I move:—
Go ndeontar suim ná raghaidh thar £808,322 chun slánuithe na suime is gá chun íoctha an Mhuirir a thiocfaidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1941, chun Tuarastail agus Costaisí Oifig an Aire Riaghaltais Aiteamhail agus Sláinte Poiblidhe, maraon le Deontaisí agus Costaisí eile a bhaineann le Tógáil Tithe Deontaisí d'Udaráis Aitiúla, Ildeontaisí Ilghnéitheacha agus Ildeontaisí i gCabhair, agus muirearacha áirithe mar gheall ar Ospidéil.
That a sum not exceeding £808,322 be granted to complete the sum necessary to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1941, for the Salaries and Expenses of the Office of the Minister for Local Government and Public Health, including Grants and other Expenses in connection with Housing, Grants to Local Authorities, Sundry Miscellaneous Grants and Grants-in-Aid, and certain charges connected with Hospitals.
The Estimate makes provision for a net expenditure of £1,211,322. Grants for housing amount to £702,380 and for health services to £364,905 making a total sum of £1,067,285 for the social services included in this Vote. There is a net decrease of £138,522 in the Vote as compared with the previous year. This reduction mainly arises from the reduced provision for housing grants. A Housing Bill dealing with grants to private persons has been introduced under which a further supplementary estimate for housing may become necessary.
It may be said that the year 1939 was unfavourable to progress in constructional works. Since 1937 building costs were increasing and in many cases tenders were submitted on the basis of an increase in the amount corresponding to increases in the costs of materials or of labour during the currency of the contract. The position, therefore, did not tend to facilitate the carrying out of constructional works. Further, in the case of Dublin the conditions in the financial market were unfavourable to the raising of housing loans. With the outbreak of the European War in September the position became more difficult. It seemed doubtful at first if essential supplies would be obtainable while the difficulties in securing firm tenders for works increased.
Due mainly to the efforts made in previous years to organise our industries and to the measures taken to safeguard a continuance of such supplies from abroad as were essential to the carrying on of public works, the position became much easier towards the end of 1939.
The number of houses built during the financial year ended on the 31st ultimo was approximately 5,300 as compared with 6,932 in the previous financial year, 4,890 in the year ended 31st March, 1938, and 6,094 in the year ended 31st March, 1937. Of the 5,300 houses built last year, 3,060 were erected in urban areas and 2,240 in rural districts. The reduction in the number of houses erected was mainly in Dublin City. The actual number of houses erected by the Corporation of Dublin in the past year was 1,341 as against 2,336 in the previous financial year. The year 1938 was a record year for house production in the City of Dublin.
If the number of houses built in Dublin in 1939 happens to be smaller, there need to be no pessimism. Even under adverse conditions we must endeavour to maintain the enterprise and effort which characterised the year 1938. The problem is too great to be allowed to assume a passive form. The committee appointed to investigate all aspects of the housing problem is likely to make a report within the next few months and with the information which will then be available the local authority should be in a position to formulate a definite financial and building policy which in turn should facilitate the building and allied industries in organising production in a manner that will secure the most economical execution of future housing schemes.
Since September last 750 new houses in Dublin have been placed under contract at prices that compare favourably with costs prevailing in 1937. Recent tenders received for the erection of flats at Railway Street also show a reduction on both 1937 and 1938 costs. There are at present 1,145 houses in progress.
In the County Boroughs of Cork, Limerick and Waterford progress in housing is satisfactory. The Cork Corporation recently completed 206 houses. There are 242 houses in course of erection, of which about one-half will be used for the rehousing of persons residing in unfit houses. Proposals for the erection of 240 houses are being considered. In Limerick contracts have recently been entered into for 366 houses. In Waterford the number of houses under construction is 96.
Up to the 1st of March, 1940, the amount of money advanced to local authorities for the provision of houses subsidisable under the Act of 1932 was £17,704,808. Of this amount £9,941,996 was advanced from the Local Loans Fund and the balance £7,762,812 was raised by the issue of local stock or borrowed from insurance companies and banks.
