On the last evening, speaking in connection with the motion to refer this Vote back for reconsideration, we discussed the question of the increase in tuberculosis. Unfortunately, there has been an increase of that disease in County Wicklow, and I made a statement to the effect that the public health side of the Department of Local Government and Public Health had broken down. I have been considering the matter, and I shall try to modify it by informing the Minister of the different complaints that public bodies have to make with regard to the public health side of his Department's activities. One complaint is that the same interest is not taken in the public health officials as in the officials of other sections of the Department. For instance, we have to pay the county medical officer of health £800 a year, plus £200 travelling expenses. His duties are to attend all the T.B. dispensaries over the whole county, visit the schools, and so on, and yet he is only allowed 12 gallons of petrol per month to travel all over the County Wicklow. It would be an average of about 360 miles, and with an allowance of only 12 gallons of petrol per month it is no wonder that tuberculosis is on the increase, because it is the poor who are suffering, as they are unable to receive attention from the county medical officer of health. There is a similar position with regard to dispensary doctors. Having regard to the geographical conformation of Wicklow, as the Minister must be aware, this is a bigger problem for doctors practising there than it is for doctors in the cities or those who merely have to leave their private homes to attend patients nearby. We have three dispensaries, with a population of 3,600 in their area, and these doctors are only allowed 12 gallons of petrol per month. I would ask the Minister to contrast that treatment with that of engineers in the Department. An assistant engineer in the same area, merely to look after the roads of a smaller area than is covered by the doctors, is allowed 40 or 50 gallons of petrol for the month, whereas the doctor is only allowed 12 gallons.
Committee on Finance. - Vote 41—Local Government and Public Health (Resumed).
I submit, Sir, that that is a matter for the Ministry of Supplies, and that I am not responsible for the rationing of petrol.
I say that the Minister is responsible for the public health of the area concerned. The doctors are under the control of the Minister's Department, and I am pointing out that the Minister's Department fought for the engineering section with the Ministry of Supplies and succeeded in getting petrol for them. I am suggesting that, without any extra petrol being involved, they could take some of it from the assistant engineers and give it to the doctors.
That is a question of petrol rationing, and I am not responsible.
The Minister is responsible for looking after the public health.
But not for the rationing of petrol.
The Minister is not responsible for the rationing of petrol.
I admit that.
The Deputy may, of course, point out the possible ill effects on public health if doctors or other officials have not sufficient petrol.
This is the Minister who recommends increased supplies for the engineers.
And, presumably, other local officials.
Through his Department, he recommends the Minister for Supplies to grant petrol to the engineers.
And for every other official of a local authority. We have fought for them all.
The engineers seem to have been more successful than the medical men, so far as I can see. Is it the opinion of the Minister and of the Government that roads are more important than human life?
My opinion on petrol supplies does not count. It is the decision of the Minister for Supplies that determines the whole situation.
A recommendation from the Minister is able to get 40 gallons a month for an engineer in charge of a small area. I am certain that a recommendation from the Minister, seeing that he has a responsibility for the health of the people of the country, would secure for county medical officers of health and dispensary doctors a supply of petrol which would enable them to give proper attention to the poor.
I was not able to get all the petrol that we asked for for medical officers, rate collectors and other officers of local authorities.
Let the Minister take off half the quantity of petrol that is being given to the engineers and give it to the medical officers. The roads are not important at the present time because we have no road improvement grants and no relief grants for roads.
The Minister for Local Government has no control over supplies of petrol, nor power to divert from one section of local officers to another.
He recommended that the engineers should get it.
And also the county medical officers of health.
I cannot understand the mentality of the health section of the Minister's Department which is able to get from 40 to 50 gallons of petrol a month for engineers, and only 12 gallons a month for a dispensary doctor.
We have no option in the matter. My Department cannot issue permits.
We have an order from the Department telling us not to repair roads, and an order from another Department asking us to make bridges that can be blown up in a short time. Notwithstanding the fact that, at the present time, we have no road improvement grants and no relief grants for roads, we find that extra petrol is being allocated the engineers to supervise the boys on the turf. The engineers seem to be the pets.
If the Deputy does not want any supervision in connection with the turf production, then I think we know what he is getting after.
I think I could make a very good case about that. It would be very interesting if the Minister would secure for the Wicklow County Council some particulars with regard to the output of turf in the case of the men employed at forced wage rates and those who are working on the tonnage rate. Those who are working at the wage rates require very little supervision. It would be interesting to know how the cost in each case works out. It is hard to understand the attitude of the public health section of the Minister's Department. It has refused permission to the County Wicklow Board of Health to pay more than £2 or £2 2s. 0d. a week to a substitute for a midwife. The result is that the midwives are unable to get a substitute to act for them, because if a substitute has to hire a taxi to attend to one or two cases in a district, the fee allowed will be swallowed up in taxi fares. Who is suffering in that case? The poor, due to lack of attention by the midwife and the dispensary doctor. There is another matter which shows how difficult it is for boards of health to carry on. Recently there was a circular from the Minister's Department urging that there should be every saving possible in the administration of their affairs. Ever since the amalgamation scheme was carried out, the practice in the County Wicklow was to have a woman attendant go out with the county ambulance. There are 34 beds in the hospital. The Local Government Department insisted that, instead of having this woman attendant, the board should employ a qualified nurse at treble the cost. As I have said, there are 34 beds in the hospital and four nurses in charge of it. The board, having investigated the matter, did not feel justified in employing an extra qualified nurse whose only work would be to go out with the ambulance.
Why did not the Department insist that a qualified nurse should be employed to attend on fever patients? In their case, a casual woman is employed, and when the patient is taken in at the hospital this woman is allowed to go out around the town. I think it is unreasonable that the Department should insist on the board dismissing this woman attendant while it takes no steps for the employment of a qualified nurse in the case of fever patients. This woman attendant had been employed for more than 12 months. We were unable to get a qualified nurse, and had to dismiss this woman. The lay attendant that we now employ for two or three days is costing us more than her predecessor. Does not all this show that a reorganisation is needed in the health section of the Minister's Department? I think it requires to have a special male doctor in charge of it.
When the managerial system was going through we heard from the benches opposite all that it was going to accomplish. I am aware that the parties concerned have another scheme ready to counteract the managerial scheme. In that way they can bring about chaos because they state that they are receiving no help whatever from the Minister's Department. The Minister is new in his present office, and I am endeavouring to point out to him his tremendous responsibility. I have always been in favour of the closest co-operation between the Department of Local Government and the public authorities. I would like to see confidence established between the two, and not have things as they are at present. The Minister talked about the roads in the country, and of the responsibility for their upkeep. I cannot understand why grants were not made available last year for the making of roads to the bogs in the County Wicklow. The turf is being produced, but it is impossible to get lorries up the kind of roads we have leading to the bogs.
The Minister's Department talks about economy, but does he realise the difficulties that public bodies have to contend with? I have before me a list of the forms issued by the Department. I am not going to waste the time of the House by reading it. Judging by the number of these forms that have been issued, it would not seem as if much economy was being practised in the Department. In the road section, as well as in the public health section, I think economy could be practised. There could also, I think, be a saving of paper because in the road section, at least, copies of 50 forms have been sent out to county engineers asking for daily and weekly returns. What happened in the County Wicklow was that the chap we had in charge of these returns got fed up and joined the Army. I will refer to some of these forms to show how the time of officials employed by public bodies is taken up preparing replies. The first form is No. 11—Roads. This is to go from the county surveyor to the Local Government Department. It deals with requisitions, details of expenditure, etc., in connection with (a) maintenance grants and Road Fund grants. The next is Form No. 16— Roads. Then there is Form O.D.1— particulars of works on road rural schemes, and Form O.D.2, particulars of labour recruitment. There is Form 11A from the county surveyor to the labour exchange dealing with the recruitment of skilled labour for gang rotation. There is Form C.S.94 (pink) from overseers to county surveyors and C.S.94 (yellow) from county surveyor to Local Government Department giving returns of numbers of men employed.
These are all in relation to relief grants.
Maintenance grants?
Roads rural.
We have no road relief grants at the present time in the County Wicklow, not even for the bog roads which we want repaired in order to get the turf out. I ask the Minister to look into this.
Go on to a few more.
With pleasure. I am sorry for taking up the time of the House, but when the Minister wants them I will give them: R.U./206/E1, from county surveyor to Local Government Department, fortnightly returns of numbers of men and expenditure on O.D. salaries; R.U./207/E2, from county surveyor to Local Government Department, fortnightly duplicate returns re roads rural schemes; No. 97 (R.U.), from county surveyor to Local Government Department, requisitions on O.D. grants—frequently during duration of work; No. 97A, from county surveyor to Local Government Department, particulars of surface dressing for Road Fund grants (quarterly); R.U./206/E7, from county surveyor to Local Government Department, analysis of expenditure submitted with Forms No. 16 and 18; R.U./208/E4, from county surveyor to Local Government Department, certificate of compliance with grant conditions, submitted with Forms 16 and 18; mid-monthly labour returns, from overseers to county surveyor, particulars of number of men on different works; mid-monthly labour returns, from county surveyor to Local Government Department, particulars of number of men on different works; T.3, from county surveyor to Local Government Department, details (in duplicate) of work carried out on bog development schemes.
As to the bog development schemes, surely the Deputy does not think it is not essential that we should know what the position in regard to bog development is?
I say it is unnecessary to have a duplication of all these forms.
If the turf was not either in Wicklow or here we would hear a lot about the Government.
You would not have 10,000 tons from Wicklow.
One junior clerk would look after the lot.
They must be certified by other clerks. Junior clerks are not allowed by the county councils to do work which they have to do in the Minister's office. The senior officials in the county councils will not allow the junior clerks to dictate as they do in the Minister's office. Would the Minister like a few more?
Certainly.
Then I will give them: P.40 (Local), from assistant surveyor to county surveyor, monthly return of petrol used; T.S.1., from county surveyor to Local Government Department, monthly mileage and petrol consumption return of vehicles on turf work: from county surveyor to engineer-in-chief, monthly return of surveyors' travelling; from county surveyor to engineer-in-chief, quarterly return of petrol used and required for surveyors' travelling; from county surveyor to finance committee, weekly return of number of men employed on road works and grants; from county surveyor to assistants, weekly statements of accounts (heretofore fortnightly); from overseer to county surveyor, weekly diaries; from assistant county surveyor to county surveyor, weekly travelling expense sheets (heretofore monthly); from county surveyor to insurance company, insurance of vehicles on turf, numerous and various returns.
Does the Deputy suggest that we should dispense with a statement of accounts where public money is to be expended?
You can keep the form for the statement of accounts but I say that all the other forms are unnecessary. One form or one monthly return giving all these particulars would be sufficient and would give the officials more time and also give more time to the officials in the Department. Then we would not have, as we see from the returns, hundreds of extra junior officials in the Minister's Department.
Where are they?
I would prefer to see some of the officials in the Department paid a living wage instead of having people employed at £2 or £2 5s. 0d. a week. We have the serious position of public bodies versus the Local Government Department. The Minister is not in the happy position of receiving bouquets from any of the Parties in this House. Even members of his own Party, I think, were loud in their criticism. I am putting forward certain suggestions which I think would lead to an improvement. From my experience, I am pointing out the things which are a cause of dissatisfaction, and the endless trouble we receive from his Department in connection with small matters on the health side. In the old days, when public bodies refused to recognise the Local Government Board, we know that the help given by the local bodies obstructed the work of the British Government in this country as much as the army. We will come to the time in this country when we will have the remaining local bodies refusing to enter into any further correspondence with the Local Government Department. That may seem very far-fetched, but I have been on public bodies for a long time and I know the feelings of men of all Parties in connection with this matter. Hence I think it only right to let the Minister know what the position is, as he is new to office, so that he will see that important letters which are sent to local authorities will come to his notice before they are sent out by a junior clerk dictating to public men who are endeavouring to do their best.
I ask the Minister to see that dispensary doctors are provided with more petrol even at the expense of the engineers. We have an alarming situation in our county owing to an outbreak of a serious disease. It was proved that the medical inspectors were unable to visit in time the houses where the outbreak occurred owing to the fact that they had no way of getting into the area. We know that in one portion of the county a serious situation is threatening. While we have been told that every precaution has been taken about evacuation, I wonder whether in this case every precaution was taken. We believe that there has been some slackness by people being allowed to come into this country who have been in contact with other people who are probably suffering from this dreadful sickness. We are satisfied that if immediate precautions had been taken the deaths which occurred would not have taken place. The medical inspectors proved that they were unable to visit the houses owing to the fact that they had no petrol. They live at a distance of from 15 to 20 miles from the place where the sickness occurred. I do not know about other counties, but owing to the geographical position of County Wicklow, the medical men there are at a very serious disadvantage and as a result the poor people in the different areas suffer. The doctors are unable to give the attention to their patients which they have given heretofore. As the Minister for Supplies pointed out, if we are unable to get proper supplies for our dispensary doctors, it may mean that the dispensary areas will have to be re-organised and we may have to have a larger number of doctors and smaller areas than we have at present. That will mean extra expense on the ratepayers.
We cannot allow the present system to continue. It is not the doctors we are worrying about, but the attention that poorer patients require. When a large area with a population of 6,000 people has only one medical officer he has no time for pleasure or for golf. He must devote his whole time to his patients. I know one doctor who got a smaller motor car, but having done that he now gets a smaller amount of petrol. I ask the Minister to give consideration to my remarks and to try to have relations between the Department and public bodies improved. After 20 years' experience my honest opinion is that if something is not done to check the attitude of the health section of the Department towards public bodies relations will not be improved as there will be a continuance of the whispering that is going on about having no confidence in the Department which it is suggested wants to abolish local bodies. I am not worrying whether these bodies are abolished or not, but I hope my remarks will receive sympathetic consideration and not be met as they have been met with pin-pricks because of the dismissal of one employee and the employment of another at a different salary. That is not my idea of public administration. I hope when the Estimate comes up for consideration again that the Minister will be able to say that he has looked into the various complaints that have been made by Deputies, and be able to announce that he has removed the serious position that has arisen arising out of the alarming increase in illness in the Twenty-Six Counties. I am not suggesting that the Minister is responsible for that, but I hope that a better spirit and closer co-operation will prevail between his Department and the public bodies responsible for public health. As those associated with public health work are doing their best, I hope that next year the criticisms that have been heard will have been dealt with in a helpful way, because I believe that the Department could be helpful to public bodies who look to it for advice and direction.
Deputy Everett has dealt with a certain amount of the neglect on the part of the Government in relation to officials of local bodies, but I think the aspect that we want to look at, and that is far more important and more far-reaching, is the whole position with regard to local government. We are in a period of a very serious emergency, and there is no voice louder than the voice of the Government in asking for co-operation and assistance from every section of the people. Unfortunately, the real body from which there has been no suggestion of co-operation, and no suggestion of mutual assistance in that work, is the Government. In no part of the Government's touch with the country does that aspect appear more clearly than in connection with local government. I have repeatedly pointed out in connection with the non-holding of local elections that in that respect the Government are wiping out of existence the most important part of public machinery which, outside of Government machinery, can assist in every branch of such work.
We have passed through a very peculiar 20 years, and the type of spirit which has dominated politics during those 20 years has been a type which has made it uninviting for people with responsibilities in their private and business lives to offer to give public service. The Government Party insisted that politics were to be brought into local government work and, when they came into office, they insisted very definitely that local bodies should serve Government policy. They extended the electorate of local bodies and made it the same as the electorate for the Dáil. In that way they made the atmosphere of local government an atmosphere where, instead of service for local purposes and for the administration of local machinery being dominant, Party political policy dominated. As time passed we reached a situation, whether the Government foresaw it or not, when local government machinery was made to play its part in serving Government policy, when tax burdens that the Government were able to put on the shoulders of the people became so great and so outrageous in their dimensions that a very considerable amount of that taxation passed on the shoulders of the ratepayers.
The situation arising out of that now is that in the year ending March, 1942, the amount collected in poor rates in county health districts was £3,508,781 against £2,445,269 in the year ending March, 1932 or £1,063,512 more than was taken out of the pockets of the county ratepayers ten years before that. In the urban districts £266,000 more was taken in poor and other rates. In towns under town commissioners £6,582 was taken in the year ending March, 1932 and in 1942 that was increased by £4,133. In the county boroughs £1,669,000 was taken in March, 1932 but in March, 1942 an additional £739,000 was taken, so that Government policy was spread so much over local authorities that they were called upon increasingly to pay for the cost of government. While that was going on we had an attitude being developed towards local authorities by the Government that is indicated by the persistent refusal to hold local elections on the one hand, and by the type of abolition that has been carried on in Clare, in County Dublin, in the Dublin Board of Health district, Balrothery and Rathdown.
When the Minister for Supplies was speaking to-day about the necessity for clothes rationing, he indicated that we were in an emergency which would last for a very long time. Anything that has been said by the Government recently has tended to emphasise that. If we are in an emergency that will last for a very long time, and if we are in an emergency that requires assistance in all the various classes of services that have had to be organised locally, then we cannot get through it unless there is close support of the people who understand their responsibilities as citizens. In nothing more than in the line adopted to the local electorate, and therefore to local bodies, does the policy of the Government tend to crush out any scrap of the sense of responsibility on the part of the electorate.
If we look around the map and consider the details given on the 20th May last, when I asked for particulars of the number of bodies at present suppressed and the dates on which they were suppressed, we find that, over the whole of that very important part of the country which takes in Leix, Kilkenny, South Tipperary and Waterford, where there are important rural areas and important urban areas, the last time the electorate were called upon to elect county councils was in the year 1928—14 years ago. It is 14 years since men or women in the Counties Waterford, Kilkenny, South Tipperary and Leix stood before the electorate as candidates for election to the county council. It is 14 years since any of those counties were called upon to elect their local representatives. We may add to that area the area of Westmeath—where the last election was held in 1934 and where the county council was wiped out in June, 1935—and the important areas of Counties Dublin and Clare. It was 1930 when the electorate of County Dublin were last called upon to elect local representatives, and it was 1934, just like the rest of the country, when County Clare was asked to elect theirs.
The Bill which is being introduced now, and which has been given its First Reading in the House, seeking further to postpone the local elections, shows that the policy of preventing the local electorate from feeling their responsibilities in connection with the very important matter of local administration is to be persisted in. That is a disastrous policy at the present time, and shows the Government are utterly misreading the character of our people. As a result of their not being called upon to select local representatives to carry on local administration, the people are losing touch with their responsibilities. When they do that in local matters, they have no sense of responsibility in assisting the institutions of government in an organised way. In the areas that I speak of, men and women who were elected in 1928, and who were wiped out of public life almost immediately before the local elections took place in 1934, are no longer in touch with any aspect of local administration. Through lack of example in front of them, and through lack of call on them in any way, there are practically no people in those areas who feel, with a sense of responsibility, that they may be called upon to discharge the duties or obligations of membership of a local or county council.
