reconstruction of Carrick-on-Shannon workhouse for use as a county home for Leitrim; improvements at Thurles district hospital; the erection of a nurses' home at Kanturk hospital, and the erection of a maternity wing at the Home, Tuam. Extensive improvements to Dublin workhouse have been carried out and are still being executed. There are a great number of works contemplated and constant discussions and communications between the Department and the local authorities, boards of health, etc., have been proceeding.
A considerable amount of work has been done in the case of mental hospitals all over the country. Perhaps I had better read out a few notes on this subject. In the case of Ardee, a new mental hospital has been completed to accommodate 370 patients, with rooms for 16 nurses, a flat for the assistant medical officer, and a house for the resident medical superintendent. The approximate cost was £138,000, apart from the purchase of land. A new chapel is almost completed at a cost of approximately £5,000. In the case of Ballinasloe, a chronic block, a tuberculosis block, and an admission block to accommodate 387 patients and 26 staff are being constructed. The estimated cost is about £200,000. In Castlerea a new auxiliary mental hospital is being constructed to accommodate 450 patients. The estimated cost is £220,000. At Castlebar male and female wings to accommodate 331 patients are being constructed and there are various other improvements also being carried out. The estimated cost is £120,000. In Kilkenny the purchase of furniture and the installation of laundry machinery and equipment and the carrying out of various improvements were estimated to cost £41,000.
In the case of Killarney, an extension is being constructed to accommodate 132 patients, in addition to providing heating, dental surgery and laundry equipment, all at an estimated cost of £77,000. In Letterkenny a new chapel, a nurses' home, the reconstruction of an old chapel, etc., will cost £34,000. We are constructing an admission hospital at Limerick, together with male and female blocks and an isolation hospital to accommodate 310 patients. We are also constructing an assistant medical officer's house. Heating and lighting and various other construction work are being carried out. The estimated cost is £128,000. In Mullingar there is a male and female chronic block, and a hospital block to provide accommodation for 478 patients, together with a nurses' home and various reconstruction works in the kitchen, laundry and workshops. The estimated cost is £173,000. In Portlaoighise, furniture and equipment are being provided at an estimated cost of £8,000. Proposed works include accommodation for county home cases and modernising the sanitary annexes at an estimated cost of £64,000. In Sligo, a considerable sum is to be spent on additional buildings, heatings, lighting and a house for the resident medical superintendent. As regards other mental hospitals, we are in active consultation with the committees of these institutions with regard to improvements which will be put in hands at an early date.
I think it was Deputy Seámus Moore who asked about the fines for breaches of the Road Traffic Act. Almost 50 per cent. of the prosecutions were dismissed or disposed of without penalty, while a large proportion of the remainder was dealt with by imposing small fines. Of the 2,288 cases of using unlicensed vehicles, slightly over 25 per cent. of the convictions resulted in fines not exceeding 5/- each. Generally, the return indicates that the fines imposed are inadequate as a deterrent for this offence. That is the view of the Gárda Síochána, and it is the view of my Department with regard to the question of fines imposed for certain breaches of the Road Traffic Act.
One other point, before I sit down, and that is with regard to the Gaeltacht Order which Deputy Mulcahy raised on Friday. It seems to me—I may have got a wrong impression—that Deputy Mulcahy was displeased that I introduced my Estimate by speaking for some time in Irish. I do not know why that should displease him, or why he should be so cranky about it. He rather suggested it was to cover certain sins of omission or commission of a grievous kind to him in the work of my Department, so far as the use of the Irish language generally is concerned. I know Deputy Mulcahy is sincerely interested in the furtherance of the Gaelic language, but I thought it might not be unreasonable to expect that he would give others credit for a little sincerity, too. We are not always prating about it, but we try to do what we can in practice and by example as well as by precept. I think the Gaelic Order which the Deputy brought in during his period of office has done good. But in certain areas, with regard to certain individuals, I have found it practically impossible to carry it out to its fullest logical extent. There were several hundreds of people who came in under that Order and were appointed to posts in areas scheduled as Gaeltacht. During the last seven or eight years many of these did qualify in the time allowed, but a goodly number did not. There are a number of people of mature age, 50 or 60 years old, some of them in minor posts, who were subject to the Order but who failed to qualify and who never could qualify, and the question now for me is: am I to give an order that would mean the expulsion of these people from their position? I think there would be 300 of such people scattered all over the country, and I do not feel like doing that. I am as anxious as anybody else to see the language promoted and people encouraged to take it up, but I would like to be reasonable.
I have been discussing this question of the Gaeltacht Order with people in my Department for the last six months. I have not yet arrived at a solution of the difficult problem of those people who did not qualify and who could have qualified, but I hope to have something to offer as a sort of substitution for the Gaeltacht Order, and perhaps to improve on it in so far as it will be more workable and more practical and not in any way hurtful to the language. I think that is all I have to say at the moment.
