Motion made, and Question proposed,
That a sum, not exceeding £10,617,048, be granted to His Majesty, to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1927, for the Salaries and Expenses of the Ministry of Health; including Grants and other Expenses in connection with Housing, Grants to Local Authorities, etc., in connection with Public Health Services, Grants-in-Aid in respect of Benefits and Expenses of Administration under the National Health Insurance Acts, certain Expenses in Connection with the Widows', Orphans', and Old Age Contributory Pensions Act, 1925, and certain Special Services." — [Note: £7,500,000 has been voted on account.]
The net amount of the Estimates for the Ministry of Health which I am submitting this afternoon is £18,117,048, which shows an increase of £41,061 as compared with last year. That increase is really made up of the difference between certain larger increases and certain decreases. The larger increases are partly due to the normal increase of the grant for housing, partly to the increased expenditure in connection with the administration of the Pensions Act, and partly to a comparatively small increase in the amount allotted to other health services. On the other hand, we have to set against that the decreases due to the saving to the Exchequer effected by the Economy sill and a larger sum by way of appropriations-in-aid. The field covered by the Ministry of Health is so vast and the number of subjects is so extensive that I am not pre-posing to go into a great number of figures, but if there are any points on which further explanations are desired we shall be happy to give hon. Members any information they want in the course of the Debate. I propose to take the oppor tunity afforded this afternoon of reviewing, more or less generally, the various aspects of the work of my Department.
The activities of the Ministry of Health may perhaps be conveniently classified under four main headings. First of all, housing. Then comes insurance with which is now coupled the administration of the Contributory Pensions Act; then there is the very large subject of local government which includes Poor Law administration; and finally there is that section concerned with the Public Health Services. I would like to say something on each of those headings, and I will begin with housing. When I first became Minister of Health in 1923 the problem of housing was so acute and so pressing that it practically excluded the consideration of any other of the activities of the Department. That was an unnatural state of affairs, and I am very glad now to be able to report that things have very much improved, and if we have not yet found a solution of the housing problem we are well on the way to a solution, and the housing question so-called is now taking up something much more approaching its normal perspective in the affairs of the Department.
Many questions have been asked by hon. Members in connection with housing, and I have been able to give the House a number of figures in answer to those questions. I would like to mention a salient feature of the situation as I see it to-day. In the five years preceding the War the total average number of houses of all classes completed per year was 61,000. For the 12 months ended on the 31st of March last the corresponding figure was no less than 173,000, of which total about 153,700 may be taken as working-class houses. The rate of progress has by no means fallen off, but still continues to increase. As an illustration of that I may take the number of houses completed per month during the first five months of the present administration which was 6,900, whereas during the last five months the figures have increased to 9,900, and, during the last two months there have been completed over 21,000 houses. It will be seen, therefore, that we are still increasing the rates at which we are overtaking the arrears of housing and that the general rate of progress in regard to the building of new houses is eminently satisfactory.
I am including not only State-assisted houses but houses without any State assistance, and, out of a total of 173,000 about 153,700 may he taken as working-class houses. On page 17 of the Estimates, under Heading F. 1 there are given details of the housing grants and those amount altogether to £8,500,000. I would like to ask the attention of the Committee to the way in which that £8,500,000 is made up. It will he seen that £370.000 of it is due to grants which have been given for houses built under the Act of 1924; £750,000 is in connection with houses built under the Act of 1923; and no less than £7,320,000 under the Act of 1919. I think hon. Members must be rather struck with the relative proportions of those figures.
The Act of 1919 is limited in its operation and deals with a maximum of 176,000 houses, but the average cost of those houses was over £1,000 per house. If you consider what the annual cost of these various classes of houses is to the Exchequer, you will find that whereas the Exchequer liability in regard to houses under the 1923 Act is £6 a year for 20 years, under the 1924 Act it is £9 per house for 40 years,, exclusive of special arrangements for houses in agricultural parishes. Under the Addison Scheme the annual cost to the Exchequer is at the present time no less than £41 per house and the liability will not be extinguished until 60 years have expired. The £41 per house must not be taken as the actual cost to the Exchequer during that 60 years, because there will be reductions as the loans for roads and other loans for shorter terms are paid off. It certainly remains a fact that long after many of us are in our graves the Estimates for my Department will he burdened in respect of those 176,000 houses built under the Addison Scheme, and they will run up to as much as one-third of the whole of the expenditure of the Department. When you add to that the enormous burden and the rapidly increasing charges in respect of houses being built so fast to-day, we cannot help feeling that our liabilities in regard to houses are mounting up both as regards the liability of the Government and the local authorities at a very alarm- ing rate, and it is extremely necessary that we should see that we are getting full value for our money.
Under the Act of 1924 I have after the 1st of October next to take into account the circumstances attending this liability and to review the conditions of the amount of the subsidy. I say I am bound to do that under the Statute, but of course the fact that this review is looming on the horizon is bound to give rise to a good deal of uncertainty and anxiety both to the local authorities and to those who have to make the arrangements to keep up the continuity of the building programme. What we want to arrive at if we possibly can is some certainty as to what is to happen, not immediately after the 1st of October next, but possibly over an extended period after that, and the only way to do that is by conversations and discussions between myself and representatives of the local authorities, and those conversations are now taking place.
There are two other things that should like to say before leaving the question of housing. One is that, while the greater part of the houses to which I have alluded are built according to what one may call the old practice, or, at any rate the long-established practice of house building in this country, yet there has been a considerable development of new ideas and new methods, and there has been established, under the direction of the Committee of Scientific and Industrial Research, a department specially devoted to research into the problems of house building, materials, and questions of ventilation and heating. This department has been set up near Watford. I took the opportunity, not very long ago, of paying a visit to it, and was extremely interested to see the experiments which were there being carried on, Already some extremely valuable observations have been made. Hon. Members, who are aware of the condition of this present building in which we stand to-day, know how the stone has been affected by the atmosphere in a, way which was completely unknown to those who chose that particular material at the time when the building was set up. One of the investigations which are being carried on by this department is directed to trying to find out certain simple tests which can he applied to any kind of stone, or wood, or cement, or other material, by which some certainty can be obtained, before the material is used, as to how it will behave in any given circumstances. Although, of course, these investigations are by no means complete, and have been somewhat delayed by the removal of the department to its present new building, I have every hope that they will result ultimately in considerable saving, due to the use of properly suitable materials instead of materials which are afterwards found to he subject to decay.
The other point to which I wanted to draw attention was this: Hon. Members will recollect that, in the Act of 1923, there were certain special provisions for facilitating the purchase of houses by their occupiers. Those provisions have had a remarkable degree of success. Since the passing of the Act, leans amounting to no less than £29,000,000 have been sanctioned for advances of this kind, and I must say that no part of the working of the 1923 Act has given me more satisfaction than that Section, because it has, I think, served to create a new section of the population, who have found it in their power to became owners of their own houses—a thing which never before had been within the range of practicability for them—thus building up a class of people who have attained a new independence and a new idea of the responsibilities as well as of the privileges of citizenship. The second subject that I have mentioned is that of insurance.
I do not know about special attention. We are paying a great deal of attention to housing in mining districts, but it is difficult to generalise on the subject, because the conditions in one mining district are frequently entirely different from those in another. There are places, for instance, where new pits are being sunk, where new coalfields are being developed, and where housing is going on under conditions which I think one might describe as model with respect to housing. Again, there are other places where the houses are deplorable, but where, on the other hand, the pits are exhausted, and one of the most difficult problems I have before me is to know what to do in the case of a mining village where the population are hanging on to the old site on which they and their fathers before them have lived, but where there is no longer any employment for them, and where, as far as one can see, there is not likely to be any employment. That, as the hon. Member says, is a question to which the Royal Commission has directed attention, and, whenever the time comes when we have before us the consideration of what is to be the future of populations who are displaced by the closing of uneconomic pits, then will be the time when I shall have to give more special personal attention to that particular aspect of the problem.
