I move:—
Go ndeontar suim ná raghaidh thar £962,958 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, 1943, chun Tuarastail agus Costaisí Oifig an Aire Riaghaltais Aiteamhail agus Sláinte Poiblidhe, ar a n-áirmhítear Deontaisí agus Costaisí eile i dtaobh Tógáil Tithe, Deontaisí d'Udaráis Aitiúla, Ildeontaisí Ilghnéitheacha agus Ildeontaisí gCabhair, agus muirea racha áirithe mar gheall ar Ospidéil.
That a sum not exceeding £962,958 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, 1943, 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 for the Department of Local Government and Public Health in the present financial year makes provision for a total expenditure of £1,461,479, as compared with a gross estimate of £1,359,699 for last year. In 1931-32 the total actual expenditure from the same Vote was £517,517. Of the amount to be provided for the current year, 88 per cent. is in respect of grants for social services. The Dáil, accordingly, may be interested in comparing this year's provision for the more important of these grants with the corresponding figures for the year 1931-32.
Under sub-head J (1), there is provided for child welfare schools for mothers, etc., £26,000 for the current year, compared with £23,133 for 1931/32. Under sub-head J (2), for grants for the supply of milk to necessitous children, there is this year provided £90,000 as against nothing in 1931/32. Under sub-head J (4), for grants towards the supply of assistance in kind to recipients of home assistance, there is asked in the current year £200,000 as against nothing in 1931/32. Under sub-head K, for medical treatment, etc., of school children, there is asked a sum of £33,000 for the current year as against £16,592 for 1931/32. Under sub-head L (1), for grants under the Education (Provision of Meals) Acts, we are asking £27,000 for this year as against £8,019 for 1931/32. Under sub-head L(2) for grants under the School Meals (Gaeltacht) Acts, £10,000 is being asked this year as against £5,169 for 1931-32. Under sub-head M, for the welfare of the blind, we are asking £7,460 this year as against £7,526 for 1931/32. Under sub-head N, for the treatment of tuberculosis, we are asking £161,750 for this year as against £110,483 for 1931/32. Under subheads S (1), and S (2), as a contribution towards loan charges under the Housing Act, 1932, and grants under the Housing Acts, 1931 to 1941, we are asking £664,000 for this year as against £241,994 for 1931/32. For the Acquisition of Land (Allotments) Act, 1934, we are asking £24,500 for this year as against nothing for 1931/32. The total provision, therefore, under all these sub-heads, which is required for 1941/42 is £1,243,710 as against £412,916 for 1931/32.
I should, perhaps, also mention in this connection that, in addition to the social services covered by this Vote, there are very substantial sums provided for like services in the Votes for National Health Insurance and Widows' and Orphans' Pensions, which I shall also move. Including the Supplementary Estimate recently introduced, the total amount asked for these two services is £779,556 as against £309,917 for 1931/32.
To sum up, it may be said that under all the Votes for which the Minister for Local Government and Public Health is responsible, the total amount to be provided this year, mainly to ensure the health and social well-being of the people, is £2,255,266 as against £857,246 in 1931/32.
The increase of £100,089 in the main Vote for this as compared with last year is in the greater part attributable to the provision of grants to public assistance authorities to meet the cost of special food allowances granted to the necessitous poor over and above the amount of assistance which they might normally receive. In view of the charges which are sometimes made, that there has been an undue expenditure on salaries and staffs, it may not be out of place to remark that under this head the present Estimate shows a saving of £1,547 as compared with last year, notwithstanding the fact that the number of demands, of one abnormal kind or another, on the services of the Department, has greatly increased, due to the difficulties created for the community by the emergency.
It has been customary in moving the Estimate for the Department of Local Government and Public Health to review the state of the public health, and on this occasion I propose to follow that course. Any vital statistics for the year 1941 which I may quote, I should emphasise, are as yet provisional and may be subject to some slight modifications or adjustments.
During 1941 the Public Health (Infectious Diseases) Regulations which make certain diseases compulsorily notifiable were amended and extended with a view to securing fuller information regarding the incidence of the various infectious diseases and providing more effective machinery for their control and prevention. The amended regulations were made on the 29th May, 1941, and came into operation on the 1st July last.