The disastrous policy being pursued by the Government is disclosed particularly by the Minister for Local Government and Public Health in the policy being pursued in connection with local administration. In the first place, he leaves the country as a whole without local elections since 1934; and he suggests by the Bill at present before the House that he is going to leave it for a further period, and to leave it indefinitely so until after the present emergency. Yet, in the present emergency it is possible for him to wipe out as important a body as the Dublin County Council and another body as important as the Clare County Council, without going to very great extremes in the first place to put anything right that was wrong, and to make a strong case in the House before he did so. The Minister cannot carry through the present emergency unless there are responsible people throughout the country who understand that the Government is prepared to assist and co-operate in every possible way.
On the 23rd April this year I asked the Minister for particulars of the number of people who had been appointed to public appointments in the counties affected by the Gaeltacht Order, who had been appointed under one year and at various stages up to 10 years, and who had not fulfilled the conditions of their appointment under the Gaeltacht Order. Under the Gaeltacht Order, where people are appointed to public positions under a local authority and have not a knowledge of Irish sufficient to enable them to carry on their business in Irish, they are required within a period of, I think, three years, to obtain the necessary qualification. The particulars will be found by Deputies in columns 766-788 of the Official Debates of the 21st April, 1942, and they are certainly very disheartening. There are 38 officials of various kinds who are appointed under one year and who have not qualified; there are 75 who are one year but less than two; 70 who are two years but less than three; 43 who are three years but less than four; 39 who are four years but less than five; 26 who are five years but less than six; 30 who are six years but less than seven; 15 who are seven years but less than eight; 15 who are eight years but less than nine; seven who are nine years but less than ten; and 27 who are over ten years. All these people got their appointments on condition that, within a period of three years, they would be qualified to discharge their duties through the medium of Irish, and they have not qualified.
I should like to know from the Minister what has been done in that particular matter and, generally, what is the policy. Has the Gaeltacht Order been scrapped? Has the policy that it was intended to pursue by means of the Gaeltacht Order been completely departed from? I should like to have some information in that connection in the light of certain information which I shall now set out. In one county last year a clerical assistant and a shorthand typist were appointed and they were not qualified in Irish. The year before that, in the same county, there was a clerical assistant appointed who has not since qualified in Irish. In another county, a clerical assistant was appointed in the last year who was not qualified in Irish. In the year before that, there was one clerical assistant and one shorthand typist appointed who were not qualified in Irish. In another county, within the last two years, a clerk-typist was appointed and a library assistant was appointed without being qualified in Irish. In another county, within the last year, there was one clerk-typist, one storekeeper and one porter, and within the last two years there were three rent collectors appointed without being qualified in Irish. In another county there was a clerk-typist appointed without Irish, and there was a clerical assistant without Irish appointed within the last year. The year before that, in the same county, there was a shorthand typist without Irish appointed.
I can understand certain classes being appointed in certain districts, but the number of nurses and the number of rate collectors that are appointed in certain very strong Irish counties, and who have not Irish, is very remarkable and should call for some comment from the Minister. In view of such a glaring departure from the spirit of the policy which the Gaeltacht Order was intended to serve as the appointment, within the last year or two, of so many clerical assistants, shorthand typists and library assistants without the necessary qualifications in Irish, it would be interesting to know what the Minister is doing.
Further, in relation to the Galway and the Donegal County Councils, I should like to know whether the correspondence between the Department and the councils is carried on entirely through the medium of Irish. If so, I would like to know why, in both Donegal and Galway, typists and clerical assistants, without Irish, have been appointed during the last two years. In 1929 I, as Minister for Local Government, approached the board of health and the county council in Donegal and Galway and I had an examination made of the position with regard to Irish among the staffs and the position with regard to their competence to discharge their duties through Irish.
After an examination of the situation, I put before the four bodies a suggestion that, by 1935, all the correspondence between the Department and those local bodies would be done through the medium of Irish. I asked them for their suggestions on that proposal. The Donegal County Council agreed; the Donegal Board of Health agreed; the Galway Board of Health made no order, and the Galway County Council substituted 1932, instead of 1935, after some funny remarks on the subject of putting the date back as far as 1935. It was accepted then by the Galway County Council that they could operate from the year 1932, and Donegal indicated that they could operate from 1935. I should like to know whether any progress has been made in making Irish the language of correspondence between the county councils and boards of health in Donegal and Galway and the Department, and whether any progress has been made along similar lines in Mayo and Kerry and with the commissioner who is in charge of Waterford, which is also one of the Gaeltacht counties. If it is intended to make any progress in that direction, will the Minister say why, in the counties indicated in the Parliamentary answer given on 21st April, clerical officers who have no knowledge of Irish are still being appointed to those bodies?
I think I can assure Deputy Mulcahy that, so far as the Donegal County Council staff and Board of Health staff are concerned, they are absolutely competent to transact all their business, with the Department and elsewhere, through Irish.
I should like the Deputy to help me to get an answer from the Minister.
The trouble in that county is that the majority of the members of those boards do not speak Irish at all and all the documents in that language that are submitted to them require to be translated when the business of the county council and the board of health is being transacted. So far as the staffs are concerned, I feel pretty confident that all the work can be done through the medium of Irish.
What I intended chiefly to speak about on this Vote is the condition of the main roads. Millions of pounds have been spent on the main roads of this country since 1924 in order to convert them into veritable racing tracks for motor cars. At the present time motor cars are conspicuous by their absence and we have as substitutes not only slow moving horse traffic, but fast ponies and traps. I find on a journey to Mass on Sunday that I can get as much exhilaration on a sprightly pony and trap, from the danger point of view, as I ever got at any time from a road hog on a short spin. Something will definitely have to be done on the main roads to cope with the increasing horse traffic. It will be necessary to carry out some alterations in order to satisfy the people living in rural parts. Complaints are general in regard to the condition of the roads. So far there have not been fatal accidents, but it is quite possible that these could occur. Because of the scarcity of newsprint, the incidents that occur daily are not getting the publicity that even minor motor car accidents used to get some years ago, but definitely the danger is there and I suggest that the roads section of the Department should pay immediate attention to it.
Tar is scarcely obtainable at the present time, but we have plenty of cement and I suggest that the centre of the road, where there are straight stretches, should be covered with gravel and cement mixed and finished off in a fairly rough condition. That would accommodate most of the horse traffic. At dangerous turns special provision should be made. I speak as a layman on this subject. I have no doubt that the county surveyors' staffs in the different counties would have very little trouble in making these roads suitable for horse traffic, particularly in the vicinity of the cities and large towns. We know that traffic is being diverted daily from the railways to the roads. It is a strange thing that for years we have been endeavouring to divert traffic from the roads to the railways while now the tendency is in the opposite direction. That is a development apparently outside our control, but if we employ some vision in planning for, say, even three years ahead, it is possible that the great bulk of our transport will be carried by road and by means of horses at that. The sooner, therefore, we tackle the problem of making our roads safe for horse traffic the better.
The only other point I want to make has reference to the delays that take place in procuring sanction from the Department for schemes of different kinds. Not so long ago we had a case in County Donegal in which an inquiry was held into the question of the compulsory acquisition of land for the building of labourers' cottages. From the day the inspector left the county until his report came to the hands of the local authority, a period of roughly 18 months elapsed. It is inconceivable to me why it should take so long for a local government inspector to furnish a report of that kind to a local authority. In this instance, there was nothing at variance between the board of health and the Local Government Department. Surely there must be some reason for the delay in furnishing the report? If the reason be that the inspector was too busily engaged elsewhere, to devote any time to the writing of his report, certainly I for one would have no hesitation in suggesting that another man should be appointed to take his place so as to give him sufficient time to finish the particular job he had in hand. I fail to see why the Government should fall for the clamour for economy in matters of that kind because it is false economy. Nothing is saved by holding up a scheme for 18 months, no matter from what aspect one views it.
It seems from correspondence in the papers, and from what I have read generally—though this is a matter that does not apply to Donegal—that the Department of Local Government and certain local bodies vie with each other in scoring points just like lawyers across a bench. It seems that they compete in scoring points one against the other. It passes my comprehension why two bodies engaged in doing the same work should adopt an attitude of that kind towards each other. I think that the Department in the first place should credit the local authority with a little commonsense, and that the local authority in turn should credit the Department with a genuine desire to do its best. It is only by a spirit of co-operation between local bodies and the central Department—in this case the Local Government Department— that we can hope to achieve what Deputy Mulcahy visualised—a spirit in the country which will inspire the people to take their stand as citizens, and to administer local affairs in the best interests of the community as a whole. If any fault lies with the Department of Local Government, I would appeal to them, therefore, to be more lenient in their dealings with local bodies. I can guarantee, as far as the local bodies in my county are concerned, that they always have done, are doing, and always will do their utmost to co-operate with the Department.
There are one or two minor matters which I want to mention at the outset in connection with this Department. The first is that I understand that the National Health Insurance Society has been compiling invaluable statistical reports relating to public health in this country and has been publishing them. Shortly after the first publication of these reports they were informed by some Government Department that their action in publishing such reports was ultra vires. I would suggest to the Minister that he has power to make whatever Order may be necessary to bring the preparation of such reports and their publication by the National Health Insurance Society intra vires. It would be a very great disaster if statistical reports of this kind were lost to the community. Unless this body undertakes the work there does not seem to be anybody else within the ambit of whose authority the preparation of such a report lies.
The second point I want to mention is this. I suppose all of us are often struck by the depressing spectacle of poor children in our cities having nowhere to play except in the streets. Many of us have heard of Mayor La Guardia of New York. One of his principal claims to fame rests upon his appointment of a man called Mr. Moses as director of playgrounds for the City of New York. It was Mr. Moses who established the astonishing system of playgrounds and bathing beaches that at present exist in that city. Anyone familiar with the lower east side of New York will tell you of the astonishing change that development made in the lives of the people, who are as poor in that great city as the poorest of our poor in Dublin. It places within their reach amenities which hitherto had been regarded as the exclusive prerogative of the rich. Again anyone will tell you that the Labour Government in New South Wales achieved one of its most remarkable successes by the creation of a vast system of bathing beaches which surrounds the City of Sydney. Those of us who have been there can tell of the astonishing change brought about in the lives of the poor —and there are poor in Sydney—by the fact of their having access to these beaches for nothing. I think the Commissioner for the City of New York and those responsible for that reform in the City of Sydney could astonish the authorities in this country by describing how little it cost to place within the reach of the poor that valuable access to fresh air, sunlight and the sea. We have the seashore at our very gates in this city—from Merrion to Blackrock and on the north side of the city as well.
I am frequently told that the Government is most anxious to keep people at home and to provide work for them, but that the great difficulty is that there is no scheme which, if started, would not have to be jettisoned for want of raw material. I believe that the development of bathing beaches north and south of the city would be as valuable an asset as the Phoenix Park at present is. It would be an enterprise which might cost a great deal of money. It would involve the employment of a vast number of men, but it would make little or no demand on our resources of raw material. I have no doubt that the High Commissioner in Australia would provide our Government with the fullest details of what has been done in New South Wales because the Labour Administration in Australia is very proud of that achievement. I am perfectly certain, too, that the American Minister would be only too pleased to place at our disposal full details of the achievements of the Administration in New York because the authorities there are very proud of the prodigious work that has been carried out. I suggest to the Minister that one of the most valuable contributions he could make to the public health of this city would be to carry out a largely-conceived scheme for the development of the bathing beaches north and south of the city to which the slum dwellers would have free access and to which they should be regularly encouraged to go. Nor should we depart from that proposal without bearing in mind that those responsible for the control of juvenile delinquency in Great Britain have, I think, established beyond question of doubt in the experiments carried out in the City of Norwich that where adequate recreational facilities were made available to juveniles there was a proportionate decrease in juvenile delinquency. Both in Great Britain and in this country, I regret to say, a great deal of anxiety is being manifested by the increase in petty juvenile delinquency. I suggest that the reform which I believe it is within the Minister's power to give effect to forthwith would contribute not only to the public health of the young, but also to the elimination of that detestable evil—the necessity of bringing young persons before police courts for the correction of recidivist delinquency.
There is only one other topic to which I want to refer in this debate. I am so accustomed to championing controversial causes in this House that I welcome this occasion of speaking on behalf of something which I believe has the sympathy both of the Government and of the Opposition, that is, the development, and the rapid development, of the equipment of our community to combat tuberculosis. I make no apology for reading a short passage from a very remarkable book called Never No More, which may be described as a biographical novel describing rural conditions in this country—the Minister may possibly have seen it himself—
"We had just stood up from our tea that evening when Andy Flaherty came in with a black leatherette-covered box under his arm.
"Shyly, he laid the box on the table.
"‘I thought you might like the loan of these to cut up the hams, Mrs. Lacy,' he said, opening the box to display a set of bone-handled carvers. ‘I won them at Brackna Sports seven years ago.'
"The boy's pride when we admired these proofs of his former athletic prowess was heartbreakingly pathetic to watch. Pathetic because while Andy Flaherty had once been the best runner and jumper in the county, he was now in the last stages of consumption and could barely hold himself erect. His poor ravaged face with its hollow temples, sunken flushed cheeks and drawn white lips, was a fevered death mask that night. But it became happy and less feverish when Andy sat down with us and commenced to go back over the days when no athlete could beat him.
"He remembered every detail of every triumph. The names of his competitors and what the judge had said to him and how the people had clapped and cheered when he went up for his prize. Tragically, each boastful little memory was prefaced with such remarks as ‘One time when I was in my health,' and ‘I remember another time before I fell into bad health.' As the days of his glory came vividly before him, Andy Flaherty was no longer there on our settle, straining against a wasted body and losing his lungs cough by cough. He was in a summer field somewhere, flying from the starter's pistol like an arrow from a bow, the wind rushing to meet him, his muscles glorying in the strength that carried him over the springy turf and his good sound lungs doing their work proudly and well.
"Andy was not sad in himself. At least, his was not the heavy sadness of despair, for he was firmly convinced that all he needed to become strong and well again were a few months in Newcastle Sanatorium. His people shared this belief, and for a long time now they had been trying to get him into the sanatorium.
"He was in great good humour that night, for the longed-for letter of admission had come at last. He was leaving for Newcastle after Christmas.
"‘That's great news, Andy,' Gran said, although she suspected that no sanatorium on earth could do anything for him.
"‘Isn't it now, Mrs. Lacy!' Andy rubbed his thin, dry hands together. ‘I believe they've sun balconies and everything there. I hear the doctors in Newcastle can put new life into you, and that they make a new man of you after a week.'
"Six weeks after Andy went to Newcastle his mother got a letter to say he was dying.
"‘We can't let him die off there among strangers,' she said, and she went up to bring him home. He travelled by train with her as far as Kildare station. The creatures could not pay for an ambulance, and a motor car was not to be had.
"Their cousin, Jack Dillon, who carried the mails between Ballyderrig and Kildare, met them at the station with his sidecar. He had two of Andy's brothers with him. I was standing on the bridge myself when the sidecar drove into the town. There was the poor dying lad propped up between his brothers. His head lolled on Paddy's shoulder. Kit, the other boy, held a check cap before Andy's mouth. I thought he was trying to shelter him from the raw February wind. I learned afterwards that Andy had his last hæmorrhage just as they came over the bridge."
I read that, Sir, because I do not think there is a Deputy in this House who has not had the experience of seeing some Andy Flaherty in his own village or in his own county. I have seen them. I have seen them before they went away and I have seen them come home to die. The tragedy of that going and coming is not only the tragedy of young persons struck down on the very threshold of life, but it is also the knowledge that, in falling themselves, they infect and destroy those who are nearest and dearest to them.
Recently, in the County Monaghan, a woman came to me in great distraction. She had nine children. Her eldest girl had gone to bed with a cold about three months ago. She got over the cold but she did not seem to be herself and then she got a stitch in her side and she spent two months in and out of bed. Eventually the doctors began to tell her she had better do something about it. The moment the mother told me that story, I said to her: "You have got to get that child away. It is a dreadful thing to have to say to any mother but, if you do not get that child out of the house, and quickly, she will die and she will kill all her brothers and sisters. You will lose them all." The mother said she would go home and talk to her husband. She came in to me about three days later and she said: "Mr. Dillon, the boy is in bed now." I knew the story that I had foreseen was beginning to unfold itself: her brother had got it. I said at once: "There must be no time lost. We must set our hands to this task at once." It was only then that it was driven home to me that, using all the resources that were available to me, there was nowhere to send them. I was consternated to discover that, were I to make myself responsible for removing those two children from their home to a sanatorium, I could not say that I believed that I was removing them to a place where they would probably be cured, because the vast majority of the sanatoria have not got the equipment wherewith to effect the cure.
It is time we spoke out honestly and frankly about this thing because the facts are grave. I do not know whether Deputies in this House realise that the tuberculosis rate in this country is still 113 per 100,000 persons. It has been reduced to 63 in Great Britain. In parts of America it has been reduced from 90 to 64. But that is not the whole of the story. Tuberculosis is the third greatest killer in this country. It is only surpassed as a killer by heart disease and cancer. But heart disease and cancer largely kill the old. Tuberculosis largely kills the young. The average rate over the whole population is 113 per 100,000, but the rate over young persons between 15 and 35 is 171 for men and 215 for women. In 1939, out of every 100 people who died between the ages of 15 and 35, 51 died of tuberculosis in one form or another, and of every 100 people who died between the ages of 15 and 35, 44 died of pulmonary tuberculosis.
I do not want this House to imagine that, in saying that the vast majority of sanatoria have not got equipment wherewith to cure, I make any reflection upon the staff or doctors attached to those establishments. They are doing their best, but they have not got the equipment wherewith to cure. In County Roscommon recently there was an auxiliary mental hospital built, not, mind you, a main mental hospital but an auxiliary to Ballinasloe, and do you know what was spent upon it? A sum of £250,000—on an auxiliary mental hospital. Now, in the face of "daft" expenditure of that kind, is it not hard to keep one's patience, when young people are dying as Andy Flaherty died of tuberculosis, and mowing down the members of their own family by infecting them, because there is no place to send them where they can be cured? Unless you are prepared to go to the mother and say: "Take out your children and send them to hospitals where they can die in peace," you have got to leave them in their homes. Why am I saying that there is no place where they can be effectively cured? Because I am prepared to state that if pulmonary tuberculosis is taken at an early stage, and there is made available to the patient expert, surgical, X-ray and medical care, a large number of persons so affected can be permanently cured, and I say deliberately that, unless you can make available to persons suffering from pulmonary tuberculosis, expert, surgical, medical and X-ray attention in the early stages, the vast majority of them will ultimately die. I think it is true to say that, out of every 100 persons suffering from pulmonary tuberculosis who get no effective treatment, 70 to 80 will die within five years. The vast majority of those people in the 15 to 35 age group can be saved if we are prepared to save them. They cannot be saved if we in Dáil Eireann do not compel the local authorities and if necessary help the local authorities to make available to the communities for which they are responsible the kind of treatment that every Deputy in this House would spend his last penny to secure for his own children. Now, mind you, I do not think Dáil Eireann ought to take the place of any child's parent. All I am asking the Government and the local authorities to do is to put within the reach of poor parents the treatment that will save their children's lives. I say that, at the present time, that treatment is not available to them no matter what they do or how co-operative they may be.
