The full significance of that fact probably inspired the Parliamentary Secretary's choice. I could not resist paying that tribute to Fr. Sweetman, long the distinguished headmaster of that school. When we come down to the Bill itself, the first question I would like to have clarified is this. When the Minister speaks of creating three new sanatoria, what kind are these sanatoria going to be? He says there are two schools of thought, one which would be content with 4,000 beds and another which would declare that 7,000 beds are requisite to deal with the tuberculosis problem as it confronts us here. Those questions are founded on statistical calculations. I believe general experience leads to the conclusion that for every death from tuberculosis in a given community in a given area, approximately two beds are required so that where you have an average death rate of 3,500 over a period, a reasonable estimate is that you will require 7,000 beds to deal with the tuberculosis problem arising from that annual average death rate.
Now, firstly as to the type of sanatorium, can we rest assured when the Minister comes to construct the units mentioned in the Bill that we shall have at the disposal of each of these units a full modern hospital adequately equipped and adequately staffed? I think all sides of the House will agree that the pavilion accommodation requisite for the patients, in which they are to take their rest and in which they may be expected to remain throughout the greater period of their curative sojourn, need not be of an enduring character. Substantial, yes; calculated to give the fullest protection and comfort to the inmates, certainly; but not designed to last a century because, if we provide sufficient accommodation now, I do not think I am unduly optimistic if I say that within 15 or 20 years we will find that nearly half of the accommodation will be no longer required, tuberculosis will have so far declined in our community. Therefore, bearing in mind that the pavilion accommodation can be of a comparatively temporary nature, I suggest to the Parliamentary Secretary that it is vital that the therapeutic centre will be of the most modern construction, should have the finest equipment that we can secure and, above all, should have in it a staff fully competent to use whatever equipment is provided, however elaborate and however modern it may be. I suggest that one of our great dangers is that we shall erect something beautiful to look at, that we shall equip it from roof to cellar with every kind of therapeutic and surgical gadget, and that we will then fail to pay adequately the staff of that institution and so fail to secure the type of men and women who are competent to use that equipment to the best advantage.
If the Parliamentary Secretary can reassure us that in each of these units such a general hospital as I envisage will be available, not only for the actual therapeutic treatment of the various types of pulmonary tuberculosis that may be lodged there, but also for the adequate treatment of the intervening sicknesses by which patients in the sanatorium may be afflicted from time to time, so that we can provide all kinds of surgical treatment that these patients may need in the period of their sojourn at that centre, our minds will be more easy.
I want to submit to the House that if we provide 4,000 beds now, what we are really doing is this, we are not starting on a programme which will eliminate tuberculosis at all; what we are doing is we are embarking on a programme that will keep the disease in control and no more. Quite apart from the social service point of view, looking at it purely from the £ s. d. point of view, if we do no more than take effective measures to keep the disease in control we can look forward for ever to an annually recurring charge for the maintenance of the services envisaged in this Bill. But if we spend a little more now and, instead of providing 4,000 beds we provide 7,000 beds, we are then spending more in this year, but we are embarking on an enterprise which will mean a diminishing charge on the Exchequer from the day we start work, and which we can look forward to dwindling steadily until, in two or three generations, tuberculosis may become in this country as rare a disease as typhus fever. I think it is not an unduly optimistic hope that, provided we construct accommodation for 7,000 patients now, in ten or 15 years we would not require accommodation for more than 3,500 and in two generations we might be able to deal with all the tuberculosis in this country in one institution.
Therefore, I suggest to the Parliamentary Secretary that he should expand his programme a little. I think geographical considerations as well as the prospect of early success in this great work will justify the development I recommend to him. I understand he has in mind approximately 700 bed units in the three sanatoria he is considering. I ask him to increase these units to approximately 1,000 bed units and, instead of sending patients from Leitrim, Donegal and Sligo to Galway, he should make other provision, which I will suggest. I think Deputies will realise there is very little geographical contact with Galway, although these two counties are in Connacht, and Donegal is in the extreme north-west. People living in Sligo and North Roscommon and Donegal look upon Galway as being almost as remote as Dublin. All the rail transport, all the bus transport and, indeed, all the orientation of normal life is towards Sligo.