The preliminary statistics of the housing conditions of the people have recently been published in the Irish Trade Journal and Statistical Bulletin. They indicate a great improvement in housing throughout the country. A remarkable change is observable in the percentage of persons in families living more than two persons per room in 1936 as compared with 1926. In Kerry County the percentage of persons in families having more than two persons per room fell from 36.5 to 25.8 and in Mayo from 41.7 to 29.7. In the review of general housing conditions in the Trade Journal it is pointed out that since 1926 there has been a marked decrease in the number of persons in private dwellings with less than four rooms and a corresponding increase in the number living in dwellings with four or more rooms. There is nothing so detrimental to health as overcrowding and the change in conditions over the period 1926 to 1936 is very encouraging.
Another remarkable feature of the statistics is the increase in the numbers of private families of one, two, three, four and five persons and the decrease in the numbers of families of six persons and over for the whole of the country. The highest increase in the number of families took place in families of two persons throughout the country, but in Dublin City and County for which separate statistics are given there was an increase in the number of families of all sizes. The number of families increased by 24,694 in the whole of the country, and of that number 18,702 were families in Dublin City and County.
Housing conditions as they existed during the period 1926-1936, have been improved still further since the census was taken. During the ten years ended 31st March, 1936, there were 50,756 new houses built and 5,952 houses reconstructed. In the four subsequent years there were 38,329 new houses built and 18,613 houses reconstructed, reflecting an improvement in conditions of the same extent as took place between the years 1926 and 1936.
There was a decline in the average size of the family. The decline was greater on the average for the whole of the country than for Dublin City and County. For the whole of the country the percentage decline was 3.8 as compared with 0.7 for Dublin City and County. The marriage rate in 1939 was 5.18 per 1,000 of estimated population as compared with 4.48 for the year 1930.
The evidence shows that generally in the rural areas there has been a very great improvement made in housing conditions, and in present circumstances local bodies would be well advised to examine very closely any future schemes for additional cottages, and only adopt proposals that are of an urgent nature and intended to remedy housing conditions that cannot otherwise be improved.
It would not be inopportune on this occasion to remind urban authorities of their powers to secure the reconditioning of houses which are structurally sound but lacking proper sanitary accommodation. Sometimes I am inclined to think the provision of new houses has been allowed to overshadow the need that exists for keeping houses that are still habitable in proper repair. Unless proper attention is given to this matter the rapid deterioration of existing houses quickly brings them into the category of houses unfit for human habitation, thereby casting upon the local authority an extended liability for their replacement by new dwellings. Legislative provision was enacted in 1937 dealing with this aspect of the housing problem and grants up to a maximum of £40 are obtainable from the Government. Practically no action has been taken so far by any local authority to avail of the powers conferred by the Act of 1937. It would repay urban authorities to examine the position in their area and see how far houses that are defective by absence of proper ventilation, sanitary accommodation or sufficient light can be reconditioned and made fit for habitation within reasonable expenditure. By doing so it should be possible to postpone for several years the heavy expenditure that the provision of new houses entails.
Many complaints reach the Department from time to time regarding the letting of new houses by local authorities. These complaints usually allege that houses, particularly in the case of labourers cottages, are not given to those most in need of housing accommodation. The Regulations under the Act are intended to secure that preference in lettings will be given to families living in condemned houses and families where some of the members are suffering from tuberculosis. Local authorities must see that these Regulations are strictly complied with.
The purchase schemes in force under the Labourers Act, 1936, relate to 51,680 cottages and applications for purchase have been received by the boards of health and public assistance from the tenants of over 6,000 cottages. One board have vested their cottages in the qualified applicants and many others are almost in a position to vest.
The delay in vesting was due to the difficulties encountered by the boards owing mainly to the loss of local records in tracing their title or the title of their predecessors, the former Rural District Councils, to the site on which the cottages were erected. Following representations made by the Department, the Registrar of Titles made the minimum demands as to the evidence required by him to enable registration of title of plots which were previously unregistered. To facilitate the Registrar in identifying these plots the boards were instructed to prepare duplicate sets of maps of their cottages and plots marked with the identifying particulars of each cottage included in the scheme in force.
