Dáil Éireann díospóireacht -
Friday, 4 Jul 1947

Vol. 107 No. 8

Committee on Finance. - Vote 71—Health (Resumed).

Mr. Blowick

On the adjournment ast night, I was dealing with the effect of bad housing and low wages on the spread of tuberculosis. The Minister should take up with the Minister for Local Government the question of the grant given for the building of new houses. Before the war, when building materials were plentiful, the grant was £40, but at the present time, when the cost of materials has gone up to such an extraordinary degree, to give the usual grant of £40 is just a joke. Bad housing has more to do with the spread of tuberculosis than anything else and new sanatoria and various health provisions will not deal with the matter while the root cause is still there.

We have a problem in Mayo which I will bring to the Minister's attention. We have a tuberculosis waiting list of about 60 and our annual death roll from tuberculosis is 104. The waiting list of 60 is an indication of the size of the problem. We have 40 beds in the sanatorium at Creagh and 12 other beds in the county home, so the Minister will see at a glance that we have only just about half the accommodation we should have. Several schemes have been put forward at the Mayo County Council for the acquisition of suitable houses or mansions, but after a careful survey of the county, none was found to be available. We have put up the suggestion that additional temporary structures of some kind should be erected at the present sanatorium at Creagh. We are informed that there will be serious delay in obtaining sanction from the Department. I want to inform the Minister that proposals will be coming in, if they have not already arrived, for the provision of additional beds. That entails other things. It will entail extension of the farm to supply milk and vegetables for the patients and staff. It will mean the erection of a new chapel and out-offices, increased kitchen accommodation and equipment and huts or chalets or whatever form the extensions will take. When the proposal comes before the Minister, I would ask him to deal with it as expeditiously as possible and not to give us the kind of treatment we have been used to receiving from the Custom House of having to wait six to ten months for sanction for a matter that should be disposed of out of hand.

Apart from the 52 patients we are able to accommodate with beds in Peamount, we have a waiting list of 60 and I think the Minister can take it that the average of 104 deaths per annum is a clearer indication of our problem than the actual waiting list or the number of patients on hand because there must be many cases of tuberculosis in every county that do not come under the notice of the medical authorities. It would appear that we have to wait three years for the new regional sanatorium in Galway. I maintain, as I maintained at the time the Bill was going through, that the provision of 400 beds to deal with five counties of Connacht, and Donegal and Clare is inadequate to deal with the waiting list in these counties. The County of Mayo will probably be allotted 20 or 30 beds. That will not cope with the problem. If we are to tackle the problem properly we must get down to it now. The County Council of Mayo is more than anxious to do the work, provided sanction is forthcoming speedily.

There is one other vital matter, that is, delay in sanctioning waterworks. While that is a matter for the Minister for Local Government, I would draw the Minister's attention to the fact that in some towns very insanitary conditions exist in consequence of insufficient waterworks or lack of waterworks. In Castlebar a scheme has been dragging on and if something is not done about it the health of the town will be affected. The Minister might direct the attention of the Minister for Local Government to the fact that in parts of that town and in other towns and in the county the water supply is so inadequate that people have to wait up until 1, 2 and 3 o'clock in the morning to fill vessels. Once the normal life of the town commences at 8 or 9 o'clock in the morning, the pressure is so low at certain elevations that people cannot get water. That is a very grave danger to health. Those concerned are to be complimented that there has not been an outbreak of fever as a result. I have raised the matter several times here. The Minister's Department and the Department of Local Government are closely linked and I need not impress upon the Minister the need for close co-operation between them. I would say that the Minister for Health requires the very closest co-operation of the Minister for Local Government.

Mr. Byrne

Last night, when the Minister was reviewing the activities of his Department in regard to the provision of hospitals and sanatoria, most Deputies were amazed to learn that it will take two years to provide a substantial sanatorium in any part of Ireland. He indicated that the Galway Regional Sanatorium would be ready in about three years' time. I want to ask the Minister is it not possible to move more rapidly, especially so far as the City and County of Dublin are concerned? Is it not possible to take over some large building, some of the new luxury hotels, or some place on the outskirts of the city to accommodate those who are urgently in need of treatment now, not in three years' time? There are 181 patients on the waiting list in Dublin alone. Only yesterday I received an application from a mother of a girl of 16 who requires sanatorium treatment. I made inquiries to see if I could obtain sanatorium treatment for her a little earlier than was promised. I was informed that she was 31st on the list and that in about three months' time accommodation might be found for her in a sanatorium. That means that the child will be three months farther from the possibility of a cure and the three months' worry of waiting will further injure her health. I also tried to obtain sanatorium treatment for a young man of 19 who had been discharged from the Army. I was informed that there is no hope of getting accommodation for him within three months.

I earnestly appeal to the Minister not to be satisfied with plans that have been presented to him for the erection of large buildings in three years' time. I ask him to move quickly to provide temporary accommodation and to give those who are on the waiting list to-day a chance of being cured.

I am aware that persons in sanatoria at the present moment are worried because of the condition of their families. There is no allowance for the family of a person suffering from tuberculosis other than that which the relieving officer of the city may give them. They give the family the barest subsistence allowance. There is no provision made for rent and the rent falls into arrears and there is always the fear of their being given notice to quit. That is not helpful to a patient who is anxious to get better and to return to his work. I would appeal to the Minister to put pressure on and see that immediate arrangements are made to give substantial allowances to the families of those suffering from tuberculosis. Take the case of a young married man earning £4 10s. 0d. or £5 a week, with a family of four or five children. The rent of his cottage is 12/6 a week. He suddenly breaks down in health and has to enter a sanatorium. While he is there, if he is entitled to national health benefit, the family gets about 25/- a week and about 7/6 a week from the local authority. That means starvation for them, and the worry of it will keep the man back from making a recovery from his illness. That family will be suffering from malnutrition as long as he is unable to earn for them.

The Minister spoke yesterday about the making of a nutrition survey, to ascertain what is possible for a family to live on. I would be glad to know if he has yet any knowledge of the conditions in the poorer quarters of Dublin, and if this nutrition survey will take in such places as the Seán McDermott Street area and the Dublin dispensary areas. Once a week the Dublin evening newspapers publish an item such as this: "Dublin relief to-day." I find that on the 2nd July the following particulars were given: "7,221 cases relieved at a cost of £3,089." That means relief at less than 9/- per week per person relieved. Everybody knows that a person must be completely destitute before he or she will get such an allowance from the local authority. I say that it is a miserable allowance. It does not provide people with bread or potatoes and neither does it afford the nutrition that the Minister hopes to give when his survey is completed. The Minister admits what we all know to be so, that the child death rate in Dublin City is excessive. I join with him in the hope that he expressed that an improvement will take place in that situation. The child death rate in Dublin is due to the hardships which are borne by the mothers. It is due to the want of proper feeding in the case of expectant mothers. That has been stated so often by medical experts that it is almost like a parrot cry to repeat it here. We have, thank God, the Catholic Social Service feeding centre and the St John Ambulance feeding centre for expectant mothers, but these organisations are not getting sufficient grants to help them in their great work. I put it to the Minister that he should see that those who are doing the work that he wants done should get the necessary moneys to enable them to carry on.

There has been no mention made in any of the statements that I have seen concerning public health as to whether the Minister has made any recommendation that a substantial sum should be put aside for cancer research. I want to ask him what is the position with regard to that. It is a matter that requires the earliest possible attention from the experts. If we can manage to cure tuberculosis but at the same time find there is a continuous growth of cancer, then I think the Minister ought to be alive to that fact. I feel confident that he is, but so far we have not been told what is being done in that direction. I appeal to him to see that those engaged in cancer research will get sufficient moneys to enable them to carry out research not only at home but on the continent so that they may be able to bring back the benefits of their experience for the relief and cure of those at home. I have no knowledge as to whether or not cancer is on the increase, and perhaps the Minister may be in a position to give us some information.

Finally, I want to put it to the Minister that the best way to prevent most of the diseases that we complain about is to see that proper food, shelter and clothing are provided for those most in need of them. It is most annoying to me and to the other Dublin representatives when visitors who come to the city say: "Why have you so many barefooted children in the streets of Dublin and why are they so badly clothed?" It is hard to explain to visitors because it is the one set of children they see, and they naturally come out of the tenement quarters. They come into the sunshine and the brightness of O'Connell Street, and because of their appearance and the way they approach them visitors can sometimes be imposed upon. I will say nothing further on that beyond this, that Deputy Cosgrave last night referred to the fact that the local authority has the power to provide the parents of those children with footwear for them.

An Ceann Comhairle

Will the Deputy say if that is within the province of the Minister or of the Department of Social Services?

Mr. Byrne

It was touched on so much yesterday that I am just making a passing reference to it.

An Ceann Comhairle

The Deputy is just asking for information?

Mr. Byrne

I would ask the Minister to see that those children will get proper clothing and footwear as they require it and not merely once a year.

An Ceann Comhairle

Has the Minister anything to do with that?

