I do not aspire to persuade the House, now that this thing has gone so far, to object to an extension of the sweepstake funds to country hospitals. I do not suppose there are many Senators who would agree with me were I to endeavour to persuade them to do so. I will take this opportunity of giving a sort of survey of the relations between the easy money to which Senator Vincent has referred and the hospitals. We have in a small country, with a population that hardly compares with the population of the City of Vienna, a capital city with nineteen hospitals, nineteen laundries, nineteen x-ray rooms, nineteen staffs, with patients to stretch over them all. It would really seem as if disease in this country is a good business. One thing that has been omitted in the case of the hospitals that are benefiting through the sweepstakes is the number of people who form staffs and who are directly deriving a livelihood through the hospitals. There are many hospitals that one could describe as more or less racketeering disease, to use an American expression. All that may seem strange coming from me, but these are really the facts. In other words, there are no voluntary hospitals in the country at all. The industry of disease supports people who are not diseased. There are certain ineradicable circumstances, and perhaps it is not desirable that they should be eradicated, which prevent a merging in this city of its nineteen hospitals, nineteen laundries and nineteen x-ray rooms.
The reason I object to an extension of this fund to almost one hundred hospitals is that it would not be good in the long run for the patients, because they would not have the advantage of a centralised system. This country is really a small country, and an accident could not occur anywhere outside a run of five hours to the city; in other words, the victim of any accident could easily be taken to Dublin within five hours. Unless you centralise medical services you will never have efficiency such as is at the moment desirable. It is a question whether you can have very competent service in the case of a surgeon who has not about one hundred beds. It is considered that Belfast will overtake Dublin, because in Belfast they have more beds and, consequently, they are likely to be more experienced and more competent. They are more centralised in Belfast, whereas in Dublin we are divided up. If you neglect to centralise the hospitals you will merely be putting the doctor in control of a local hospital in a very anomalous position. He will have to know all about eyes, ears, midwifery and kidneys. Of course, he could not be expected to be a specialist in all these matters. The great advances made in medical and surgical spheres tend naturally towards what is called specialisation. To become a specialist in any one matter affecting the human body entails many years of study and experiment.
The spending of this fund which has been accumulated through sweepstakes will, in my opinion, tend to increase the maintenance of hospitals. Every hospital which has benefited through the sweepstakes has either built additions or planned to extend buildings. Looking back over a period of twenty-five years, I do not think that there has been a single life lost in this city on account of inadequate hospital accommodation. In no instance has the roof leaked, and nobody has lost his life on account of inadequate architectural construction. I think it is madness to extend the maintenance charges. If that practice is allowed to go on, in a few years there will be bigger hospital buildings with higher maintenance charges, and in that connection there is no provision envisaged. When we are dealing with this sweepstakes fund we should bear in mind what happened in the case of the Road Fund. It might not be wise in the case of the hospitals to set aside a sum of one million pounds for the future. I strongly urge upon the Committee not to allow the money to be run into architecture. The other day a sum of £700,000 was set aside for cancer research. That will probably result in a skyscraper, reaching to something like one thousand feet, and the human element will scarcely be considered at all.
I am strongly of opinion that the revival of certain country hospitals should not take place. Certain country hospitals have been merged into county infirmaries, and workhouse hospitals have been similarly merged. I would like some assurance that we will not have more than one hundred hospitals when all the awards have been made. It is evident that the sweepstakes cannot go on for ever. There are certain things that may be called national sweepstakes. In Spain and France they had a system of lotteries, and after a short time people became apathetic about them. The sweepstakes that have been organised in this country have been the means of accumulating large funds, which will be divided amongst the various hospitals. If that sort of thing continues, we may easily have more hospitals than we can ever hope to have patients to fill.
There is not so much extraordinary illness in Ireland. If a man breaks his leg in the country, it is quite easy to get a local person to diagnose what has happened, without having any x-ray treatment at all. Thirty years ago one was supposed to diagnose cases of fracture without the assistance of all the equipment we have in modern times. I cannot see the necessity for an extension of this money through the country. What should be done in the interests of the public is to centralise all the hospitals. In this small island there is no need for so many different buildings, and there should be a general merging. We will at least have it on record that somebody saw the farce of having twenty hospitals in a city with about 400,000 of a population. A large city like Vienna, with two million people, has only one hospital. People come from the very ends of the earth to get surgically treated there. Many of the outstanding discoveries which have lessened the burden of human misery have come from places where disease was concentrated. It is at a place like that, where disease is concentrated, that alleviation will be found.