I know a lot of people are inclined to say that the country people are obscurantist, that they will not help the tuberculosis officer and try to conceal sickness. There may be a grain of truth in that, but assuming that the country mother was as anxious as the tuberculosis officer to go the limit, to take any precautions, to adopt any measures to save her children, I say there are hundreds of mothers in this country who have not available to them the means of saving their children's lives. Signs on it, the children are left in the home, to infect the other children. Of those ghastly derelict farms which we in the country are familiar with, where the whole family has died out, you will be told that a number of people got delicate there and that nobody went into the house after the last of them died. That is the present situation.
What I am asking for is a remedy, and I am going to suggest what the remedy is. I want to see established in this country two centres in Leinster, one centre in Munster and one centre in Connaught, for Connaught and Donegal, where we would have a central administrative building with adequate X-ray equipment, with the full surgical equipment required for whatever surgery might be necessary, and with the necessary laboratories and equipment for careful investigation of every case that came in, with a view to determining what was the most effective method of treatment that could be applied to the patients in question. I want to see erected around those centres accommodation for all the people—and, mind you, that is a pretty tall order—who stand in need of treatment for pulmonary tuberculosis, and I want it to be on a scale which will permit of the retention of each patient sent there for that treatment for a period of 12 months, because I believe in the vast majority of cases such retention will be necessary in order effectively to make a cure.
I am not a medical man, but I venture to say that seven out of every ten patients suffering from early pulmonary tuberculosis require surgical treatment. The question as to whether surgical treatment is necessary or not cannot be resolved except after X-ray, by an exceptionally competent operator of X-ray photography, and by the interpretation of those X-ray plates by a physician who is specially trained for that work. There is no illusion more absurd than to imagine that a general practitioner can read X-ray plates with that degree of skill which is requisite to determine the proper mode of treatment for early cases of tuberculosis, and the tragedy is that, if you must wait until the symptoms of that disease are manifest to a doctor not specially trained in its treatment, in nine cases out of ten it is too late to save the patient's life. Having secured then the equipment and technical staff for adequate X-ray examination of those patients, those centres must have in them or available to them not only general surgeons who are prepared to attempt everything from gynæcology to a broken leg but surgeons of a very high degree of specialised skill who can undertake the peculiar operative interference which is necessary in pulmonary tuberculosis, and only in pulmonary tuberculosis.
Around those centres should be built the hospital accommodation in which the patients will reside for the duration of their period of treatment. What I want to emphasise is that while the treatment centre must be elaborately equipped and generously staffed, the attendant accommodation should not be of a permanent or enduring character, because we might reasonably hope, from the experience of the State of New York in the United States of America, that a period of intensive treatment of tuberculosis would make the accommodation required now hopelessly redundant at the end of 20 years. The Minister will confirm me in this, that, about 30 years ago, the State of New York built accommodation for its tubercular patients designed to accommodate every case of tuberculosis in the State, and that, as a result of that intensive work, they now discover that half their sanatoria are empty and unavailed of because there are no patients to go into them. They have all been cured and the disease has been materially reduced in its incidence. Expense is bound to influence our judgment. We should expend money freely on the centre, the laboratory, operating and diagnostic centre, but the accommodation should be of a temporary character for a lifetime of, say, 20 years, so that, at the end of that time, we should not worry if the whole thing fell down, because we could rebuild such further temporary accommodation as might be required to deal with whatever residue of the disease was left on our hands, and glory in the fact that our new building need not be designed upon a scale calculated to accommodate one-half of the patients for whom we had originally to cater.
This, I think, is a work which we can put in hands at once because there certainly is preliminary work which requires to be done and which could be done now without any search for expensive or inaccessible equipment. There is the statistical work which must be done in order to get a true picture of the problems to be faced, and there is the organisation of dispensaries throughout the country, and more especially in the cities, which would enable diagnosis and home treatment to be initiated for the people. Perhaps one of the most vital things at present is to organise the accumulation of the necessary statistical records because it is something to which we can put our hand to-morrow, and for which we have the organisation available, if it is gingered up and slightly modified in order to make it meet the requirements of the new larger scheme which we ultimately have in view. I feel, however, that we have fallen into error in this country. We have county medical officers of health and we have recollections of the activity of Lady Aberdeen in her campaign against bovine tuberculosis, and we have a kind of easy feeling in our minds that we have done a terrible lot for tuberculosis. The tragic fact is that the net results of our efforts have not been very impressive and the menacing fact is that tuberculosis is increasing all over the world at present as a result of the hardships consequent on the present war. In Great Britain it threatens a very great crisis, and in all the other countries involved in the war there is the gravest apprehension about the appearance of tuberculosis, amongst young people particularly who are under-nourished, suffering from overcrowding in the shelters and under the strain of excessive labour in factories and the other special war work in which they are engaged.
We in this country have to face the fact that this, at first, seeming paradox is true, that in the cities, where opportunities for treatment along the lines I am advocating seem to be most abundant, the incidence of tuberculosis appears to be higher than in rural parts where the type of treatment I am advocating is not so readily available, but we have to bear in mind that statistics and study of this problem suggest that tuberculosis is the child of overstrain and undernourishment which you expect to find in the poorer, overcrowded populations of big cities rather than in the open spaces with the comparatively high standard of nutrition which obtains in a country house. It is true that the most acute problem is in our cities, if we take it from the point of view of numbers, but it is not in the least true to say that the greater tragedy is in our cities, because that tragedy, for a description of which I have turned to the novel Never No More, is as bitter and as grievous a tragedy as it is humanly possible to conceive.
It is in our power to remedy that, and it is one of those things about which there is no controversy. I am convinced that the Minister is as solicitous about this problem as I am, and that the Leader of the Opposition is as concerned, and more so, as I am in regard to this problem. I am equally convinced that the Leader of the Labour Party will be glad to sanction any expense, or any exertion, that may be requisite to control the ravages of this disease. But, for some strange reason, it is one of these problems in respect of which a sort of universal lethargy descends on us, not for the want of goodwill, but because there does not seem to be anybody to kick up a row about it. Why must we wait until some unscrupulous person comes to this country and then, in the international Press, writes an article to say that the Irish people are being ravished by the Irish disease? If a trenchant, vicious attack were made on our public health authorities, representing tuberculosis as being rampant among our people and suggesting that our people are dangerous immigrants on the ground that they are carriers of tuberculosis wherever they go, forthwith energetic measures would be taken to make it perfectly clear that our public health measures in regard to tuberculosis compare very favourably with those of any other country in the world. Why cannot we do that on our own initiative, without being shamed into doing it? What is it that holds us back?
Frequently, since I have come into politics, I have watched with regret valuable reforms become the subject of violent political controversy. I have seen what the Chinese call "face" become involved and men taking their stand on two opposite sides, and a desirable reform collapsing in the midst of the political fury that enveloped them, but here is an issue in which all are of goodwill and all anxious to help, and all ready to say that we cannot count the value of Andy Flaherty to his mother in terms of money. If there were anybody in a position to snatch these children back from death, surely there is nobody in this country who would say that a child must die because the Department of Finance will not put up the money that is needed to save it? Do I overstate the case when I say that at this moment there are hundreds of Irish homes where there is a child getting ready to die as a result of the circumstances I have outlined, and that our position at the present moment is that we know how to save it, that we can provide the means whereby to save the life of that child, but that we have to tell the parents that the Department of Finance says that it will cost too much money? Is there any parent in this House, if his child were dying, who would go to its mother and say: "Now, we can save the child, ma'am, but it will cost too much. It will mean that we will have to sell a couple of cows, so we will keep the cows and order a coffin"? Of course, there is not. But there, again, we come back to the same old story. We here in this House are the trustees of the poor. Any man or woman of substance in this country, whose child is stricken down by this blight, will come up to Dublin and get the very best physician that can be found and be prepared to go to whatever expense is necessary in order to save the child. They will mortgage the place or sell the stock, if necessary, and all that will be willingly done to meet whatever expense may be necessary to save that child. We are the trustees of the poor. It is our duty, if we have any duty, to place within the reach of the poorest mother in Ireland the same resources for the redemption of her child from death as are available to the richest citizen, and I do not think there is any Deputy in this House who would contend against that proposition.
Finally, the curative measures that I have outlined have also a preventive quality, because the great and horrible tragedy is when you see the two eldest children in a family of nine getting ready to contaminate the remaining seven: when you see the tubercular person left in a house full of children, and watch the children, one after another, drop off. The provision of centres where curative treatment will be available will make it infinitely easier to persuade parents to permit their children to go to them to be cured, and to be thus removed from the centre of the household, where they could infect the remaining children. Part of the cure, over and above restoring the patient to health, is that it renders the patient innocuous to his neighbour. The patient ceases to be a source of infection to the children around him and, in the process of his own cure, he makes himself harmless to those who come in contact with him, whereas, before that time, he was a standing menace to every young person who came near him.
Albeit, however, that we take these measures, I suggest that something further must be done, but I am not going to ventilate this aspect now because I am not satisfied that it can be done within the four walls of the Minister's Department, and that is that we have got to remove destitution from the homes of the poor. Poverty, involving hunger and malnutrition, is the most fruitful source of tuberculosis. Whatever remedial measures we may take, that essential preventive measure is of the first importance. That brings me to the sphere of family allowances. I have dealt with that on another occasion and I do not propose to deal with it now, but I hold that it is an essential pre-requisite to the question of dealing with this problem. I know the Minister to have the goodwill and the desire to do all that he thinks can be done, and I am going to suggest to him that in a period in which the youth of most countries of the world are being slaughtered, he should do his part to preserve the lives and health of the youth of our country.
I am very pleased that Deputy Dillon, after dealing at great length with the treatment that tuberculosis cases should receive, said that the greatest cause of the disease was poverty. I am pleased that he referred to that and, particularly, to the question of introducing family allowances. Now, to bear out Deputy Dillon, I may say that I am one who takes some interest in public health affairs, and I should like to quote for the House the statement of the medical officer of health for Dublin. Dealing with tuberculosis in his report of this year, he says:—
"Too great stress could not be laid on the improvement of sanitary environment and the removal of social conditions, particularly poverty, with its impairing effect on the general health."
And he stressed the fact that increased wages in Dublin in recent years reflected a downward trend of this disease. He also stated that "disease and poverty are allied by the closest bonds", which bears out that poverty is responsible for the increase in tuberculosis and some of the other diseases which the Minister's Department has to deal with in connection with the big problem of public health. Recently, the British Medical Association set up a council to determine what should be the weekly minimum expenditure on foodstuffs for families of varying sizes, if health and working capacity are to be maintained, and here is one of the statements made in that report: "Man's health or ill-health is dependent upon nutrition, exposure to infection, and conditions of environment." I want to emphasise the fact that nobody can deny what Deputy Dillon has stated—and I am prepared to back it—that poverty and bad social conditions are responsible for the increase in sickness and disease that we have in this country.
If anybody would take the trouble to read the reports of medical officers, not only of the cities but of the counties, he would realise that they are the most depressing things anybody could read. Here are the facts, as reported by the medical officer in Dublin. Of the 40,868 children examined in Dublin during 1940—we have not yet got the figures for 1941, and they are probably worse—there were over 14,000 suffering from defective teeth; over 4,000 suffering from defective vision; over 1,000 suffering from malnutrition; over 800 suffering from tuberculosis; and there were 5,770 suffering from defective clothing and 4,546 suffering from defective footwear. We are told in that report that the infant mortality rate in Dublin last year was 1,039, which means that of every 1,000 births in Dublin, 92 children died before they reached the age of 12 months. It is also stated in the report that in a school that was visited, of 45 children undergoing routine medical examination, 22 were found to be suffering from malnutrition, and these were children of unemployed parents.
I was rather disappointed at the casual way in which the Minister dealt with these matters in his statement introducing the Estimate. I wonder if it was purposely that he made no reference to the health of Cork City or to the position there. The report of the medical officer of health for Cork City for last year makes most depressing reading. For the information of the Minister and of the House I propose to give some details from it. The births last year were the lowest ever recorded. The death rate was higher than in previous years. Deaths from tuberculosis were higher. The infant death rate was higher, the corresponding figures being 95 per 1,000 of the population in 1940 as against 73 in 1939. Maternal mortality was also higher. The report of the school medical officer showed that 11 per cent. of the children were suffering from malnutrition, and over 9 per cent. from unsatisfactory clothing. Over 55 per cent. of the children were found to be suffering from defective teeth. I noticed in the report of the medical officer of health for the City of Dublin that over 14 per cent. of the children—out of a total of 40,000—were suffering from defective teeth.
In the Minister's statement we were told that over 55,000 children were found to be suffering from defective teeth. That information would appear to have been gathered from inspections made under the school medical services scheme. In Cork City, where we were somewhat alarmed by the report we received from our medical officer for health, we asked the school medical officer to give us her opinion of the causes for such a high percentage of defective teeth in school-going children. She submitted a somewhat elaborate but very interesting report. I propose to quote only some striking points from her report. She reported that vitamin D is of paramount importance for the normal structure of the teeth and their resistance to dental caries. She stated that children, on account of poverty or because they cannot be supplied with adequate amounts of dairy produce, including eggs, are liable to suffer from dental caries.
The report of the medical officer of health for the County of Cork—he was dealing with the rural areas, which include very few towns of any importance—stated that he found 204 children suffering from malnutrition. The number in 1939 was 178, and in 1938, 123. I am satisfied that when we get the 1941 report a serious increase will have to be noted. I am stressing these points for the reason that, I am inclined to think, there are very few people in this country who realise the importance of this question of public health. For example, I heard one or two Deputies congratulate the Minister on the way he is administering his Department. It is not my intention to indulge in unfair criticism, but I think it is necessary to stress these points in order to direct public attention to the all-important question of our public health. I do not know if the question of public ill-health is half sufficiently stressed by anybody in this House or outside of it. On former occasions I have had occasion to criticise medical officers of health for their timidity in making the reports that they could make. We have had a report from a medical officer in this country which states that tuberculosis is a very sensitive illness to economic conditions. That is a very respectable way to talk about poverty. We had another man reporting on the question of doubtful malnutrition. My opinion is that malnutrition is just a 12-letter word for starvation. I think that the sooner the Minister's Department faces up to the serious question of the health of the people the better it will be for the country.
The county medical officer of health for County Kerry makes an alarming report about the increase in tuberculosis in that county. He says that, honestly speaking, he did not think there was any marked improvement in the incidence of the disease. He states, or rather asks, how many of our schools are damp, draughty, insufficiently heated and ventilated and in other ways unsuited to ensure the health of the scholars, and that much ill-health is engendered in them which later on may provide a fertile soil for the development of tuberculosis. In speaking of tuberculosis and its relation to housing, he states that housing conditions are bad in most towns, but ventures the opinion that the small farmer's house is frequently the worst. Most of the dwellers of these houses, situate in valley or on mountain tops, get just as little fresh air during their indoor hours as do the dwellers in our city slums. When I relate that report to the statements so often made here by the Taoiseach that we are never short of money for anything that is necessary or useful to be done in the country, I must say that I think the sooner we get off that pretence and make-believe the sooner we will have an honest government in the country.
The medical officer of health for Limerick, in his report, has some comments to make on some of the things that he knows to be happening. He says that the people are not horrified at the sight of malnourished children and that artificial respectability has destroyed our sense of the real. I agree with him 100 per cent. in that. He says that diets should be given that would abolish malnutrition, and that this can only be achieved when the profession of agriculture is restored to its high place as a vocation, and is protected at every point against the destructive power of a civilisation based on money changing. I hope the defenders of the financial system will take a note of that statement. I am sorry that Deputy Dillon is not here to hear me read the last paragraph in the report of this medical officer. He states that the degree of necessity for State social services is a measure of the imperfections of the social system. I thoroughly agree with him on that. Whilst swimming pools and all the rest of it are very necessary and desirable things for the health of children, unless we give the fathers and the mothers of the children sufficient purchasing power to enable them to buy food and clothing for their children, so that they may be maintained in good health, we are not, I think, going to achieve very much.
I am sorry that Deputy Walsh is not here to hear me read some extracts from the report of the county medical officer of health for the County Louth, because on the last day I heard him say in this House that he looked upon the Minister not only as the dutiful father of the national family but also as the loving mother of it. I do not want to take away that appellation from the Minister because I am prepared to admit that he probably has as much sympathy for the poor as any of us and is as anxious as we are to see disease and sickness eradicated. At the same time, I think that a statement of that kind from any member of the House is treating a serious question of this kind entirely too lightly, and is calculated not to have a good effect on unthinking people. I would be very much surprised if Deputy Walsh would make the statement had he read the report of the medical officer of health for the County of Louth. In his report for 1940, he states that of the 2,680 school children examined, there were 100 suffering from sub-nutrition and 20 suffering from malnutrition, while in the case of 30 footwear was absent.
The report goes on to say that at a meeting of the County Louth Board of Health in 1940 the chairman said that tuberculosis was never so prevalent in the county as then, and that the percentage must be higher than it was 20 years ago, or, at any rate, ten years ago. Here is a statement in his report which, I hope, will be copied by every other county medical officer of health in the country. I hope they will not be reprimanded if they think it necessary to copy it. He states that T.B. cases will not be cut down by any brick and mortar policy alone or by the mere building of a sanatorium or a tuberculosis hospital. I think that is a thing we should all take a note of, because we are all too much inclined to deal with effects rather than with fundamental causes. He winds up by saying that it is more food, better living conditions and more medical staff that are the primary necessities, and that the better living conditions required chiefly affect the poorer classes.
Now we come to a statement from Dr. Shipsey of Waterford. He said that the poverty existing in that city is appalling and that the hospital was never so full, full of people who are not so much sick as hungry, and who come to the hospital mostly to get fed. We have a very strong confirmation of that from Dr. Nicholas Purcell of Tramore, who said that there were quite a number of people in and around Tramore suffering from defective nutrition amounting in some cases to semi-chronic starvation.