The principal infectious diseases which were compulsorily notifiable prior to July, 1941, were typhus, typhoid, scarlet fever, diphtheria and puerperal sepsis. Amongst the principal infectious diseases to which compulsory notification has been extended are cerebro-spinal fever, dysentery, measles, whooping cough and trachoma. The amended regulations also confer increased powers upon medical officers of health in dealing with typhoid carriers employed in any trade or business concerned with the distribution or handling of food or drink for consumption.
As regards the principal infectious diseases which were compulsorily notifiable throughout the whole of the year 1941, viz., typhoid, typhus, scarlet fever, diphtheria, and puerperal fever, there was a decrease in the aggregate mortality as compared with 1940, the total number of deaths in 1941 from these diseases being 261 as compared with 273 in the previous year. During the quinquennial period 1936 to 1940, there was an annual average of 475 deaths, and, as compared with the year 1936, the mortality in 1941 showed a reduction of 62 per cent. The number of cases in 1941 shows a reduction of 50 per cent. when compared with the year 1936.
The number of deaths from all causes registered in 1941 was 43,823, or 1,938 more than in the preceding year. The death rate per 1,000 of the population for 1941 was 14.7 as compared with 14.2 for 1940. The general death rate, of course, is naturally affected by many factors, and consequently fluctuates within fairly wide limits from time to time. For instance, for the ten-year period 1931-40, the lowest rate recorded was 13.2 per 1,000 of population in 1934, while three years afterwards, in 1937, the rate of 15.3 was recorded.
The steps taken in recent years by local authorities to combat diphtheria have been effective in reducing its incidence and the mortality due to that disease. The total number of cases reported for 1941 is 1,447, which is the lowest on record since notification of infectious diseases became fully organised. The peak figure was recorded for 1933, but the incidence as from that year shows an almost continuous decline, the number of cases in 1941 being less by 444 than in 1940, and by 963 when compared with the average annual number for the quinquennial period 1936 to 1940. As compared with the peak figure of 1933, the decrease in 1941 amounted to 57 per cent. The mortality from the disease in 1941 was 163, showing not only a reduction of 15 on the figure for 1940, but a decrease of 41 per cent. on the annual average for the quinquennial period 1936 to 1940, which was 275.
In conjunction with arrangements which were being organised for the evacuation of portion of the population resident in Dublin and Dún Laoghaire in the event of an emergency, special immunisation schemes were carried out in these areas during the months of May and June, 1941. 50,604 children received the full course of two injections and 7,733 attended for one injection. Later in the year as a further protective measure immunisation schemes were carried out in the areas intended for the reception of evacuees. These areas included in whole or in part the countries of Carlow, Kildare, Kilkenny, Laoighis, Leitrim, Longford, Meath, Roscommon, Westmeath, Wexford and Wicklow. So that, over a wide part of the country a general immunisation service has been provided.
Statistics for the incidence of scarlet fever also show a decline. The number of cases notified in 1941 was 2,318 or 147 less than 1940, while the average annual number reported for the quinquennial period 1936 to 1940 was 3,816. The mortality from this disease is comparatively slight, being only about 2 per cent. of the reported cases. The total number of deaths reported in 1941 was 32.
The protection of mothers during and immediately after their confinement has in recent years received considerable attention in conjunction with maternity and child welfare schemes, and it is extremely gratifying that the mortality from puerperal fever has shown a steady decline in recent years. The number of deaths in 1941 was 23, and is the lowest yet recorded, being six less than the number for 1940, and 81 less than the number for 1936.
Measles is an ailment of childhood which is regarded as practically unavoidable, and therefore, unfortunately very often does not receive the attention that it deserves. The death rate from this disease varies considerably. The number of fatal cases in 1941 was 87, being 10 more than the number returned for 1940, but, at the same time, was only one-half the average annual number of deaths for the period 1931 to 1940. Under the amended Public Health Regulations measles is now a notifiable disease, and we may hope that with greater care and attention its menace to child life will be considerably lessened in future.
Whooping cough has usually been regarded in the same light as measles, but it has proved even more dangerous to children. It is also marked by recurrent epidemics. The average annual mortality due to it during the decennial period 1921 to 1930 was 365. In the decennial period 1931 to 1940 this fell to 215, while for the year 1941 the mortality further declined to 145. This disease is also compulsorily notifiable.
The number of deaths from cancer in 1941 was 3,613, which shows a slight decrease as compared with the previous year, when the number was 3,773. The deaths in 1941 are the lowest since 1936. The provisional Cancer Council which was set up to investigate and report on certain aspects of the causes and incidence of the disease has been obliged to suspend operations owing to the difficulties of obtaining information as to the methods, etc., of treatment in other countries.