Mr. Byrne

I think he has because it is a public health matter. If the children are provided with proper clothing and footwear their health will be safeguarded. If they are allowed to run about the streets barefooted in the snow and in the rain then they will become prospective patients for our sanatoria. Perhaps another Department would help the Minister to see that they are properly covered and sheltered. Every member of the House has joined in praising the Minister for his efforts on behalf of the health of the people. I will say nothing further on the points that I have put to him beyond this, I believe he has them all at heart and is anxious to do things. I could not sit here, however, and not say something about what I see going on in Dublin. Most of my colleagues in this House know O'Connell Street from the front door of the Gresham Hotel. There are so few of them who know Dublin from the back door of the Gresham Hotel that I would advise them to go there on any Tuesday, Wednesday or Thursday when the free turf is being distributed so that they may see the condition of the men, women and children who are availing of that free turf. You will see barefooted children wheeling perambulators and handcarts and the turf depôt is at the back of the Gresham Hotel. They should see Dublin from the back door of the hotel as well as from the front door.

Mr. M. O'Sullivan

The one matter in which I am mainly interested on this Estimate has been very largely adverted to by Deputy Byrne and that is the question of tuberculosis. In the course of the Minister's statement last night, he mentioned that he believed he had secured a site for a sanatorium to replace the one at Santry Court. No Deputy would like to jeopardise in any way the negotiations which are presumably going on and which are not completed; but I should like to direct the Minister's attention to the fact that opinion is divided as to whether the right steps were taken in connection with Santry Court in so far as it related to a 1,000-bed scheme. If I refer to the matter now it is to ascertain from the Minister if his new site is intended to provide for a 1,000-bed scheme in the same way as the one at Santry Court. If not, may I point out to him that the Dublin Corporation on their own volition secured a site in Ballyowen quite convenient to the city which was deemed suitable in every way for a sanatorium? That site is still in their possession. That scheme was not intended to provide 1,000 beds but it was intended very largely to relieve the existing situation with regard to tuberculosis in the City of Dublin. The question arises as to what is to become of the Ballyowen site if the Minister has secured this other site. I suggest that the Minister should inform the Dublin Corporation at the earliest possible moment of his decision in regard to that matter.

There was also a second scheme, for which a site was secured in Ballyfermot, to replace Crooksling and the Pigeon House. I understand that that scheme was abandoned because it was understood that the purpose for which it was intended would be served by the 1,000-bed scheme at Santry Court. I understand that the site at Ballyfermot is on the point of being disposed of to the Office of Public Works for a Borstal institution. Before the final stage in this matter is reached we ought to know whether either of these sites will be required for a sanatorium.

It is true, as Deputy Byrne said, that notwithstanding the interest aroused about 18 months ago in the drive against tuberculosis, comparatively little progress has been made so far as the provision of additional beds is concerned. It is true that some additional beds have been provided, but the position to-day is that some 200 persons are waiting to get into institutions under the control of the corporation.

There is also an ancillary scheme, namely, the domiciliary scheme, which has been undertaken by the Dublin Corporation for the treatment of patients in their own homes. I understand that that scheme has been reasonably successful up to the present and that good work is being done under it. But, in my opinion, and in the opinion of a good number of people, the results are bound to be negligible owing to the fact that the housing accommodation of the persons concerned is not all that might be desired. It is proposed, under the regulations made by the Local Government Department, to assist such people by putting up an additional room to their houses. But anybody who knows Dublin and the number of people affected by tuberculosis will readily understand that the provision of that very desirable amenity is not possible in a good many cases. Many of these people live in overcrowded tenement rooms and the provision of an additional room in such cases is not practicable. Where it is practicable, I understand that the provision of the additional room is being undertaken by the corporation in consultation with the Local Government Department and that where that additional room cannot be provided the provision of a chalet will be undertaken.

The question of the allowances referred to by Deputy Byrne in connection with the treatment of tuberculosis has been a matter of concern for quite a long time. In fairness to the Minister, however, it should be stated that he has made provision for that in the Health Bill and that in future the cost will be borne as to 50 per cent. by the local authority and 50 per cent. by the State. On that point, might I say to the Minister that the Dublin Corporation have already initiated a scheme which was forwarded to the Local Government Department when it dealt with health matters based on the scheme in operation in Great Britain and Northern Ireland so far as the scale of allowances is concerned? For reasons which can be understood, that scheme has never been implemented and I should like the Minister to have an early consultation with the corporation as to the type of scheme which would be suitable for the City of Dublin. So far as the corporation are concerned, they will be generous in the matter of the scale, particularly when they know that the Minister is prepared to supplement it to the extent of 50 per cent. There is just another matter to which I should like to advert. I am not sure whether it comes within the functions of the Minister for Health, but it is closely allied.

An Ceann Comhairle

Why give warning?

Mr. M. O'Sullivan

Because I am switching over to the question of tenement by-laws, the operation of which is very largely a matter for the Minister for Local Government. The Minister for Health, however, can perform a useful service in connection with it. We have what is almost an international standard relating to the cubic space per person required from the point of view of public health. I am not quite sure whether the present standard—I think it is 400 cubic feet for adults—is quite sufficient. But, in any case, in connection with these regulations there are extraordinary anomalies and hardships. There are rooms in this city, particularly in districts like Mountjoy Square and the older sections of the city which, because of their Georgian construction, are of a very large type. We have cases where a father and mother with five or six children living in one room are not eligible under this peculiar standard to be provided with accommodation by the corporation. Obviously, owing to the present need for housing accommodation, the local authority are precluded from housing a family of that kind because, if they do, they will lose the subsidy attaching to the Housing (Miscellaneous Provisions) Act, 1932.

I have a case in mind which will illustrate the position in the best way for the Minister. It is the case of a man who has a small four-roomed house on the North side. He let a room to a friend, who at the time had three or four children, because of the very bad housing position in the city. The family in that one room has now increased to six and the man has been there for four and a half years, and simply because the room occupied by that family of eight persons does not come within the tenement regulations the Corporation Housing Department is precluded from housing that family, even though the room which they occupy does not comply with the standard cubic space regulation I refer to. There are other cases of rooms of that type throughout the city. There is, for instance, the case of a family on the fourth flight of stairs. The woman has to come down 50 or 60 steps to get water and the sanitary accommodation is outside. Such conditions are apparently not taken into consideration because of this arbitrary standard of cubic space. The corporation are anxious to rid themselves of these anomalies.

An Ceann Comhairle

Is it the duty of this Minister to do it?

Mr. O'Sullivan

I was about to suggest that, as in the case of Ballyowen and Ballyfermot and the treatment of tuberculosis in the city, plus the matter I am now referring to, which is an urgent matter, the Minister should lend his good offices to the corporation in a joint conference with Local Government on these matters. I venture to say that, if he did, very good and useful results would follow.

Mr. Cogan

I want to raise the matter of cancer research. We have discussed the question of tuberculosis at considerable length in this debate and there is not very much that can be added, but I think it will be generally recognised that the death rate from cancer in this country is very high. It is perhaps high in all civilised countries and the fact that this malady is associated with modern conditions of living and modern diet makes it an urgent matter for investigation and the provision of some effective cure or preventive. I should like to know if vigorous methods are being adopted to investigate all possible source of information with regard to the causation of this disease and possible remedies or preventives. If it is due to a nutritional deficiency of some kind, or to some defects in our modern diet or conditions of living, it is the duty of all connected with public health to devise a remedy, and I regard it as a welcome step that this country is being linked up with other countries in an international health organisation. It is desirable that the most up-to-date scientific knowledge on this subject should be availed of by our Department, and I should like to know if special investigations are being undertaken by the Department in the matter and if any useful results are forthcoming.

We all know that cancer is very difficult to diagnose and that it has usually reached a critical stage before either the patient or the medical officer is aware of it. On the other hand, we know that external cancer is frequently and almost invariably dealt with in rural areas by unofficial or non-medical practitioners, who, in many cases, achieve apparent success. This may be due to the type of cancer with which they are dealing not being of a very dangerous character, or to the fact that it may not be cancer at all, and it may be due to the fact that they have, in some way, got a little ahead of the medical profession. On the other hand, most of the cases dealt with medically or surgically are of an advanced internal character, and, very frequently, success is not achieved which does give a certain amount of prestige to the quack as against the medical or surgical profession. The whole matter is one for close investigation and it would appear to be a type of malady which ought to be overcome by the elimination of the causes, if they can be discovered. It might be due to some defect in modern conditions of living.

I welcome the promise of the Minister that a rapid advance will now be made in the provision of institutions not merely for the treatment of tuberculosis but for hospital treatment generally. We have had a seven or eight years' interruption of the building programme, and it is necessary that the time lost should be made good as early as possible. People are more inclined to avail of institutional treatment to-day than in the past and, on the whole, I think it is a desirable tendency, but in many counties there is a serious shortage of accommodation.