Purchase schemes have been prepared and submitted by 20 boards in relation to 4,297 cottages which were provided and occupied subsequent to the preparation of the scheme in force. In addition to these schemes, amending schemes have been prepared and submitted in relation to 612 cottages which had not been purchased on the terms of the schemes in force. Of these schemes 597 related to cottages to which, following representations received from the boards, as to alterations in rentals, etc., the consent of the Minister was obtained to the making of new schemes. In the remaining 15 cases the boards concerned were directed to prepare and submit new schemes owing to alterations in the rents following changes in the tenancies of the cottages.
I will deal with the position in regard to houses erected by private persons when the new Housing Bill is under consideration. Closely connected with the improvement in housing throughout the country is the state of the public health. The public health services are developing gradually each year and considerable progress has been made in their reorganisation throughout the country. Sanitary services such as water supplies, sewerage systems and disposal of house refuse are being improved and extended and a higher standard of public sanitation is being attained.
Definite progress has been made in combating infectious disease. It is permissible to judge the general improvement in sanitation which has been achieved by the effect on the incidence of infectious diseases so far as these are preventable. The vital statistics for the year 1939 are at present only provisional and may be subject to slight modifications, but they are on the whole of an encouraging nature. In this connection it is to be noted that the incidence of influenza is a disturbing factor. The numbers of deaths from that cause for the last four years have varied considerably. In 1936, the number of deaths was 683; in 1937, 2,772; in 1938, 702; and in 1939, 1,045; while the average for the ten years 1929 to 1938 was 1,300. In 1938 there were 343 more deaths attributed to that cause than in 1939. If deaths from influenza are excluded the total number of deaths from the principal infectious diseases in the year 1939 would be 454 as compared with 589 in 1938, and 668 in 1937. It may be claimed that the lowest mortality on record from these diseases was registered in 1939.
As regards the individual infectious diseases the year 1938 was the first year in which there had been no death from or outbreak of typhus fever in this country since the Infectious Disease (Notification) Act, 1889, came into operation. As far as the districts in which typhus had been endemic for a considerable number of years are concerned the same record continued in 1939, but in one of the eastern urban areas an outbreak of the disease occurred involving five cases in two families. The virulence of the outbreak is indicated by the fact that of five patients attacked three succumbed. The source of the outbreak is doubtful, but it is a tribute to the energy and efficiency of the local medical service that the disease was so promptly diagnosed and dealt with that it did not extend beyond the two families immediately attacked.
As regards typhoid fever there was a slight increase in the mortality in 1939, when 54 deaths were registered as due to that cause as compared with 46 in 1938. The latter figure was the lowest on record and the increased mortality in 1939 was due to a serious outbreak of the disease in Kerry County, which resulted in nine deaths. The number of cases notified in 1939 showed a considerable increase mainly due to the same outbreak being 398 as compared with 268 in 1938. There were, however, 37 urban districts and 93 rural districts in which no cases were reported.
The number of deaths from diphtheria showed a definite decline being only 241 in 1939 as compared with 314 in 1938, and is the lowest number recorded since 1928. The number of cases notified was 2,097 as compared with 2,983 in 1938, and is the lowest number recorded since 1930, from which year notification of infectious diseases has been more efficiently organised. There were 13 urban districts and 46 rural districts in which no cases were reported. Approved schemes of immunisation against diphtheria have doubtless had an effect in bringing about this satisfactory reduction in the incidence of the disease. The number of children immunised in 1938 was 31,393, being a substantial increase on the number immunised in 1937, viz., 18,545. Approved schemes of immunisation operated to some extent during 1938 in the four county boroughs, in 15 county health districts and in 13 urban districts. The total number of children who received immunising injections from 1st January, 1931, to 31st December, 1938, totalled 254,153. The remuneration to be paid to medical officers of health for work under immunisation schemes has not yet been agreed, but negotiations on the subject are proceeding with the Irish Medical Union.