During the discussions that we had some time ago upon the Economy Bill, there were frequent references to the very valuable and exhaustive Report of the Royal Commission on National Health Insurance, which sat under the chairmanship of Lord Lawrence of Kingsgate. That was the first complete review that had ever been made of the working of the National Health Insurance scheme, and it is very gratifying to find it recorded that, in the opinion of the Commission, that very bold and very novel experiment has stood the ordeal so well, and has, on the whole, justified the expectations that were formed of it. Anyone who reads the pages of the Report cannot but be convinced that, to the individual members of approved societies, the scheme has brought great and substantial benefits, by giving them free medical attendance and medicine, and by assisting them with cash benefits during the time when their income has diminished by reason of sickness. The Report of the Commission contains upwards of 120 recommendations and conclusions with a view to still further improvements in the scheme. Some of those would require legislation; others, again, could be effected by administration. This is not the time to talk about legislation, and all I would say about these matters is that what the Commission say is being sympathetically con- sidered by my Department, and that in due course their conclusions and representations will be discussed with those who are representing the approved societies.
I would venture in this connection to commend to the notice of hon. Members the very interesting philosophical reservation to the Majority Report by two members of the Commission. They point to certain possible consequences of our present system. If I might sum up the trend of what they say in a sentence, they emphasise the old maxim that prevention is better than cure. While I was reading what they were saying, I could not help reflecting to myself that, without in any way minimising the skill of our doctors or the value of the treatment which members of approved societies receive under the scheme, it is very possible that such measures as those for the purification of milk, or the abolition of preservatives in food, may rank, in their effect upon the maintenance and improvement of the health of the people, even with the tons of drugs and the oceans of medicine which are swallowed every year in this country.
If I may turn for a moment to the Pensions Act, I think the Committee will realise that the initiation of the working of this great new Measure has thrown a tremendous strain on the staff of my Department. Indeed, so great has been the strain, with the shortness of the time available and the number of claims continually coming in, that it has almost passed the physical endurance of the human frame, and I have more than once been seriously concerned for the health of those who were responsible for its administration. I cannot say too much for their devotion and intense application, which have resulted in the remarkably full and successful working of this Act. Under the widows' and orphans' Section 160,000 claims have already been received, and these claims are coming in at the rate of about 1,350 a week.
Yes. Of course, the number of persons concerned would be far greater than 160,000, which is the number of claims. At the beginning of this month, there came into operation the Section of the Act which enables old age pensions to be enjoyed free of the tests of means or residence or nationality; 78,000 claims have been received up to the present, and they are coming in at the rate of 2,000 per day, so that hon. Members will see that that too means a tremendous amount of extra work for the Department.
No; that number of claims have been received. I have not the figures of those admitted, but I should say they are considerably less than that, because, of course, investigations have to be made and titles have to be ascertained. It is worth while to call the attention of the Committee to the relief which the Act has afforded to the rates. From returns which have been given to me by boards of guardians, I find that already 78,500 persons who were in receipt of relief have ceased to require relief in consequence of the working of the Act; another 57,000 are now receiving a reduced amount of relief, and, altogether, those two alone—and that, of course, does not take into account the case of widows who have not applied for relief, but would have had to apply if it had not been for these pensions—mean a relief to the rates of over £1,750,000 a year. That will be still further added to when, in 1928, pensions begin at the age of 65.
The third heading which I took was that of local government and Poor Law administration. Last autumn, I made what I think is a new departure in the history of the Ministry of Health, and that is that I paid a number of personal visits to different local provincial centres, in order that I might see for myself what was being done there in local government, and that I might come into personal contact with the people responsible for its administration. I took with me on each occasion officers of my Department. In the South, I went to Bath and Bristol; I went to Cardiff, in Wales; and in the North I went to Liverpool, Dundee, Newcastle, Bradford and Halifax; and although these tours were not exactly restful, they certainly proved to be full of interest and, I think I may say, full of instruction too. I had the opportunity of inspecting a great variety of institutions. I looked at housing schemes, slums, voluntary hospitals, workhouses and infirmaries, blind institutions, town-planning schemes, and methods for the treatment of town refuse. Altogether, I was so satisfied with the advantages of these tours, not only from the point of view of the local authorities, who were glad to have the Minister come and see what they were doing, but also from the personal interest to myself in seeing how different problems were being worked out in different places, that I am proposing, if I possibly can, to repeat the experiment this year.
I think there is only one subject connected with local government, apart from the Poor Law, that I want to mention this afternoon, and that is town planning, a very important subject. On the whole, I think it is proceeding satisfactorily. To-day there are over 2,000,000 acres that are subject to town planning, and there is a comparatively recent development, to which I attach considerable importance, that of regional planning, which covers the area of more than one local authority. At the present time there are 36 of these regional schemes in operation, covering 550 authorities and comprising a population of 17,500,000, and when one realises that we are passing through a period in which very rapid development is going on, not only in house building but also in road building, I think it must be admitted that, unless we are going to keep some sort of control over this development, we are very likely to see some of the characteristics of our country, to which we attach great value, disappearing before our eyes. In particular, I am anxious not merely that we should preserve the amenities of our towns, but that we should also preserve those of the country, and I therefore, welcome very warmly these regional schemes, which cover very vast areas and which, whilst interfering very little with legitimate development, do control it in such a way that the country is not cut to pieces and that we still retain the special characteristics of our countryside.
One particular scheme which, perhaps, I may mention is that of Manchester and district, which covers an area of about 1,000 square miles, and not only have those responsible for the scheme prepared plans for regional roads and open spaces, not only have they determined generally the boundaries of residential and industrial districts, but they have recommended the formation of group committees, which should prepare localised plans covering the areas, perhaps, of one or two of the localities, in the hope that they may get some joint financial arrangements for carrying out the localised plans within the lines of the general scheme covering the larger area. That is a development which is exceedingly interesting and which may, I thing, perhaps, prove to be of considerable importance in the future. Another very interesting scheme is the one which has come under consideration in the East Kent coalfield. There the scheme provides for the development of shopping and residential areas away from the coal pits, but, nevertheless, at such a distance that they can readily be served, and in that way it is hoped to prevent the formation of pit villages and that sort of straggling development which has spoiled the development of coalfields in other districts. I am hoping before very long to pay a personal visit there myself, in order to see what is going on.
Now, a word or two about the Poor Law. The problems which face boards of guardians are always difficult and troublesome, but they have recently been very much aggravated by the existence of the stoppage in the coal industry and the consequent increase of unemployment in other industries which are dependent on coal. We know from past experience that stoppages in the coal industry are apt to last a very long time. We know too that this particular stoppage began under specially unfavourable circumstances, so far as boards of guardians are concerned, for, if I may make a comparison with the coal strike in 1921—[An HON. MEMBER: "Lockout!"]—we need not quarrel about words—that came with a population of 650,000 in receipt of relief; a population which was doubled before the stoppage came to an end. This time we began with 1,222,000 in receipt of relief, and on the latest date for which I have got figures, which was the 19th June, that had risen to no less than the absolutely unprecedented figure of 2,305,000 persons. Having that sort of consideration in my mind, and seeing the financial difficulties which were already besettng boards of guardians in many parts of the country, I thought, at the beginning of this stoppage, it was my duty to issue to boards of guardians some advice and some words of guidance. Accordingly, I prepared and issued to them that Circular which is now known as Circular 703. There were two main features of that Circular. In the first place, it pointed out what was the state of the law as settled by the Merthyr Tydvil decision, as affecting the giving of relief to persons who had withdrawn their labour, and, in the second place, it suggested to boards of guardians that it was necessary for them, in view of the possibly prolonged character of the stoppage, to conserve their resources as much as possible, and that they might find it convenient to set up some sort of scale beyond which their relief should not go.
I went further than that, and I suggested figures to them for their scales, but the figures which I suggested were based upon those which had been found sufficient in the stoppage of 1921, adjusted merely to take account of the reduced cost of living. I took care in the body of the Circular to point out to boards of guardians what was their statutory duty, namely, to relieve destitution, and, further, I specifically said to them that the scale was to be taken as a guide, but that any scale, whether adopted by themselves or suggested to them by anybody else, must always be subject to exception in cases where exceptional circumstances obtained. The Circular was in some cases criticised, on the ground that the figures it suggested were higher than the scales actually enforced in some places, but, on the whole, I think I may say, from the reports that I have received, that that Circular was welcomed by the guardians as giving them some guide as to the sort of action which they might properly take in a time of special and exceptional difficulty.