I also welcome the investigation in regard to nutrition which is being undertaken. I hope, however, that it does not mean the subjection of human beings to experiment in the matter of diet on the same lines as those on which one would experiment with guinea pigs and so on. I hope it is more in the nature of discovering not what type of nutrition is harmful but what gives the best results. I should be very much opposed to human beings being subjected, for example, to some type of diet which the medical profession might consider injurious but in respect of which they had doubts which they wished to remove by experimentation. That would be altogether wrong, and, if I may say so, somewhat immoral. I hope that is not being undertaken.

I think the net result of this survey will prove that a very large section of our community are living under nutritional conditions which are very low. The food upon which they support themselves, particularly the younger people, is altogether inadequate. It is lacking in many essentials which are absolutely necessary for health. I am told that the younger people in some of the war-racked countries, and even in Great Britain—those who have grown up within the past seven or eight years—show a lack of vitality when compared with other generations. That, I think, is also true of those who have to live in crowded tenements and who are compelled to exist on a very limited diet, insufficient, in the first place; and, in the second place, limited in variety and quality. The net result of this investigation, if it is carried out fully, would be to show how our modern conditions are failing in the provision of essential food. As a result of this investigation I believe we shall have to make a resolute effort to step up the living and nutritional conditions of the lowest paid and humblest sections of the community.

Mr. Beegan

This is an important Estimate and it gives us some idea of the steps that the Minister is taking to improve the health of our people. I was glad to hear him state yesterday evening that he had approved in principle of a 50-bed hospital for Ballinasloe. Approving of a hospital in principle is one thing, but approving of the plans is very often a long time away. That is our disappointing experience in County Galway, as I am sure the Minister is well aware. I should like to know if the hospital in Ballinasloe will be a district or an auxiliary hospital. I favour the latter. I believe that not merely should it be a 50-bed hospital but, by reason of the proposed situation and the position of the county, it should be an auxiliary hospital of 75 beds, with surgical, medical, maternity and fever accommodation on the lines of the proposed regional hospital. It would greatly relieve congestion in the proposed regional hospital.

I would like, as well as approving the principle, that something would be done to hasten the completion of the plans. We have had a very disappointing experience in County Galway as regards approving in principle and then planning. I am sure it is at least 20 years since steps were taken to have erected in Galway a hospital suitable for the accommodation of patients there. Time went on. The board of health did their part. An architect was appointed and I do not know how many sets of plans were prepared. I am sure there were almost ten sets of plans prepared, between the original plans and the revision of plans sent up to the Department. They eventually came back but, with the exception of having a fever wing and a maternity wing and a nurses' home built, we seem to be as far away as ever from getting the regional hospital. I hope the Minister will see that whatever difficulties are there, they will be removed.

An Leas-Cheann Comhairle took the Chair.

Mr. Beegan

I cannot understand, nor can any man down the country understand, why it is that when the medical people under the local authority and the medical experts in the Department want something and fix their minds on getting something to meet the requirements of the people, and explain it to the architect, it should take such a long time to get the plans completed. It is very difficult to understand the cause of all that. We are now in an unfortunate position in that the architect who was preparing the plans, a very good man, died. May the Lord have mercy on him. I suppose that will cause some further delay.

I think the Minister quite well understands the position in Galway. There was an inquiry there and evidence was given at that inquiry showing the great lack of accommodation for patients and the difficulties under which the medical, surgical and nursing staffs are operating. I wish to urge on the Minister the need, in regard to the regional hospital in Galway, or any other hospital, to have something definite arranged between his medical advisers and architects and to see to it that this matter will not carry on for a period of anywhere from seven to 20 years. There can be no excuse for that. There can be an excuse, so far as Galway is concerned, in one sense, and that is that since 1939 the difficulty of getting materials was there, but still we had from 1927 to 1939 and from 1939 to 1947 and the plans could have been completed, but apparently they are not yet completed.

This is something that the local authorities and the people generally are disappointed with. It is not very encouraging to them to be prepared to provide money when there is a hold-up like the one I have mentioned. I would like the Minister to reconsider this matter of the Ballinasloe hospital. I think he should provide there an auxiliary hospital to the regional hospital. Perhaps we will be told we have been pretty well treated in County Galway. If we have been, we were always prepared to meet that treatment by putting up the money. We have gone as far as anybody in that connection; as far as the cost of anything in the way of maintenance of any of our institutions is concerned, I think we can boast that we are second to none in that respect.

We had before our county council meeting last Saturday a letter which was read by the manager asking that permission be given to the county medical officer of health to take, with other county medical officers of health, a course in Canada. I understand that the county medical officer of health is quite prepared to go, on certain conditions, of course. Naturally he is entitled to expect an adequate subsistence allowance and allowances for certain other purposes. We are called upon to put up a certain amount of money, half of which is to be recouped but should the county medical officer avail of this course, as we hope he will, we expect at the same time that we should be entitled to have a claim on his services for at least five years after he returns.

If we put up the money, and if some other county which perhaps will not provide any money to send away its medical officer of health, offers him a position and he agrees to accept that position, I think it would be unfair to charge County Galway for improving the position in the other county which, of course, would be the result of his going to that county.

Furthermore, if the medical officer of health is sent on a course like that—and I know that it will not be wasted on our medical officer of health—his loss would be very greatly felt in County Galway because it is almost impossible to describe the success which he has made of his work since he came there. The pavilions which have been erected are a credit to him. The whole outline of Woodlands has been completely changed and great progress has been made in the county in the fight against tuberculosis. Consequently I should like—and I am sure other Galway Deputies will speak in support of the suggestion—if he goes away and we put up the money that we should be entitled to require that he would remain in the county for at least five years after he comes back and that if not, in the event of his being promoted to another county or even to the Department of Local Government, the ratepayers of County Galway should be entitled to a recoupment of the money they put up.

Mr. Donnellan

It is very necessary in my opinion that Deputies from County Galway should on this occasion, the first on which the new Minister has introduced an Estimate for his Department, bring before him a position that for many years we have been bringing before another Department. Personally I welcome the Minister. I think he was a good selection for the position because it was very necessary to have a member of the medical profession at the head of a Department such as this. I believe myself that he has a thorough understanding of the functions which the Department should fulfil. I want, first of all, to support the point made by Deputy Beegan regarding the position of the county medical officer of health in Galway. It would certainly be a bad day for the county if he should decide to leave it as he would be a terrible loss to the people. I have not the slightest hesitation in saying that he is the most self-sacrificing man who ever entered the profession. I believe he is responsible for saving more lives in Galway than any other doctor before him. He is an honest and sincere worker and, to a certain extent, he risks his own health in trying to work under terrible conditions for the sake of the patients in the county. That has been the case for many years and I join in the tribute which Deputy Beegan paid to him in that connection.

I should also like to refer to the dilapidated condition of the dispensary buildings throughout County Galway. It appears to be the official view that anything in the line of a make-shift is good enough for the country. Something should be done immediately especially in rural areas to improve the condition of these buildings, as doctors and patients are very often wet to the skin when they arrive there and it is unfair to house them in dilapidated buildings. Of course the medical officers in the various areas do their best. There is another matter, which it may not be popular to mention at the moment, but nevertheless it is very necessary to mention it. Dispensary medical officers are very hard workers. They are at the beck and call of all sorts of people night and day and they do their work very conscientiously. Sometimes they have to work for nothing when it is a case of a poor patient. In the times in which we are living, I put it to the Minister that it is necessary that the salary conditions of these officials should be improved.

I was delighted to hear the statement in regard to the hospital at Ballinasloe which will supply the long-felt want in East Galway. I am sure the Minister remembers his friend, the late Monsignor Joyce who, for many years before his death, fought for the erection of some institution of this kind in that part of Galway, especially in Portumna. It was his pet subject. It is more necessary to provide such a hospital in Ballinasloe than in many other parts of the country. County Galway is a very large county. It may appear strange to some Deputies, although it is true, that one portion of Galway is nearer Nelson's Pillar than the other end of the county is to that portion. There is, therefore, a great necessity for cottage auxiliary hospitals. For instance, I know that instructions are being issued to dispensary medical officers to send only urgent cases to the Central Hospital in Galway on account of the overcrowding there. None other than surgical cases can be accepted at times. That is a terrible state of affairs, but the manager is obliged to send out instructions such as these because of the overcrowded conditions in the so-called Central Hospital. I believe the provision of a hospital at Ballinasloe is, therefore, a step in the right direction.

I should like to point out to the Minister that districts in the extreme north end of Galway, such as Williams-town, Ballymoe, and Glenamaddy are 40 or 50 miles away from the Central Hospital. It is very necessary that, in that portion of the county, some auxiliary or cottage hospital should be set up. I would like to make a few remarks in regard to the Central Hospital in Galway as this happens to be the first time this Department is under the charge of the present Minister. I want to point out, as Deputy Beegan has pointed out, that for the last 20 years, I might say, there have been proposals to do something about the matter. The Central Hospital was an old disused workhouse which was taken over, and all the people of County Galway have to use it. Very often, on account of overcrowding, very necessary cases cannot be taken in. I believe, as a matter of fact, that the fault that a new hospital was not erected in Galway years ago lies with the Department that held control previously. I agree that the fact that it was not there was responsible for the deaths of hundreds of people in County Galway and I hope that the Minister and this new Department will not allow that situation to continue. I know that during the past few years it could not be done because of shortage of building materials and so forth but I think that the time has now come when something can be done. In Galway the Central Hospital is looked upon as an old dead-house.