The decline in the incidence of scarlet fever still continues. The number of notifications for 1939 (2,779) shows a decrease of 1,213 cases as compared with the figure for the previous year. There were 42 deaths from the disease in 1939 as compared with 81 in 1938, a decrease of 39 deaths.
The incidence of scarlet fever, although gradually declining, is still high, the number of cases of the disease notified during the period under review being 797 above the number notified in 1930, but due account must be paid to the more efficient organisation of notifications since that date. The number of cases which occurred in rural areas in 1939 was 1,256, whilst the urban incidence was 1,523. Notwithstanding the comparatively high prevalence of the disease, its fatality remains low. Its mortality has not varied very widely in recent years but reached in 1939 the lowest figure since 1930 in which year the number of deaths registered was one less than in 1939. The fatality rate of the different communicable diseases varies from time to time, and the position that any one disease occupies as a destroyer of life at a particular time or place may vary considerably from that which it previously occupied, or may occupy at some future period.
Measles being compulsorily notifiable in only a few urban areas, it is not possible to give an accurate return of its incidence, but it is pleasing to be in a position to record a very distinct drop in the mortality figures for 1939 from those for 1938. The number of deaths from measles during 1939 was 83, compared with 102 in 1938. The average number of deaths from this disease during the five years preceding 1939 was 165, and the figure for the period now under review is almost half of that average. This reduction in mortality is most encouraging, when it is realised, that next to whooping cough, measles is one of the most fatal of all infectious diseases of infancy. The mortality from measles has always been regarded as being influenced by overcrowding, and to the admittedly improved housing conditions, now met with in our towns and rural districts, must to a certain extent be ascribed the reduction in the death rate from this disease.
Deaths from cancer, which had been steadily increasing in recent years, showed a welcome reduction in 1939, when 3,579 deaths were registered from the disease as compared with 3,703 in 1938. The average for the five years 1934 to 1938 was 3,582. The investigations of the Provisional Cancer Council which was set up to investigate and report on certain aspects of the causes and incidence of this disease have been very much curtailed owing to the international situation.
Much attention has been devoted in recent years to the question of removing as far as possible the preventable dangers attendant on childbearing, and of safeguarding the health of mothers during their period of pregnancy and confinement. The object aimed at is to reduce the incidence of puerperal diseases and to obviate accidents of pregnancy and childbirth which levy so great a toll on maternal life or result in long periods of illness and incapacitation. It is encouraging to note that a gradual improvement in this respect has already been achieved, and that with occasional variations the maternal death rates have shown a downward tendency during the past 10 years. In 1939 the mortality attributed to puerperal sepsis reached a new low record in 31 deaths as compared with 46 in 1938, and an average of 78 for the decennial period 1929 to 1938.
There was a further reduction in infantile mortality in 1939. The rate was 65 per 1,000 births registered as compared with 67 in 1938; 73 in 1937; and 74 in 1936. The lowest record hitherto attained was in 1934, when a rate of 63 per 1,000 births was regisfered. In the County Boroughs of Dublin, Cork, Limerick and Waterford the latest figures available for infant mortality are those for 1938, and these show an improvement on the figures recorded for 1937, in the two largest county boroughs as follows:—
1937 |
1938 |
|
Dublin C.B. |
102 |
96 |
Cork C.B. |
103 |
71 |
Limerick C.B. |
68 |
70 |
Waterford C.B. |
97 |
99 |
With the development of maternity and child welfare schemes and improved housing conditions it is hoped to reduce infant mortality progressively in these areas.
The school medical inspection schemes, which are in operation in every county and county borough, continue to progress. They have been found to be invaluable in the matter of the detection of defects in children at an early stage which if left untreated would, in many cases, undoubtedly develop into permanent incapacity. The expenditure per child is inconsiderable and ensures an improvement in health, happiness and efficiency for the individual and cumulatively for the community in general.