Does anybody suggest that if you build sanatoria or hospitals of the most modern, up-to-date type that that will reduce the number of cases of tuberculosis or any other sickness while you have such a state of affairs as that existing? We have a statement from Dr. Russell, Medical Officer of Health for Dublin, that a census taken of the families in the Railway Street, Towns-end Street and Hanover Street areas showed that 57 per cent. of them had weekly incomes under £2 per family, while the income of 26 per cent. was under £1 per family. I suggest to the Minister and to his Parliamentary Secretary that the sooner we get away from the idea that everything depends on hospital treatment the sooner we will deal effectively with the problem of ill-health as we know it in this country.
Somebody said during the previous debate on this Estimate that people were slow to go to hospital when suffering from tuberculosis. Do people ever ask themselves why a good many of the wage-earners refuse to notify their sickness or are not anxious to go to hospital? Do they realise that a man earning £3 or £3 10s. 0d. a week knows that the moment he gives up his job, even though he has not been feeling well for a long time, he will have to support himself and his wife and family on the 15/- a week which he will get from national health insurance? Not only that, but after six months' illness the 15/- is reduced to 7/6 per week, on which he may have to keep a wife and five children. I know of many cases where men have gone to a sanatorium or hospital and where their wives and children had to exist on 15/- a week. If the man was six months in the sanatorium or hospital or was unable to resume work within that time, the income was reduced to 7/6 per week. Has any Deputy ever given any thought to these things? Does the Minister ever think of them?
I know of cases where the wives of men who have gone to a sanatorium have collapsed and have had to go to the board of assistance in order to get home assistance. I have a case in mind where a man with a wife and five children, the eldest of whom was ten years, and the youngest two and a half years, and who was in receipt of £3 12s. 6d. a week, had to go to a sanatorium. He has been in the sanatorium now for seven months and the national health benefit has been reduced from 15/- to 7/6. Home assistance had to be given to the wife to bring her income up to £1 per week so as to give the family something to live on. She is paying 5/- a week rent and is also attending a doctor, who tells her that she is in want of various kinds of nourishment. Is it not all make-believe to think that hospital treatment will cure people in that position? I also know of cases where men have come back from a sanatorium to homes where there are four or five young children and we have been unable to find houses for them because of the shortage of houses. The only way we can deal with sickness, particularly this unfortunate disease, tuberculosis, is by improving the conditions of the people.
I should like to come back to other aspects of the Estimate. Anyone who is a member of public boards and who gives serious thought to the problems of public health and local government and who has to deal with local matters and matters of national importance at the different boards—mental hospital boards, boards of public assistance, boards of public health, etc.—must be convinced that it is not possible for any one Minister to deal efficiently with all these departments of local government and public health and that there is a very definite need for a second Minister to deal with social services as apart from local government. Until such time as we have a reorganisation like that we will have criticism and complaints, which are justified, about the difficulty of getting any kind of help from the Department. Anybody who reviews the social services in this country for the past ten or 15 years must realise also that there is great need for some kind of co-ordinated social insurance scheme which would include national health insurance, unemployment insurance, unemployment assistance, old age pensions, widows' and orphans' pensions, hospital and medical treatment, and I would also include workmen's compensation. They are all forms of social insurance. In bringing in a unified scheme of that kind I think we should also include the well-paid workers as well as the poorly-paid workers. Some scheme of that kind would be worth having.
In that connection I think some study should be given to the schemes in operation in New Zealand. We would probably find that some of them would be suitable for this country. I hope that the Minister and the Government as a whole will take some interest in having these different schemes of social services co-ordinated. There is nothing so depressing for poor people as to have to go to two different departments every week for assistance. A man drawing unemployment assistance who has more than five children will have to seek home assistance to help to support his family and therefore has to go to two different departments every week to draw his money. I think that is a deplorable state of affairs. Then again a man who has been drawing national health insurance benefit when he applies for an old age pension is cut off from national health insurance benefit and has to go to the board of public assistance to get help until he gets his old age pension. All that creates unnecessary work in the Department of Local Government and Public Health.
Reference has been made to the abolition of the public boards. I have not been a member of a number of public boards for some years without hearing and knowing something, and I am not disturbed when a board which does not carry out its duties is abolished. Some boards have been held up to a certain amount of suspicion that they have not been all that they should be. I think the Minister is wrong in abolishing these boards. As far as those associated with me on public boards are concerned we would be prepared to give the Minister every co-operation in an endeavour to clean up any kind of corruption that was known of, or that had taken place, but we would not agree to the abolition of boards that have recently been abolished. I am not at all satisfied that it is wise to abolish public boards in that way. We have to face up to the fact that for nearly 20 years we have been passing through abnormal times. If trouble has taken place on public boards I think it has arisen because we have not had local elections for many years. If the elections were held every four or five years I am quite satisfied that the personnel of our public boards would be greatly improved. While elections are not held boards are being abolished and managers appointed, and that means that people with a deep sense of citizenship, who would be prepared to help in such work have been hunted off. It is bad in the interests of the country to kill civic spirit of that kind. While some boards may have been guilty there should be some means of discovering if certain practices have taken place rather than to abolish them. I know that there are men on boards I am connected with who are prepared to do their duty to the people conscientiously and well. It is not fair that such bodies should be abolished without having an opportunity of answering any charges that might be made against them. I am not standing for anything that is dishonest or unclean in public life. On the contrary, I feel that anybody responsible for anything of that kind should be dealt with very strongly, and also those who encourage them. We have a Secret Service Vote, and I do not think that money could be spent in a better way than in stamping out any practices of the kind I am referring to. I am satisfied that any Minister and any Government will get support in that respect from those who are anxious that public bodies should be administered honestly. I warn the Minister against appointing managers to replace public bodies that have been abolished.
If it is necessary to abolish a board I suggest that the acting secretary of it should be given the executive power that is given when managers are appointed. If that were done, I believe conditions would improve in a short time. On some of the boards with which I am connected the officers have a certain amount of executive authority, and I have never yet known of any case where a member of the board objected to propositions put forward by these officers. Sufficient men will always be found on public boards to do the right and the proper thing. I warn the Minister against taking action against these bodies and abolishing them unless there is a case for doing so.
I notice that the Minister hurried over the question of hospitalisation. I do not blame him for doing so, having regard to the way in which the Department has mishandled that question. Nothing has been done about hospitals that should have been built in Cork six or seven years ago, and for which plans and sites were prepared. Some of these plans have since been scrapped, but the sites are still there. The site for one public hospital cost £3,500, but was subsequently condemned and all that has been offered for it now is £750. I suggest to the Minister that if a public board was responsible for a transaction of that kind action would have been taken against it. Cork Corporation has, on two occasions, asked for a sworn inquiry about this hospital and about a site that was acquired and subsequently rejected. I leave it to Deputies to decide if that was the right attitude towards people who were anxious to do the right thing.
I want also to refer to the question of relief work. I mention this matter because many people at the present time look upon institutions like this House with a certain amount of contempt. We had legislation passed here which carried with it a taint of class distinction. A number of men employed on relief work from time to time are taken from the labour exchange, but ten or twenty are known as "key men" to look after those from the exchange. A section of an Act passed here in 1939, providing holidays for employees, states that any man who has worked 150 hours within five weeks of a bank holiday was to receive payment for the holiday. Men who happen to be engaged on relief work where the money is provided by the Oireachtas do not come under the provisions of that Act.
Does the Deputy contend that this work comes within the sphere of Local Government?
Yes. The Minister's Department sent out a circular last December informing the Cork Corporation that men employed on such work are not entitled to the bank holiday. I suggest to the Minister that if economy is to be practised it should not be practised on unemployed because they are unemployed. It should not be practised on men who get five days' work because they cannot get six days' work. As the Minister has had correspondence from the city manager as to why men so engaged are not entitled to the bank holiday, I hope he will reconsider the matter. I suggest that happenings like that are responsible for bringing a certain amount of discredit on our public institutions.
Would the Deputy please state whether that is the law on the question? If it is, then I would remind him that change in the law may not be advocated in discussing administration.
I am not advocating a change in the law. The Minister is interpreting an Act which meant that if a man worked 150 hours previous to a bank holiday he was entitled to the bank holiday, as meaning, according to the Department's circular, that men employed on relief schemes who were paid from moneys provided by the Oireachtas are not to be entitled to the bank holiday. I suggest that that is too small a point for the Department to take up with local authorities and I hope that the Minister will look into it again.
The final point I wish to stress is this. Is it through hard-heartedness, through indifference or lack of appreciation of the conditions of the poor that we have done some of the things that are done in regard to national health, widows' and orphans' pensions and old age pensions throughout the country? The sooner we see that the poorer sections of the community are not ground down in poverty on account of the increased cost of living the sooner will there be some regard for democratic institutions. At the moment there is the question of old age pensions and the means test, of widows' and orphans' pensions and the non-contributory pension. The person with six or seven children to maintain is in receipt of a miserable pittance; yet if she goes out to clean some offices or some floors to supplement that allowance of 7/6 she finds that her allowance is reduced.
That is a new question.
It may be a question of submitting or suggesting legislation. These are matters which every member of the Government and of the House should take note of. They are too serious to pass them over as things we cannot touch because of the need for changing the legislation. It must not be forgotten that things are changing at the moment, and if there is anything that will stir people up it is such question as these. The sooner they are dealt with the better for the institutions of the State.
I would also mention the need for family allowances. That also is a function of the Minister, and I hope there will be consideration for the people who are rearing large families for the State and who justify being looked after. I am not suggesting that the Minister or that members on the Government Benches are hard-hearted. That is not to be taken from my criticism. I am saying, as Deputy Dillon said a while ago: "What is keeping us from doing these things?" It is a very important question. Why are we pressing so hard on the poorer sections of the community? Any nation will be judged by its treatment of the poorer classes, particularly the aged, the infirm and the growing children. We are treating the growing children of the nation in a scandalous way. We allow a man who has a wife and five children only 1/- or 2/6 and nothing for the sixth, seventh or eighth child. That is something every member of the House should feel ashamed of. The sooner we correct that, the sooner we can talk of running this country on Christian lines.
Let Deputy Dillon take heart. In his opening statement the Minister said the Department was determined to press forward with all speed with the provision of a new tuberculosis hospital in Monaghan. But let him not take too much heart, for, if my memory serves me aright, it took four years to determine the site and then the war came along and building was impossible. Whether he or I ever will see that hospital built remains to be seen. Nearly every Deputy who has spoken on this Estimate so far has dealt with the fact that this is a Department which affects the ordinary man in the street more than any other Department. The Minister for finance touches our pockets, but the Minister for Local Government and Public Health touches us almost every day of our lives in one form or another. It is all the more pity that being so, that it is nearly the most inefficient Department in this State. The number of things which must be lying in the pigeon holes of the Custom House must be appalling. There are many I could raise here to-day, but there is one in particular I would like to recite, as it is an interesting one, originating with the Department.
On the 14th November, 1932, the Department of Local Government and Public Health wrote a long and extraordinarily interesting letter to the Grangegorman Committee. It dealt with a variety of matters affecting the treatment generally of insanity in one form or another and was a most valuable letter—or would have been, if anything had happened. The particular section to which I wish to refer is this:—
"There is another development in mental hospital practice which appears to be now ripe for consideration by mental hospital committees, viz. the voluntary case."
It was "now ripe" in 1932: it must be nearly rotten by now.
"For over 30 years private mental hospitals have been receiving voluntary boarders, that is, persons suffering from mental trouble who appreciate their position and desire to co-operate in their treatment. They are not certified as insane. The formalities before admission are reduced to a minimum and they can leave the hospital on giving notice. Up to the present, voluntary boarders have not been received in district mental hospitals. There is no prohibition of the reception of such cases, but in the absence of explicit legal authority for their admission they have not been received."
The letter covers many other points and goes on:—
"It is recognised that the adoption of the suggestions here made would necessitate an amendment of the law. The Minister wishes to assure the committee that he will be prepared to give careful consideration to any proposals put forward for the purpose of obtaining increased powers for mental hospital committees in relation to out-patient clinics, voluntary boarders, after-care, the treatment of mental disorder in its early stages, the better development of a system of leave on probation, and such other powers as the committee would regard as now necessary."
That letter was written in 1932, and gave a clear indication that the Minister realised there was something to be said for this voluntary admission of patients. It goes so far as to say that the Minister was ready to prepare the necessary legislation. Arising out of that, nothing much having happened in the meantime, the resident medical superintendent, on the 18th of January, 1935, sought the committee's sanction to consult the inspector and the law adviser on the preparation of draft rules covering voluntary admissions. It was obvious that fresh rules would be required if voluntary admissions were to be made, and this it was proposed to do. On the 8th of February of the same year the Local Government Department replied:—
"With reference to your letter of the 18th January, I am directed by the Minister for Local Government and Public Health to say that he will be prepared to consider rules for the admission of voluntary boarders to mental hospitals."
Arising out of that, those rules were prepared and were submitted by the resident medical superintendent to the committee, approved of by them with instructions that they would be forwarded to the Department. Subsequently a conference was held between the inspector and the resident medical superintendent, at which some amendments to those draft rules were suggested. On the 17th November, 1938, rules as amended after the conference were resubmitted to the committee and forwarded to the Department. A further conference was held on the 8th November, 1940—two years later. A special sub-committee of the Grangegorman Mental Hospital met on the 25th November, 1940, at which they passed the following resolution:—
"That this committee, having considered the correspondence with the Department of Local Government and Public Health on the subject of the admission of voluntary patients and other means to be adopted to secure the early treatment of those who are sick in mind, is of opinion that the views of the Department and the joint committee are similar, and requests the Minister to receive a deputation at an early date in order, if possible, to discover and remove any misunderstanding which may be the cause of these matters being so long in abeyance."
That is where the matter rests to-day. That resolution was passed in 1940 asking that a deputation be received by the Minister to discuss this matter.
Some Deputies speaking here to-day have suggested that some local authorities and the Department approached each other rather in the spirit of trying to score points off one another than in the spirit of co-operation. I suggest the wording of that resolution, which says that the desire of the deputation was, if possible, to discover and remove any misunderstanding which may be the cause of these matters being so long in abeyance, does not indicate any desire to score points. It rather shows that on the part of the Grangegorman Committee they had every desire to co-operate with the Department in order to get something done. Here is this thing, possibly a very valuable aid to the treatment of mental disorders, raised in that valuable letter to the Department in November, 1932, and here we are in June, 1942, and nothing has been done one way or the other about it.
Deputy Dillon, in his able remarks on the subject of the treatment of tuberculosis, emphasised the absolute need for early treatment. Surely, in the case of mental disorder, it is likely, if not certain, that in very many cases early treatment might result in a cure and thereby result, as Deputy Dillon mentioned in the case of tuberculosis, in a diminution of the number of patients in the hospitals and a diminution in the cost to the country of maintaining patients and staffs and buildings. I think the Minister should have this matter carefully examined again in order to see whether it is not possible to have some agreement reached.
One of the objections—it was a verbal objection—raised in this connection was that the mental hospitals were full and that, therefore, there would be no sense in allowing voluntary admission of patients because there would be no place to put them. There appears to be a saying—I do not know on what it is based—that when there is a war on the population of the mental hospitals decreases. There is, presumably, some connection between the two—I do not know—but it does happen that there is no room now in the mental hospitals, although there has not been for years. It would, therefore, appear that this is a suitable time for the voluntary admission of patients.
There are some other points in connection with mental hospitals to which I should like to refer. One is the provision of a special hospital for the treatment of mentally deficient children. There were many occasions on which the members of the Grangegorman Committee, on their visits to the hospital, reported adversely on the fact that children of 14 or 15 were being kept in the hospitals with grownups, the reason being that there was no means of segregating them and they were not sufficient in number to make a separate ward for them. It appears there is no institution in the country which is capable of looking after them.
There is one other matter on this Estimate which I wish to mention, and it is in connection with the 1940 amendment of the Act affecting local officers and employees. A certain point arises out of the interpretation of the Act as to whether it did or did not include head nurses and head attendants. It was impossible for the committee to come to any decision on the matter and the Department, apparently, is not very clear, either, because it has been asked, without success, to interpret it. That is understandable, because eventually, when the matter was referred to two senior counsel, the first question those senior counsel were asked was whether these particular officers were excluded from the Principal Act by the amending Act, and one of the counsel said: "In my opinion, no," and the other counsel said: "Yes, in my opinion." They say that when doctors differ the patient dies. I do not know what happens when lawyers differ. Possibly the Minister may be able to clear up that matter as to whether the amending Act does or does not refer to those officers.
Before I leave the public health end of the Minister's Department, I should like to enter a protest against the word that he used in his opening statement —in fact, I think he used it in connection with a single patient. I refer to the word "hospitalisation". So far as I am aware, there is no such word in the English language. I do not know what it means and I do not know whether anybody else knows; but I do not think it means anything sensible, anyway.
I desire to say a few words in regard to town planning. Town planning at the moment is very much in the public eye. We know that in Great Britain they have appointed a Minister of Works and Planning, and we know that there are all sorts of ideas being talked about in relation to the control of building everywhere throughout the country after the war. Probably it is essential that some such scheme should exist because, with the amount of building which will be taking place after the war in Great Britain, unless there is full control exercised—as, unfortunately, there was not after the last war—then some of the many evils created at that time may be recreated. So far this country has not had the same opportunity of replanning its cities and towns, for which we must be thankful, but at the same time, when this question of planning is so much in the air, we ought to take every opportunity we can of cashing in on what other people are doing and thinking.
We know there is this Ministry of Works and Planning in Great Britain. We know, too, that Northern Ireland has appointed a consultant and that his recommendation, amongst others, is that the whole area shall be planned as one and not as a series of separate entities. I would be glad to know from the Minister whether the planning section of his Department is alive to the various developments that are taking place, whether his officials are watching all the schemes that are being put forward and are trying to select the wheat from the chaff; particularly whether there is any liaison between Northern Ireland and this State, on this matter at all events, whatever there may be in regard to other matters. It seems ridiculous, in two countries which have a comparatively long Border, if there is no liaison between the one and the other; in such circumstances it does seem impossible properly to plan. It might be that Northern Ireland would bring a road up to the Border and there it might end in the middle of a green field. That is, admittedly, a reductio ad absurdum, but it is a matter on which there should be some common action between the two States. I hope the Minister will be able to assure us that such co-operation does exist.
One reads in the Press complaints regarding delays in coming to decisions in the Department. I have had some experience of that— very little, I must say. Some four or five years ago I remember there was a meeting in Cork in connection with the building of a hospital and there was a complaint in regard to the alteration of the site, but, as far as I know, nothing has since been done as regards the building of that hospital. The second case concerns a contract which was subject to approval by the Minister. In consequence of the non-approval of it within a reasonable time, the cost was increased to twice or three times the figure it should have been. That was entirely due to the unnecessary delay in the Department.