Now I come to the subject of public health. There are certain services that are subsidised by the State. There is maternity and child welfare work, there is venereal disease, and there is the treatment of tuberculosis. I think that all those services are progressing very satisfactorily, and that we may congratulate ourselves upon the results, as indicated by the continued decrease, not only in the general mortality rate, but also in the infant mortality rate. But I believe it would be perhaps of greater interest to the Committee if I were to say a few words to them about four specific complaints which rather bulk large in the public eye and as to which, perhaps, some alarm exists. First of all, I would like to take cancer. Cancer is particularly alarming, because of its rate of increase. Last year, for instance, the deaths from cancer in this country amounted to 1,336 per million. This is equivalent in our population to the deaths of 50,000 persons and it has been estimated that out of every seven persons who reach the age of 30 one will die of cancer. That is not a circumstance confined to this country. It is only an illustration of what is going on practically in every civilised country in the world. There is a great deal of research going on into the causes of cancer and possible methods of treatment.
I will try to have that information for the hon. Member before the Debate closes. He may take it they show a very rapid and alarming increase. There are two schools of thought about the causes of cancer. I speak with some diffidence on this subject as it is a technical matter and there are Members of the House who are much more qualified to dilate upon it than I am, but I think there have been two ideas as to the cause of cancer. One is that it is due to a sort of infection outside the body—something in the nature of what we ordinarily call a germ. The other is that it is not due to any outside source of infection but is caused by a chemical change in the cells of the body itself, and these two schools have each of them produced evidence in support of their theories. But quite recently there have been published some very remarkable investigations carried on in this country by two young men, Dr. Gye and Mr. Barnard. Dr. Gye is a, research medical man and Mr. Barnard a physicist of exceptional gifts, and combining their efforts, they have made certain discoveries which seem to indicate that possibly the real cause of cancer is a combination of the two causes. I had an opportunity not long ago of visiting the laboratory in which these investigations were carried on and of seeing actual photographs of the virus which has been discovered by Dr. Gye. I call it a virus because it is so small as to be of the order of size of a molecule and one could not say whether it is animal or vegetable. These photographs cannot be taken by ordinary light at all. They have to be taken by ultra violet rays in the dark, and that will give Members some idea of the delicacy and precision of the instruments which have been invented and constructed by Mr. Barnard.
If I may put shortly what I understand to be the significance of the discovery, it may be said to be this, that cancer is due to a virus which enters the body from outside but which does not produce cancer unless it is associated in the body with some other factor, the nature of which is not yet clearly ascertained. Thus cancer can be, according to this theory, communicated from one kind of animal to another only if in the victim there is already present a specific factor. That is the new theory. The observations have been tested and repeated by other observers in other countries. Generally I think they have been confirmed, and with these and other observations we are continually adding to our knowledge of the cause of the disease and the methods of its treatment. It is too soon yet to say that we have in sight any cure or any certain means of securing immunity from cancer but nothing is more certain, than that it is coming, and in the meantime the most important thing of all is to get early diagnosis, because if you can get diagnosis before the disease has become generalised it can be removed completely and life can be substantially prolonged. There are two things which are important to us to-day in connection with cancer. One is investigation and the other is the education of the public so that they may understand the necessity of consulting those who are skilled in the disease when the very first symptoms appear and when it is not too late to treat them.
The second disease I will mention is tuberculosis. Here I can give a much more hopeful account. When you consider that infection by tuberculosis is practically universal throughout the population but that most of us never know that we have suffered from the disease at all, when you consider that out of every 1,000 persons who undergo sanatorium treatment there are 800 still alive after 10 years, one may fairly say that tuberculosis ranks amongst the most curable diseases. But there is one problem connected with this treatment that gives very great concern. One finds so many cases of tuberculous persons who have been to a sanatorium and received treatment and benefited greatly from it, and left the sanatorium without any trace of the disease, but in. six or 12 months they have had to return. in such cases all the skill and the money that have been expended upon these unfortunate people have been thrown away. In connection with that I should like to mention the very successful experiment which has been carried out by a very remarkable Welshman, Dr. Varrier Jones. Papworth is a village near Cambridge which is inhabited entirely by tuberculous ex-service men and their families. Industries have been started in this village so that the men can work at them and earn their living, all the time under the constant care and advice of the medical superintendent. They are watched to see that they do not do themselves injury by working too long hours or at physically exhausting occupations. If they should have a check or set-back they can be taken into hospital until they are better. Perhaps the most remarkable thing is that in this village, where every householder is a tuberculous man, tuberculosis is absolutely unknown amongst the children. Here are these men, living almost a normal life instead of lying in a bed or walking about aimlessly, trying to adapt themselves to conditions which are really impossible for them to live in. They are working at interesting work, not too hard for them, to give them something else to think about than their complaint, which not only keeps their bodies fit but keeps their minds fresh and alert. They seem to lead a happy and almost normal existence. At present Papworth is almost unique. Recently a similar village, Preston Hall, has been put under the charge of Dr. Varrier Jones. I cannot help thinking it points the way to a mitigation of this problem connected with the sanatorium treatment of tuberculosis, and that there is a great opportunity here for one of our big progressive local authorities to repeat the experiment of starting a settlement of its own on Papworth lines in connetion with its own sanatorium, and of thus initiating a plan which might be of immense value and importance in our treatment of tuberculosis.
There is working in leather, carpentry, toy making, and one or two others that I do not remember. They are all industries which are chosen because they give the men occupation without putting them to tasks which might be dangerous.
I do not remember having seen any scheme sent by the West Ham authority. Now I come to another complaint about which perhaps there will not be such general agreement, and that is small-pox. There is no doubt that. small-pox is rapidly increasing. In 1922 there were 973 cases, in 1923 that had increased to 2,500, in 1924 there were 3,800, in 1925 5,300, and in the first six months only of this year 5,500. I cannot regard those figures without a good deal of anxiety. It is true at present the disease in this country is of a very mild form, but in the past we have had this mild form side by side with a form in which it is one of the most deadly of all maladies, when some of those who fulminate against vaccination would rush off quickly to the vaccination officer and avail themselves of the one certain protection against the disease, but probably, in the meantime, before vaccination could he effected, a good many would succumb to a complaint which is not merely deadly, but peculiarly distressing in its effects. I cannot help thinking that the evidence about vaccination in connection with smallpox is not regarded with a fair and open mind by a number of people. It is a subject of prejudice. Of course, our vaccination laws were framed a good many years ago, and knowledge has increased and widened very much since then. I think there are something like 7 groups of diseases to secure immunity against which vaccination is practised. This subject of vaccination is the only one in regard to which compulsion is applied. It may be that the very fact that this particular disease is picked out and separated from the others for this exceptional legislative treatment has served to inflame the fanatical feelings against it which have led to so large a proportion of our population going without vaccination. At any rate, I have recently set up a Committee under the chairmanship of Sir H. D. Rolleston, the President of the Royal College of Physicians, to investigate the whole subject, and I am content for the present to await that Report and any recommendation which they may make on the subject.
The only other disease which I would say a word about is sleepy sickness. I think a good deal of alarm has been created in this country by the very distressing after-effects of this disease. There have been some very painful cases of after-effects showing mental and moral changes due to this particular complaint, and it is unfortunately the case that as matters stand at present there is considerable difficulty in giving what we may regard as proper treatment to cases of this kind. The legal definition of mental deficiency does not cover cases of persons who have been affected by encephalitis lethargica. There is something in certification for lunacy which is quite inappropriate to cases of this kind. That is a matter which is engaging my very serious attention, and it may be that I shall have proposals to make to Parliament before very long to meet it. In the meantime, it may reassure hon. Members if I tell them that the disease appears to be distinctly on the wane. In 1924 the number of cases was 5,039. In 1925 it came down to 2,635, and therefore I think we may be justified in drawing the conclusion that this compaint which appeared so suddenly and developed so rapidly has reached its maximum and is now passing away, and that soon it will become, not a matter which can be neglected, but one which will no longer give us serious concern and anxiety. I apologise for having detained the Committee so long. There are many other subjects which I have not touched upon If I have not said anything about the details of maternity and child welfare or venereal disease or the much larger question of the future of the voluntary hospitals, it is not because I underrate their importance, but merely because I recognise that there must be some limit even to the patience and toleration of the Committee. I hope, however, I have said enough to show the huge extent of the field which is covered by my Department, and point to the earnestness, and I think also on the whole the success, with which we are grappling with the problems which confront us.