Therefore, if the Parliamentary Secretary will provide for those areas a fourth sanatorium in or about Sligo —somewhere between Sligo and Bundoran, or wherever will be a suitable site—and, if necessary, a fifth in Athlone, which will take off the Tipperary district and the Midland counties from the proposed Cork sanatorium, and, lastly, a sixth institution somewhere in the Rosslare area for non-pulmonary forms of tuberculosis, for which I understand sea air and sunshine are peculiarly necessary, it would be much more satisfactory. I think I am right in saying the Rosslare area has the lowest rainfall and the highest degree of sunshine of any part of this country. I suggest that area is one that will be peculiarly suitable for an institution, the occupants of which are in special need of sunshine and sea air. If he would do that, then I believe he will have provided the accommodation necessary to combat the problem which confronts us.
I would like to give credit where credit is due. I have often accused the Fianna Fáil Government of jobbery and pushing their friends into jobs, and I believe they have been frequently guilty of it, but, in connection with tuberculosis administration—and I am not talking now of the Parliamentary Secretary's reference to Dr. T. W. T. Dillon doing research work; he has nothing to do with the executive end of the tuberculosis administration—in regard to the executive end of the tuberculosis administration, I am bound to say, and to rejoice in the occasion of saying it publicly, that the Parliamentary Secretary, Dr. Ward, has shown himself disinterested and informed in his reorganisation of many of the key positions which had to be reorganised if effective work was to be done in the control of tuberculosis. And it is because he has shown that capacity and will, in regard to this matter, to do the right thing, that I would not hesitate to commit to his care the creation of these additional institutions that I have envisaged, because I would be confident, if he would follow the same line in staffing them as he has been following in regard to the other key positions, we might reasonably hope to have not only an adequate number of beds, but an adequate staff to use them to the best advantage.
Assuming we had the beds—and, please God, before this debate is over we may get them—and assuming we had a staff competent to deal with the problem, there is one outstanding difficulty which I cannot see any escape from. We will not end this evil if we cannot persuade the patients to come into the institutions. I would never support, and I hope this House will never support, the utterly detestable doctrine enunciated by Deputy Allen, that people, before they are allowed to get a public position or to enter this or that service, are to be constrained to enter rabbit hutches and undergo elaborate tests and examinations, whether they want to be examined or not. If a man in this community elects to die and wants to die, it is his own business, and God forbid that we would ever legislate to insist that he would go in and have done to him what we think will do him good unless and until he is convinced that it is going to do him good. I agree that in regard to tuberculosis that doctrine I enunciate has to be considered in the light of the fact that a man with active pulmonary tuberculosis has not only himself to consider—he is imperilling the lives of everybody around him—but, bearing all that in mind, I will never be a party to treating people upon whom that tragic disaster has fallen as pariahs or lepers and locking them up nolens volens. It is not necessary; it is unchristian; and it is utterly detestable, more especially when, if we do our part, we have no reason to believe that the sufferers will not collaborate with us in getting control of this tragic disease.
It may, however, be possible for a Deputy—and I include myself—who has £480 a year to contemplate going into a sanatorium for two years, but consider the feelings of a working man in Dublin—I am not now speaking of a destitute person, but of a working man earning £4 or £5 a week, who has a comfortable little home, a couple of boys at the Christian Brothers' school, a daughter going to the nuns and a wife who is accustomed to hold her head high, to present a respectable appearance and to keep a nice house —who feels a little run down, goes to the dispensary doctor and is told that he has a patch on his lung, but that if he will take effective measures now, there will be no difficulty in making him as good as ever he was, and that he need not worry. That man says to the doctor: "Very well; I will do whatever you say. What am I to do?", to which the reply is: "You must go into one of the new sanatoria which have been built for this purpose, where you will be treated and made all right". The man says: "I shall be glad to do that. How long will I be expected to stay?" The doctor replies: "You must be prepared to face two years." Can a conscientious doctor say anything else? He may hope to get the man back on his feet in a much shorter time, but is he not bound to warn him that he must be prepared to face two years?
Conceive what that means. That man will get 15/- a week and certain other little contributions from national health insurance. His wife and family, to subsist, must dissipate whatever little savings they have accumulated for the higher education of their children or for the provision of a modest marriage portion for the daughter, and when all that is done, they must consider giving up the home, moving into a tenement room and applying to the relieving officer to supplement the allowance they are getting from the National Health Insurance Society and such other social services as are automatically available to them. What is the use of talking of the control of tuberculosis if it involves in every case the pauperisation and degradation of the family of every citizen who has not independent means and who undertakes to cooperate with us by going into one of the sanatoria we provide?