I wish to bring to the Minister's notice the fact that it has been stated that there is some hidden hand or influence operating in Galway which is responsible for holding up the erection of a new hospital there. I may as well tell the Minister what it is, even though I myself do not believe it because I know that the gentlemen concerned would not be responsible for such a thing. It is definitely stated in Galway that the reason why the erection of a new hospital has been held up for years is in order to accommodate certain private homes and private hospitals there, because if the people had a good hospital to go to, they would not go to these private homes and private hospitals. That is supposed to be the hidden influence although I myself do not believe it. Still it is as well that I should bring the matter to the Minister's notice. I need not dwell on the sworn inquiry which was held there recently. The Minister has got the report and he knows that lack of accommodation is responsible for all of it.

I wish to refer to another matter which concerns the erection of regional sanatoria in this country, with particular reference to County Galway. I would ask the Minister to speed up the matter because very often tubercular cases are taken into the Central Hospital in Galway and surely he as a medical man realises that it is ridiculous to have tubercular patients beside other patients in hospital. We all know the harm it does. We all know the name it gives a hospital. We all know that people do not like to be in a hospital where there are tubercular patients. I would ask the Minister, therefore, to be more active about this matter than the Department which was controlled by another Minister was and which was responsible in the past in this connection. As a matter of fact, the Central Hospital in Galway has got such a name—not because of the professional people there, the nurses, the doctors and so forth, but because of the terrible conditions—that people who cannot afford to pay in a private hospital or in a private home prefer to go, if possible, into hospital in Roscommon, rather than turn up in the place that is supposed to be such an old dead-house as the Central Hospital in Galway is supposed to be. In my opinion the conditions in that hospital are a crying shame. I believe that, for years back, the conditions in that hospital have been responsible for the deaths of hundreds of our people in the county. In some instances, because of lack of accommodation, urgent cases cannot be admitted there and are, consequently, very often lost. As a result of these conditions, they go to another hospital if at all possible rather than to the Central Hospital in Galway. I would ask the Minister to take special note of this matter particularly on account of rumours of a hidden influence in the matter, although I myself do not believe them. I am sure the Minister will take steps in this matter because, as a member of the medical profession, he must realise the great necessity which exists in Galway for the erection of a new hospital. I believe that no other county of the Twenty-Six Counties which Dáil Éireann rules is in such dire necessity and want for hospital accommodation as County Galway is.

Mr. Coburn

I wish to bring one matter to the Minister's notice and that is the provision of a new county hospital in Louth. I mention this matter now lest the Minister may put it on the long finger as he is new to the job. I would like to remind him that this matter is a long time on the carpet. My colleague, Deputy L.J. Walsh, will agree with me that Louth was one of the first counties which was eligible for a grant out of the first sweeps.

Mr. L.J. Walsh

I am afraid Louth will be one of the last counties to get it.

Mr. Coburn

£70,000 was got from one of the first sweeps for that purpose and that money is lying there still. It is possible that some of it is being used to relieve the rates or the upkeep of the present hospital. As this Minister and the previous Minister know, we have been very patient. We realise, of course, that due to circumstances over which neither the county council nor the Government had control, no action could be taken in the last few years. I refer to the war and to the lack of materials or to the difficulty in securing materials which would be necessary for the erection of a building of the size required. As I say, we have been very patient. We do not usually harry any of the Departments in these matters. But we feel now that the time has arrived, as the war is over, as building materials are becoming more plentiful and, as far as I can understand, as there are no outstanding points of any great importance as regards plans or the selection of a site to be decided.

The people of County Louth are hopeful that a start will be made in the very near future in connection with the erection of a new hospital. I do not wish to worry the Minister unduly. I feel sure he knows all about it already. The hospital we have is a very old hospital with limited accommodation. It is not, in fact, able to meet the demand. For that reason, large numbers of patients have to be sent to the city hospitals which, by the way, are themselves already overcrowded and have difficulty in accommodating even the people from the City of Dublin. Taking all these things into consideration, I would ask the Minister to see that the erection of this hospital in County Louth is proceeded with as soon as possible, so that this long-standing grievance may be removed.

Mr. Killilea

A few statements were made by Deputy Donnellan which should not be let pass, as they conveyed the impression that the Central Hospital in Galway is a death trap. There is no doubt it is very crowded, but I have yet to know of anyone who has made a statement to the effect that it was responsible for numerous deaths all over the county. It has as good a staff as there is in Ireland and the patients who go there are catered for as well as in any of the homes referred to in Galway. In regard to the talk about a hold-up in the new hospital, I have never heard it rumoured that there was some hidden hand stopping the erection of the new hospital. The county manager his indicated on many occasions to the Galway County Council, in Deputy Donnellan's presence, as well as in mine, that the work of erection was held up during the war through the lack of materials—as has been the case with many similar buildings all over Ireland. I understand that the materials are practically ready, and I hope the Minister will see that the work is put in hands now without delay. The Central Hospital is definitely overcrowded, but to make statements beyond that would not be fair to the hospital or to the nursing or medical staff.

In the sanatorium in Galway we have the nursing staff housed in the same institution as the patients. The county medical officer of health has made an effort to get up a nursing home and that should be proceeded with immediately. If there is any delay in the Department in regard to the erection of that particular hospital, I would ask the Minister to see what he could do to speed the matter up. I know there is probably a difficulty there because a new sanatorium has been erected in Galway. There may be a difficulty in connection with the erection of a suitable hostel for the nurses, but it is not right or reasonable to leave the staff where they are. Their work is very heavy and they have to deal with a very infectious disease and it is not a proper thing to have them housed where they are at the moment.

I have heard many comments during this debate on the spread of tuberculosis, but I do not think anyone has put his finger on the real cause. I have visited the sanatorium in Galway and other sanatoria all over the country and, to my mind, the cause of tuberculosis all over this country at the present time is dance halls. People leaving dance halls at four and five in the morning go home for half an hour's sleep and go off on the following day to do a day's work, after being in a sweat all night, and they are half dead from want of sleep. When you talk to a young fellow in a sanatorium and ask him what happened to bring him in there, he will tell you: "I went to a dance on such-and-such a night and when I came home after it I did not feel well. I got a dose of a cold, but I did not want to admit it, as I knew my father would not be sympathetic, since it was at a dance hall that I got it." We will have to face this question of closing down the dance halls at an earlier hour. Three o'clock in the morning is no hour for dancing; people can dance up to 12 or even 1 o'clock, and that is late enough for any man who has to work the following morning. If you examine the vast majority of the younger people in the sanatoria at this particular time, you will find you can trace the reason back to coming home late from some dance hall.

Deputy Beegan mentioned the suggestion to ask each county to send out a doctor to make a study of the up-to-date methods of dealing with tuberculosis. The Minister should take note seriously of what he said. We have as good a medical officer of health in County Galway as you will find in Ireland and we are quite prepared to send him away; but if every county is not prepared to send a doctor away and bear the expense, the expense should be borne by the State. To send our doctor away would cost in or about £1,000 and we have no guarantee that when he gets back he will work for even two hours for our county, and we may get a man from another county who will not have the experience he has had. Unless every county in Ireland is prepared to bear the expense of sending someone, the expense of sending out a certain number should be borne by the State, as I do not see why one county should be mulcted and another get the benefit of it.

I listened to Deputy Blowick's condemnation of everything in front of him and behind him and above and below him. Everyone should look to his own end of things first and set his own house in order, before starting to condemn everyone else. It is the grandest thing in the world to come in here and condemn the Department or the Government. One of the reasons why our Central Hospital in Galway is packed out is that we have to keep a number of patients from Mayo, since they seem to have very poor hospital accommodation in Mayo. I do not know if they have anything at all in the nature of a sanatorium. Our children's home in Tuam is in the same way. Half the patients are from Mayo and Deputies such as Deputy Blowick should make a little effort in their own counties to start off with. They should see that Mayo is a shining example before they start to condemn the Department or anyone else. We will have an opportunity at a later stage of discussing this further when the White Paper comes before us.

I am glad that the advance has been made in Galway, where the county council is second to none in Ireland and where the regional hospital is second to none. So far as the care and comfort of patients are concerned, the county council and the Galway public health authority have not been lacking in any respect. For that reason, they deserve first consideration from the Department in any of the schemes that are put forward from time to time.