The incidence of influenza varies considerably from year to year. In 1941 the number of deaths attributed to the disease was 1,321 as compared with 828 in 1940. The most serious outbreak during the past ten years was in 1936, which resulted in 2,772 deaths. The number of admissions to mental hospitals has fallen in the past few years. At the 1st of April the number of patients was 464 less than on the 31st December, 1938, and if allowance were made for the number of mental defectives transferred to one hospital from a county home during that period the reduction would be about 620.
It will be noted that increased provision is made in the Vote for the treatment of tuberculosis, in the mortality from which there was a slight reduction in 1941 as compared with 1940, though the number of deaths was still higher than the number for any of the previous years back to 1935. While mortality, due to tuberculosis, is distressingly high, a considerable improvement has taken place in all age groups over the past 20 years. The analysed figures for 1941 are not yet available; but we have them for 1940. In that year the number of deaths due to pulmonary tuberculosis in the age group under five was 20, as against averages of 66 and 37 per annum for the five-year periods 1924-1928 and 1934-1938, respectively. Thus, in this age group in 1940, there was a decrease in mortality of 70 per cent. as compared with the average over the five-year period 1924-1928. Similarly, in the age group five to 15 years, deaths from pulmonary tuberculosis in the five-year periods 1924-1928 and 1934-1938 averaged 141 and 76, respectively, as compared with 62 in the year 1940, showing a reduction in mortality of 56 per cent. on the average for the five-year period 1924-1928. While we must not accept the figures with any degree of complacency, it is gratifying that they do indicate that there has been a distinct reduction in the mortality from pulmonary tuberculosis during the childhood period. The reduction is more pronounced for the age group under five years and is largely due to child welfare activities, to more active search for child contacts with tuberculous patients, and the early treatment of such cases.
The non-pulmonary form of the disease is more prevalent amongst the younger age groups than is the pulmonary. But even in the case of non-pulmonary tuberculosis the age group under five years shows a decreased mortality, the number of deaths being 140 in 1940, as against an annual average of 216 for the five-year period 1924-1928, and of 163 for the five-year period 1934-1938. For the age group five to 15 years the mortality in 1940 was 143, as against a yearly average of 180 in the five-year period 1924-1928, and of 136 in the five-year period 1934-1938. There are four special institutions with an aggregate of 395 beds for the treatment of sufferers from non-pulmonary tuberculosis, and a considerable number of beds is also available for the treatment of non-pulmonary cases in the general and county hospitals.
The increase in mortality from tuberculosis in 1940 is mainly attributable to the age group 15 to 65 years, and within this age group the heaviest toll is from those sufferers who range between 20 and 35 years of age. It is generally accepted that the incidence of the disease would be considerably reduced if isolation of all infectious cases could be effected; but here the difficulty has to be faced that in general advanced cases are reluctant to go to hospitals far removed from their homes. This aspect of the problem has been mitigated by the establishment in recent years of local sanatoria for the hospitalisation of advanced cases. Prior to 1922, in addition to about 1,200 beds in existing hospitals, there was only one special institution available for advanced cases. There are now local tuberculosis institutions or special bed accommodation in 19 counties and in three county boroughs. The local authorities in the remainder of the counties have been urged to provide similar institutions, but have failed to do so.
The total number of beds in special tuberculosis institutions for advanced and moderately advanced cases is now 634. There are also 119 beds reserved for the purpose in institutions in three other counties. For early treatment of the disease, sanatoria exist at Peamount and Crooksling in County Dublin, at Heatherside, County Cork, and at Newcastle, County Wicklow, in which institutions there is a total of over 800 beds. In addition a considerable number of beds in general county and district hospitals are available for tuberculous patients as and when required.