Would Deputies have any respect for the man with a wife and family, who felt well and able to do his work, albeit he was sometimes tired and troubled with a cough and a little undue perspiration at night, if he did not struggle on to keep the home together, if, at the first sign of tuberculosis, he flopped into bed and said to his wife: "Carry on whatever way you like. I brought the five children into the world with you and I am now done with them. Get along as best you can. I am going to bed for the next two years"? Would not every respectable neighbour say: "He is taking it very coolly. What is that poor woman to do? She has worked hard all her life and she is not fit to go out and earn money at charing or such work. She is to be left to sink down from the respectable home into which she married from her own respectable home into a tenement room. She is to be left to watch her children enter blind-alley occupations because there is no money to educate them up to that standard which would enable them to get decent employment with prospects, and his lordship is gone to bed. I was in to see him last week and he has put on about a stone in weight resting as coolly as you please in the bed?"
Dr. Ward, Dr. Deeney, Dr. Ryan, Dr. Murphy and Dr. Jones, if they went in to see that man, might know perfectly well that his very existence depended on his staying in bed and resting and that if, fat and all as he is, he got up and precipitated a haemorrhage, the work of months might be destroyed in an hour; but that man has to live amongst his neighbours, and what self-respecting man will lie in his bed getting fat while his wife gets thin and his children are ill clad? He will come out, and I need not call to the mind of the Parliamentary Secretary the case of a man he and I know well in Monaghan Sanatorium, a man for whom, for old association's sake, he had a warm regard and for whom, for more recent associations, I had a very warm regard, who kept coming out until he killed himself, because he could not bear to think his neighbours would see him lying in bed resting while his children and his wife had become burdens on his parents, who already had more to do than they were able to do in maintaining themselves.
I saw that man and I sought to persuade him to stay in bed. I sought to reassure him that all who knew him and understood his circumstances appreciated the reasons for which he stayed in bed, to recover his health and to maintain his family over the protracted period—because the children were all young—during which they required maintenance. He could not see that. He felt that every time a neighbour came to visit him he was a disgrace to be lying in bed, without providing for the wife and children for whom he felt himself responsible, and, as certainly as I am standing here, that man killed himself because he wanted to do for his children what he was not physically fit to do. He would be alive now, and a long way towards his cure and towards restoration as the proper prop of that family which now has no father and no wage-earner, if we had been in a position to say to him: "From the first day you go into a sanatorium, you will get your wages every week as if you were out at work. We all know that it is not for want of a will, but for want of a way that has you where you are, and the community will be glad, inasmuch as you are not only saving your own health but protecting the health of your wife and children and your neighbours by staying in a sanatorium, to give you your wages, such as they were, to give you what you were earning when you lay down until such time as you are able to stand up again. If, at a future date, you want to give some contribution to charity as thanks for what you are getting now, well and good, but if you cannot see your way to do that, the community gladly makes this available to you".
Unless we are prepared to make this arbitrary decision, not that we will give to every man who is declared to be a proper inmate of a tuberculosis sanatorium a flat rate, but that we will say to him: "A certain type of certificate will be required showing your average earnings over the 12 months prior to your certification as a tuberculosis patient and so long as the sanatorium authorities require you to remain on the flat of your back undergoing the cure, you will receive these wages from public funds," we are simply building castles in the sand in trying to control the incidence of tuberculosis. We are asking men— particularly men—to do that for which their neighbours would be the first to point the finger of scorn at them. No man who is worthy of the name of man will like to go into an institution and grow fat there while his wife and children are abandoned and left on the roadside to starve, and I think that until we do something to remedy that position we must abandon all hope of fighting this disease in the way in which it should be fought.
We are going to invest a large capital sum in the development of this project, but it must be remembered that, although we are investing that large sum, it will be a diminishing charge, if the right steps are taken. If we can succeed during the next ten or 15 years in reducing the death rate from this disease from 1,500 to 750, as a result of paying a proper wage to those people who, otherwise, would be hopeless and helpless invalids for the rest of their lives, it will be money well invested, because those people who, otherwise, would be helpless invalids for the rest of their lives will be put into a position in which they will be able to earn a living. In that connection, it should be remembered that the death rate is far smaller than the rate of incidence of this disease, is far less than the number of people disabled by the disease and who, as a consequence, are unable to earn a livelihood. I think that if we could reduce the number by even one-half, it would mean that thousands of people who, otherwise, would be chronic and permanent invalids would be able to earn a livelihood. I think it would be a very good thing if we could say to everybody who goes into those sanatoria that he will get, not luxury, but at least the same wage which he had been earning, that it would be the best method of combating the disease. The only thing that the patient must then sacrifice would be the prospects of financial advancement that he might have looked forward to in the ordinary way.