Mr. Flanagan

I look on this Department as the most important one in the State, as it is solely responsible for the administration of schemes for the general health and well-being of our people. This is the first Estimate we have had from the Minister for Health and I believe that, no matter what demand is made in this House or in any other Parliament for the improvement of health, it could not be great enough or big enough. The millions that are spent on the provision of schemes or on cures for diseases or the administration of a proper Department of Health are moneys very well spent. The old saying is that a man who has his health is a millionaire. From what we read time and again of millionaires who have not their health, we know they look upon themselves as very poor people. If we have our health, we have everything that is required.

At the moment, the vast majority of our people are not healthy. Tuberculosis has got such a grip that if some serious effort is not made to put a check on it, the greater portion of our people in ten or 20 years' time will be wiped out. It is definitely a plague. Although there is something being done, I am not satisfied that any great battle is being waged against tuberculosis. It is a disgraceful state of affairs that there should be so many persons suffering from tuberculosis parading the streets, living in the same houses as their families, and hundreds on waiting lists for sanatorium treatment. I have known many cases of tuberculous patients being refused admission to hospitals or sanatoria because of lack of accommodation. The first work the Minister for Health should undertake is the provision of sufficient accommodation for all such people. Where hospital accommodation cannot be provided, every effort should be made to make special provision in the patient's home. For this purpose the Government should go all out and give full grants for the erection of a room attached to the patient's house. I am aware that grants are provided by local authorities for that purpose but I consider that the local authorities should have more power in that respect so that any member of a family suffering from tuberculosis who could not get immediate accommodation in a sanatorium or who, perhaps, would be discharged from a sanatorium after treatment, could be provided by the State with an additional room to the cottage or house, where he could be isolated from the rest of the family and have all the facilities necessary to effect a cure. Such provision would go a long way to remedy the situation.

Deputy Killilea says that he believes that the dance-hall is responsible for the spread of tuberculosis. Surely Deputy Killilea cannot attribute tuberculosis in a child of three or four years of age to the dance-hall. How many school children are there who are suffering from tuberculosis? How many old people are there who have never been in a dance-hall who are suffering from tuberculosis? I think that is "tripe". The dance-hall has nothing to do with it. I honestly believe that the real cause of the spread of tuberculosis is the low standard of living and lack of nutrition which arises from the enormously increased cost of living. Our people are unable to purchase their full requirements of beef and milk. Our farmers are unable to produce milk in quantities sufficient to allow every citizen to have as much as he requires for proper nourishment. We have appeals being made and warnings issued as to the safeguards that should be adopted against tuberculosis, but the only remedy that I see for tuberculosis is proper clothing and good food. That is the greatest defence of all against tuberculosis. How many children do we see going to school without footwear, without proper clothing? How many of our people are unable, when winter comes, to buy extra woollens? I believe that the cause of tuberculosis lies in our low standard of living, our low wage system, and lack of nourishment. We are only whipping a dead horse in this House when we talk about providing temporary measures. What we want is to stamp it out completely. We can do that by providing for our people the necessaries of life and healthy housing accommodation.

I want to draw the Minister's attention to the fact that diphtheria and fever are increasing, at least in my constituency, at an alarming rate. I maintain that the cause of that is the neglect by the local authorities to carry out the necessary maintenance of town drains which have sewage flowing into them. I consider that there should be a law requiring every local authority to have every drain closed and properly piped. There should be no open drains in any town or village. I have known cases where local authorities were willing to provide for the piping of town drains and the county engineer would not recommend it to the county managers, and the schemes were not carried out. In the days of the boards of health more was done in the matter of public health than is being done at the present time. I believe that the County Management Act is a hindrance to members of local authorities, who would like to exercise their duties in the matter of public health. I have known cases where the engineering staff of local authorities turned down recommendations and the local representatives had no say whatsoever. There should be subcommittees of each county council, solely responsible to advise the county manager and the medical officer of health on matters relating to the public health of the county. It was unwise on the part of the Government to abolish the boards of health. While there was a good deal to be said about the encumbrance they were, there was a good deal to be said in their favour. The members of the boards of health knew exactly the remedies to apply in matters of public health requiring urgent attention. I believe that at some future date the Minister will have to see that there is more co-operation between local authorities and himself and between the local authorities and county managers and the public representatives. To my knowledge, that co-operation does not exist and cannot exist until there is legislation introduced or until the Minister for Health takes special note of this matter. There is great need for the establishment of sub-committees of each county council who would devote their whole time to the question of the health of the county. The old boards of health did a very good service. They were always there to advise the dispensary doctors. They were responsible for the administration of the health services in their districts and they knew where there was urgent need of proper sanitary accommodation, sewage schemes and proper water supply. We all know that nothing can spread disease as quickly as bad water. In this case, when we had the old boards of health in existence they knew the problems that concerned each area and were able to get them attended to.

An Leas-Cheann Comhairle

It is not in order for the Deputy to advocate legislation on an Estimate. When the Sanitary Services Bill, which has been circulated, comes up for discussion the Deputy will have ample opportunity to discourse at length on all these matters.

Mr. Flanagan

In my opinion the mental hospital committee and the other committees that we have in the various counties have not enough power to enable them to advise and to assist in these matters. I think that if they were given more power, and were put in the position of being able to make recommendations to the Minister, it would lead to a general improvement in the case of our county institutions.

The Minister and his Department are actively engaged in the provision of sanatoria and hospitals, but I wonder when we have sufficient hospitals built where the Minister thinks he is going to get personnel to staff them. We all know that nurses are flying out of the country. They have received some increase in their salaries, but they find even with that, it is not sufficient to enable them to live up to their professional calling. Due to the low salaries they receive there is nothing to attract them to remain at home and we find every other week the nurses in our county institutions tendering their resignations and going to England or elsewhere. Nurses are as important to the community as doctors, and we should endeavour to keep them at home. One attraction for them would be, I believe, if homes were provided for them in which they would reside when off duty. I believe that a nurse who works 12 or 13 hours a day should not be obliged to spend the remainder of her time in the same institution as the patients. It is bound to get on her nerves, and hence I say nurses' homes should be provided convenient to the public institution. We have one of the finest hospitals in the country in Portlaoighise. It is one of the most efficiently run in the country. When it was being built a few years ago it was thought that it was too big and too elaborate for the county, but now we find that it is too small and that the patients are lying on the floors. That hospital is run by a religious order of nuns. I suggest to the Minister that a convent should be provided convenient to these hospitals for the accommodation of the nuns and a nurses' home for the nurses.

A good deal has been said about our dispensary doctors who play a great and a noble part in discharging their very responsible duties. One may say that they are on duty for the 24 hours of the day. In my opinion they are deserving of more consideration than they have received in the past. I trust the Minister will formulate a general scheme whereby dispensary areas will be made smaller than they are. They are altogether too big. In some places, parts of a dispensary doctor's district are seven and eight miles from his residence. An effort should be made to have smaller dispensary districts and more dispensary doctors. People may say that it would be a waste of public money to do that. In my opinion money that is spent on public health is never wasted. There are some dispensary areas, too, in which the doctor does not live in his district. That is due to the failure to provide a dispensary residence. There is one such dispensary area in my constituency. I refer to Ballyroan. There has not been a dispensary doctor there for many years. A doctor is appointed and he comes there, remains a little time and then goes away because of the lack of housing accommodation. It should be the Minister's aim to see that a residence is provided for each dispensary doctor.

I desire to draw the Minister's attention to the state of affairs that exists in the town of Birr. Numerous requests have been made over a long period for the erection of a hospital in that town. The Minister's attention has been drawn to it lately by the Birr Urban Council. The dispensary is situate about three-quarters of a mile outside the town. That is very inconvenient for the people living in the town who have to frequent the dispensary. I had a question down some time ago asking the Minister whether he would not see that suitable accommodation would be found in the town of Birr for the dispensary. I think that such central accommodation could be secured. Offaly is a very big county. The county hospital is in Tullamore. That caters for Edenderry, Clara and Daingean, but it is not at all convenient for the people in West Offaly and those living near Roscrea close to North Tipperary. If they require to get treatment in the county hospital they have to be taken all that distance through Birr to the town of Tullamore. I think it would be far better if a hospital were provided in Birr for the treatment of people in West Offaly and those on the border near North Tipperary—in areas such as Monafadda, Shinrone and Banagher. Everything seems to be centralised in the town of Tullamore for the County of Offaly. That should not be the case. The town of Birr is equally important and it would be convenient for everybody if there was hospital accommodation in that town. I trust that the Minister and his Department will see that such a hospital is provided at a very early date.

I wish to take this opportunity of congratulating the Minister on what has been done. I believe the Department of Health suits the Minister far better than the Department of Agriculture. Owing to the fact that he is a member of the medical profession, he has practical knowledge of the matters to be dealt with. I believe the Minister for Health should have a thorough knowledge of public health matters and should be a member of the medical profession. The present Minister, I think, takes a great interest in the promotion of public health and he will have the co-operation of all sides of the House in any efforts he makes towards improving the health of the nation.