I beg to move to reduce the Vote by £100.
I should like to say that on this side of the Committee we all appreciated the speech of the right hon. Gentleman, and particularly the latter part. There are, indeed, two Ministers of Health—one whose better side has been obvious in the latter part of his speech and one who is an ex-Chancellor of the Exchequer. Just as there are two theories about cancer, there may be two theories about his dual personality. I am not suggesting that his economic propensities at the moment are due to some inner chemical change, but I rather suggest that they are due to some external agency. The right hon. Gentleman, instead of being the Minister of Health, is, unfortunately, because of this external germ embodied in the Chancellor of the Exchequer, become more or less the subservient instrument of the Treasury, and he is carrying out a policy on many sides of his Department with which at heart he must disagree. He has said nothing this afternoon about a proposal which he submitted when he met the Urban District Councils' Association, but this, it seems to me, gives the key-note of the policy of that other Minister of Health whose existence I deplore. Speaking within the last fortnight to the Urban District Councils' Association—I am quoting from the "Times" report, we are told that he asked them
to consider sympathetically the suggestion for the substitution of a block grant system for the present system. In suggesting an alteration in favour of the block system, he had in mind that by the change they would secure economy, and they would be able to give the local authorities greater individual responsibility and greater freedom.
I interpret that statement to mean, I hope I. am wrong, that the Minister has
set his heart upon introducing a block grant system because he believes that thereby he will be called upon to spend less money and he believes that he can bribe the local authorities into accepting it by telling them that they will enjoy greater freedom. That, I think, is rather unfortunate.
I am not quite clear whether new legislation would he required. If it is only a change in grants, which could form part of the Appropriation Act, it could be discussed; but if the present system rests on Statute, and if new legislation were required to give statutory authority to the new system, we could not go into that.
I think the Grants would probably fall under both heads. On the larger question of housing, the right hon. Gentleman congratulated himself and the country on the very substantial increase that is taking place in the actual building of houses. I quite agree that we are now beginning to overtake those arrears which accumulated during the War and even before the War, and were accumulating in the very first years after the War. At the same time, I would like to draw the attention of the Committee to the part which I think we may claim the Act of 1924 has played in bringing about this fortunate result. As things stand at the moment, although the Act of 1923 had a year's start, more houses have been completed by local authorities under local authority schemes, and under the Act of 1924, than under the Act of 1923. That seems to be some justification for that Measure, and I am glad to think that under the right hon. Gentleman's administration there are actually built and building more municipal houses under the 1924 Act than under the Act of 1923. On the 1st June of this year the number of local authority houses actually completed under the 1923 Act was 37,509, and under the 1924 Act it was 38,243. On 1st June there were under construction 8,459 municipal authority houses under the .1923 Act, and 39,822 houses under the 1924 Act. I mention that because, while it is true that the majority of houses that have been constructed under these two Acts jointly have been constructed by private enterprise, we on these benches believe that there is a large sphere for the municipal authority to build houses
to let. I mention it also because the right hon. Gentleman has told us to-day, and has indeed said it in public before, that he is now giving consideration to the revision of the subsidy. Speaking to the Urban District Councils' Association, he used these very significant words
He did not want to see any interruption of the continuity of the housing programme. On the other hand, he was alarmed at the high figures piling up in the national and local expenditure on housing. He was alarmed also at the gradual rise in the cost of houses, a rise which did not seem to be warranted by any rise in the cost of labour or material. He asked himself whether the existence of the subsidy might not contribute something to this rise in the price of houses. What they wanted to get at was what was going to be the cost of the subsidy in the next year or so.
It appears to me that the right hon. Gentleman's mind is working in the direction of a reduced subsidy, which of course he can carry out under the Act. He is going to base his claim very largely on this mysterious rise of price, which as far as he knows cannot he traced either to the cost of labour or the cost of material. I would suggest that there are other ways dealing with this problem than of reducing the subsidy. What I fear may happen if he reduces the subsidy, is that a very considerable amount of the building now being undertaken by municipalities will be reduced, because local authorities will no longer think it worth while to continue. Private enterprise will no doubt continue in its way to supply the need, but what it gets out of the subsidy now it will endeavour to get out of the public. I am not satisfied, and Members on this side are not satisfied, that it would be wise public policy at this stage, notwithstanding the increased amount of building that there has been, to reduce the subsidy, and I would like to ask the right hon. Gentleman whether the House will have an opportunity of discussing his proposals before he puts them into effect. It is right and proper, of course, that he should consult the local authorities, but at the same time he owes it to the Howe that they should have some opportunity of discussing any alteration that may be made in the terms or the period of the present State subsidy.
Now I would like to turn to a question with which. the right hon. Gentleman dealt very briefly. I was more interested in what he said about public health than about Poor Law, but the main reason for the proposal to reduce this Vote is the question of the right hon. Gentleman's administration of the Poor Law. During the past four years, or at any rate since 1921–22 and up to the time for which we have no figures at all—there has been a reduction in the Poor Law expenditure as a whole. That, apparently, has been due largely to the reduction in the level of prices, which has made it possible to give the same amount of relief with a smaller amount of money. We may therefore expect that reduction. During last year, however, the amount which was expended in domiciliary relief increased. Whereas the expenditure in 1923 on domiciliary relief had been nearly £7,500,000, at the end of 1924 it had fallen to £5,350,000 odd, but at the end of last year that figure had risen a little, to £5,600,000. During 1924 it is known that the average number of persons in receipt of poor relief of all kinds was diminished for two main reasons. One was the improvement which took place during that year in the conditions of unemployment benefit; and the other was the real reduction which took place in the volume of unemployment. But during the whole of last year and this year there has been a steady and substantial rise in the total number of people in receipt of poor relief, swollen, it is true, during the past two months by extraordinary conditions but, notwithstanding, real during the whole of the year 1925, when the Government were never tired of telling us that unemployment was diminishing and trade was improving. If we take the figures for the end of 1924 and the end of 1925, the number of persons in receipt of Poor Law relief per 10,000 of the population increased from 279 to 342. That increase was due primarily, I believe, to an increase in the number of people receiving out-relief. That increase was substantial. The increase in the amount expended on out-relief in 1924 and 1925 was a mere £250,000. What does that prove? It proves that the conditions of those who are receiving poor relief have been in the past year worsened. Expenditure on out-relief has not increased to the same extent as the volume of pauperism has increased. The Minister of Health, as a. Member of the Government, is very anxious, as far as he can, to thrust the cost of unemployment upon local funds to relieve the Exchequer. At the same time, of course, he is very anxious to reduce Poor Law expenditure. It is very difficult to have it both ways. In so far as he has succeeded at all, he has succeeded at the expense of the poor and at the expense of those who are driven to seek relief. During the period when we were told that trade was reviving, the difficulties of many Poor Law authorities continued to increase and, whereas at the beginning of April, 1924, 24 Poor Law authorities had been authorised to borrow money for current account and loans had been sanctioned amounting to nearly £7,000,000, by the end of May, of this year—due, of course, to the general stoppage—36 unions had applied for loans. The Parliamentary Secretary told us a few days ago in this House that at the beginning of this month no less than 66 unions held borrowing authority in respect of current expenditure. I think the total was 66; the Parliamentary Secretary did not give the total, but I have added up his figures very carefully. Of that number 37 were actually in debt at the end of March of this year to the tune of £6,600,00 odd and un to the present the maximum borrowing which the right hon. Gentleman the Minister of Health has sanctioned amounts to close upon £11,000,000 for those 66 Poor Law areas, the bulk of them Poor Law areas in mining districts.