The provision of further general facilities for the institutional treatment of tuberculosis is unavoidably held up owing to the falling off in receipts from Sweepstakes and the necessity of capitalising the greater proportion of the Hospitals Trust Fund to meet the deficits of voluntary hospitals. Thus, for example, though the establishment of a chest hospital in Dublin remains part of the provisional plan for the better treatment of tuberculosis, it is impossible to hold out any definite prospect of development along these lines at present. This is a position which has been causing myself and my colleague, Dr. Ward, the gravest concern, as indeed has the whole question of the existing arrangements in Dublin for the treatment of the disease. We had the advantage of discussing this matter in January last with representatives of the Irish Academy of Medicine in a way which was both informative and helpful. It was agreed that the present bed accommodation for tuberculous patients in Dublin is inadequate and representations have been made accordingly to the Corporation to provide extended accommodation as quickly as possible. The need for additional institutional accommodation in Dublin is also great, and the scheme for a new sanatorium to meet the needs of the city population is, therefore, being pressed forward with all speed. Furthermore, the Corporation have been asked to submit proposals for improvements to the central tuberculosis dispensary, and to extend arrangements for after-care of patients in their own homes.
One of the matters raised, at our meeting with the representatives of the Academy of Medicine, was the question of compulsory notification. At present, notification is restricted to infective cases. There is a reluctance, a natural reluctance, on the part of persons suffering from the disease to seek medical advice at the outset, and it is feared that this reluctance would be increased if notification were to be made compulsory. With the spread of better knowledge regarding the nature of the disease, however, and the recognition that it can be cured if medical advice and treatment are sought in the early stages, this reluctance is being gradually overcome. It is likely, therefore, that even though it would be very difficult to enforce compulsory notification of all cases of tuberculosis, the same end would be secured by closer co-operation between medical practitioners and the tuberculosis medical staffs of local authorities. In view of the importance of this, from the standpoint of the public health, I confidently hope for such co-operation. Local bodies, in the meantime, are also being pressed to take every available opportunity to let the public know that tuberculosis is curable, especially in its earlier stages, and that facilities for diagnosis and expert medical advice are available free of cost at any of the tuberculosis dispensaries.
Arrangements are being made to open, in Dublin, a clinic for the treatment of rheumatism. The clinic will be under the control of a committee of management, and there will be a medical director in charge. The cost of establishing the clinic is being met out of the Hospitals Trust Fund. The House may be aware that the Hospitals Commission, in their reports, recommended the provision of facilities for the modern treatment of the disease or diseases to which the common name of rheumatism is applied. They also accepted, in principle, a scheme which was placed before the commission by the National Committee Against Rheumatism, and it is upon the Commission's recommendation that the present project is being started. In view of the prevalence of rheumatism, and the economic loss which results to sufferers from it, it is hoped that the Committee, in addition to providing treatment, will undertake investigations into the causes of rheumatism, and that the experience gained in the working of the clinic, and the results of the treatment, will be valuable in formulating the wider measures necessary to combat the disease in other parts of the country.
Early in October, last year, it was noted in the Department that an abnormal number of children's deaths was recorded in Dublin as being due to an outbreak of diarrhoea and enteritis. For the weeks ended 4th and 11th October, 45 and 30 deaths, respectively, were so attributed. A full report as to the probable source of infection and the measures taken to prevent the spread of the disease, was requested from the Dublin Corporation on the 15th October. The reply which was received made it evident that the disease, then epidemic, affected only Dublin City and the surrounding districts, and what was more significant was that it differed in certain respects from summer diarrhoea inasmuch as it was more widespread, and deaths occurred among children of all classes. At the instance of the Department, close examinations were made into the history of the cases treated in the Fever Hospital, Cork Street, and in Vergemount Fever Hospital, but these did not afford evidence of the real cause of the outbreak, or such information as would assist in preventing a recurrence. Accordingly, Dr. Ward, as Parliamentary Secretary to the Minister for Local Government and Public Health, convened a conference, over which he personally presided, of the medical officers and bacteriologists concerned, to consider the whole situation. The Medical Research Council were also invited to send representatives. At the conference a medical committee was formed to examine the position further and to make recommendations to the Medical Research Council, and, as a result, a full investigation is being undertaken forthwith under the direction of the Medical Research Council. The total number of infant deaths in the whole country, in 1941, was 4,123, as compared with 3,759 in 1940. The increase in the number of deaths was mainly due to the peculiar outbreak in Dublin. In the rest of the country there was no marked change in the mortality rate. In the counties, the heaviest infant death rate was recorded in Carlow, with 91 deaths per 1,000 births. In Wicklow, Kildare and Kilkenny the death rates were 85, 83 and 82 per 1,000, respectively, and the counties where the lowest infant death rates were recorded are Roscommon, Mayo and Galway, in which the rates were 36, 41 and 42, respectively, per 1,000 births.