In offering to the Minister my appreciation of his services, I think he should do something to expedite the work of dealing with any matters that come up to his Department for sanction. It is unreasonable that matters should be left undealt with for many weeks. When a county manager sends up a recommendation for an increase in the wages of wardsmaids or other employees in any public health institution, the Department should not copy the methods of the Local Government Department which, we all know, takes six months or a year to answer a letter. This is a new Department and it should start with a clean sheet and give good service to the people, as it is one of the most important Departments in the State. The only thing I have to complain about is the slowness of civil servants in dealing with matters that come before them. They are good men, they know their job, they are very obliging, but they should deal with matters coming to them from local authorities with more speed.

The county manager in my constituency has submitted certain proposals for increases to certain employees in the institutions at Portlaoighise and Abbeyleix and they have not been sanctioned yet. In connection with such matters there should be an appointed officer who should know whether an increase was justified or not and either sanction it or not sanction it at once, and not have it hanging on for months until some civil servant sees fit to dictate a letter. Less time should be lost in dealing with such matters so as to give local authorities a chance to carry on their work. With more co-operation between the Department and local authorities a good deal could be achieved. Since the Department of Health has been established, a great many improvements in various institutions throughout the country have been outlined. I am very glad to hear that. I should like again to impress on the Minister the need for a complete overhaul of the county home at Mount-mellick which is very necessary. That building is almost 100 years old and a big general scheme of repairs will have to be carried out there at a very early date. The same thing applies to the fever hospital in Abbeyleix, which serves all of South Laoighis, and the county hospital at Portlaoighise. I hope no time will be lost in sanctioning any proposals that come forward for the erection of a nurses' home or any additions to the existing institutions in that county.

We happen to be fortunate in having in that county a sanatorium which is very efficiently run and serves a great portion of North Tipperary and Offaly. The manner in which the staff have catered for the many patients sent there is a great credit to them. I think that institution needs to be completely modernised. Just as there is an inspector for mental hospitals, there should be a medical inspector to go round to these other institutions periodically and, where repairs are necessary, draw the attention of county managers to the fact. The sanatorium outside Portlaoighise is most beautifully situated and has a lake convenient to it. I would be glad if the Minister would see that improvements in the way of decoration and making the place more attractive for the patients are carried out. He will have the full support of the local authority in doing that. I wish the Minister good luck in his present position, as he is the right man in the right place. He knows more about public health matters than any other Minister. I believe that he is the most suitable person for this Department. I can assure him that he will have my full support and wholehearted co-operation in any matter that he puts forward to achieve the aims for which his Department was formed.

Mr. L.J. Walsh

This is the first Vote of the Department of Public Health. I think the nation is very fortunate in having a Minister so well fitted to guide the destinies of that Department. I want to add my voice to that of Deputy Coburn in appealing to the Minister to expedite the provision of the county hospital for Louth. It is true that this hospital has been on the stocks, so to speak, for the last 22 or 23 years. It was one of the first hospitals to be earmarked for a grant from the Hospitals Trust Fund, even before the Government controlled that fund. The delay in building that hospital is not entirely due to the Department. It is true to say that the local authority was responsible for the delay up to 1939. I want to make my position quite clear. I am not blaming the Department for that delay, but I do think that since 1939, notwithstanding the fact that we passed through a very trying time, something more might have been done. In the town of Drogheda, a first-class, up-to-date, modern hospital of some 50 beds was erected, which is known as the Lourdes Hospital, under the guidance of that great person, Sister Mary Martin. Surely if a private enterprise can succeed in erecting a hospital, there is no reason why public bodies could not achieve something on the same lines. I know that the Minister has only begun his duties, and I am not so foolish as some Deputies to expect him to wave a magic wand or to perform miracles in a short space of time.

Hospitalisation necessarily must be a long-term policy. All of us are claiming our rights for our constituencies, but the Minister must consider what is best for the people as a whole and for the treatment of any particular disease, in particular tuberculosis. I have studied this question from the statistical point of view over a long number of years and I am quite satisfied that there has been no marked increase in tuberculosis in this country. I say that unhesitatingly. Very fortunately, there is an awakening with regard to tuberculosis amongst our population, which is all to the good. People to-day are more ready and anxious to submit for examination and treatment than they were ten or 15 years ago, and that is largely responsible for the suggestion that it is more prevalent to-day. Statistics will prove that, as I say, there is no marked increase in the incidence of tuberculosis.

In County Louth, we have four institutions serving the people as hospitals, but none of them is a hospital in the strict sense of the word. They were erected 100 years ago, most of them having been created during the clearance period after the famine when they wanted to get rid of our people. North County Dublin is about the only area which levelled the institution to the ground and made a road of it, and the sooner all these institutions are levelled to the ground, the better it will be for the health of the people. There is no proper hospital service in any of the four institutions in Louth— the Louth County Infirmary in Dundalk, the district hospital in Dundalk, the district hospital in Drogheda, and the district hospital in Ardee.

Our county is a small county with a population of some 63,000 and a valuation of something like £275,000. Notwithstanding all that, we, the public representatives, are very anxious that we should have our own county hospital in Louth, and I see no reason why there should be any great delay in the Minister giving final sanction to the plans that are being prepared. Last October, we agreed to an alteration in these plans, which have since been submitted to the Department, and I ask the Minister to take a special interest in this hospital, in view of the fact that Louth was one of the first areas to be recommended for Hospitals Trust grants. We have got substantial grants from the Hospitals Trust Fund, much of which has been invested, but it will take a good deal more than the amount now available for this purpose to provide the necessary institution.

With regard to the Drogheda Cottage Hospital, this is an institution some 50 years old. It was built as a private hospital to cater for the needs of the town and it has always been very highly appreciated because it has saved many of our citizens from having to travel to Dublin for treatment. This institution, like the rest of our institutions, has now become too small and the hospital authorities seek to make an extension. The matter has been hanging for the past couple of years. It is a small matter of adding something like a dozen rooms to the existing building. During the war years, we succeeded in getting built a completely new hospital —an achievement of which the citizens of Drogheda as a whole feel very proud —and I ask the Minister to give his attention to the sanctioning of the county hospital plans in particular and the proposed extension of the cottage hospital, an institution responsible for a considerable saving to the public purse. The very large number of patients treated in that hospital, both intern and extern, is surprising, and for that reason the hospital is entitled to special consideration. We are told that building material is now becoming freely available, and we are all very glad to hear that, and I hope the Minister will see to it that there will be no undue delay in sanctioning the plans submitted for the Louth County Hospital and the Drogheda Cottage Hospital.

Mr. Heskin

With regard to tuberculosis, I want to say that money spent in the direction of reducing the incidence of this disease is money well spent and I should like to draw the attention of the Minister to the growing demand for better treatment of tuberculosis cases. In Waterford, we have not got accommodation for these cases and, quite recently, at a meeting at which the report of the medical officer was considered, it was stated that 20 cases were awaiting treatment. These cases while awaiting treatment are a danger to other members of their families and there is the danger of 100 and more other people becoming infected in the near future. For that reason, every effort should be made to eliminate the danger which threatens the country in relation to this terrible disease.

The Waterford County Council recently sought to make provision for such cases by placing at the disposal of the appropriate authority a wing of the hospital in Dungarvan. I believe that has been turned down, and I should like to know if the Minister is taking any steps to provide alternative suitable accommodation, because the people involved have tried different counties and institutions in which treatment is given to find accommodation and have failed to get it. I should like to hear the Minister say that he is taking immediate steps to provide for these people.

Another matter with which I have been dealing in my own locality is the matter of better provision for children whose parents are not able to maintain them properly on their earnings. When a recommendation to this effect is made by a doctor, the assistance authorities should be in a position to provide more financial assistance for these people, with a view to the provision of better and more suitable nourishment for these children. When neglected in their early years, these children are the people most likely to be affected by tuberculosis in future. I urge the Minister to take steps to provide for tuberculosis cases and to arrange for their immediate removal from contact with other members of their families and thereby remove the danger of further infection.

Mr. Dillon

I want to renew to the Minister my urgent application that, if necessary, in the Seanad, the views of those of us who regard the compulsory powers contained in the maternity and child welfare part of this Bill——

An Ceann Comhairle

The Deputy is discussing legislation now. This is an Estimate.

Mr. Dillon

I quite agree that we cannot advocate, on an Estimate, an amendment of the existing law.

An Ceann Comhairle

Nor discuss anything but the administration.

Mr. Dillon

Absolutely. Therefore, I shall confine myself to saying to the Minister that I trust, in his administration of this Department and in excogitating the various problems that may arise, he will bear carefully in mind the strongly held opinions of Deputies with a view to creating that atmosphere of bland conciliation which so greatly facilitates, not only Parliamentary procedure, but the effective implementation of the legislation of this House.

Dr. Ryan

I think the big subject of discussion on this Estimate was the position of sanatoria and, while we all agree that everything possible should be done to provide more sanatorium accommodation, I think Deputies might like to hear something more with regard to the difficulties we are up against and, to some extent, an explanation of what they believe to be very unwarranted and unnecessary delays.