Circumstances have been too strong for the right hon. Gentleman. Notwithstanding his wish to reduce expenditure, expenditure has increased because of the present situation, but he is using his financial control as far as he can to keep it down. Of the 37 unions who, before the end of May, had been authorised to borrow, all of them were conforming to the scale of relief laid down in his Circular No 703, and 11 of them had had to reduce their scales of relief before the loans were sanctioned. The Minister was using the power of the purse to compel boards of guardians, whether extravagant or not, to cut down their expenditure, and that expenditure has only been kept down by reducing the actual amounts of relief to applicants. That has not been sufficient for the Minister. We have now his Circular No. 703, a Circular of infamous memory. This Circular, as I rather gather from what he told us, was intended to deal with the mining situation, rather than with the general stoppage. On the morning of 4th May the general stoppage occurred—
—I will call it "a general strike" if the hon. Gentleman wishes, but I have accustomed myself, because of the varying interpretations put on the terms "strike" and "lock-out," to use the word "stoppage" as covering both. On 4th May the general strike commenced. On 5th May the right hon. Gentleman issued his Circular, as it seems to me with undue haste, having regard to his own statement that the duration of the stoppage might possibly be prolonged. This Circular, to which the right hon. Gentleman has referred, explains the Merthyr Tydvil judgment. There are two points, I think, to which attention ought to be drawn in this Circular. One is that which says:
Where an applicant for relief is able-bodied and physically capable of work the grant of relief to him is unlawful if work is available for him or if he is thrown on the guardians through his own act or consent.
Then the Circular goes, on to talk about penalties. The second point is:
If in those cases in which the applicant, though ordinarily able-bodied, is as the result of continued unemployment or otherwise no longer physically able to perform work, relief may be granted.
I am not going to challeng the law. This may be good law, but it does not seem to me to be sound common sense. The point I wish to raise is whether this judgment is actually being operated. I submit that the right hon. Gentleman is causing relief to be withheld from a substantial number of people on the coalfields to-day to whom this judgment does not apply; in the case of boys who cannot, by the rules of the various miners' associations, be members of the union. They are not out by their own act or consent and work is not available for them. I remember during the general strike that the "British Gazette" had for several days a small framed question:
Was your consent asked before the strike was declared?
Of course, the implication was that it was not, in which case all the people on the coalfields and all the people who were out in the general strike were not out by their own act or consent. But 1 think it is true that, as far as a large number are concerned as individuals—and the boards of guardians have no concern whatever with the general mass of the people or with the dispute or its causes; they are only concerned with individual applicants for relief—those individual applicants cannot return to work if they choose and they ought, therefore, to be receiving relief to-day. What is the use of 10, 20 or 50 men who may be surface workers, or who arc employed on half a dozen things in a pit, going back to work to-day? The work is not available for them. They would only be turned away by the manager. If that be so, these people are entitled to relief to-day. They are not getting it, and the people who are suffering are not merely the miners but they are the miners' wives and dependants.
Secondly, the Minister of Health has suggested a scale of relief. That scale of relief—not to the strikers' families but to others—is the scale given under the Unemployment Insurance Act, to which attention is definitely drawn. I wish to suggest that that scale is quite inadequate for the reasonable physical maintenance of the families who are applying for relief to-day. It has been said repeatedly in this House that Unemployment insurance benefit was never intended for complete maintenance. It was merely there to supplement the savings and other means of people who became unemployed and never in this House has it been said that that scale was the scale for full family maintenance, even on the most modest scale. The Inter-Departmental Committee on Public Assistance and Administration, the Chairman of which was the present Parliamentary Secretary to the Ministry of Labour, explained quite clearly that " unemployment benefits have not been designed to cover all the responsibilities of the unemployed persons but rather to supplement private effort in mitigating distress due to involuntary unemployment." But ex hypothesi, the people who go for relief have not got any other means of any kind at all; they are destitute. Indeed, if they have other means, those means are taken into account and a reduction is made from this scale, which is a maximum scale. Therefore, I suggest that, as those who apply for relief are destitute and have no other means—they must have exhausted their other means before the board of guardians will allow them to receive benefit—this scale is utterly inadequate. I am sorry to have to say it, but I think it is a heartless and a cruel scale. Even if it were adequate for mere physical subsistence, for food and perhaps for rent, it does not meet the situation which to-day affects so many in the coalfields where you have had for two, three or more years a substantial number of miners who have been out of work or who, if not out of work, have exhausted their reserves long ago, where they have got down to the very lowest level, where there is not any more which can be cut down, where the boots and clothing of the members of the family, particularly of the children, are a national disgrace. It does seem unfair, therefore, that the right hon. Gentleman may in effect go down to the coalfields, and say that, small as the out-relief has been, now at the end of a long period of difficulty he is going to reduce it. Fortunately, boards of guardians need take no notice of the right hon. Gentleman if they can pay their way, and I hope that those who need not go to him for financial assistance will run the risk of the district auditor. But he has used this power where loans are required in order to effect a scaling down of the existing rates of relief to fall within the maximum which he has laid down.
The charges we are making against the right hon. Gentleman are two. We believe that this Circular does definitely encourage boards of guardians to reduce their scales. He is going to aid and abet any reactionary board of guardians who want to save money at the expense of the poor. Secondly, if he can exercise compulsion because of the financial position of boards of guardians, which gives him a hold over them, he is going to drive them willy nilly to reduce the scales of relief hitherto paid. I go so far as to say that the right hon. Gentleman is now engaged on a perfectly deliberate policy of forcing down scales
of relief, utterly regardless of the social consequences, with the result that he is playing into the hands of the worst types of boards of guardians. Here is the action which is to be taken by the Lichfield Board of Guardians, situated in a coalfield—Cannock Chase—which has suffered very considerably before this present stoppage began. Last week the rates of out-relief which this board of guardians was paying for a wife without children was 5s. The husband as a miner is not entitled to anything at all. If she has one child, 7s. 6d. is paid, two children 10s., three children Its. 6d., four children 14s. 6d and a maximum, however large the family, of 16s. 6d. But this is not the worst of it. This is the kind of difficulty the right hon. Gentleman is letting himself into. I take this cutting from a local newspaper:
A drastic step which will lead to the discontinuance of relief to miners' families, mostly resident in Cannock Chase, was taken to-day "—
I think that was on the. 8th July—
by Lichfield Board of Guardians, who decided that the scale of relief of every striker's family which was at the maximum of 16s. 6d. should be reduced by half during next week and that that amount should again be reduced the following week and then discontinued.
This is perfectly wicked. I suggest that it is an illegal proposal deliberately made against the men and boys in the lock-out on the coalfields. The paper goes on:
The proposition was made by Mr. Sheleross, who said the miners would never go hack to work as long as the guardians looked after their wives and children.
There are worse passages than that. I believe this conclusion of the Lichfield Board of Guardians is in a direct line of descent from Circular 703. But for that Circular they would not have been so stupid. This is probably not an isolated ease. What does this scale mean in the miners' home? It means they are not going to have sufficient to eat or be able to pay their rent. They will be plunged more heavily into debt; and the expenditure which the right hon. Gentleman has increased this year on infant and Maternity centres is going to be thrown away. What is the use of starving miners. on the coalfields and providing infant Welfare centres? The suggestion is a mockery.
If the hon. and gallant Gentleman will see some of the large mass of authenticated correspondence which we have, I think he will be content. Perhaps the hon. and gallant Gentleman will tell me how a woman can live on 5e. a week? This policy is definitely a policy of starvation. This board of guardians has definitely and deliberately gone against the miners. Whether the miners are right or wrong is irrelevant from our point of view, but it is only in keeping with the action of the Government itself that this policy should have been followed. Circular 703 is a weapon with which the Government hope to break the spirit of the miners. They are going to attempt to secure by semi-starvation what they could not attain in other ways. We have high authority for saying—and it was corroborated by the Leader of the Liberal party in this House the other day—that " it would be an unsatisfactory end to a dispute that the other side should boys to give way on account of the suffering of their dependants." For the right hon. Gentleman to suggest that he is holding the balance fairly is a mockery. This policy means that the Government are prepared to allow, not merely normal starvation but deliberate starvation by the reduction in the scale of relief to bring the miners to their knees by sheer economic pressure. I think one can say that the Government have very little confidence in the righteousness of a case which really depends upon trampling on the miners' families. The right hon. Gentleman, because the Chancellor of the Exchequer's side is uppermost at the present time, is blighting every activity in his Department. He is undoing the good work he is trying to do by his public health services as the result of these foolish economies. This, the greatest Department of the State, instead of being a medium of social advance, as we and the right hon. Gentleman would like it to be, has under this campaign of economy and class war,. been converted into a vast engine of oppression.