The third case was of a more personal character and concerned a friend of mine who had been a surgeon in the West of Ireland. He was a member of a family which had a long and distinguished national record. One of his brothers had given his life for this country. He had given such a long and faithful service that one would imagine—he had really injured his health in the public service—that he would have been given the benefit of one or two, or possibly three or four, years' addition to his service. That practice is not unknown to the Department, but in this case no addition whatever was made to the period of service. Eleven months after he had retired he was informed of the pension he would receive. He is now dead so it does not matter, but it is unsatisfactory and indeed very painful, that a person who has given the best years of his life to the public service in that way should be left for 12 months without knowing what pension he would receive when, as it transpired, he lived 12 months only after he got it. Why there should have been any delay in cases of that kind passes my comprehension.
The Minister gave us some very interesting details in presenting his Estimate. He pointed out the great increase in social services which had taken place in the last few years, but it might be also interesting to know what were the causes for this increase. Within the last year or two there have been certain additions to the social services—a provision of £100,000 or £200,000 for home assistance in kind. In that regard, one does not expect that a prisoner would get a very elaborate diet, but the cost of maintaining a prisoner in 1937 was £7 14s. That was about the period at which a sum was fixed for unemployment assistance. The cost of maintaining a prisoner last year was £16 whilst this year it is £21. That shows that there has been a very considerable increase in the cost of living over those years. In the year 1931-32 the cost of maintaining a prisoner was £11 5s. as against the figure of £21 for this year. Obviously if we are to have any regard for the standard of living of people who are dependent on this assistance, some extra provision should be made to meet the increased cost of living and, in the absence of such provision, we cannot parade ourselves as possessing a particularly Christian spirit.
Another item that might reasonably be deducted from the social services mentioned by the Minister is the cost of paying interest and sinking fund on housing charges—£540,000. If we can assume for a moment that a body of men were appointed to govern us who were anxious to do away with all social services, they would still have to pay their debts. This sum represents merely the payment of debts and what struck me was that it was rather unusual in a matter of this kind to hear the Minister claiming credit for a saving of £1,500. I was very glad to hear of it, but I think it might be very much more. We expend a sum of over £200,000 in salaries, travelling expenses, telephones, etc., and the Minister claims that on that figure we have saved a mere £1,500. Well, we are thankful for small mercies.
We come now to the alteration made by the Minister in connection with public health services. I am rather glad that Deputy Dillon and Deputy Hickey anticipated some of my remarks in regard to the question of tuberculosis. I do not propose to say very much about it now except to point out that there is a possibility of some misunderstanding arising out of some of the observations made by Deputy Hickey. He said that he wanted to do away with the causes which led to tuberculosis. I am sure he does not mean by that that special efforts should not be made to deal with the disease itself, because the disease, to a greater degree than almost any of the other infectious diseases, has a tendency to spread. More important, to my mind, than the curative effect of sanatorium treatment on a patient is the fact that you remove the patient from the possibility of infecting other people. In the course of his statement the Minister said that one of the matters raised at the meeting with the representatives of the Academy of Medicine was the question of compulsory notification. He said that at present notification is restricted to infective cases. There is a reluctance, he pointed out, on the part of persons suffering from the disease to seek medical advice at the outset, and it was feared that this reluctance would be increased if notification were to be made compulsory.
It is 33 years ago now since tuberculosis was made notifiable in the City of Dublin. There was a great outcry in the first year or two on the part of one rather thin-skinned member of the medical profession, but from nobody else. I think he employed this rather as a political weapon. The public health committee which at that time was presided over by the late Alderman Tom Kelly made a proposal to the corporation and it made tuberculosis a notifiable disease. I think that was a wise decision, notwithstanding all the criticisms that were made. But the unfortunate thing was that it was not found possible, for one reason or another, to go further in the matter. The late Sir Charles Cameron recommended the provision of an extra room in each tenement house where any person suffering from the disease could live, this extra room to be paid for by the municipality. The idea was to separate the patients from the other members of the family so as to limit the ravages of the disease. That, to my mind, is one of the most important considerations in the treatment of tuberculosis—to prevent the spread of the disorder by infected persons moving around amongst others.
It is not easy to understand what the Minister means by these words: "At present notification is restricted to infective cases." If it means that non-infective cases should be notified it is a step in the right direction. Surely, it is our bounden duty to make it a notifiable disease in these cases, regardless of what the immediate reactions would be to a policy of that sort. If it is sound, if it means the prevention of the disease in a single case, surely it is our duty to step in in cases of that sort and take the necessary steps to prevent infection.
It is over 30 years since what might be described as the beginnings of an attack on this disorder were made. It has always been my impression that the outbreak of the influenza epidemic in 1918 did more to reduce the incidence of tuberculosis in this country than any other factor. I think it wiped out more than half the sufferers. We got a start there. However objectionable the nature of the start might be, at any rate we ought to have taken advantage of it. One gathers from the statements generally made by the Minister that there is something which prevents us from building at the present moment. From my room in Leinster House I can see a building that has gone up in the last few years. I would say it was put up regardless of expense, to provide for an expanding Civil Service. In my opinion, it would be far better for us if we had a building erected for the treatment of tuberculosis in this country.
In the course of his statement the Minister says that in 1941 the total deficits of the hospitals amounted to £173,000, approximately, which was about £16,000 in excess of the total deficits in 1940. "It is quite clear that unless this matter of the deficits is tackled with vigour and determination the real purpose of the Hospitals' Trust Fund will be nullified." Not withstanding that, notwithstanding the necessity for capitalising very large sums of money to meet those deficits, there is still enough money there to provide adequate sanatoria in this country to deal with tuberculosis.
What was the purpose of the Hospitals' Sweeps? The original purpose was to enable the hospitals to keep their doors open. That developed after a while into a grandiose scheme which was described as a hospitalisation scheme—a word that Deputy Benson objected to. It was thought by some people that we must have big hospitals in Dublin and that the purposes of the Hospitals' Sweeps would be frustrated unless we got them. The idea ought to be to provide hospital treatment for those who require it. In that connection we must remember that, so far as the Government is concerned, and all their works and pomps, they have not provided since they came into office for the treatment of as many patients as any one of those hospitals which are the subject of criticism here has provided. These hospitals have been in existence for over 100 years. At a precise moment in our history it was found that they could not meet their expenses. When one considers the increase in the cost of keeping prisoners here for the last few years, is it to be wondered at that there should be a rising deficit, or series of deficits, in the hospitals' accounts year after year? Is there anybody, civil servant or otherwise, in the employment of the State, or getting money out of the State, who had not to spend more money on his own household last year than he had five or six years ago? What is the use of wasting time with the nonsense, that you must regiment hospitals in this form? It cannot be done. Why mention it then? Food alone would represent the extra sum of money. Anybody who has had any experience of these institutions—I have been in contact with only one, and that is not even a hospital—knows that expenses have gone up considerably.
What have we done to deal with the situation with which we are confronted? Are we making any effort at all to deal with it? The mortality rate from tuberculosis of persons from 15 years upwards is rising. We can point to a fall in respect of the earlier years only. There is no country in the world in which as much money has been made available for hospitals of all sorts and kinds as has been made available in this country in the last ten to 12 years. What is the result? It takes five years to consider, and not decide, the provision of a hospital for Cork City. It takes 10 years to decide whether or not a fever hospital will be erected inside or outside the City of Dublin. We have had plans, Bills, and so on, for a hospital on the north or south side of the City of Dublin, and no decision has yet been reached as to what we are going to do in the way of extension.
In regard to the numerous complaints about delays, indecision, no decision, and all the rest of it, we get a criticism such as this: "It is quite clear that this position cannot be permitted to develop, that those who are responsible for the management of these hospitals will have to give this matter serious consideration." Is there anything done towards improving a single one of these hospitals, towards providing them with the equipment which they may require? We had a Hospitals Commission, costing £3,000, £4,000 or £5,000 every year for the last ten years. What is it doing—making up its mind as to whether or not there should be a hospital on the north or the south side of the City of Dublin? It has not yet made up its mind as to whether or not there will be one in Cork.
Within the last two years we passed a Bill setting up a Hospital Bed Bureau for the City of Dublin. Could the Minister give us any information as to how that is operating, whether it is a satisfactory arrangement; whether more beds have been made available for the people; whether it is any improvement on the system that existed; and what was the cost? Nobody can derive any great satisfaction or pleasure out of seeing these deficits increasing. I would like very much to see them decreasing, but I would prefer to know that whereas X patients were treated in these hospitals last year, we have been able to treat X+250 this year by reason of the hospitals sweepstakes. That is a task for the Ministry, unless I am very much mistaken. I should like to know whether there is accommodation afforded to any of those hospitals if they require extra equipment. If there is the same delay with regard to those matters as there is with regard to local government matters, certainly it is regrettable.
There is one other matter about which I should like some information from the Minister. We had here a question to the Prime Minister in connection with the making of a professional appointment in a hospital in Cork. It transpired in the course of the reply to that question that the terms of each one of those appointments are fixed by the Ministry of Local Government, and that in the fixing of those terms it is for them to arrange what are to be the qualifications of applicants. The same thing may apply to positions of medical officers of health for counties. In the early stages of the development of that policy, the Ministry had to wait until properly qualified persons were available. I do not know whether, in certain cases, it is regarded as necessary that persons should be qualified bilingually.
I should be very glad to see every medical officer of health bilingual throughout the country, and every surgeon bilingual as well, but I would venture to suggest that if any member of the Ministry required the services of either a surgeon or a physician it is not his bilingual qualifications he would first inquire into. While we are very anxious to see them bilingual, the fact that they are bilingual or that they have three or four languages does not relieve us from the necessity of seeing that they are otherwise the most highly-qualified persons available for those appointments. That is all the more important now, having regard to the position of a medical officer of health in a county. He is regarded as the leading person in the profession in the county, and it is desirable in his own interests as well as in the interests of the other medical men in the county that he should be the most highly-qualified person in the profession in the county.
The matter referred to by Deputy Hickey is of very considerable importance, and the Minister could lend his own services towards effecting some solution of it. It was put to me by a ratepayer in the City of Dublin in this form: A man occupying a house which was the property of the municipality was called upon on a Monday morning for his rent by an officer of that municipality. The man was unemployed, and had to go to the labour exchange to register for unemployment assistance. Having a wife and six children, the amount which he got in unemployment assistance was insufficient for the needs of his family, and he had to go to the board of health for supplementary assistance. The labour exchange people investigated the case in the first instance, the relieving officer visited him in the second instance, the rent collector preceding the two of them. He is being called upon by three officials. It ought to be known from the very commencement, in the case of an unemployed man, that he would be entitled to those extra sums, but here we have three officials engaged in dealing with a single individual. It is obviously an expensive method of administration, and it is a situation which has grown up over the last six or eight years. In those matters, it is desirable that we should convenience the persons themselves as much as possible. We should also convenience the ratepayer and the taxpayer, and it does seem extraordinary that the administrative costs should be so high in the case of one single individual.
The reference in the Minister's statement to the incidence of a new disorder here in the City of Dublin reminds us of the desirability of paying particular attention to the health of the people during the coming year. Those who are paid small wages or who have not sufficient money to get the nourishment that is necessary for their families are prone to get those disorders which have been responsible for an increase in the mortality rate. It is all the more desirable in consequence that every branch of the public health service should be at its peak point. I venture to hope that we may escape the disorders which, from all accounts, are prevalent on the Continent.
Many Deputies have referred to the increase in tuberculosis in the country at the present time. I have not the official figures for Westmeath, but, travelling through the county, I see a big increase in the number of boys and girls suffering from tuberculosis, and they are not being taken away from their homes. I had one case brought to my notice recently. It was that of a small farmer's wife, whose sister wrote to me saying that this woman had been suffering from tuberculosis for 12 months. She had five young children. The doctor had been attending her for 12 months. He had warned the eldest child not to go to her mother's room as she was likely to get the disease. The next morning that woman's brother came to me to ask if I could get her removed to hospital. He told me that her husband was ill, too. The doctor who had been attending this woman lived within a mile from me. I immediately sent him a letter by special messenger to Mullingar. The doctor's excuse was that for a long time he had been trying to get this woman into hospital and could not get a place for her. To give him his due, within three or four days he did get the woman into hospital, but she died within a week. That woman had been ill in her own home for 12 months, with five young children. Her husband is now ill. I do not know what is wrong, but I suspect that it is tuberculosis in his case, too. I think that is an awful state of affairs to exist in a country in which so much money is spent on hospital sweepstakes and so on.
Two young boys came to me a fortnight ago, fine young boys of 22 or 23 years of age. They were in Mullingar Hospital for 12 months and then they were sent back to their families. I think that is a disgrace. They are two young boys, but they are suffering from tuberculosis, and I think it a shame to send them back to their families. I believe that is due to want of accommodation. One of them told me that the doctor said that if he could get light work in England, he would be able to do it, and he applied to get away to England. I wrote to some place in the Castle explaining the circumstances and pointing out the doctor's recommendation—the boy had got a job—and I got a letter back saying that he would not be allowed to leave. These matters should be looked into, and, as Deputy Cosgrave says, an effort made to get these people away from their families and into some place in which they will be cared for.
I understand that a number of small farmers' children who are suffering from this disease are not being taken away because they are compelled to pay for their keep in the hospital. I have several letters from fathers and mothers whose boys or girls have been in hospital for 12 months and who bring home bills for £20 or £30. This has the effect of preventing many of these people from going into hospital and from being removed from their families amongst whom they are spreading the disease. I am glad that so many Deputies have mentioned this matter because it is my opinion that tuberculosis is on the increase here. Looking at the people around one, one sees numbers of boys and girls with the pale cheeks of that dread disease. In my young days, every other family was dying off from tuberculosis, but the disease went out of the country. I am afraid, however, that it is coming back again and the Government should do something drastic to stop it, because when one member of the family contracts the disease, other members of the family cannot be saved, unless the source of the infection is removed. Something should be done to enable those persons to be got away.
Deputy Cosgrave has pointed out that no Government ever had as much money to spend on hospitalisation, but I think it would be much better if smaller hospitals were built. We have a hospital in Mullingar and I do not know how many thousands of pounds it cost to build. I do not know what number of beds are available, but there is not half the number available now that was available some years ago, although a lot more money is being spent. If the poor people—the small farmers, who, in my opinion, are the poorest people in the country—go into that hospital, they get a bill a yard long on coming out.
Would the Deputy give me some particulars of these bills?
The small farmer who goes into Mullingar hospital is charged a maintenance rate, to begin with, and many of them have not the wherewithal to pay that rate.
Maintenance is one item a week. The Deputy has said that they get a bill a yard long when they come out. If a poor man gets a bill a yard long, it is unjust, and if the Deputy knows any case of the sort, I will have it investigated. I should be glad to get the Deputy's help.
Would the Minister consider a bill of £10 or £12 a small or a big bill?
It would depend on the circumstances and the treatment.
I think the amount is about 9/- a week, though I am not sure, but a small farmer with seven, eight or ten acres is not able to meet a bill which is accumulating for two months. If he is a "red ticket" case, he is treated free, but something should be done to help these people I speak of. Within the last year, I have written to the matron of the Mullingar hospital with regard to certain people. One of them came to me with a bill of £12 or £13, and another with a bill of £22 or £23, together with a threat from a solicitor of being taken to court.
Some of them might have had means, too.
Some of the farmers I speak of have not got the means. My point, however, is that it prevents many people who are suffering from tuberculosis and who do not come under the insurance scheme from being taken away. I ask the Minister to take a sensible view of this matter and not to get cross——
I am not cross with the Deputy.
——but to try to get something done. I want to refer now to the state of the roads at present. We know that there are no private motor cars on the roads now and that people have gone back to ponies and traps. Some effort must be made quickly to make these roads safe for such people. It is lamentable to see people trying to get to Mass on Sunday on the present road surfaces. One Deputy mentioned concreting the middle of the roads, but if we have to wait for that, petrol supplies will again be available and things will be normal.
I want to make a suggestion as to a cheap and quick way of dealing with the problem. Our county surveyor, when frost began to make its appearance, had loads of fine gravel left at intervals of 200 yards along the roads and one of the section men coming to work in the morning had instructions to throw a shovelful over the surface. If that fine gravel was left along the tarred roads at 200-yard intervals, it would do for six months of the year. A section man could be appointed to throw a shovelful over certain distances and then the people could travel these roads with their ponies and traps and horses and carts until some other remedy is devised. Many people at present have to draw turf for distances of ten and 12 miles. They cannot get rubbers to put on the horses' shoes and have to use by-ways in order to avoid the tarred roads, whereas if the suggestion I make were adopted, the people would be enabled to drive to Mass and carry on their ordinary business. Whatever is done must be done quickly. The ratepayers are paying for the roads and have not got the use of them. It is the task of the Department of Local Government to have these things attended to and I urge the Minister to look into them. I ask the Minister also to consider the position with regard to tuberculosis, because I am sorry to say it is on the increase and it is sad to see how some families are suffering.
On this Estimate I should like to refer to the housing activities of the Local Government Department. In recent years, very commendable progress has been made in housing, particularly in the erection of labourers' cottages in rural areas, and those local authorities which took advantage of the facilities provided by the 1932 and subsequent Housing Acts have been able to erect very substantial housing monuments to their credit. County Kildare, for instance, a very small county, has erected over 1,200 cottages since the 1932 Act, and when the present housing scheme in that county is complete, one house in every four in the county will be a labourer's cottage, which gives you some picture of the fruitful activities of the board of health there and the contribution which the board has made to the proper housing of the people.
There is, however, an aspect of housing to which I should like to draw the Minister's attention, and that is, the provision of housing schemes in small non-urbanised towns. In the urbanised towns and in the towns where there are town commissioners it is possible for these local authorities, on their own, to raise the necessary funds for the purpose of financing housing schemes for their respective areas, but the small non-urbanised town is in a somewhat different position. It has no local authority of its own. It has got to rely on the board of health to erect houses for it in the town, and by reason of the fact that there are numerous demands from a large number of small urbanised towns, local authorities are rather inclined to push housing schemes for the small non-urbanised towns somewhat into the background. I think a good deal of progress has been made in respect of the erection of labourers' cottages. In fact, in some areas the demand for labourer's cottages has almost been met, and probably will be met in a very short time. That being the position, and where it is the position, I would suggest to the Department that it might now direct the attention of local authorities to the desirability of paying attention to the provision of houses in these small towns.