We are merely dissipating our energy by throwing money into every village in the country. If a man is seriously injured in the country, he can be taken by bus to Dublin within a few hours. If a country doctor declares that he is not an eye specialist, he will lose prestige for having some hole in his armour. In Dublin, a specialist can say: "I know nothing about the eye; you will get better treatment in the next wing." You are merely putting a doctor in an anomalous position if you set him up as specialist in a country village. Many unfortunate cases have failed to get relief for the simple reason that the diagnosis was not arrived at in time. Human nature will scarcely prompt a doctor in the country to say "I do not know what is wrong with you, but I may be able to tell you in about six months." There have been instances where relief has been too late just because the diagnosis was not arrived at in time.
There are many places in the country where the unfortunate local doctor is expected to know more than all the medical men in the City of Dublin. That condition of things will be accentuated if you start to endow the county infirmaries. It was stated here that money has to be spread over nineteen hospitals in Dublin. Years ago a sum of two million pounds had to be refused simply on account of the conditions under which the hospitals were originally founded, conditions which made religious considerations paramount. That was a really lamentable condition of things. I am satisfied that people realise now that it is high time there was a merging of the Dublin hospitals, as far as it is possible to bring that about.
I will go back now to staff conditions. Suppose we had the nineteen Dublin hospitals merged to-morrow, we would have nineteen leading physicians and surgeons all over the place, becoming senile. The whole question of medicine will have to be considered. It might easily get to be considered here if it were mixed up with economics. The question might arise: What are you to do with the doddering doctor? I must be the lonely voice in this matter. It is not that I wish to deprive anybody in the country of assistance. The fact is that there are too many hospitals in this small country. By endowing district hospitals you are putting further away the day when centralisation will be facilitated. The advantage of centralisation will be denied the men who are practising in this country. It is a very serious thing. Belfast is getting ahead of us, because in certain hospitals there they have more beds. We have more buildings, but not more beds.
I am speaking on this matter without any ill-feeling. I have no axe to grind. I was very nearly presiding over the distribution of £100,000 yesterday. A certain hospital got a large grant from the Government, and it proposes to spend £100,000. Sweden has the latest hospital. In Sweden there are no more than four people in a ward, and, therefore, it is a much later hospital than the one which has eight people in a ward. The whole thing is perfect nonsense. There is not a single hospital in Dublin that is not water-tight and clean enough. Of course we may have local philanthropists interested in running up a shack. If a wealthy man is ill he goes to a private home; but that is really only a lodging-house with a good deal of plumbing at the back. It was never built as a hospital, and one of the effects of these private homes is to lower the rateable value of Merrion Square, Fitzwilliam Street and around that area. The man who has a good deal of consideration for the value of his life goes there. Where the geraniums used to be there are now buckets and pipes and tin tables. The sooner we get rid of the nonsensical mixture of charity and pathos, with a foolish administration of cash, the better.
There is no need for any new building in this city. There is really great need for the nineteen existing hospitals to be merged into one big central hospital. Another thing to which I would like to draw attention is that the hospital are erected in the most insanitary parts of the city. That is the extraordinary thing about it, that notwithstanding the great advance in medical knowledge our hospitals are still situated in the slums. The slums are round the hospitals because no one wants to live near the hospitals, and the fact that the hospitals are there is one reason why the slums exist around them. Suppose the nineteen sites were sold and a central hospital were established, the position would be ever so much better. In my opinion, however, the sites should not be sold; they should be turned into playgrounds. One big central hospital should be built near the mountains, up at Kilbride, say. That is only a matter of eight or ten minutes in a modern bus. Of course, that will never be done. They will prefer to go on enlarging the hospitals.
Let us even take Dublin City. It was never built by sanitary engineers. Those who built the city built it round a large sewer which is punctually emptied by the tide. It is about the most punctual service that we have in the City. The City of Dublin was never built by people who had any idea of health. If ever there is a big central hospital built the question of the site ought to weigh very considerably with those in authority. It is monstrous to have this city splattered all over with lazar houses. It must be a strange thing to come to a city where you see nothing but saints and doctors and cinemas. If the Corporation are not checked we will soon have a cement lid in the middle of the River Liffey for the accommodation of transport. The suggestion has been put forward that they should build a big bus garage over the Liffey. I hope the citizens of Dublin will take serious consideration of this proposal. The only ventilator we have is the Liffey; brings the land and sea breezes up every day. Some provision ought to be made to prevent any attempt to make the city more unsightly and unhealthy by extending the existing hospitals in places where a hospital should never have been erected.