I should like to add my tribute to that of the hon. Member who has sat down in respect of the extremely lucid statement made by the Minister. If, after all the political vicissitudes, he has to seek his own living, I think he will be qualified to become a professor of public health in the institute he opened the other day. I do not want to tread the ground which has been covered and which will be dealt with by the Parliamentary Secretary in his reply. I only wish to say in regard to my interjection—and it is a query I address also to my right hon. Friend—that I hope the hon. Member opposite will be able to give us some evidence as to any starvation which exists. As a medical man, my heart was wrung by these details of starvation. The hon. Gentleman, I am sure, did not realise how much he was wringing our hearts, looking at it as we were from a purely philanthropic point of view. But as doctors we must not allow our hearts to be wrung without evidence, and I hope he will give us this evidence. The papers come out again and again with these stories of starvation, but I have seen no evidence given by the Press or by the medical papers suggesting that there is such starvation. On the other hand, I have evidence that the health of the children and the wives in the coalfields is better than before. Before these words are used or any weight is attached to them we ought to have evidence.
There are so many other subjects to be taken up that I hope I may be allowed to refer to one point which was briefly referred to by my right hon. Friend, that is, the serious question of maternal deaths. In the interesting Report on Public Health for the year 1924 we have very serious figures showing how unprogressive is our dealing with the question of the danger of child-birth. Although there has been a considerable reduction of maternal mortality, it has been nothing in proportion to the reduction in infant mortality. More than that, there has been an actual increase in the mortality of mothers during child-birth during the past three years. The mortality per 1,000 in the last four years was 3.7, 3.5, 3.6 and again 3.7. The last three years have shown an increase in deaths through child-birth. Out of every 1,000 births, four mothers are dying, and the amount of distress caused in the homes must be obvious to everyone. It is questionable what measures are possible in order to deal with this maternal mortality. Various measures have been adopted in recent years, which are dealt with in the Report, but we need further steps and further progress. Amongst other questions, the question arises of the appropriate amount of provision of beds in, maternity homes and maternity hospitals. There is room for considerable increase in that direction. I wish some measure could be brought forward, on the voluntary and on the municipal side, for increasing the provision of maternity beds, as soon as possible. It is of great value to get a proper extension of maternity homes, and I hope we shall get that as a result of the Bill which passed this House and has now come from the other House, with Amendments. Obviously, we must create amongst the people confidence in these homes, and for that purpose we must have as part of our system, proper inspection.
There is another side to the question. Although everyone believes that it is of great value in certain exceptional cases to have access to maternity homes, for what may be considered a natural part of every individual life, but it is only to meet emergencies and special conditions that are unnatural that these maternity homes are required. These' homes must not be considered as part of the normal carriculum of ordinary family life. There would be great danger if that happened. The danger must be faced at the present time, because-above all, of the inadequacy of housing. The inadequate housing among working-class families makes it very essential to find, if we can, further accommodation in time of maternity. In this connection, I should like to read a warning, which might well be borne in mind, from a medical man now retired from Colonial practice, who has had large experience. This is what he says with respect to maternity homes:
My Colonial experience makes me regard them as bad for the fathers. The wife leaving home and going to a nursing home is, as regards the father, like getting a baby from a shop. His missing the discomforts and anxieties of the baby's arrival' is a real deprivation and a check to his development.… Such homes should be regarded as a mere makeshift until such. time as housing is adequate.
That must be borne in mind, and we must not look upon the provision of
maternity homes as a normal part of family life.
I hope other hon. Members will deal with the question of tuberculosis, especially as regards the provisions that are about to be made for trying to get a greater hold over the production and distribution of milk It is a perfect disgrace to this country that we should still be depending upon a milk supply in which, apparently, something like 8 per cent. of the samples of milk retailed are found to contain the tubercule bacilli. There has been a great deal of controversy over the Milk Order, the draft of which was produced in March last. It has been held up for some reason of adaptation to meet other requirements. Obviously, we do not wish to stop the great bulk supply of milk, because that is so essential, but we want to have as little adaptation or belittling of that Milk Order as possible, in order that we may do something towards wiping out the disgrace of the unclean milk, which is always before us; a disgrace which has been wiped away by drastic methods in other countries, to the advantage not only of the consumers but the producers of milk.
My right hon. Friend dealt with the question of town planning. That is a question of preventing the ills that are arising now, and which, one of these days, will be found hindering us and checking us on every side, and which will have to be remedied at a vast cost which could be prevented now if drastic measures were taken in time. The right hon. Gentleman spoke of the number of schemes that were coming forward, but we cannot look upon that progress as being adequate. The schemes in the report which have been finally approved only number 17 schemes for 12 local authorities. We have heard that there has been some progress in the past year, but the progress is inadequate. Unless we take prompt measures to deal with this matter in connection with building programmes, we shall find that the building that is going on now is laying down lines of deterioration for years to come. In that way we are building up the actual conditions which we deplore. I am afraid that the amount of will and enthusiasm that is put into these town planning schemes by the authorities, where they are urged to bring forward schemes, is only half-hearted. There is not a real will, in most cases, to make the schemes effective and real. There are, of course, notable exceptions, and certain cases which are shining examples. Town planning is compulsory now for towns of over 20,000 population, and yet in regard to the large majority of authorities, which may have submitted schemes, they are doing so without being really convinced of their value. They realise how essential it is in regard to the amenities of life or the business of life or the health of the community to get powers and to put them into force straight away. We see this most in regard to amenities. It is the observances of amenities of life that strike one most, even in these times of great distress.
There is more money spent in amenities, in entertainment and amusements now than ever before in our history, in all classes. I regret it, because I think it is carried to extremes. It is the amenities of life which attract people more than anything else. The necessity for going into the country and the facilities for doing so I heartily welcome, especially for the town population, and yet the people who live in the towns are allowing the countryside to be spoiled, because no action is being taken to prevent it. The countryside look at it from another point of view. They say, " Why should we go in for these town planning schemes, expensive, irritating, worrying and troublesome, and all for the benefit of the towns? We do not see why we should do this business. Why should we produce these plans?" I am afraid that some of these remarks apply even to my own exceptional, exemplary county of Hertfordshire, a county unique because it has had the privilege of being addressed by my right hon. Friend and representatives of the local authorities and has been asked to prepare a town planning scheme for the whole county as a type of what can be done. I have been co-opted on to a committee. A committee has been formed and has appointed an adviser who has produced a scheme, but it has to be submitted to us again because when first submitted it contained no estimate of the expense. After five months delay, we shall have a meeting of the committee next week. I have not the least doubt that the plan will again be referred back for further evidence of one kind or another until the autumn. The reason for these delays is that there is no real backing behind the schemes. A few of us who are enthusiasts and dubbed cranks, are keen and realise the importance of these schemes, but I am afraid that the business community in Hertfordshire are afraid of London and London is afraid of worrying the counties.
We need pressure from the Ministry of Health in order to get things done, pressure brought in the right way, so that we may realise that it is not interfering pressure, but that it is helping people to do what is the business of their constituents. While that is not being done, vested interests are springing up on every side, and we are creating a millstone which will hang round the necks of the community in future. I would like to refer to a subject which has been forgotten for the last seven years, since the Ministry of Health Act was passed and the Ministry of Health was created. The Ministry of Health Act, Section 2, says:
It shall be the duty of the Minister.… to take all such steps as may be desirable to secure the preparation, effective carrying out, and co-ordination of measures conducive to the health of the people, including measures for the prevention and cure of diseases.
There was no limitation about that provision. That was a general mandate. The Act, in Section 3, says that there shall be transferred to the Minister the powers and duties of certain Ministries, amongst others, the powers of the Board of Education, and of certain other Ministries, which have been transferred. The powers and duties of the Board of Education have not been transferred. The Act, further says:
It shall he lawful for His Majesty from time to time by Order in Council to transfer to the Minister …
the powers and duties of certain Ministers in regard to various matters, and
any other powers and duties in England and Wales of any Government Department which appear to His Majesty to relate to matters affecting or incidental to the health of the people.
