Very good, Sir. This Estimate provides, I take it, for the payment of £2,150 to the present Minister. I suggest that I am entitled to say that I am not prepared on this Estimate to pay the Minister £2,150 for going around the country trying to give political injections to the shattered remnants of Clann na Poblachta. If the Minister is sincere in his efforts to get the co-operation of the local authorities and to get the people interested in health matters, I would suggest that he should discuss these matters with them and confine his attention to these matters. They are much more interested in discussing the urgent matters of health that the Minister proposes to deal with than they are in listening to the Minister discussing the age of Deputy de Valera.
At all events, I believe the Minister was sincere when he set out on this tuberculosis campaign and my only regret is that on this Estimate he has his wings clipped financially. He certainly did set out like the youth who bore the banner with a strange device —"Excelsior"—but evidently the Minister for Finance has substituted economy for "Excelsior." We find the Minister in the position that he is not getting sufficient money to fight the health fight, and, consequently, will not be able to carry out what he felt it would be necessary to do, or to make the provisions he felt it would be necessary to make to meet the scourge of tuberculosis and the other evils that the Minister proposes to deal with.
In connection with tuberculosis, I see the Estimate provides for the expenditure over a period of 15 years of £3,800,000, roughly £250,000 per annum. If the Minister confines himself to that, and if the problem of tuberculosis is as grave and as urgent as the Minister says it is, and as the country feels it is, I am afraid it will be a great number of years before the Minister will be able to provide the accommodation that he requires and will not be able to make the strides that he thought he should make and that the country feels he should make.
In the administration of the various schemes initiated by the Minister's predecessor, there is a certain amount of cutting down through red tape. For instance, in connection with the scheme under which country people were entitled to a grant of £150 where some member of the family was suffering from tuberculosis in order to build an additional room, in practice the people find it virtually impossible to avail of the grant because so many obstacles are put in the way and the various medical men—I presume as a result of departmental direction—more or less insist on a number of members in the family being in a very advanced state of the disease before they can get the grant. People are held up. I have also been informed that a grant under this particular scheme was refused simply because the member of the family affected was resident in a sanatorium and the other members of the family were free from the disease. One would imagine that this scheme was intended to provide for that very position and that when the individual who was affected by tuberculosis got sufficiently well to return home, he would have a separate room in which he could be isolated, thus diminishing the danger to the other members of the family.
If that is the position, I would ask the Minister to direct local authorities who are administering the scheme to cut out the red tape and not to curtail the grants but, on the contrary, to encourage every family possible to avail of the grant so that they would have an isolation ward, as it were, in their own homes and thereby decrease the danger to the other members of the family.
As a layman, I do not know how far climate or altitude affects the treatment of tuberculosis. But I know that there are people outside this House and some members of the medical profession who maintain that the most effective treatment for tuberculosis is to send suffers to a high altitude and a dry climate. If that is so, instead of pouring millions into the tuberculosis drive as we propose to do here, it would be better if the Minister considered building a national sanatorium in some place like Switzerland or Western America and have suitable patients for treatment sent to those centres. It may be that climate has very little to do with it. It may be that altitude has not a great deal to do with it, but it is true that tremendous success has been achieved in Western America and Switzerland, particularly in Western America.
I also feel that in connection with the treatment of tuberculosis in this country the surgical side is greatly neglected. As far as I have been able to gather from inquiries I have made, we are a very long distance behind America in this matter. I understand that there are numbers of patients who could be dealt with on the surgical side and that nothing is being done for them. Very few men in Ireland have specialised in that particular line and I would ask the Minister to get some of our doctors specially trained on the surgical side in the treatment of tuberculosis. If they get the results we are led to believe they get in places like Glockner Hospital in Colorado and the Mayo Clinic in Western America, it would be worth while, as it seems that great strides have been made there by surgical operation. I would ask the Minister to look into this and not to let finance determine it, if it is necessary to have some of our surgeons trained to specialise in this particular sphere and pay them special salaries in order to induce them, when they get these qualifications, to stay here and work for our own people.
I fear it will be a long time before it will be possible to achieve mass radiology. The Minister should insist immediately, however, on the other members of a family being subjected to radiography when there is one patient affected in the house. At present, when tuberculosis is diagnosed in one member, the others are left as they are. The Minister is well aware that there is grave danger in that. There should be some way whereby the other members of the family would be checked every six months for about 18 months, to ensure that they have not contracted the disease. It would be practicable to do that, as it would have to be done only in cases where one person was affected.
It is true that most of the sanatoria are simply isolation wards, particularly in the country. The conditions in some of them are not all that we would desire. I could refer specifically to an institution in my own county. Some of these places were unsuitable for sanatoria—the sites were unsuitable and the buildings were unsuitable. It may take some time to replace them and, seeing the amount of money provided, I fear it will take a long time. Such as they are, we must make the best use we can of them. Where there is a long waiting list, such as we have in my country, if we cannot otherwise provide for them, I would ask the Minister to keep open the offer of his predecessor, that in the new addition to Peamount a number of beds would be earmarked for County Mayo. The Minister may be able to provide for our surplus patients in Castlerea, but if he cannot I would ask that the beds earmarked for Mayo in Peamount should be kept available. Peamount has been very popular with patients from the West of Ireland and very good results have been achieved there. When people are going to an institution a lot depends on the confidence they have in it. Some institutions got a bad name, due to the fact that many of the patients who went there were, unfortunately, too far advanced and a large number of them were dying; and some of these sanatoria got the reputation that people died immediately they went into them. Consequently, many patients do not want to avail of the treatment in these country sanatoria.