I take it that we do not contemplate the abolition of these small towns and the diffusion of the population in labourers' cottages throughout the country. If we assume that the small town will continue—and I hope it will —and if we assume that we ought to beautify it as much as possible and make it a real, decent, up-to-date town, then I think it is desirable to utilise some of the vacant, derelict sites in these towns for the purpose of erecting houses thereon and, at the same time, providing the town worker with a house in the town, which would probably be more suitable to his needs than a labourer's cottage some distance from the town. The provision of such town houses would supply a long-felt want in many of these areas. It would help to improve the amenities and appearance of the town, and I hope the Minister will direct the attention of local authorities to the desirability of not overlooking that aspect of their housing activities.
While on the question of housing, I should like to refer to the position of persons, who are serving in the Army for the duration of the war, in relation to their tenancy of labourers' cottages. I understand that the Local Government Department issued instructions to local authorities to the effect that persons serving in the Army were not eligible for the tenancy of labourers' cottages. I, however, took up a particular case with the housing section of the Department, and I received a reply to the effect that, as I contended, where the person concerned was, prior to joining the Army, an agricultural labourer within the meaning of the Agricultural Labourers Act, he should, or his wife should, whilst he was in the Army, still be deemed to be eligible for the tenancy of such a cottage. Having established that principle, as I thought, with the Local Government Department, I communicated with the county medical officer of health and asked him to see the Department's reply in this case and examine the matter, with a view to giving a cottage to this woman, who had a large number of children and whose husband had joined the Army for the duration of the emergency, but, notwithstanding the reply I had received, the medical officer of health said that instructions to the contrary from the Department were in his hands and that a person serving for the duration was not, in fact, eligible for the tenancy of a labourer's cottage. Now, I think that that is a most unfair ruling, and I hope the Department will not persist in it. After all, a man who joined the Army when it was believed that this country was in danger and when it was found necessary to mobilise portion of our manhood to defend the country, should not be penalised in that way because of the fact that he had joined the Army. I hope the Minister will look into that aspect, with a view to ensuring that, in respect of a person, who is an ordinary worker and who is ordinarily eligible for a cottage, he or his wife will not be deprived of the tenancy of a cottage merely because he happens to be serving his country in the Army.
I should like to ascertain the attitude of the Minister and his Department to the Act which provided for the sale of labourers' cottages to tenants. I am sure that the Minister and his Department must be aware by now that the scheme, as operated by the Department, has been a thoroughly unsatisfactory scheme. I think that not more than 10 per cent of the persons occupying these cottages have sought purchases under the terms of the Act. The other 90 per cent. have abstained because they regard the scheme as unfair, and as something that imposes a burden on them, and I think it will be found on examination that where purchase has been contemplated at all, or has been entered into, the purchase, in the main, has been by tenants of cottages where the period of repayment, owing to the age of the cottage, is rather on the short side. I think the Department must now have abundant evidence that the scheme is an unpopular and unsatisfactory one. If it is desirable to encourage the sale of labourers' cottages to tenants—and I am personally in favour of it, where the terms are fair and do not impose a burden—I think the Department should now review the whole position with a view to introducing some amending legislation which would enable the ownership of these cottages to be transferred to tenants, and on terms which would be equitable to the tenants on the one hand and to the local authority on the other hand. I should like to hear from the Minister, when he is replying, whether the Department contemplate an examination of the operation of the Act and whether they contemplate an easement of the terms of sale which were imposed by the executive action of the Department under the Labourers Act.
The question of the treatment of tuberculosis has occupied a very important part in the discussion of this Estimate, and of course everybody, who knows the ravages of that disease, and who looks with horror upon its increase, will rightly recognise the necessity for directing attention to the desirability of a more vigorous campaign to grapple with the disease and to prevent the ravages which are following in its wake to-day. It seemed to me that the Minister's statement on this matter was a rather routine kind of statement: as if tuberculosis were an inevitable disease, as if it were something to be dealt with in the form of a file, something upon which you had to present an annual report, something with which we will be dealing for a very long time and— oh, well, let us have a regular report dealing with it. I think, however, that the problem is a much more serious one than that, and unless we are prepared to contemplate the wanton slaughter—for that is what it really means—of thousands of our people each year, we will have to accelerate the rate at which we are dealing with the problem in this country. I am sure that the Minister has goodwill in this matter, and is anxious to have it dealt with. I am sure that it sickens him, just as it sickens every one of us, to hear of the appalling ravages of tuberculosis among our people, but I suggest that it is very easy to be caught in an administrative machine, which works on a kind of treadmill principle.
It is very easy to be told that this matter is being dealt with, and that this is the way it was dealt with last year and the year before, but, mind you, while we are doing that we are putting human beings into coffins, and the responsibility, to a large degree, for this mass slaughter of our people rests with ourselves because, in fact, we are too lazy as a nation to deal with the problem in the vigorous way that it ought to be dealt with, and would be dealt with, in other countries. I do not think that the treatment and eradication of tuberculosis can be dealt with merely by the provision of up-to-date sanatoria. Although they are a vital necessity they represent but one factor in dealing with it. I am convinced that the problem must be dealt with under a number of heads. As statistics show, the main basic cause of tuberculosis is malnutrition and bad housing. Other contributory factors are infection and the inability of persons to maintain themselves while they have the disease, with the result that many hide it and struggle on at their work, infecting others, when they ought to be isolated, undergoing curative treatment. I have had, in the course of one phase of my activities, occasion to visit hospitals on a number of occasions. The most amazing thing to me is to go into the general ward of a hospital where there are patients undergoing ordinary surgical treatment, altogether unconnected with tuberculosis, and find in the same ward a young boy or a young girl coughing for the best part of the 24 hours and spitting into handkerchiefs. If you scratch the surface to ascertain why, it is easy to ascertain the cause. The cause is that the hospital has no specialised accommodation for T.B. patients, with the result that these T.B. cases are put into the general ward. If anybody were to visit the ward to find the reaction of the other patients, I think he would get an idea of the general condemnation of the arrangements which necessitate a T.B.-infected person sleeping, for perhaps months, in a ward with other persons who are not infected with T.B. at all. I should imagine that, while some of the non-T.B. patients may go out cured of some disability, they may also go out infected with T.B. because of their contact with a T.B. patient. If, of course, we had a sufficient number of sanatoria in the country, it would not be necessary to have a situation like that.
Unfortunately, there has been an appalling want of a recognition to insist on the provision of sanatoria. While we have done very well, in many respects, in connection with improved hospitalisation throughout the country, we seem to have fallen down very badly in the matter of the erection of adequate accommodation for tuberculous patients. I have had experience from day to day of endeavouring to get persons into a sanatorium. I must say that it is extremely difficult, in some cases quite impossible, to get patients into a sanatorium convenient to the city. I have had experience of asking the city medical officer of health, who deals with all these cases in a broadminded, humane, understanding kind of way, to get a man or a woman, living in bad surroundings, admitted to a sanatorium, but notwithstanding all his goodwill and all his efforts, I have known patients to have to wait for two or three months and sometimes six months, before they can be admitted, and then only after there has been close and intimate contact in the home with other members of the family. It is not a question of payment on the part of the tuberculous patient. I have had cases in which an organisation was prepared to pay the normal maintenance charge in a sanatorium for the patient. Even though the authorities in charge of it admitted that the patient in question was one who was likely to respond to curative treatment, it was impossible to get the patient admitted unless one was prepared to wait for three months as a minimum, and in many cases for a very much longer period. It is not, therefore, a question of economic circumstances that prevents persons securing admission. The whole difficulty is that we have an insufficiency of sanatoria, with the result that what we are doing to-day is that we are simply relying, in the main, on home methods of treatment, with a dissemination of the infection that necessarily goes hand-in-hand with that type of close association between the members of a family.
Some alarming statistics have recently been issued in connection with this question of the prevalence of tuberculosis. A preliminary report was recently prepared by the management committee of the National Health Insurance Society. The report showed that the number of claimants in each county certified for tuberculosis or tubercular diseases revealed a situation of "unusual gravity" in the opinion of the committee. There are other statistics in the report to which I need not refer, but they all justify the use of these grave words in the committee's report. A sub-committee of the Academy of Medicine recently presented a report on the subject of tuberculosis. At the outset it declared that tuberculosis was costing the country £1,200,000 per annum. I am rather inclined to think, if the existence of tuberculosis were examined in all its ramifications, that even that figure would be found to be a gross understatement, because it does not take into account the national loss of burying people who die from tuberculosis. The committee's report on the matter is well worthy of quotation. It sets out that tuberculosis stands third among the killing diseases, and points out that it is unique in that it kills the young and those otherwise at the prime of life: that half the deaths occurring between the ages of 15 and 35 were due to tuberculosis, and that 67 per cent. of the deaths between 15 and 45 were caused by it. These seem to me to be staggering figures, the magnitude of which, if once recognised, ought to bestir us into dealing much more vigorously than we are doing with this disease. The committee go on to say that the present anti-tuberculosis measures were inadequate on all counts. It refers to the fact that the National Health Insurance Report showed that 72 per cent. of insured tuberculosis patients were at home. In other words, 72 per cent. of tuberculosis patients are being treated in their own homes because there are no facilities for treating them elsewhere.
Dealing with the bed accommodation in sanatoria and the equipment of dispensaries and diagnostic centres, the committee made reference to the fact that these were very unsatisfactory and that there was need for a very radical improvement. The clinical hospitals, it stated, were besieged by patients in all stages of the disease. It went on to add:
"Since the disease was income-conditioned, economic treatment was most important, and a survey of the police force, schools, etc., was advisable."
A small council of experts was suggested by the committee to advise on the execution of reforms. The committee further suggested an increase in the dispensary staffs, an improvement in equipment and the provision of temporary accommodation near a hospital or sanatorium for diagnosis and treatment. Then it added:
"The conditioning of the disease by economic factors was shown by the relation between the death-rate from the disease and the density of population per acre."
Giving some information on the subject of the death-rate, the committee stated that in Dublin the death-rate was 24.9 per 1,000 compared with the medium rate of 17.1, and that the lowest death-rate was recorded at Howth, where it was 8.2. It also stated that the standardised tuberculosis death-rate calculated over the years 1901-1910 was: professional classes, 9.8 ; labourers, 33.4; showing quite conclusively that tuberculosis is obviously an income-conditioned disability. A report of that kind from the sub-committee of the Academy of Medicine must obviously carry weight. These are not just propaganda statistics quoted for the purpose of debate. They reveal a very alarming position so far as tuberculosis is concerned and a position which demands instantaneous and drastic action on the part of the Department, which is the responsible authority for directing our national efforts to curb the disease of tuberculosis.
An even more revealing statement was made recently by the assistant county medical officer of health for Kildare. The question of raising the standard of home assistance was discussed at a meeting of the board of health and the assistant county medical officer of health was anxious to have the scale of assistance increased, believing that it was impossible to maintain good health whilst people were living in a state of starvation or semi-starvation. In the course of the discussion, the assistant county medical officer of health said that 90 per cent. of the tuberculosis cases came from the poorest families. They would not have such a high death-rate from this disease, she said, if people had more food to eat and if they were not half-starved. She then drew attention to the prevalence of this terrible disease amongst the children of the poor. She was asked what was the cause of it, and she said in reply that "the cause was malnutrition amongst the people". She went on further to say that it was their aim to prevent tuberculosis in so far as it was possible, but, as things were at present, her principal duty was the signing of death certificates.
There is a statement from a highly-qualified and extremely talented lady who is an assistant county medical officer of health. What an indictment of our laziness, what an indictment of our slothfulness, when an assistant county medical officer of health declares publicly that her principal duty was the signing of death certificates. The reports of the county medical officers of health throughout the country and a statement of that kind from an assistant county medical officer of health, that her principal duty was the signing of death certificates, ought to bestir us into some positive activity, of a kind likely to reach maturity in the near future to grapple with this very serious problem of tuberculosis which springs from malnutrition, hunger and starvation and which is aided by bad housing conditions and by inability on the part of people to maintain themselves during periods of illness.
The assistant county medical officer of health for Kildare, when asked had she any idea as to what was the best way of dealing with cases of tuberculosis amongst the poor, made this interesting suggestion which I think is worthy of examination. Referring to cases where the parents have contracted the disease, she said:—
"If a scheme could be devised where a mother could be relieved of the duty of looking after her children and the bread-winner of the responsibility of the upkeep of his family, they would have made some progress."
In the course of my ordinary business I meet many persons suffering from tuberculosis who have been recommended for sanatorium treatment. One of the greatest problems affecting them all is how their families are to maintain themselves while they are in the sanatorium. Take the position of a man with a wife and four or five children. The bread-winner is stricken and has to go into a sanatorium and whilst he is there the family has to live on 15/- a week. At the end of six months, the 15/- is reduced to 7/6. You can imagine the plight and anguish of that man, hoping to recover from a disease which needs cheerful surroundings and a state of mental contentment, when he realises that his family are living on 7/6 a week and are likely to be compelled to live on it so long as he is in the sanatorium.
I agree with Deputy Dillon that there is probably no issue in the country, not even, I suppose Deputy Dillon would agree, the issue of neutrality, on which there is so much co-operation and so much unity of outlook and of purpose as there is on the question of the treatment of tuberculosis. I think if the Minister were to come to this House and ask for money for the purpose of a vigorous campaign to combat the ravages of tuberculosis that he would get the enthusiastic co-operation and the hearty good wishes of Deputies of all Parties. I think this debate has been revealing from this standpoint, that it is probably the first occasion in the past 20 years that there has been such a concentration by Deputies of all Parties on the necessity for a vigorous policy for dealing with tuberculosis. I think the Minister can gauge the pulse of the country from the speeches made in this House on that question, and I hope he will indicate his intention to take into consideration the viewpoints which have been expressed and that he will give some indication that the efforts to deal with this problem throughout the country will be much more vigorous and much more radical than the efforts which have so far been made.
I desire to call the Minister's attention to a few matters affecting the constituency of West Cork. Some Deputies referred to the slowness of the Department in replying to letters from local bodies. Cork County Council has repeatedly asked the Department to proceed with the appointment of a veterinary inspector for Clonakilty rural and urban districts. The position there has been vacant for six or eight months. The veterinary officer from Dunmanway has had to divide his time between Dunmanway and Clonakilty rural districts. It is very hard for one man to try to cover the two areas. That arrangement might continue for a short time, but it should not be allowed to go on indefinitely. As far as I am aware the Department has not acknowledged the demand of the county council to have an appointment made there. The local farmers' association are interested because they would suffer as a result of not being able to procure the services of a veterinary surgeon if he is required. Deputy Norton and other Deputies dealt with the position of tuberculosis as it affects human beings. It is important also that cattle threatened with tuberculosis should receive attention. The slowness of the Department about appointing a veterinary inspector there is typical of what is happening in other matters. I hope it will not be necessary to refer to it again, and that the Department will take steps to have an appointment made so that farmers will not have to be worrying about the position.
The Minister's Department deals with appeals in connection with old age pensions claims. The Referee at the Custom House decides these appeals and in many cases may not be satisfied with the facts or may require more information. The cases are then referred to an inspector, who visits the claimants in order to find out their circumstances. That has been a very satisfactory arrangement in cases that I have known. I do not blame the Referee in the Custom House for any delay that occurs, because it would be impossible for him to give an immediate decision in all cases. Where the inspector visits the people it has proved satisfactory. But the provision is that there is only one inspector available, while numbers of cases are awaiting decision. In the area that I represent there are six or eight cases pending for the past 15 or 16 months. Some of these poor people are in need of the old age pension, but there can be no decision in their cases until the inspector visits them. It is impossible for one man to deal with cases all over the country, particularly under existing transport conditions, and I suggest that the Minister might appoint somebody from his Department to help the inspector to finish off all claims that are pending for some months. As it is very hard on poor people to be without a decision in their cases for that period, I hope the Minister will do something to expedite the matter.
The Minister might also be able to help in another matter to which attention was directed at Question Time to-day by Deputy O'Neill, regarding the petrol supply for home assistance officers. I appeal to the Minister to intercede with his colleague, the Minister for Supplies, on behalf of home assistance officers in congested areas like West Cork, where it was found necessary some years ago to appoint a superintendent home assistance officer. If it was right then it is also right now that the superintendent should visit all parts of the area. The Minister has a good idea of the conditions and he knows that it is impossible, in such areas, for a man to be here, there and everywhere at the same time. Teipeann ar an ngobadán freastal ar an dá thráigh. If there was a demand for his attendance in one place where there might be a small outbreak of sickness, and also a demand 50 miles away, the home assistance officer could not possibly get to the two places in one day under present conditions.
I also ask the Minister to see the Minister for Supplies regarding the position of dispensary doctors in such areas as Durrus or Crookhaven, where they might have to travel distances of 15 or 20 miles to attend red ticket cases. The position of dispensary doctors there differs from that of doctors in the towns. In the congested areas there is a dense population, many hamlets, and big mileage to be covered under bad conditions. Where roads are not satisfactory a good deal of petrol must be used, but the allowance that doctors receive at present might not suffice for more than one visit to patients. We have had rationing of petrol for some time and it is working satisfactorily, but the Minister might be able to persuade the Minister for Supplies to reconsider the position of dispensary doctors, and also home assistance officers, in isolated districts. Their claims for increased petrol allowances are deserving of attention under present conditions.
I wish to call the Minister's attention to the position of the fever hospital in Clonmel. It is only when someone very near and dear to one has to go into one of these institutions that one realises their importance. Although I have been associated with public life in Tipperary for many years, it was a surprise to me to learn that South Tipperary has allowed the fever hospital to remain in the condition it is in at the present time. I am not making any complaint against officials or anything of that kind. I am not even acquainted with the hospital building. I think it was used as a jail. I am informed that the windows are six or seven feet from the floor. I want the Minister to ask for a report from his medical inspector or from the commissioner, Mr. Meighen, and see what can be done in the matter. I believe the building of a new hospital has been contemplated. What is called a hospital at present seems to be a good structure, in so far as walls and roof are concerned, and the size seems to be pretty reasonable, too. I suggest the Minister and his advisers should arrange to have the whole centre taken out. I have been informed there is sufficient accommodation to make suitable wards. I want, also, to have an electric lift put in this hospital. I have made some comments in connection with its condition which I would not make here. Why it has been allowed to continue so long I am unable to say. The Minister should go into this question and have something done about it. I am particularly interested in it because it came under my notice recently. It is very unfair to the patients who have to be accommodated in an institution of that kind.
The only other point to which I wish to refer is the condition of the roads for horses and ponies at the present time. It is a very difficult problem, and I do not know how it can be solved. The position is pretty precarious from the point of view of the person who wants to drive a pony and trap. Road repairs should be done at the sides of the roads so as to make them accommodate horse traffic. In conclusion, I again appeal to the Minister to deal with the question of this hospital in Clonmel and see that something is done about it. I believe it is the only one of its kind, and it should not be allowed to exist so long in its present condition.