The ailments found in children after examination by the school medical officer, and for which the necessary treatment is provided, are usually ordinary ailments of the teeth, eyes, ear, nose and throat and defective tonsils and adenoids. In some cases exceptional ailments or defects are found, treatment for which, if not within the scope of the school medical service schemes, is provided in the case of necessitous persons in the county and general hospitals. In other cases the parents are referred to their private practitioners.
School children are instructed by the school medical officer and nurse to look after their bodily health, and "follow-up" inspections are made by the nurse and in special cases by the school medical officer. Literature on various subjects pertaining to the children's health is distributed in many districts and tonic medicines are issued on the instructions of the school medical officer, especially in cases of malnutrition.
Generally speaking, there are no distinguishing features in the matter of defects in the health of the children as between one district and another except that there is a prevalence of goitre amongst children in one district which is stated to be due to the water supply. The matter is the subject of investigation by the county medical officer of health.
As evidence of the gradual extension of the schemes it is of interest to note that whilst in 1929 there were 147,300 children on the rolls of elementary schools in districts in which approved schemes were in operation, the corresponding number for 1938 was 469,925. There were 130,500 children examined in 1938. The numbers of defects ascertained were as follows: Dental, 56,759; diseased tonsils, etc., nose and throat, 25,118; eye defects, 17,812. The numbers treated were: Dental, 42,473; diseased tonsils, etc., nose and throat, 7,591; eye defects, 16,179.
Under the school medical service it has been possible to a certain extent to investigate the prevalence of malnutrition amongst school children. The following extracts from reports of two county medical officers of health indicate the result of their investigations:—
1. "..... there were 534 malnourished children out of a total of 4,481 examined, i.e., 11.9 per cent. This is a slight increase on last year's figure (10.9 per cent.) Of the above 534 cases of malnutrition, there were only 67 of marked degree requiring treatment. The remaining 467 were classed as moderately undernourished or for observation. Thus the actual percentage figure for severe malnutrition is 1.5 per cent., practically the same as last year's figure (1.6 per cent.). As already remarked, the majority of the children classified as undernourished are kept under observation for some months and cod liver oil and malt are generally prescribed. The value of clean milk as an addition to the child's dietary is always stressed in the talks to parents at the school examination."
2. "Malnutrition does not necessarily imply insufficient feeding; more common factors in its production are unsuitable food and general unhygienic methods of living, such as overcrowding. There can be no doubt that the institution of school meals, as already discussed, is of enormous benefit in connection with the prevention of this condition.
"Printed advice is conveyed to the parents of all children noted at school medical inspection as suffering from malnutrition. Needless to remark, it is only too often one sees that tea and white bread form a large part of the dietary of the rural community. At the moment, however, effort is being made to teach the people to appreciate food values, and the value of good cooking. The Government is very much alive to the situation, and throughout the country numerous vocational schools are provided. In there schools domestic economy and cookery are taught, and girls are trained in the art of cooking. As time marches on, and as the children of to-day are the men and women of to-morrow, it is obvious that the training our girls receive under vocational education schemes will have a very far-reaching effect in the future. The homes will be better, the dietary will be better, the cookery will be better and, in general, we may look forward to a brighter era as far as nutrition is concerned."
School meals are provided in four county boroughs, 41 urban districts and seven towns under town commissioners. The meals are provided in 214 national schools. For the year ended 31st March, 1939, the average weekly number of children in receipt of meals was about 29,000. The total number of meals provided was approximately 5,000,000. School meals are also provided in rural areas of the Gaeltacht by the board of health for West Cork and by the boards of health for the counties of Galway, Donegal, Kerry and Mayo. The total number of meals provided in the last financial year was approximately 2,600,000. In the majority of districts the school meal consists of milk or cocoa with buns or bread and butter or jam. Local authorities have been advised from time to time to make milk of a special designation, so far as it is available at a reasonable price, the basis of the school meal. The importance of milk as an article of food cannot be too strongly stressed. For young children especially it is an essential part of diet.