I hope that that position will change. It is a question of having the disease diagnosed at an early stage. The great tragedy is that, until recent times, people were not prepared to admit that they were suffering from it. I think that phase has passed and that they are now to a large degree tuberculosis conscious and prepared, instead of hiding the disease, to come out and fight it and take the necessary precautions when one member of the family has the misfortune to be stricken by it.
Bovine tuberculosis is something about which the Minister will have to take action, if he expects to achieve any success. The present scheme for the destruction of tubercular cattle is completely inadequate. Even though a farmer notifies the local authority or the Gardaí that he has an animal suffering from tuberculosis, when a veterinary surgeon examines that animal and finds it is so suffering, the farmer is entitled only to 75 per cent. of the cost of the animal. That is no inducement to the farmer to make a report. On the contrary, it means that the agricultural community when they find such animals will cloak the disease and get shut of them. What should be done is to make the position profitable for them, to appeal to the farmer's money sense, and instead of paying a reduced value for animals so diagnosed, they should be paid, if possible, an enhanced value, so as to encourage them to report any suspected animal immediately.
In the same way, to get dairy farmers to supply pasteurised milk or have their herds tested for tuberculin-free herds, some improvement must be made. The cost at present is prohibitive. A veterinary surgeon will charge from three to five guineas to carry out the test per animal. That is beyond the means of a small farmer, a general man supplying milk to a country town, who keeps ten or 12 cattle; and he is not going to pay a veterinary surgeon £50 or £60 for the sake of certifying his herd free from tuberculosis. If the Minister himself cannot provide free testing for dairy farmers, then I think he should get some of his colleagues, possibly the Minister for Agriculture, to do it. Unless he does that, he will not get the farmers who are supplying milk to the public to have their herds tuberculin tested because, as I say, the cost is prohibitive. If we are serious about this question from a health point of view, we should see that a free tuberculin service is provided by the State. Possibly, the Minister might suggest that where there are young families the milk supplied to them should be boiled. I do not know how far that would be effective as a preventive measure. In my opinion, until a free tuberculin service is provided by the State, the Minister will not make any great strides towards getting the kind of tuberculin-free milk that he desires.
In connection with bovine tuberculosis, there is also the question of meat. The testing of meat is all right in places where you have a public abattoir, but in most country towns the butchers kill their beef and mutton in a backyard. Even in some places where they could get the animals killed under departmental inspection, they refuse to have that done for the reason that they know they are going to be at a loss if an animal is condemned. In the case of bacon factories, there is an insurance scheme. The factories pay so much into a pool, and in that way their losses are covered if pigs are condemned. In my county, apart from pigs killed in the factories meat is not subject to inspection at the time of killing, and there is nothing to prevent a butcher from selling meat that may be affected. It is true that the meat is supposed to be inspected, but there is no inspection when the animals are being killed. I do not know what the Minister can do about that, but I think something should be done. There should be some system of testing at the time the animals are being killed, in the same way that the Department of Agriculture insists on inspection when pigs are being killed.
Samples of milk are taken at various times by the food and drugs inspectors throughout the country. The queer thing about it is that the samples are analysed by different analysts in the different counties. We had an extraordinary position recently in my county when it was discovered that in the case of some samples that were taken and sent away for analysis it was found the analysis was wrong. I suggest to the Minister that all food samples should be analysed in the State laboratory or possibly by the Dublin City analyst. Recently a sample was sent to the public analyst for the County Mayo. The analyst certified that it was badly infected with accri. Another sample, taken out of the same packet, was certified by the Dublin City analyst and by a second analyst as being perfectly free from accri. They certified that the sample was never so infected. One must feel that a number of people in the country have been convicted in the wrong on these certificates, particularly farmers from whom samples of milk are taken. For economic reasons they do not have the tests carried further. In many cases they find it is too late to do so. The certificate comes along, and because the sample they retain has deteriorated it is not possible for them to get a second opinion. Evidently what happens in the offices of some of these analysts is that some minor assistant fills up the necessary certificate, and that certificate is evidence against a defendant until the contrary is proved in court. I think this system is much too loose, and that some responsible department, some State Department or the department of the Dublin City analyst, should supervise these matters. I do not think we should have different analysts dealing with different countries, acting, evidently, not with a great sense of responsibility or a big amount of efficiency.