Some weeks ago a circular letter was issued to local authorities from the Minister's Department, with reference to the necessity to effect economies in local administration. I agree that there is a very grave necessity for that, and that local authorities should make every effort to effect economies at the present time; but it seems a rather strange paradox to examine the Estimate for this Department and find the cost of running it has increased by £100,000 this year over last year. As the Minister himself points out, since 1932 the increase has been from £517,517 to £1,444,958 this year, showing a very steady spiral over that period.
The only complaint I make in that regard is that, side by side with that situation, there was an inevitable increase in the amount of local taxation levied on a particular section of the people. Certain of these social schemes and relief schemes were conditional on contributions being made by local authorities. Some time ago the Minister read a paper for the National University, in which he attempted to foretell what this country may have to face in a post-war period. He drew a very gloomy picture, indeed. He suggested that greater burdens and greater financial responsibilities would have to be thrown back on the agricultural community in the future and that possibly our agricultural policy would have to be remoulded and reshaped. He visualised the position where we might have no live stock exports at all. If he visualises that state of affairs, there should be some effort on his part to ensure that the burdens and financial responsibilities thrown back on that important section of the community, the agricultural community, will be as small as possible.
This is a Christian State, and we must ensure that civilised conditions obtain for every section of our people. Certain charges must be borne by the people, in order to relieve distress and destitution and to provide for any social schemes Parliament may think wise, in the interests of the community as a whole. In the financing of those schemes—which have been definitely on the increase and which I have no hesitation in saying I support—the burden should not be thrown on to one section of the community. Under the present system of finance and local administration, some people are escaping their just and moral responsibilities: some individuals, single people, are earning fine salaries in commercial life and in other walks of life. It is unfair to assess the liability on the individual to make contributions to local administration and public social services of this sort on the valuation basis. The Minister should consider the necessity to provide for assessing contributions for social services on income, and not on the valuation of property, which is a purely nominal affair and may not have any relation to the owner's income.
Would the Deputy like to impose an income-tax on farmers?
If farmers are liable to income-tax they have to pay it, and that is all there is about it. Does the Minister suggest that farmers are excluded?
Not at all.
The Minister knows as well as I do that they are not and that so far as the assessment for income-tax is concerned——
They are assessed on a nominal basis. Would the Deputy like that, instead of being assessed under Schedule A or Schedule B, he should be assessed under Schedule D?
Many a man pays under Schedule D, does he not?
Many farmers do in respect of businesses run——
The Chair is not prepared to hear the Minister or the Deputy further on income-tax, Schedule A, B, C or D.
Quite so, but if the Minister intervenes I attempt to defend my argument. I do not wish to advocate legislation, as I do not think I would be permitted, but I would throw out the suggestion to the Minister——
——that a man should be assessed on his income?
A man should make a contribution to social services on the basis of his income. I think that is the fairest basis of all. We all recognise that social services must be maintained and every Deputy who has spoken has advocated the necessity of providing more social services—more effective services in certain directions, particularly with regard to the treatment of tuberculosis. I wish to join with them in that respect. The Minister has referred to the progress that has been made. He said: "While mortality, due to tuberculosis, is distressingly high, a considerable improvement has taken place in all age groups over the past 20 years." The Minister made that observation from statistical information.
I am not inclined to take the gloomy view that has been taken by some Deputies in regard to this matter. I do not think the position is quite as bad as has been represented here. We were told that whole families have been wiped out by this dread disease. I think the Minister has proved that an improvement has taken place, by going into the age groups. I believe that progress has definitely been made, but that progress is too slow. At times it is very difficult to get patients into sanatoria. There is hardly any doubt that we have not made sufficient sanatoria provision for all our tubercular patients. We all appreciate what has been stressed here, the necessity of isolating tubercular cases, getting them away from the home atmosphere and so avoiding the dissemination of the germs among the younger members of a family, because therein the real danger lies. It would be unwise to state that no progress has been made in combating the disease. I do not think the position has got worse; I think the Minister is correct when he says that some progress has been made.
I am glad that a clinic has been set up for the treatment of rheumatism and that it is the intention to investigate the causes of rheumatism. There is no doubt a big number of our people suffer from it, particularly in rural Ireland. The agricultural workers are exposed to all sorts of weather conditions, and climatic conditions certainly have a lot to do with it. Some of our best workers are, early in life, made as old men through developing rheumatism, which is a very tedious and irritating disease. Great sympathy is felt for anyone who suffers from it, because it appears to be a very difficult disease to combat. It is difficult completely to get rid of rheumatism, because it is liable to recur at different stages in one's life. You cannot put it in the same category as tuberculosis; it has not the same ravaging effect, but it has a crippling effect on many of our young people and tends to make them old long before their time. I am sure many people will be glad to hear that there will be a thorough investigation into this matter with the object of finding out if it is possible to remedy it.
I was amazed to learn from the Minister that the infant death-rate for Carlow was 91 per 1,000, because in Carlow we have a very hard-working people and very few persons suffer from malnutrition. I cannot understand why we have that high infant mortality. When the Minister made the statement, I asked him to indicate the cause and he was not able to tell me at the time, but possibly he has looked up the matter since and I should like to have some information with regard to it because I am particularly interested in that part of the country. I was amazed to hear that in Carlow we had the highest infant death-rate in Ireland.
The Minister stated, with regard to Dublin hospitals, that the deficit this year was £175,000, or £16,000 in excess of the 1940 deficit. He warned the hospital authorities here that something would have to be done about it. It is about time the Minister arrived at some decision. He said that the amount available for financing certain new hospitals in Dublin and elsewhere cannot be finally decided upon so long as the voluntary hospitals continue to make increasing demands on the Hospitals Trust Fund to meet expenditure incurred by them in excess of their annual income. I presume that those of us in the country who are still waiting for the realisation of our hospital schemes will have to wait a little longer because the moneys that are ear-marked for country schemes have not yet been allocated.
Within recent years there has been a very substantial drain on the Hospitals Trust Fund, but in fair play to the institutions one must recognise that the cost of maintenance has gone up considerably and that prior to the inception of this scheme those hospitals were financed out of charitable donations and much of that money is no longer available, and those institutions cannot possibly exist without this assistance. The Minister has warned the hospital authorities that a grave view must be taken of the situation. Will the Minister say what he proposes to do about it? Is he going to set aside a capital sum to meet a substantial portion of this amount? These hospitals must be kept going. They treat patients not only from the city but from the country at a nominal charge, and it is in the interest of a very considerable area to have these institutions functioning. It is up to the Minister to make a decision to the effect that some capital provision should be made out of Hospitals Trust Fund to meet those deficits. Apparently the Minister is not prepared to swallow that.
I am very interested in what the Deputy is saying.
On the question of providing hospitals for the country generally, we will have to get down to the idea of regional institutions. The modern idea in relation to hospitals is that it is a team job; if you are going to have really successful hospital treatment you must have a complete team. It is unfair and unreasonable to throw all the responsibility on one individual; it is unjust to ask him to be the radiologist, the surgeon and everything else. Very often such a man is called upon to make grave decisions with regard to patients. It is too much of a responsibility to place on any one man. It is in the interest of the country to provide institutions on a regional basis and the Minister ought to face up to that responsibility. No purpose is served by individual counties making demands for their own hospitals.
We could not send all the cases to the regional hospitals; there must be some arrangement for local treatment.
I agree that some provision should be made for local treatment of cases that might not be considered serious. Deputies have referred to the present condition of our roads. I suppose, while we were able to drive round in our cars, we had very little consideration for the unfortunate fellow who was obliged to drive a horse and cart on these roads. A very fine surface was put on the roads without any consideration for the people who had to use horses on these roads. We frequently saw an unfortunate man trying to drive a horse along practically in the water table, because the roads were virtually impossable as far as horses were concerned. Now that many of us are compelled to use ponies and traps, we are greatly concerned about the condition of the roads and are inclined to kick up a row because the surface is not suitable for such traffic. Deputies, however, must realise that it was absolutely necessary to put a high skin on these roads if they were to be preserved against wear and tear over a long period. It was necessary to seal the road and to make it water-tight because if water percolated into the material on which the road was built up, when frost came an expansion occurred, and the road burst. The object of the engineers in putting a skin on the road was to make it waterproof and to prevent frost from doing any damage to the foundations of the road. The waterproof skin preserved the life of the road. I think, however, that at the present time the Minister might consider the feasibility of scarifying a passage on the side of the road so that we can travel in safety with the type of transport that we are at present forced to use. Let us hope that we shall have to use it only for a short time. That, however, is not the principal matter I wanted to raise in connection with the roads.
In the last two or three years, I have referred to the fact that contributions from the Road Fund to local authorities are, under the 1926 Act, divided into two parts—an improvement grant and a maintenance grant and these grants are available only for main roads. While the principle of the 1926 Act was good at that time—roads were in a very bad condition then and improvements all round were necessary on main roads— in recent years we have reached a situation in which I think that Act has outlived its usefulness. Under the terms of the 1926 Act, the maintenance grant is based on 40 per cent. of the money spent by local authorities in maintaining main roads. If the cost of maintenance is reduced by the local authority, the contribution for maintenance out of the Road Fund is proportionately reduced. I should like to point out to the Minister that there are many counties in which the main roads at present are in an excellent condition. The Minister might bear in mind that the proportion of main roads to county roads is one-fifth to four-fifths. We have 10,000 miles of main roads while there are 47,000 miles of county roads. Under the terms of the 1926 Act grants issued from the Road Fund are devoted to main roads only. I think it is time to drop that provision and that it is only reasonable to leave it to the local authority, or if the Minister is distrustful of the local authority—he has the name of being rather distrustful of local authorities—he might at least leave it to the county surveyor to determine where the money should be spent. Those who contribute to the Road Fund certainly use roads other than main roads. The people who contribute to that fund live all over the country and use the county roads just as much as the main roads. If it is unnecessary to spend money on the main roads, or to spend only a nominal sum on them, why should we spend any more money on them when it can be more economically spent on county roads? I put it to the Minister in this way. I know engineers who, in order to qualify for maintenance grants, scarified main roads that would have been quite good enough for another two or three years. They were forced to do that in order to qualify for a grant under the 1926 Act. I have referred to this matter for the last two or three years, but nothing has been done about it so far, and I should like to urge on the Minister to reconsider it.
Several Deputies have referred to the delay in making decisions in the Minister's Department. It is the experience I think of every member of a local authority that there is considerable delay in making decisions. I do not want to be unduly critical because I appreciate that there is a tremendous volume of business passing through the Department, as is evidenced by the huge amount of files Deputies will sometimes see before an official in the Department. I think, however, the whole policy and administration of the Minister's Department must be overhauled if decisions are to be expedited. After all, the managerial system has been introduced, and we were told that the purpose of the managerial system was to speed up decisions, that local administration, owing to the tremendous volume of work that had to be done by local authorities, was becoming top heavy and had been slowed down to a great extent. I think the same argument applies to the Minister's Department. The system followed apparently has been to pass a file from the medical section to the engineering section, and from the engineering section to some other section. It has to be passed from the architect to the engineer, from the engineer to the medical officer, right through the various sections of the Department. Sometimes it comes in on top of the file but in the accumulation of business it gets buried for weeks in passing from one Department to another. I think that instead of continuing that system the Minister might consider calling together for consultation the various officials concerned so that a decision might be made at once on all aspects of the case. I think this system of passing the file from one Department to another definitely has the effect of slowing down the work. It strikes me that what has really slowed down the machine is this laborious method of making decisions by passing a file from one section to another.
When the Minister is examining local authorities and their work he should not forget to put his own house in order. That is always a good policy before you attempt to criticise the other fellow. "People living in glasshouses should not throw stones." The Minister has earned a name for himself in dealing with local authorities. He has become famous for his ruthless abolition of public bodies but he is not himself altogether free from blame. I agree with Deputy Mulcahy that it was a mistake to allow many of the local authorities at present in existence to remain in office all the years they have remained in office. Many of them have become apathetic and have lost interest in their business. An election would certainly rejuvenate the whole machinery and put new life into local authorities. We have had the experience annually of the Minister introducing a measure to postpone local elections. I think that was a very great mistake. Possibly the Minister has found himself in recent years, owing to the emergency, up against a position in which he felt that it was not in the public interest to cast the country into the throes of an election. That may or may not be but, in my opinion, the fact that local elections have been postponed for many years has resulted in some local authorities losing interest and going stale. I agree that the whole system of examination into any charges which the Minister may make against a local authority is all wrong, that is, sending an inspector from the Department to investigate a charge made by that Department. It is like going to law with the devil and holding the court in hell. There is no chance whatever for the local authority. The decision is made before the investigation is held. It is a foregone conclusion. It is certainly not fair to the local authority and in the long run will create a situation that decent men will not be prepared to serve on local authorities. They will say: "Our intentions were good and sincere; we were anxious to have the right civic spirit in looking after public affairs, but if we are going to be treated in this shabby manner we will leave the responsibility with the Minister." The best people will not serve. I think there is also the other aspect, that the dissolution of local authorities is highly dangerous during this emergency.
What are you going to do? Are you going to let those that have been dissolved carry on?
I was going to say that the Minister should give a warning of some sort and should try to preserve the local authorities.
They are getting their warning now. They will either do their job or get out.
How many of them got that warning? Have not a number of local authorities been dissolved recently who got very short shrift?
No.
I think there is no doubt about that. It is only right and fair that the local authority should get warning. The Minister, instead of showing anxiety to abolish the local authorities, should be anxious to preserve them.
I am not anxious to abolish them. I am anxious to keep them there but any local authorities that do not do their job will have to go.
I feel that in the present emergency local authorities would prove a very useful and effective link between the people and the higher authority. A man is put on a public body for some reason or other— because he exercises a certain amount of influence in his district and because the people in his locality have some confidence in him. There is always some reason for his election to a local authority. If this country were faced with an emergency such a man would act as a leader in his district. For that reason, I agree with Deputy Mulcahy. I think it is unwise for the Minister to ignore that aspect of the case. Possibly the Minister at times is forced to take action through sheer incompetence on the part of a local authority or dereliction of duty on the part of a local authority. I am not going so far as to say that the Minister should preserve a local authority that has squandered public moneys or anything like that, but I suggest that he should stretch a point at the present time, in view of the situation in which we find ourselves, and should try to preserve any local authority that can be preserved because, in the event of the country having to face a crisis, the local authority will, in my opinion, prove more useful than a commissioner or an individual in charge of a county.
In conclusion, I may say that particular attention should be paid to public health generally at the present time. In view of the scarcity of food and the increased cost of food, the standard of nourishment for many of our people must have decreased, and the danger of disease is thereby greater. The fact that a war situation obtains near this country renders the danger of disease here very great. For that reason there is urgent necessity for being extremely vigilant during this emergency. I think our medical officers of health realise that necessity. I suppose the Deputies who have asked for consideration for doctors in remote districts of the country, where medical officers find it exceedingly difficult to carry out their duties, have that in mind. In my opinion there is a case for consideration in their regard. I do not think there would be adverse public criticism if the Minister were to make representations to his colleague with a view to ensuring sufficient vigilance with regard to public health generally.
The Minister has been in charge of several departments of State and I am sure he will agree with me that the Department of Local Government is a unique Department inasmuch as the Minister has to supervise not only a staff of officials but also the activities of a number of democratically and semi-independent bodies. This places him, in some respects, in a position somewhat similar to that of the Secretary General of the League of Nations in pre-war days except, perhaps, that the Minister's powers to enforce sanctions are rather more drastic than those of the Secretary General of the League of Nations. I think everyone will agree that the Minister has been very active in exercising these powers. It is a question which deserves very serious attention as to whether the whole system of local government as we know it to-day is efficient or if it can be continued for a very prolonged period. We know that when the present system was inaugurated a number of years ago the circumstances were very different. This country was not independent and the people accepted local authorities as a means by which they could exercise a certain limited function in local control of their affairs. As a number of Deputies have pointed out, interest in local government amongst the ordinary people of the country has been waning to a very great extent during recent years.
It is becoming increasingly difficult to get the best type of representative of the people to accept a position on a local authority, and to carry out the difficult and very often onerous duties which are associated with the position. I do not think the Minister has improved matters by going around, somewhat like a mad bull, suppressing, abolishing and demolishing local authorities all over the country. In many cases the democratically elected representatives of the people are to a very great extent at the mercy of their officials. If a county council or a board of health are in the fortunate position of having very efficient officials in their county, they can and usually do escape censure from the Local Government Department, but, if they are in the unfortunate position of having officials who are not entirely efficient, sooner or later they will come up against the Local Government Department, and there does not seem to be any justice in suppressing a local authority simply because some fault is found with the administration of the county, which may be due and very often is due to a mistake on the part of the officials.
We all know how difficult it is for locally elected representatives, attending a county council meeting once in a month or perhaps once in a quarter, to investigate every detail of the operations of their public servants in the county. In the matter of economy, which the Minister has very strongly stressed, the county councils very often find that, in their efforts to enforce economy, they are up against a thousand difficulties. They are up against the fact that grants are made available by the Local Government Department for various schemes which are conditional upon the local authorities putting up a certain amount of the money required, thereby increasing the rates. Another matter for which I think some local authorities that were suppressed have been censured is that they have sought to reduce the estimates prepared for them by their county officers. I think that, if local bodies are to endeavour to enforce economy, the only way they can effectively do so is by cutting the estimates of their officials.
Can the Deputy give me a case of a local authority which was dissolved because it reduced the estimates prepared by its officials?
If my memory serves me aright, I think that one of the complaints made by the Minister against the Kilkenny Corporation was that they had not struck a sufficient rate to meet the estimates.
But they did not reduce the estimates. They accepted the expenditure without making provision to meet it.
That is the point which I am making, that it is difficult for a local authority to secure the economies they seek, having regard to the difficult and complex nature of the service under their control, and they find that one of the most effective means of preventing increases in expenditure is by cutting the cloth a little bit shorter than the measure provided for them by the county officer, thereby forcing the county officer or the staff of the county or city to seek overdraft accommodation. That, I would suggest, has the effect of curbing expenditure, in this way, that when the local officers find difficulty in raising the money they will not be so ready to incur additional expenditure. That little obstacle——
I hope the Deputy manages his private affairs on a different principle.
There is no comparison between the management of private affairs and the management of county affairs.
That is where we differ.
