I would like to make an appeal to the Minister to extend the school medical services as much as possible and as soon as possible. I ask this because I am aware of the splendid results which have already accrued from the totally inadequate medical services we have now got in the schools. As it operates at the moment examinations are carried out within the first or second year of a child's entry into school and then there is usually only one other examination which occurs approaching the time when the child is about to leave school. That is a very great advance of course on the position operating 15 years ago when we were working in the schools without any kind of medical services whatever. But in the light of the good results that are now being achieved through these medical services I urge on the Minister to expand these services as soon as possible. The ideal thing would be to have a complete examination of every child in every school once a year. That may be too much to expect, but there should be a pretty complete examination of every child once in two years, which would mean that a child would be fairly thoroughly examined at least four times during his school life. I have seen a medical officer discover defects of vision, even defects of hearing, and chest and other defects in children which were quite unsuspected by parents, teachers or anyone else until the examination was made in the school, and I have seen children having their eyes attended to and other things done for them which would not have been done if this service were not in operation.
Another suggestion I would make is that, when the medical officer carries out his examination and inspection, a report should be furnished to the manager of the school as well as to the local authority, and it would be a good thing if these reports were retained in the school amongst the permanent records, so that, when the ordinary inspector comes in, he can query if the points referred to by the medical officer have been attended to, and, if they have not, will have an opportunity to consult the manager and ask him to have the points attended to. I am afraid that very often the first thing the manager knows about the opinion of the medical officer is when he sees some scare report in the public Press. That is the least helpful way of dealing with the matter. A report might be furnished to the manager of every school immediately after the medical examination has been carried out, and, in saying that, I have particularly in mind the condition of the lavatories and of the school yard and of the other matters which impinge so much on the health of the children. Another service which I think is completely inadequate is the dental service for school children. A great part of what is done is merely extraction of teeth and I do not think that that is enough. The service should be such that remedial measures, short of extraction, could be carried out, and that cannot be done without a very great extension of the existing facilities.
The matter of food in hospitals and institutions came up for discussion today. I have fairly considerable experience in this matter and I am satisfied that, in nearly all cases, the quality and quantity of food are quite good, but I am not at all satisfied that the preparation and presentation of the food are all that might be desired, or that it is always suited to the patients in these public institutions. A dietician should be appointed to every hospital of any size. We have here in Dublin an institution in Cathal Brugha Street where a very excellent course in dietetics is given. Students qualify in that subject and most of those who qualify have to leave the country and find employment in Britain or elsewhere, and it looked as if that very excellent course would have to be discontinued. It would give a great fillip to this training and great encouragement to that institution if those who qualified in dietetics there could obtain employment in our hospitals and public institutions and I should like the Minister to encourage in every possible way the appointment of a qualified dietician in our institutions.
It is not at all an easy matter for hospitals, sanatoria and institutions of that sort to keep an adequate domestic staff and this, too, has a good deal to do with food not being cooked and presented in the way it should be. It is extremely hard to keep the domestic staff in these institutions and very hard indeed to keep the nursing staff, because conditions are not good or tempting enough to hold them in the steady employment of these institutions. This applies particularly to the domestic staff. In one or two hospitals with which I am connected, we find it very difficult to retain our staff and we have constantly to chop and change. Although we do everything in our power to make the conditions as satisfactory as possible for these people, we cannot compete with conditions over in Britain.
Deputy Ryan urged the Minister to proceed with the implementation of the mother and child service provided for in the 1947 Act and he described it as the kernel of that Act. I quite agree with that. The mother and child service is, or should be, the foundation of any public health effort made in this or in any other country. The 1947 Act was a very admirable over-all plan for the betterment of health in this country and, whether we liked the Minister who put forward that plan or not, we must all admit that it was a very detailed and very excellent plan in almost every respect. It made the mother and child service the real foundation and I, too, urge the Minister to attack the whole problem of public health from that angle. To take full advantage of the legislation we have, it is possible to proceed in several ways, and I think the most logical thing to do would be to ensure that the mother and child service would be made as perfect as possible and then to take particular care of the health of our children in our schools, and especially in our primary schools. If we make sure of that foundation we can then go on to deal with all the other problems in their order of merit and of urgency.
There is no doubt but that very good progress is being made in the city of Dublin in the matter of the provision of beds for tuberculous patients. It is one of the things on which we can congratulate the Minister and the corporation authorities. It is now becoming possible to obtain equipment, so that we can get ahead very much more quickly than it was possible to do up to this year. I hope that progress will be continued until the terrible want that existed with regard to the hospitalisation of tubercular patients is fully met.
Another thing on which we have to congratulate ourselves is the virtual wiping out of diphtheria fatalities in the city of Dublin anyhow. The Dublin Fever Hospital Board Report for 1947, which is the latest one available, states that the fatality percentage for 1948 was nil. It might be said that one could not draw a legitimate general conclusion from the results for one year, but may I point out that there has been a steady decline from 1936 down to this year. That, I think, should be of great satisfaction to the members of this House. In 1936 the percentage was 12.5; in 1937, 9.1; 1938, 8.9; 1939, 7 per cent.; 1940, 5 per cent.; 1941, there was a rise to 8.9, but it fell again to 5.4 in 1942; in 1943 it was 5.1; 1944, 2.4; 1945, 2.4; 1946, 3 per cent.; 1947, 1.1, while in 1948, the year just concluded, the fatality was nil. Now that is a very wonderful result, and it really strengthens my plea that the mother and child services should now be attacked with at least as much energy and enthusiasm as have been devoted in the last year to the provision of beds for patients suffering from tuberculosis. Dr. Russell, who was the Chief Medical Officer for the city of Dublin, attacked this diphtheria problem with very great results. The children throughout the city have been immunised over the years that I have mentioned, and so Deputies can see the results of that care in a reduction of the fatality rate from 12.5 in 1936 to nil in 1948.
The Corporation of Dublin also launched a great attack on gastroenteritis with almost equally gratifying results. All that goes to show that if our various problems are attacked with resolution and determination, and particularly if we start with the mother and child, and in the primary schools, that most wonderful results are possible. I hope that, no matter what the financial stringency may be, the Minister for Health will insist that these services be extended and improved, and that when the various hospitals and institutions make little demands on his Department, that they will be met as generously as possible by the Department. I am sure, in so far as the Minister's own inclination goes, that that will be the case.
I might give another instance of the value of these services which, I know, cost a little money. I might mention the results of the use of streptomycin in cases of tubercular meningitis. Previously this disease was absolutely fatal, and there was no hope at all for the patient. It is still a bit early to draw a general, final conclusion as to what will eventuate from the continued use of streptomycin, but we have found that it prolongs life to a marvellous extent. So far, in the case of a disease that previously was absolutely fatal, since we introduced streptomycin we have found that we have been able to save from 30 to 50 per cent of the cases. Of course, that can only be done if we are prepared to undergo the expense, to provide the money and equipment necessary. I hope the Department will show itself to be sympathetic and helpful and, above all, that it will not hold up the local authorities unnecessarily when requests of one sort or another come up for consideration.
I have said that we found it difficult to keep the nursing staffs attached to our hospitals. That will remain the case until we give them as good treatment in our hospitals as they can get elsewhere. There, again, I know the Minister is in full sympathy, but I will urge him to do everything possible to make life as pleasant as possible for the nurses in our institutions.