There may be reasons against transferring to the Ministry of Health all the health powers and functions of every Government Department, because at the present time the Ministry has enormous responsibilities and duties, and it would be excessive to expect it to carry out all
the health functions of other Departments, but it seems to me that under the Ministry of Health Act it is the duty of the Minister of Health to keep a watchful eye and to have a liaison with every other Department, so that he may know what is going on there and may bring to the notice of the Minister concerned, or the Government as a whole, the fact that certain things are not being done. In that way he might help in getting things improved. Take the question of the Factories and Workshops Act, which is to be revised, and for which purpose a Bill is promised. That is outside the domain of the Ministry of Health, and yet it vitally affects the health of the people. There ought to be an absolute liaison between the two Departments concerned, in preparing measures for reorganisation and carrying out any measures that may be necessary. At present these Departments act independently of each other, whether in the centre at Whitehall or in the provinces. It is much more important when you come to a subject which we are all considering at the present time in the coal mines. It is a recent discovery by a medical committee of this House that there is absolutely no provision for the supervision of health conditions in the coal mines. The mortality is not higher than that of the normal population, but there are certain diseases and complaints which are troublesome, and there are certain conditions of working due to the inefficient physiological arrangements in the miner's curriculum, But there has been no action to control the sanitary arrangements of the miners in the, mines and something should be done in that respect. I only refer to this to illustrate what is required; that the Ministry of Health shall take up the attitude of being responsible for the health of the people in every department of life, should know the conditions of life in every department of the community, and that there ought to be some substantial and official liaison between all the departments concerned in the health of the people.
I do not know whether I heard the hon. Member who has just spoken correctly, but it seems to me extraordinary that a man who is a doctor should say that the provision of maternity homes should not become part of the normal life of the people, other- wise the infant's father is not made thoroughly uncomfortable at the arrival of the baby and so does not cultivate the virtues of fatherhood. It is like the Bishop who objected to the abolition of poverty because it would interfere with the flow of Christian charity. I want to draw the attention of the Minister of Health once again to the question of the necessitous areas. We have heard, and we shall hear a great deal more, about the terrible conditions in the mining areas, but I want to bring before the Minister the case of areas which are suffering terribly as a result of the coal dispute, and which are suffering through no fault of their own. I am speaking for one of the great iron and steel areas which I have the honour to represent, the area of Middlesbrough. The case of the other iron and steel areas is the same, they are all 'suffering cruelly as a result of the War and the financial policy of the present Government, which has aggravated the position.
The rates in Middlesbrough are extraordinarily high. It really has a good board of guardians, from the Minister of Health's point of view. I can understand the right hon. Gentleman lecturing West Ham and proposing to punish them by taking away their powers and giving them to someone else, but in Middlesbrough you have the most exemplary board of guardians, a board which is trying to do the utterly impossible thing, and that is, to make the present rates of Middlesbrough pay the expenses. They are in an awful position. All the blast furnaces are being closed down because of the coal strike, the coal lock-out, which is having a terrible effect upon the area, and, as a result of the right hon. Gentleman's Insurance Act over £1,000 per week has been added to the amount spent because of the number of people who have been compulsorily transferred from the National Insurance Fund to the board of guardians. They are facing an absolutely crippling burden: the position is impossible. I want to call the right hon. Gentleman's attention to the appalling burden which is being placed on the average citizen in a place like Middlesbrough. The ordinary man is trying to pay these crippling rates. Men who have been unemployed, or very much under-employed for the last three or four years, are facing this enormous burden of the rates, and a large number of homes in Middlesbrough are being sold up, and are going for a mere song. I am talking about Middlesbrough, but it is only a typically distressed area, like other great iron and steel areas. It is an area which is soaking in poverty and which is going steadily down the hill.
We have done everything we can bring the position before the Minister. We have had deputations to the Prime Minister which produced a Select Committee, but practically nothing has been done. I ask the Minister of Health whether, in view of the really appalling conditions in these areas, he is prepared to consider whether Grants-in-Aid, or a Bill to equalise rates, as between the more favoured areas, or something in that way, cannot be done. There are areas which have completely recovered from the economic difficulties which followed the War, but Middlesbrough, which bore a tremendous burden during the War, and places like Middlesbrough, is left to face alone the appalling result of the present position. I suggest to the Minister that this is not fair. Whichever way we turn, whether it is by feeding school children through the education authority or by local maternity and child welfare centres, it always means more burdens on the rates, and people cannot possibly afford to pay what is being asked. We are in this position it should be a great privilege to have one of the council houses which have been erected by the Ministry of Health outside Middlesbrough in beautiful surroundings, which give better health conditions to the people, but instead of it being considered a privilege it is considered a hardship that they cannot get any other houses. The rents are so high on the top of this appalling rate burden, that men earning what is the standard rate, when they are in work, 37s. 6d. to 39s. as labourers, and 54s. a week as skilled fitters, are asked to pay such an amount in rent and rates that it is utterly out of the question if they are going to feed their children.
I hope this question will receive the attention of the Minister. There is no man who knows more about, this matter than the present Minister of Health. He has been a specialist in it, and all the time this is dragging on the health of the people is suffering, the conditions are get- ting worse, and they are just sinking down and down into a morass of poverty. Nothing can be done locally. Local people have done all that they can. It is a much bigger question. The only thing to be done is for the Government to come to their assistance, not only by loans, but by way of Grants-in-Aid. If the Minister lectures and severely punishes the West Ham Board of Guardians because they have dealt with this matter locally and given decent grants in relief to the people, then in the case of a board of guardians which is trying to carry out his instructions to the letter, he should do something to prevent the area getting deeper and deeper into poverty and distress. I shudder to imagine what the conditions will be like this coining winter. In spite of this tremendous poverty the women have worked in order to keep their homes together and their children fed. The unemployed man, working three days a week, cannot bear this appalling burden of the rates, and I hope the Minister will give these areas some hope that they will not be left this winter to face these conditions alone, but that they will have some real and substantial help from the Government.
The question of the maternity and child welfare centres has been raised by an hon. Member on this side of the House. These maternity and child welfare centres are intended to relieve the eases of the expectant mother and the nursing mother, and large sums of public money are very usefully and properly expended upon them. But there are cases, as the Minister of Health must. know, sent to these maternity centres of married women who have borne children who are in such a condition themselves that, judging from the children they have already produced, the doctor attending that centre knows it is a wicked thing to allow that woman to have another child. It may be that the burden of another child will put the life of the mother herself in jeopardy, and there are cases where it is known that the disease from which the mother is suffering will mean that the child must be blind or syphilitic. In those circumstances, if the woman was well to do, her own doctor would tell her that she ought not to have another child, and would advise her as to the means by which to prevent pregnancy, but in the ease of the poorest of the poor there is no medical attendant to whom they can go. What ought the policy of the Ministry to be in regard to the directions to be given to the medical officers at these centres in such cases? There is some obscurity as to the policy of the Minister. I think he has stated that he is following the policy of his predecessor.
If I rightly understand that policy it puts an absolute prohibition upon the doctor giving any advice to the woman and says that if such advice be given the grant of public money will be withdrawn. I am speaking from a letter which was addressed by the Ministry to the Edmonton Urban District Council. It goes so far as to say that although the doctor attending the centre may not give advice himself he may refer the woman for advice to a- private practitioner or a hospital. That is to say, he can tell the woman, "I know the advice which ought to be given to you, but I may not give it myself; so go round the corner to some other practitioner or to a hospital and get the information there." If I am wrong in thinking that that is the policy of the Ministry I shall be very glad to hear it, but, if I am right in thinking that is his policy, I most respectfully suggest that it ought to he amended. If in such a ease as I have quoted, the doctor thinks that pregnancy ought not to take place again, he ought to he allowed—if he thinks it right to do so on medical grounds—to give that advice without the penalty of losing the grant to the centre. That is all I ask. Obviously, these maternity centres are not to be converted into birth control clinics it would be most undesirable that anything of that sort should take place and all we ask is that where a poor woman comes in, and where the doctor thinks she ought to receive this advice, he should be free to give it without any penalty such as at present attaches to the giving of that advice, by the instruction of the Minister.