As I have pointed out, it is very difficult for the locally elected representatives to exercise control over expenditure, and it is only in the way I have suggested that they can seek to curb it. I do not think that is a ground upon which local authorities should be censured to any great extent. They are merely exercising pressure upon their staffs to restrict expenditure by making it more difficult for them to provide the money which they think they require. This just illustrates the difficulties which local authorities have in endeavouring to carry out the duties imposed upon them by the present local government system. It seems also to emphasise the need for some improvement in the local government system such as has been suggested by the establishment of local councils. Under legislation passed last year, the local parish councils have been approved of by this House. I think that in the present emergency, and having regard to the difficulties of transport, it would be a definite advantage to have a local committee in every parish co-operating with the local authorities, particularly in such matters as home assistance, medical attendance, the provision of institutional treatment for sick persons, and all those other duties which are incidental to local government.
Another advantage, I might say, of those parish councils is that they would bring the clergy more actively into local administration. We claim that this is a Christian State, but, personally, I do not think that our clergy have been permitted as much authority in local administration as would be desirable. The Department of Education is the only Department in which the clergy—and rightly so— exercise a very considerable amount of authority, but in the matter of home assistance, in the matter of providing for the relief of sick persons, and in the matter of hospital treatment for sick persons, I think it is very desirable that the clergy should have much greater authority. That may be a rather revolutionary suggestion, but it is one that requires consideration.
Reference has been made to the apparent failure of all methods which have so far been adopted in regard to the treatment of tuberculosis. Every year on this Estimate I have suggested that the local medical officers should have greater powers or even compulsory powers in regard to those infectious diseases. I am prepared to admit candidly that, although I have made that suggestion repeatedly, it is a rather crude suggestion inasmuch as there are very great difficulties in securing the right type of institutional treatment for persons affected. During the last few months—and this is what has brought the position home to me— I have come up against several cases in which I am not sure that compulsory powers would be effective, having regard to the institutional treatment at present available.
One case which has been brought to my notice is that of a mother with five children who lives in a labourer's cottage. This woman is in the first stages of T.B., but as her children are very young, it would seem to be a very grave hardship to send her to an institution, particularly as we have not at present that measure of confidence in institutional treatment which is necessary. This woman is very industrious. She has managed her home and her family very well and provided herself and her family, by her own industry, with a very comfortable home, and it would seem a very great hardship to remove her from her family, particularly as she has taken all possible precautions to guard against contact and the spread of infection. I have spoken to the county medical officer in connection with the matter and he has suggested that it would scarcely be advisable to remove her. What is needed is some type of institution which would be confined to cases which are not serious and which would show a very large percentage of complete cures.
In such a case, confidence would inevitably be established. If people find that those sent to an institution or a sanatorium come back completely cured, or if a large percentage come back completely cured, a very large measure of confidence will be established and it would be far more easy to put compulsion into operation. If, on the other hand, a very large number of those sent to institutions never return, and if the position appears to be that removal to an institution is the first step on the last long journey, you cannot expect people to have confidence, and the inevitable result of enforcing compulsion will be that people will be very slow to notify the medical officers, and the danger would be even greater than it is at present.
There is another matter which I think the Minister should consider, having regard to the abnormal conditions in the world. It is the possibility of the spread of many dangerous infectious diseases as the result of the present war. It is highly desirable that all steps should be taken to inform medical officers of the dangers which are likely to arise and to circularise them as to the measures which ought to be taken in case of any suspected infection. In my constituency last year, there was a case of typhus in a very remote country district. For many reasons, it was not possible to have the case dealt with as expeditiously as it should have been dealt with, but, fortunately, the infection did not spread. There was, however, as. I think everyone admits, a very grave danger of extensive spreading of the disease as there had been considerable contact. Typhus is such a deadly disease that all possible precautions should be taken. In this case—it may have been only a coincidence—it was known that there was a similar infection about 40 years ago. I do not know whether there could be any connection between the two outbreaks, having regard to the period which elapsed, but it is quite possible that there was, and for that reason wherever such infection occurs in a house and particularly in one of these old thatched houses in the country, if no other means of preventing the disease can be found, steps should be taken to have the place completely destroyed.
Reference has been made to the condition of the public roads, and I think it was Deputy McDevitt who said that there is not sufficient publicity given to accidents to horse-drawn vehicles. If Deputy McDevitt were in my county, and were he to read the "Haggardstown Notes", he would see every week accounts of runaway horses and very serious accidents being narrowly averted by the courage of some local resident. I think that would be publicity enough. It is true that the present road surfaces are not suitable for horses, but that difficulty could very easily be got over by resurfacing these roads with gravel or fine sand which would give a grip to the horses.
I ask the Minister to consider carefully the difficulty and the danger which faces the country in having such a large number of local authorities abolished, in having such a large area of the country administered directly by Government officials and in having the citizens of such large areas completely cut off from local government, except through whatever contact they may establish with the paid officials of the State. Where a local authority is abolished, the ordinary procedure should be to hold an election in the area at once, even though the local authority might have been in office for only a year or less. If the locally elected representatives of the people are proved not to have been carrying out their duties, the people should have the right to elect a new body to represent them. Otherwise, you are taking from the people rights which they have enjoyed for a number of years and which they are entitled to continue to enjoy. In abolishing these locally elected bodies and replacing them by a kind of dictator, we are setting up a very dangerous precedent. If these local dictators prove to be satisfactory and efficient, the people may eventually get it into their heads that this national Parliament should be abolished and a commissioner for the entire country appointed.
I understood that that was the Deputy's policy. Was he not talking about that in Galway the other day, when he wanted no politicians?
I think the Minister has been obtaining his news from a very unreliable source. He should read a newspaper in the future, and not a propaganda sheet.
There is just one matter I want to raise, and that is in connection with the shortage of explosives for quarrying purposes, and so on, that county surveyors are experiencing. I want to point out to the Minister that this shortage of explosives is bound to create a lot of unemployment in the very near future. I know that the matter is serious in my own county, and I am sure it is equally serious in other counties where there is a number of quarries, and where the work cannot be carried on because of the lack of explosives. I happen to know that the amount of explosives available for such purposes is very small, and I think the Minister should make every effort to see that an adequate amount is provided for the county surveyors to enable them to keep on their ordinary road staffs in good employment. If something is not done in that regard, it will lead to the closing down of some industries, because road maintenance cannot be kept up and the road staffs cannot be retained in employment. The roads must be maintained and a certain amount of material must be produced, for all of which the use of explosives is absolutely necessary. I think that, probably, the Minister could persuade the Minister for Defence to release some of the explosives that he has at his disposal.
There are other places where explosives are available, apart from the Department of Defence.
I know that a certain amount of explosives is available, and I hold that a fair proportion should be made available for the use of county surveyors. I understand, from one of these county surveyors, that this is a really serious matter and that he may have to lay off his staff. I hope, therefore, that the Minister will see his way to do something about this important matter.
Listening here this evening to the debate on tuberculosis, one would imagine that the country was reeking with it, that it was some new form of disease that had broken out, and that the Minister and his Department had been doing nothing to combat it over the last 20 years. I think it will be admitted on all sides of the House that the efforts to combat this disease that have been made by the Government of this country during the last 20 years have been far greater than in previous years. Medical officers of health have been appointed in every county in Ireland, and a large number of sanatoria have been established all over the country. In addition something like 400,000 houses have been erected in the last few years, and many other things have been done, such as the provision of free milk, and so on, to help to combat the spread of the disease. Many other services have been established for the help of persons suffering from that disease, and I think that all that possibly could be done has been done during the last 20 years to deal with the matter. A number of Deputies seem to have the impression that all forms of tuberculosis are infectious, but I think the Minister will bear me out in my contention that that is not so, and that more than one-third or one-fourth of the cases of that disease are not infectious in the ordinary sense of the word, as we would use it in the case of certain fevers.
I think it is bad for the country generally for this House to give publicity to the alleged fact that there is an increase in tuberculosis, when actually that is not really so. There may be some slight increase of the disease in some areas, but I am sure it will be found that it has decreased in other areas. I think that these are the actual conditions, and certainly, with the improved housing conditions and improved treatment by medical officers of health in the different counties, a lot has been done to combat the disease. The greatest possible efforts have been made by the Government here during the last 20 years to wipe out that disease, if it ever can be wiped out.
Deputy Norton talked about malnutrition as being one of the chief causes of tuberculosis, but it is a well-known fact that tuberculosis exists in places where there is no malnutrition or even bad housing conditions. Deputy Fagan talked about the cost of treatment of people in sanatoria and hospitals. I think the local authorities have a fair amount of control over the matter of free treatment of patients suffering from that disease and that, if they wish to do so, they can treat a patient free of cost, no matter from what walk of life he comes. I believe it is the policy of local authorities to encourage the free treatment of people suffering from tuberculosis. I would urge similar treatment with regard to patients suffering from fevers of any kind, and certain other diseases. I notice that nobody, during this debate, mentioned cancer, and yet the deathrate is far higher there. Nobody suggested that the increase in cancer in this country was due to any neglect by the Government.
We will keep that till the next time.
At any rate, it is quite true. There is another matter to which I should like to refer, and that is the question of doctors being appointed to dispensaries by the Local Appointments Commissioners and afterwards transferring to another county. We have had a number of cases in County Wexford of doctors coming before the Appointments Commissioners and being selected, then remaining only a few weeks or so and transferring to some other county. Some of them remain about a week or two before getting transferred to another area and thus creating a vacancy, with the result that the local doctors pick up all the private practice in particular areas and it is very hard to fill a vacancy. The system, as it obtains at present, lends itself to abuse, and it is time that something was done about it. I think the Minister should go into this question of doctors, having been selected by the Appointments Commissioners, transferring to their own native counties after spending only three weeks or a month in the place for which they were selected. I do not blame the doctors, because it is only natural and human for them to want to get back to their native area, but there should be some restriction on these transfers for a certain number of years. It is all right to allow the doctor to be transferred within the area itself. If the local authority wants to transfer him, there is nothing against that, but I think it is unreasonable that a doctor should be allowed to transfer out of a county after spending only a few weeks in it, particularly when that district had probably been waiting for two or three years for the appointment to be made. In my area we have had the experience of having to wait for nearly two years for the Appointments Commissioners to make an appointment, and when the appointment was finally made, the doctor came, remained for a week or two, and then was transferred to another county. I hope the Minister will see his way to deal with that matter.
We have listened to a good deal here in the House about the conditions in regard to public health in the country. Some years ago, one would have thought that millions of pounds were to be available for the improvement of public health conditions in this country. Millions of pounds were collected for that purpose, and one would have expected, as a result, that the standard of public health in this country would be second to none in any country in the world. I doubt if the Minister and the Public Health Department deserve all the laudations that they have got. I do not know what method expert medical men would employ to arrive at a decision as to whether or not there has been an improvement in our public health. By taking the statistics available, a layman, applying a rough test of that sort, might be able to arrive at some conclusion on the matter. The latest statistics that we have dealing with deaths from all causes are those for the year 1939. They cover the period 1931 to 1937, inclusive. The number of deaths registered in 1931 was 42,947. Of these 7,151 were due to senility. The comparative figures for 1937 were 45,086 and 6,433. I think these figures reveal an unsatisfactory trend. I take the figures for senility, and apply them as a rough test to the standard of life generally in the community. By doing so, I think the Department cannot be complimented on the state of our public health.
The only Deputy, I think, to refer to mental diseases was Deputy Hannigan. In my view sufficient attention has not been paid to that disease which causes more human suffering than, I think, any other. People who are said to be insane are sent away compulsorily and kept in confinement, in many cases for the remainder of their lives. We have not been given any figures by the Minister as to the percentage of those in mental hospitals who leave cured. That is a matter that deserves more attention from the Department. I am in complete sympathy with the views expressed by Deputy Hannigan on this matter. The old method of taking people before a doctor and getting them certified as being insane, and then compulsorily sending them to a mental hospital should, I think, be abolished. It is an out-of-date method and the Minister should take serious notice of it. The unfortunate people concerned are surely deserving of more sympathy and consideration than they are getting from public bodies, from this House, from the Department and elsewhere.
I am glad to see the Minister proposes to do something for the relief of victims of rheumatism. It is a disease that afflicts an enormous number of our people, especially in the rural districts where because of wettings and hardship many people, even before they reach middle-age, become victims of it. Anything that could be done for their relief would certainly be a great blessing.
More, I think, should have been done to bring about an improvement in the public health than actually has been done out of all the millions of pounds that have come to this country. We have not very much to show for it except, perhaps, a few big buildings, and, as some Deputies have pointed out, even these are not a very great improvement on the old hospitals we had. I think it was a mistake to waste so much of that money on the erection of these big hospitals. It would have been far better if a lot of it had been devoted to bringing about an improvement in the general health of the people. If that had been done we would not be in the position in which we find ourselves to-day with the standard of health lower than it was ten years ago. It was regrettable to hear from the Minister that the cancer council has suspended its operations for the reason that we are not now able to get information from other countries as to how they are treating this disease. That does not reflect much credit on us. In view of all the millions that have come here one would imagine that this country would have done something in the way of trying to introduce new methods for treatment of that dread disease. Unfortunately, it is very prevalent amongst our people, and it would not be expecting too much if our doctors had given a lead in its eradication. It would be making some return for all the money we have got.
I want, again—this is a hardy annual with me on this Estimate—to refer to the slippery and dangerous condition of our roads. I have done this every year for the last ten years. I am glad to find now that I am not a voice crying in the wilderness. In previous years neither the Minister nor anybody else paid very much heed to what I had to say. But now, since people have to move around more on foot than they used to, they are being brought to their senses and have a keener realisation of the hardships that people in the country especially had to endure in this matter. The rubber has now been taken from under them, and they would appear to have a little more sympathy for those who have to use horses and cars on the road. I am glad to see that many of them have wakened up to the dangerous condition of the roads. I hope that something will be done to bring about an improvement in this connection. It may be too late before anything is done. If we are to judge by their handling of other matters, it may take the Minister and his Department a year and perhaps two years to consider this. We know what happens when commissions and committees are appointed to consider a question. They take steps to carry out an investigation and then, very often, things are left as they were. Some excuse or other is found for doing nothing, and perhaps it will be the same in this case. When the period of incubation is too long the result is that no chickens come out.
There is no need to leave this matter over. There is a simple remedy. I have mentioned it in this House before and I have written to the county surveyor of Cavan and asked him to point out if there was any snag in it, because, of course, no man pretends that he can see every point when he suggests a certain scheme for dealing with slippery roads. I asked the county surveyor to examine it, and if there was any snag in it I would be very glad to know of it. He wrote to me that he would look into the matter and write to me at length about it. I waited for months and months but I got no reply from him. Then I wrote to the public Press about the scheme, and I challenged him to show there was any snag in it. He did not reply, because I suppose he could not find any snag in it. The remedy is, in the summer season when the tar is soft and sticking to people's boots, bicycles and motor cars, to spread fine sand over the surface of the road which would stick in the tar and prevent slipping, instead of finishing the road off with limestone chippings which when they are ground into the tar add to the slipperiness. When the tar comes up in the summer, if it is covered over with fine sand it will not only improve the road but make it safe for all classes of traffic, including motor traffic. I proved that ten years ago. I asked the then county surveyor of Cavan to try the experiment on a few places that were very slippery. He did it and it was a complete success. That is why I am confident in recommending it. Neither the Minister nor the county surveyor for Cavan could point out that there was any snag in it.
I challenge the Minister to get any engineer in his Department to say that there is anything wrong with it. At least I am entitled to the courtesy of a reply. I do not pretend that I am infallible, but I say that the experiment is worth trying to see if it will work out all right. There is a lot of nonsense talked about not going back to the old roads and getting into the old rut again. If we can make the roads serve a double purpose why should we not do it? What right have people in motor cars and lorries to put people off the roads who are paying more than their fair share for maintenance? Is it right that these people should not be allowed to use the roads because they have no motor car? I am glad that a great many people now find themselves in the position that they were forcing other people to accept for the last 15 or 20 years. It is poetic justice that the position should be brought home to them. Something must be done in the matter and I appeal to the Minister not to put it on the long finger but to have the experiment tried out. He should consult some county surveyor or some surveyor in his own Department about the scheme. Let them try it out on some public road and see if there is any snag in it.
The Minister has gone the length of abolishing certain county councils because they did not squeeze the rates out of unfortunate ratepayers before they were in a position to pay, but he did not dismiss any county surveyors for not giving value to the people who were paying the rates, for not giving them roads which they could not use. The Minister ought to look into the matter at once. This has been going on long enough. Now that Deputies have called attention to the matter I hope it will receive consideration. There is no use putting it off from one day to another. Some Deputy suggested that something should be spread on the roads in frosty weather. I say it should not be done in frosty weather. It should be done in hot weather when the tar gets soft, so that it will stick.
This is a Department which serves a very useful purpose because it relieves distress in many homes. Since the establishment of our native Parliament 20 years ago great strides have been made in improving the administration generally. There has been a demand for increased social services and both this Government and the former Government have done good work in the way of housing, sanitation, road-making and all those things which are necessary for the progress of a nation. We must give credit where credit is due, and the Local Government Department deserves great credit for what it has done in this respect for the last 20 years. It must, however, be admitted that it has put a very great strain on the taxpayer, but the taxpayer will gladly bear the strain if he finds that the money is being spent to advantage. That is where the snag comes in. We often find that the money is not spent in a proper manner and that is what provokes criticism. At the same time, when people are calling out for more social services the Government have to provide these services. The people are as much to blame in that respect as the Local Government Department because they demand these services, and, when they get them, they do not want to pay for them. In that respect criticism can be levelled at the people themselves as well as the Local Government Department. However, we have reached a situation now when further progress in that respect cannot be made until the war is over.
One matter which is a great bone of contention in my constituency is the keeping in repair of labourers' cottages. I do not know how many cottages are in my constituency, but the ratepayers are demanding that the cost of the upkeep of these cottages should be taken off their shoulders. Unfortunately, the cottage purchase scheme which was brought in some years ago does not seem to have been a success. Very few tenants have bought out their cottages under that scheme. The cost of the repairs to these cottages is an enormous burden on the ratepayers. I think it is only right and fair that that burden should be taken off the ratepayers and that a decent purchase scheme should be brought in under which each tenant can buy his own cottage and look after the repairs. The amount required for the repair of these cottages is increasing every year. It is sufficient for the ratepayers to have to provide new cottages and bear the cost of repairs of cottages built in the last ten or 15 years without having to carry the burden of the repair of cottages built many years ago. I ask the Minister, who is an active and energetic man, to investigate what are the defects of the present cottage purchase scheme and bring in a scheme under which the tenants can purchase their cottages and the burden of upkeep of the cottages will be taken off the local ratepayers.
During the course of this debate many Deputies dealt with the question of tuberculosis. That is one of the most difficult matters which our medical officers of health have to contend with. Medical officers, especially in my county, are greatly alarmed at the increase of this disease. Of course we may expect it to increase at a time like this when there is a good deal of privation and poverty owing to the war.
I move to report progress.