Santry Court was mentioned by a number of Deputies. Santry Court was selected and all the experts were unanimous in believing that it was the most suitable place available at that time. The medical men, not only in the Department, but also medical opinion from those who had a good deal of experience of the administration of sanatoria, together with the architects and the engineers, combined in recommending Santry Court as the most suitable place. What they were looking for was a place which would accommodate 1,000 patients and, on the pavilion system, they thought they would want 250 acres for that purpose.

The first thing was to get a place big enough, and there was a limited number of places that came up to the standard with regard to extent. In a sanatorium, from the medical point of view, you require a very well-drained site; you cannot have that sort of retentive soil which you get in some places. And again, it must be well sheltered. Santry Court fulfilled this condition also. Then it must be within reach of the city, for two reasons. Patients are a long time in a sanatorium and relatives like to go to see them and the patients like to see their relatives. You must, therefore, consider the convenience of relatives visiting patients. As well as that, you must consider the convenience of an institution of that kind for the staff. There would be a very big staff in such a sanatorium; it might number 300 or 350. Where you have a big nursing and domestic staff it is not so easy to get them to stay in a place unless it is convenient to a city or town. All these conditions were fulfilled by Santry Court and, therefore, it was selected as the best at that time.

The point was made that there was a good lot of muddling in selecting it and then giving it up. I do not think it should be called muddling. It must be remembered that when Santry Court was selected, Collinstown was an aerodrome with grass runways and was used entirely for cross-Channel traffic —that is, small planes between here and Great Britain. If it had remained like that, I do not think it could be considered a nuisance to Santry Court as a sanatorium. But gradually the conditions changed. At that time it was considered that Collinstown would be purely a cross-Channel aerodrome and that Rineanna would be the aerodrome for the big planes dealing with transatlantic traffic. Gradually it was realised it would be necessary to fit out Collinstown for bigger planes. If a plane could not land at Rineanna it would be well to have an alternative place where it might land in this country rather than have to continue to England or the Continent.

Then there was a bigger development than might have been expected in the traffic to far-away centres on the Continent. There was also a tendency to use bigger planes and everything combined to make it imperative that Collinstown should be developed with concrete runways to take larger planes. These larger planes make more noise. I do not think the risk of a plane falling on the sanatorium need be considered, because that risk is something like a million to one chance that it would ever do so. The real point is that these big planes coming in constantly would have a disturbing effect on patients lying there day after day and liable to be annoyed by anything of that kind. People in a sanatorium must have rest and contentment above all things and if there is anything that might irritate them, it would be very bad for their health; in fact, it might mean all the difference between recovery and death if there was annoyance of that kind.

There was also the consideration that people coming back from that sanatorium and asked by their friends what sort of place it was might say: "Well, it was a very nice place and we were very well treated, good medical treatment, but the frequent passing of planes over the institution was terribly annoying and it was very hard to sleep at night because of the noise." That report might get around and people sent to Santry Court might go there with a prejudice that it was not a very nice place to be sent to under any circumstances. When Santry Court was selected there did not appear to be any great danger from the aerodrome at Collinstown, but there was a gradual growth of business at Collinstown and it was only when that became appreciable that there developed a doubt in the Department of Local Government that perhaps it would be a bad thing to continue with Santry Court.

In the end, we decided that as we were to spend over £1,000,000 on the building, it would be a great pity to go ahead with it if any fault could be found afterwards arising from any such cause as I have referred to—heavy planes passing over. In these circumstances, we decided to abandon the site.

The next thing that arose was the expense that had been incurred. It is not true to say, as some Deputies have said, that the place was not insured. It was. The mental hospital authority that actually owned the place at the time the fire occurred did, in fact, draw the insurance, which amounted to more than they had paid for the place in the first instance, so that they had it very cheaply.

Mr. Cosgrave

The State was stung for £25,000.

Dr. Ryan

The State was eventually "stung," I believe, by the insurance company who took action against the Minister for Defence but I am not sure whether they recovered the whole amount from the Department. The point I want to make clear is that the place was actually insured but negligence was established by the insurance company and that cost the Minister for Defence a certain amount of money. The money spent on the development of this place will, of course, to a great extent be lost. Some equipment such as piping which will be useful on the new site will be recovered and practically all the plans and the architectural work done will also be utilised on the new site. I have asked the architects about the matter and they say that with some slight modifications, we shall be able to adapt the plans to the new site. In all probability, the plans drawn up for the various buildings on the Santry Court site will be used practically in their entirety on the new site so that the work done for the past two years in the architects' offices is not altogether lost. The delay in changing from one place to another will be only a matter of, I should say, about six months. We must remember that local authorities as well as the Department, the Dublin Corporation for instance, have met with great difficulties in making even alterations. The alterations made by them at Rialto have been going on for three or four years although it was a matter of adding only 65 beds. I am not blaming them for the delay; I do not think they could have done any better. I am only just giving you an instance of how difficult it has been for the last five or six years to get materials. We must not find fault with the Department, the corporation or any local authority if there has been a serious delay in providing sanatoria during the past few years.

The question of the sanatorium in Mayo was mentioned by Deputy Blowick and other Deputies. This institution, which is situated at Creagh, near Ballinrobe, has never been a satisfactory sanatorium by any means and there have been many disadvantages connected with it. The administration building, where the cooking is carried on and where the nurses stay, is a good way from the pavilions in which the patients are kept. A very serious disadvantage is that food must be carried from the central block to the patients and it is impossible to have the food conveyed to them in a warm and good condition. There is the other disadvantage, as one Deputy pointed out, that the sanatorium is situate in a corner of the county, miles and miles away from the northern end, and it is not by any means popular when a patient has to be sent to the sanatorium from the northern part of the county. The Mayo County Council asked to have the sanatorium enlarged but the report which I got on the matter indicated that we could not stop at increasing the bed accommodation because we should also have to increase the cooking accommodation and the accommodation for the necessary staff. It has always to be borne in mind in enlarging any nursing institution that it is not simply a matter of adding a ward with ten or 20 extra beds. We must always keep in mind that accommodation has also to be provided for extra nurses and extra domestic staff.

The sanatorium is also situated in a place where it is practically impossible to buy milk or vegetables, so that they would have to provide these commodities themselves. It was difficult to see how that could be done because I understand the amount of land available is limited. It is not easy to see how more fresh vegetables and milk could be provided if the institution were enlarged. Some of these difficulties might be got over. They are not insurmountable, but they are difficulties that we must count with. Even if all these things were provided and the money spent as advocated by the county council, we should still have a very unsatisfactory and unpopular institution, a place that might possibly be closed when good regional sanatoria became available. On the whole it would appear that the least possible expenditure should be embarked upon there now and that we should try to deal with the waiting list they have by providing accommodation for them elsewhere if we can. That is a matter into which we are looking, to ascertain if we can spare for patients from the County Mayo some extra beds in the institutions around Dublin in which increased accommodation is being provided at the moment. I think that would be the best solution of the problem.

A number of Deputies mentioned dispensaries. It is intended, of course, to improve and, in fact, to rebuild most of the dispensaries and to provide the buildings, according to the modern clinic idea, where people who are waiting on the doctor would have a proper waiting-room and would not be obliged to stand out in the weather, where the doctor would have a proper room to examine patients and where there would be a room also for the extra staff that will be needed. In some of the bigger dispensaries there may be an extra medical man and in the smaller dispensaries accommodation will be needed for nurses and midwives.

Mr. Dillon

Are you going to replace the county homes?

Dr. Ryan

That is another matter. We hope to see all the dispensaries brought up to the standard which I have indicated. It may be possible to bring some of them up to that standard by alterations but many of them will have to be rebuilt or replaced entirely by new buildings. It will take some years to have that done.

In regard to the county homes, Deputy Cosgrave asked about St. Kevin's. It is intended to take the chronic patients away from St. Kevin's and to establish as it were a county home, apart from St. Kevin's. Again, it will take some time to provide some place for these chronic patients. The commissioner is, with the approval of the Department, at the moment investigating the possibility of removing these chronic patients. He is to make a report and to submit rough plans for discussion with my Department as soon as possible for that purpose. It will take some time of course before all these discussions are complete and the scheme is brought to a conclusion but at any rate we are making a move in that direction.

Take the ordinary county home itself. The first thing I believe we should do is to take certain classes of people away from most of the county homes. As soon as we can provide other accommodation for imbeciles and epileptics they should be taken away. We should like to provide, as soon as possible, special institutions for people such as imbeciles and epileptics. The next class that should be removed as soon as possible are the unmarried mothers. Then, eventually, we would be left with only the old people who have retired there for the rest of their lives. I certainly will favour any proposal from any local authority that will go towards getting a more congenial home for these old people when they alone are left and all the other classes removed.