The arrangements for the supply of free milk, for which a sum of £90,000 is provided in this Estimate, were continued during the year in urban and rural areas with the exception of two urban districts in which the councils again declined to co-operate on the grounds that the amount allocated for their districts was inadequate. The conditions governing issues from the grant were the same as in previous years. The allowances of milk are limited to children under five years whose parents and guardians are in receipt of assistance or are unable to provide from their own resources an adequate supply of milk for children of this age. The value of this scheme continues to be highly reported upon by county medical officers of health.
There was a scarcity of suppliers of milk in some of the rural areas in Donegal, Galway, Kerry and Mayo. In these areas the issue of supplies of dried milk powder was resorted to as a temporary measure so as to obviate as far as possible any hardship on the children eligible for a supply of free milk.
The administration of the Milk and Dairies Act, 1935, was, on the whole, satisfactory during the year and active steps were taken by sanitary authorities in general to ensure that the requirements of the Act and the regulations thereunder were complied with. Legal proceedings were successfully instituted in many cases. During the year 164 orders refusing registration under the Act were made by sanitary authorities. Formal appeals against these orders were received in six cases. In every case the appeal was disallowed after investigation of the circumstances. Applications for consent to the cancellation of registration under the Act were received in 12 cases. Consent to the making of two cancellation orders was given, and in one case consent was refused. In the remaining cases the dairymen took steps to comply with the necessary requirements, and the sanitary authorities decided not to proceed with the making of cancellation orders.
Schemes for the treatment of tuberculosis are in operation in each county and county borough. There has been a slight increase from 2,498 deaths from pulmonary tuberculosis in the year 1938 to 2,574 in 1939, but a decrease from 718 deaths from non-pulmonary tuberculosis in 1938 to 633 in 1939. The figures for 1939 represent a rate of 0.9 per 1,000 population in respect of pulmonary tuberculosis and 0.2 in respect of non-pulmonary tuberculosis, making a total of 1.1 per 1,000 of the population for all forms of tuberculosis, which is a small increase on the rate of 1.09. The progressive development of institutional treatment of all types of tuberculosis on modern lines is proceeding throughout the country.
During the year there was further progress made with waterworks and sewerage schemes in urban districts and in towns in county health districts. Grants from the Employment Schemes Vote were allocated towards the cost of 35 schemes undertaken by local authorities, involving a total expenditure estimated at £250,000.
In the year 1938 the deficits in the accounts of voluntary hospitals amounted to approximately £115,000, showing a substantial increase over the preceding year. The total amount of deficits has increased by £65,000 since the year 1933, and the matter has now become one of serious import by reason of the growing demands on the Hospitals Trust Fund.
In the past three years the Hospitals Commission has drawn special attention to the trend of rising expenditure, and on more than one occasion it was necessary to exhort the voluntary hospitals to exercise a greater measure of internal supervision with a view to reducing working costs. Further suggestions to this end were made in September, 1939, which if closely followed should help to arrest the growing excess of expenditure over income. As pointed out on previous occasions, an increase in endowment reduces the amount available for the provision of new hospitals.
The Hospital Library Council set up in 1937 have rendered very valuable service in the administration of the library service for hospitals. I would like to pay a special tribute to the chairman, Father Browne, S.J., and his colleagues on the council and their secretary. Seventeen additional hospitals were registered during the year, bringing the total number to be served with books to 74. The service is very much appreciated by patients. In 1939 over 6,000 books were issued.
During the year grants amounting to £5,000 were made to the Medical Research Council out of the Hospitals Trust Fund. This sum was part of a grant of £25,000 which is payable over a period of five years in accordance with arrangements made with the Council in 1938. The grants so far paid to the council amount to £17,500. A number of Grants-in-Aid and awards have been made to research workers who are carrying out investigations into various medical problems. A special investigation into the causes of goitre is being made.
Full particulars of the collection of revenue by county councils at the 31st March are not yet available. The general financial position of these bodies at the end of the year was satisfactory with the exception of four councils which failed to collect sufficient revenue to discharge before the close of the year temporary overdrafts obtained for the purpose of meeting current liabilities.