Let us remember that tuberculosis chiefly strikes the young. It is between the ages of 17 and 28 that it wreaks its greatest havoc, and these are the years when a young man is getting on in the world—the years in which he might expect to get a better position than he has had heretofore and to improve himself. The fact that he is struck down by tuberculosis during those years compels him to forget that laudable hope or ambition. His capacity for work is not destroyed, but it must be remembered that when he gets up from his bed of illness, and when the reconditioning influences, which will be a feature of these sanatoria, take place, it may be recommended that he should seek some other type of work than that in which he had been engaged prior to his illness. For instance, if he had previously worked in a factory he may be advised to seek some other occupation and offered an opportunity of getting some other occupation. The thing to be remembered is that his trials are not ended when his capacity for work is restored, because he may have to adopt an entirely different form of life. Now, I say that that is a sufficient sacrifice to ask him to undergo without expecting him to go to bed in a sanatorium and grow fat while his wife and children are starving outside. Let us not, in effect, write up above the beds of all these men in the various sanatoria that they are getting this treatment while the people dependent upon them are to be allowed to starve.
There are two other matters that I wish to refer to. I could not help smiling, albeit in absentia, when the Parliamentary Secretary proceeded to wax eloquent upon the question of calcium deficiency. I am sure that this House will remember that, 18 months ago, I addressed an inquiry to the Parliamentary Secretary as to whether he would not think it wise to add calcium to the bread inasmuch as the phytic acid in the loaf at that time prevented absorption of the proper amount of calcium for those who have to depend, to a large extent, on bread for their main diet, and, of course, in the case of the poor, bread bulks very largely in their diet. Of course, at that time, laughter rang loudly from the Parliamentary Secretary's seat. It was, of course, only a question of ignorant amateurs talking about what they did not understand and misinterpreting the whole matter. The Parliamentary Secretary knew all about it, and for any ignorant amateur, such as I, to talk about calcium deficiency in the bread was “all my eye and Betty Martin.” I remember the words of the Irish Press on that occasion, where I was taken to task for daring to criticise—inexpert criticism on a highly technical matter, we were told—the Parliamentary Secretary, Dr. Ward, T.D., M.B., B.Ch., etc. Well, it has taken ten years to teach the Fianna Fáil Party the elements of economics, but it has only taken me two years to teach the Parliamentary Secretary the elements of dietetics.
Now, in opening his speech, the Parliamentary Secretary said that he had come here to outline a scheme for a great improvement in this matter, and he asked for agreement from all Parties. He said that he was asking everyone to help in the job, and that people should not be unduly critical of any weaknesses in the Bill: that he wanted help from all sources, whether it came from voluntary, semi-voluntary or paying sources. That appeal, I am sure, touched a responsive chord in everybody's heart. It certainly touched a responsive chord in me until I discovered something that, I am sure, will come as a bombshell to this House. I think that it will be a bombshell to this House, because the Censor's department has been, and is being used, to keep these things from the knowledge of the Irish people. Do Deputies of this House realise that one organisation in this country, which has been in the forefront of voluntary co-operation in the tuberculosis campaign and in every other campaign against disease in this country—namely, the St. John Ambulance Brigade—has been sent for by the Taoiseach and told that they must wind themselves up or merge in the Red Cross, and that, if they do not merge in the Red Cross, they must disappear? Is not that a great encouragement towards co-operation with the Government? Is there a Deputy on any side of this House who will dare to assert that the St. John Ambulance Brigade has not been in the forefront of every activity in the fight against disease in co-operation with the Minister for Local Government and Public Health, whenever he has asked for it? Yet, their reward now is that they are told that they must dissolve, or that they must subside into the Red Cross or get out. Now, if the St. John Ambulance Society were a Protestant association, it would be a detestable outrage to issue any such ukase. It would call to mind the days in Rome when the Catholic Boy Scouts were told to dissolve or merge in the Ballila, or the days in Germany when the Catholic Association were told to sink themselves in the Nazi Youth Movement, or get out—incidents which bring to my mind the Holy Father's Encyclical message Mit Brenender Sorge. Are we reaching a stage in this country when only those organisations which are prepared to bow to the Government's views are to be allowed to exist?