On the subject of dispensaries, Deputy Cosgrave asked about Crumlin. Crumlin is one of the first places we have on our list with regard to a new clinic. Naturally, with the great increase of population there, the present facilities are not adequate. Deputy Cosgrave also mentioned, as an instance, the supply of surgical boots where, apparently, some delay occurs. A medical man recommends something to a patient: the county manager agrees and sends up to the Department for sanction. I think the Deputy's point was that sometimes there is a delay and that the patient suffers by the delay, in fact, not only pain but perhaps more permanent injury. A rather undesirable state of affairs exists there. Wherever, in the past, the Department had given a grant—say half the cost of a scheme of that kind— the county manager has always to get prior sanction. We must try to arrive at some more workable arrangement by giving sanction for a certain scheme or a certain proposal which will cover such things, and where there would not be necessity for individual sanction, so that there will not be any unnecessary delays.

Deputy Cosgrave also asked me if the scheme which I had outlined for the City of Dublin lying-in hospitals and mother-and-child welfare would apply to County Dublin. The answer is no. County Dublin will have to come into the scheme like any other county on the district medical officer system, that is, the men who are now known as dispensary doctors will become the district medical officers and will take over public health as well as their other duties in their own areas.

Two matters were raised by Deputies which they do not realise are already being done. The first is a request that where sanatorium accommodation cannot be found for a patient an extra room should be provided in his own house. That is already provided. The local authority is authorised to sanction this extra accommodation where there is a tubercular patient. Under this scheme the cost is paid up to £100 or up to two-thirds of the cost, whichever is the lower. I think it was Deputy Byrne who made the second point which is that we should try to provide for the family of a person who is suffering from tuberculosis. There is provision in the Health Bill which has just passed this House that the local authority will submit a scheme of payments in such cases and the Minister will sanction, or sanction with modification, the scheme put to him and the Department in that case will contribute half the cost.

I was asked if there was any provision for research into cancer. A committee was set up to consider this question of cancer pre-war, but I think they had not got very far with their deliberations when the war interrupted them. We have been considering again either the revival of the same committee or the setting up of a new committee to consider this whole question of cancer—research into the cause, the treatment, and provision for institutional treatment, and whatever may be necessary in that way. I hope we may be able to proceed with that in the very near future. It must be remembered that, as with tuberculosis, early diagnosis of cancer is the important thing, that is, as our knowledge stands at present. Maybe we may reach the stage of scientific advancement where cancer can be cured even at a later stage than now, but as our knowledge stands we must diagnose cancer at an early stage if we are to have hope of curing it. Generally speaking, people are inclined to submit themselves for examination much earlier now than they did, say, some years ago. There is no doubt that that is the experience with tuberculosis. Many cases are discovered earlier now than 25 or 30 years ago, and it is easier to deal with tuberculosis on that account. I think the same may apply to cancer, although I cannot say I have seen any great evidence of it. In these various schemes of mass radiology, etc., that are coming along we may attack cancer as well as tuberculosis as time goes on.

As we improve the public health and eliminate the mortality from infectious diseases, and so forth, people must die from something and we may have more deaths from cancer as time goes on than at the moment. If we eliminate cancer, then, I suppose——

Mr. Dillon

They will have to be shot.

Dr. Ryan

We will see about that later on. Some Deputy spoke—was it Deputy Cogan—of the nutritional survey and protested against any idea of experimenting on human beings with regard to diet. We are not. Deputy Byrne asked about this matter too. We are taking representative samples —people living, as Deputy Byrne said, in a place like Seán McDermott Street and people living in better circumstances—and inquiring into the exact diet they have at the moment and what it is costing them. That is followed up by medical examination of these people to see how they stand under that particular diet. That is the nutritional survey that is going on at the moment. We are getting a great deal of material, but it has not been analysed yet to see what deduction is to be drawn from the present dietary and what modifications can be suggested.

I was asked about Galway Hospital, the regional and county hospital, the hospital at Ballinasloe and many more hospitals if they could be provided in other parts of the county. I will admit that there has been a long delay about the regional hospital in Galway. I only came across this a few weeks ago in my research into this new Department and I am inclined to spend another few weeks in investigating it. Times have changed in this and in everything else, and I am not sure at all that the regional hospital plan for Galway to replace the county hospital would be at all big enough. It may be better to plan on a different scale or to go ahead and build it and leave the county hospital there, as it might be needed as well. We need a few weeks more to look into it, and what we do there will rule what is to be done in Ballinasloe or elsewhere.

From what Deputy Flanagan said, one would think we were all slave workers—that the dispensary men, the nurses, the wardsmaids and the attendants were all slaves. He said we should feed them, clothe them and house them properly. It is the easiest thing in the world to say that. The medical men have got an increase recently and the organisation for the dispensary doctors accepted it; the nurses working under local authorities have got a big increase and the nurses' organisation has accepted it; but Deputy Flanagan thinks they should not, and says it was not nearly good enough. There is no use in Deputy Flanagan or anyone else being positive about tuberculosis being due to malnutrition or low nutrition. If that were a fact, there should be very much more tuberculosis in other countries than there is here. There is a variety of causes, as in the case of other diseases. Probably, as suggested by Deputy Killilea, going to a dance hall and dancing all night, then going out into the cold air and going home and then working all day, has been the cause in a number of cases. However, as medical men will tell you, if it was as easy as some Deputies suggest to name the cause without there being any doubt about it, the task of the doctors would be very much easier. You can never get such a simple cause of any disease and all sorts of things come into it.

Mr. Dillon

If you eliminate malnutrition, you would knock down a lot of tuberculosis.

Dr. Ryan

Quite possibly. I agree with the Deputy on that, but that alone will not eliminate it. I have known of cases of tuberculosis in very wealthy families.

Mr. Killilea

A lot is due to the dance hall.

Mr. Dillon

We can be too healthy and we could get so healthy that we would all be living in an incubator. If I could not dance a step occasionally, I would sooner be dead.

Dr. Ryan

Deputy Flanagan is under the impression that fevers and diphtheria are increasing in incidence. That is not true at all. There is a very big decline in the incidence of all fevers, as I mentioned in my opening statement last night. Things got worse from the beginning of the war up to 1942 or 1943, but since that there has been an improvement all round and that improvement is being maintained, not only in regard to the incidence of infectious diseases, including diphtheria, but also in a number of other diseases.

Mr. Dillon

Except in the case of infantile paralysis, which appears to be on the increase.

Dr. Ryan

Infantile paralysis varies very much. We have had a few bad years and then it disappeared and we had none. It flares up and then disappears. With the small incidence of disease we have, it would be hard to draw any sort of graph and make a deduction.

Amongst the hospitals mentioned was the one at Birr. The existing hospital there has been improved and a new hospital might be built sometime, but I am afraid we could not justify putting it high on the priority list. On the other hand, the hospital mentioned by the County Louth Deputies, that is, for Dundalk, was mentioned by me in the opening statement, when I said it was very high on the list and one of the first that would be tackled. In regard to the Cottage Hospital at Drogheda, I discussed that matter with Deputy Walsh and pointed out some of the difficulties about it, but I am sure we will get over them in time.

Mr. McCarthy

I would like to ask the Minister whether, before the dispensary clinics are improved or extra depôts established, there is any definite idea of revising the extent of the dispensary areas, as many of them are unwieldy and inconvenient for patients; or whether it would be a function of the local authority to make suggestions to Ministers where there is a prevalence of these unwieldy dispensary areas.

Dr. Ryan

There is a public health survey going on for some time, as well as one on nutrition, though not by the same people. I do not want the two to be confused. It will be necessary to revise some of the dispensary boundaries, and we will not have any dispensary built until that is decided.

Mr. Dillon

The Minister dealt with the Department's intentions in regard to county homes. I wonder if he will keep an open mind on that matter and visit at his convenience some of the rural county homes. I went into a Roscommon county home to see Charley Dwane—may the Lord have mercy on him—about three months ago and I was appalled at the realisation of what I myself was living beside without worrying about it.

An Ceann Comhairle

Would the Deputy please put his question?

Mr. Dillon

Will the Minister reconsider his decision to take people out in categories and open his mind to the proposal that the first duty is to build buildings which will enable us to pull down the workhouses, as in this day and age it is shocking that we should be content to let the old people die in such places?

Dr. Ryan

I can assure the Deputy I have a very open mind on that, but if the Deputy were in my place, he would have to consider whether we should not first build sanatoria and hospitals to save lives. As I said before, if any county authority puts up a good proposal for a good house or building, which would give them more congenial surroundings, we will go into it.

Mr. Cosgrave

Would the Minister look into the matter I raised about the manual staff, such as porters and attendants, in Cork Street?

Dr. Ryan

As far as I can find out, there is no change whatever in the situation. This misunderstanding may have arisen because one person was not sanctioned recently, but I am told he would not have been sanctioned either by the old board.

Mr. Cosgrave

I understood a circular was sent round informing the staffs that they might no longer regard themselves as entitled to superannuation.

Dr. Ryan

I cannot trace that circular in my Department.

Motion to refer back, by leave, withdrawn.

Vote put and agreed to.