With regard to the new school inspection system, I am of opinion that it is very inadequate. I am sure the Minister will appreciate that very competent medical officers of health have merely become collectors of statistics. The county medical officer of health in any county visits a school and examines the children. It may be five or six years before he can return to that school again to see the results of his first inspection, but by that time most of those children will have left school. Therefore, I suggest that his work cannot be effective. He can only achieve very limited results. I do not know whether the Minister would consider having additional county medical officers of health, but, in my opinion, the present system is a sheer waste of time. It will not become more efficient, I think, until we provide additional officers. If a job like this is only half done, it might be just as well to leave it completely undone.
I was rather surprised to find that the Minister was completely silent on the question of rheumatism. I think the statistics show that rheumatism in this country, considered as a national disease, is 50 times worse than tuberculosis. There are far more man hours lost and more people incapacitated through this disease than there are among those afflicted with tuberculosis. The fact that people live quite a long time with rheumatism and that it is not immediately fatal may be the cause of this attitude of public complacency. In view of the serious figures given by the National Health Insurance Society and the fact that a very large section of our people are incapacitated through rheumatism, I think that some drive should be made in connection with that disease and that it should be classed as being of equal importance with, if not of more importance than, the tuberculosis problem. I hope the Minister will endeavour to tackle this problem, too, and try to get us as advanced on this line here as they are in other countries.
One matter which I would like to mention to the Minister before I finish is that many of the Minister's staffs in sanatoria throughout the country are working in conditions in which they are continually in contact with tubercular patients. The position arising from that is that in some institutions nurses and maids have developed tuberculosis as a result of serving in these institutions, and, strange as it may seem, they are not entitled to take advantage of the Workmen's Compensation Acts, as tuberculosis is not classed as an industrial disease. There is a far greater case for classing tuberculosis as an industrial disease for people who work in these institutions than there is for people who develop silicosis from working in mines. There is no doubt that maids and nurses who are continually serving patients in sanatoria are much more likely to get tuberculosis than anybody working in any other kind of hospital. We had a few sad cases in County Mayo where maids belonging to poor families, and some nurses, developed tuberculosis while working in the sanatorium. When in one case there was an endeavour to recover under the Workmen's Compensation Act, it was found that the patient was not entitled to recover anything. This is a matter to which the Minister should devote some attention because the Minister is by now, I am sure, aware that one of the big problems in these institutions is to get staff to stay. Some of these institutions are out in the country away from towns and the usual facilities for entertainment and amusement are not there. For that reason we have great difficulty in getting the staffs to stay and they are continually leaving these institutions, in the West, at all events. It will not help matters if they also consider that if they have the misfortune to contract tuberculosis in the course of their duties there is no provision for them, so I would suggest that the Minister might consider that in the very near future.
With regard to hospitals, I see that the Minister proposes to expend approximately £5,000,000 over a period of 15 years. I suggest to the Minister that that is inadequate and the Minister will find that it is more inadequate as time goes on. Although new hospitals may be built throughout the country the Minister will find that there is not enough accommodation in those hospitals as people will take advantage of the extra facilities provided. If an old hospital had 60 beds and a new hospitals is built to cater for 120 patients it will still be found throughout the various counties that there is not sufficient room. In the county hospital in Mayo patients have to be put on the floor and have to be put out of the hospital into the county home in order to make beds available for other patients who are more serious cases and have more urgent need of them. There is an urgent necessity to provide a new wing in the near future and I am quite sure that the same position will arise in other counties throughout the country. People are getting more hospital conscious and more inclined to avail of the treatment which is now made available to them. I am afraid that the provision for hospitalisation that the Minister has in this Estimate and what he proposes to do over a number of years in connection with this matter will not meet the public demand as far as additional accommodation is concerned.
The question of the staff of hospitals has been dealt with, and I do not want to refer to it except to say that I am sure that the Minister is aware that ordinary nurses in this country can go across to London and get £6 10s. a week as private nurses, and that it is too much to except that they will remain in our hospitals here at the present rate they are getting. It is no use to talk about nursing being a vocation. They are going every day because of the amount of money they can earn on the other side, and unless the Minister does something for them, and does it in a hurry, I am afraid that he will have difficulty in keeping a nursing staff in the different hospitals. They are experiencing that difficulty already and the longer the position is allowed to drift the more people will be attracted by the high rates which are being paid on the other side at the moment.
I am glad to see that in connection with the blood transfusion service the Minister proposes to have a central storing station. This matter has been left in rather a haphazard position for quite some time. The position which we find throughout the country is that the small number of blood donors on the panel are simply being chased day after day when the hospitals find that they want a donation urgently. I am afraid that this matter, too, is a question of money. In the case of private patients I understand that the sum of two guineas is paid for a transfusion. In the case of the ordinary patient in a hospital—which, I might say, represents 95 per cent. of the cases—nothing is paid to the blood donors except the honour and glory of giving their blood to help those people. I suggest to the Minister that there should be some fixed sum payable throughout the country to any of these people who want the money. Quite a number of people in the country have been giving their blood voluntarily, and I am sure that quite a number of people will continue to do so. Unfortunately, however, the number who are prepared to give their blood voluntarily are very much in the minority. In some cases, where blood has been taken, the particular doctor who does the job is not very successful or causes a certain amount of pain. Then the donor spreads the news among his pals and frightens away other donors who would normally be prepared to come in.