I have never heard, as yet, any argument against the view I have submitted. I know it is opposed on religious grounds, but you cannot argue with people who think there is something morally wrong in the relations between man and woman —that such sexual intercourse is a sin only to be excused by child-birth. That is their view, but it is not the view of the majority of the people of this country. The other argument is that in this matter the Minister cannot go in advance of public opinion; that these centres are largely supported by local authorities, that this support is largely enhanced by the amount of voluntary support which they obtain, and that the Minister must not do anything to alienate that support. If 1 may say so, respectfully, I do not admit the validity of that argument. The Minister cannot, in this matter, go in front of public opinion, but the Minister surely ought to recognise the trend of public opinion. I agree it is always difficult to say how far public opinion has advanced in a particular direction, but if, on a subject of this kind, one is seeking to find the direction in which public opinion is moving, is it not reasonable to take an expression of opinion by an august body which sits in another place? That body may be supposed to be the depository of Conservative principles, and if we found that in such a body the suggestion which I am putting forward had been received with acceptance; if we found that on a Motion being made to this effect in such a place as that, the Government of the day put on its Whips against the Motion and were defeated, then, surely, such a Resolution, passed by such a body, in such circumstances, would be the strongest evidence of the trend of public opinion. I do not know that I should be in older, in referring to what actually occurred in another place, but at least I am entitled to say that if, in another place, a Motion pressing the Government to withdraw the ban which is at present placed on doctors giving this information was carried by a considerable majority in face of Government opposition, the Minister ought to be satisfied that public opinion would support him in taking the very moderate step which I ask him to take in the interest of the poorest of the poor.
The first matter which I wish to raise relates to a certain interpretation which is being given to the Merthyr Tydvil judgment, which, I think, it was never intended to have. I understand that in many districts pit boys are being denied relief on the assumption that cases of that kind are governed by the Merthyr Tydvil case. It was never contemplated when that judgment was delivered, that it should apply to any persons other than able-bodied persons who were capable of working and could reasonably obtain work. I have no complaint to make of the Minister's circular, which properly represents the position. What I am complaining of is a certain interpretation which is being given to that circular and which in my view works an injustice. If I succeed in persuading the right hon. Gentleman that it does so, I hope he will issue another circular explaining what the law really is. There are two types who are being refused relief in many areas. First there are boys who have never been to work at all. These are boys, between the ages of 14 and 16, who, owing to the unemployment which has prevailed for so long in the mining industry, have never had any work at all. It is quite impossible to say that these boys come within the definition of being physically capable of the work and able to obtain it as they have never been tried at mining at all and no one knows whether they are in any way suited for mining or not.
They are in quite a different class from the miners in the Merthyr Tydvil case who went on strike and refused to work at a certain rate of pay which had been offered to them. They have never been offered work at all. As a matter of fact, in many districts they have been relieved but by no means in all. For instance, in Edmondsley in Durham, in Chester-le Street and in Wrexham relief has been given to such boys up to the age of 16, and in certain other districts in Durham and in Marsden Colliery, South Shields, relief has been give up to 18, but in the vast majority of areas, relief has been refused to boys who have never been at work and who are living as members of the families of miners or of other persons affected by the dispute. I feel sure the right hon. Gentleman will agree that there ought to be one uniform treatment for boys of this class. It. is very unsatisfactory that, in precisely similar circumstances, boys in one area should be able to obtain relief from the Poor Law, while boys in another area are denied it. It is quite clear from everything that has been discovered, that different boards of guardians are interpreting the Merthyr Tydvil decision in different ways. Some seem to think that it covers the case of boys who have never been at work while others think—and probably it is the right view—that these boys are not persons for whom work is available or who are physically able to do the work, and therefore, that they ought to fall under the Statute of Elizabeth and get their relief. I would point out to the right hon. Gentleman that his Circular was issued at the time of the general strike, and did not deal specifically with the problem which is raised in the mining industry. One of the questions to which we ought to have a reply is whether boys who have never been at work in mining are covered by the Merthyr Tydvil judgment. Their only connection with mining and miners is the fact of relationship. There is no industrial connection, and there is no reason to suppose they ever would have become miners in the ordinary way.
The second group affected are those who have been at work in the mines, but are under the age of 16. Their case is rather different. Under the Trade Union Acts, particularly the Act of 1876, boys under the age of 16 cannot become voting members of a trade union. Therefore, they are without any voice as to whether a stoppage shall continue or not, or as to what conditions or terms of work shall be accepted. Whether the Merthyr Tydvil Judgment be right or wrong, we must accept it as the law, and, under it, able-bodied men, having control of their industry, if they elect not to work cannot go to the guardians for relief unless they become wholly destitute. But there is no reason to say that that should apply in the case of boys who, by reason of their youth, have no voting rights and no control over the industrial position. By Statute, they are excluded from voting under the age of 16; and, in many cases, under the rules of the trade unions, that exclusion applies up to the age of 18. Just as in the ease of the boys who have done no work at all, there is a great variety of methods of treatment in the different areas where the matter has been considered. If the right hon. Gentleman thinks there is substance in what I say he ought to issue another circular explaining to the guardians the difference between these two classes of boys and adult workers.
I would not have said any more this afternoon had it not been for the speech of the hon. and learned Member for Lon donderry (Sir M. Macnaghten), in which, I understand, he criticised the Minister for having refused to alter the present Regulations dealing with the information given in clinics and other places with regard to contraception and other practices of the same kind. Personally, I am very happy to congratulate the right hon. Gentleman. I think he has acted absolutely rightly, and I hope he will persevere in the line he has taken. I do not understand the argument of the hon. and learned Member when he says that the objection to this is really a religious one, and therefore—apparently so he thinks—it is to be treated as of no account. There is no doubt that in past times it was no part of the function of the State, in any way, to deal with these delicate domestic affairs.
Many of the problems raised by this matter are perhaps not very suitable to be discussed this afternoon, and the subject only becomes material, if I understand it aright, in this case because we are dealing with the administration of the right hon. Gentleman. Therefore seeing that the matter has been raised, I want to say that I do not think that a very large majority of the people of this country, or that a majority of working-class men and women desire to see this information given in this way. All sorts of dangers will arise if these institutions are financed or encouraged by the State. The border-line, for example, between contraception and abortion is a very narrow one, and there is a very real danger that places which are not fully regulated may take advantage of this kind of assistance. That is what really may happen, that many things which are now subject to the criminal law will take advantage of this State recognition. I shall always, personally, fight so long as I am a Member of this House against any attempt on the part of the State to assist or recoganise this practice at all. I believe it to be wholely against the interest. Of the country. I believe that the practice on a large scale would produce all kinds of psychological effects which people who only look at these things from the economic standpoint do not appreciate. Particularly from the Labour standpoint it seems to me to concede the whole position, and to argue that our economic system and the industrial structure of society is so incompetent to provide people with an adequate standard of living that these abnormal methods have to be used to keep us in a state of physical efficiency.
I believe there are other methods, by means of the proper distribution of wealth, and by renewing country life whereby we can achieve what we require for the community without recourse to these very dubious methods. I hope the right hon. Gentleman will not lightly fall into the trap of assuming that mere temporary expedients to reduce the population will justify him in making this change in the moral outlook of this country. I do not want to press the point, because the right hon. Gentleman's conduct is entirely satisfactory so far as I am concerned. I am alarmed, however, at the observations of the hon. Gentleman opposite, the Member for Londonderry (Sir M. Macnaghten).
I hope in this matter the right hon. Gentleman will show himself a better Conservative than his supporter below the Gangway, and refuse, for all these various reasons, to have anything to do with this matter.
In view of the fact that as the Member for Leith I understand that the Scottish Board of Health, and other Scottish Departments, follow very closely in the steps of the English Boards, and that the Scottish local authorities, particularly the larger authorities, also take their cue from those in England, I think it is desirable we should know from the right hon. Gentleman the Minister of Health when he will be able to tell us definitely as to how the subsidy for housing stands, and how it is likely to stand. Section 5 of the Housing (Financial Provisions) Act, 1924, says:
In the year 1926, after the first day of October in that year, and in each second succeeding year, after the first day of October in such year the Minister and the Scottish Board of Health shall take into consideration the expenses which are likely to be incurred…,
and so on, and the decision shall be so and so. Apparently the Minister is under the impression that this Section 5 lays upon him some new decision, and that he cannot make it known until the 1st October. As I understand it, the position is that after the 1st October he has the option of varying the amount of the subsidy. When is he likely to intimate what is his intention? It is perfectly obvious that it is extremely inconvenient for the local authorities to be left in doubt longer than is absolutely necessary to enable the Minister to arrive at his decision. There are contracts placed, and houses to be begun. There is likely to be a gap in the period. I myself fail to understand the practical difficulty of the Minister making a forecast as to what the situation is likely to be in the two ensuing years, and thereby giving an example for the Minister and the Scottish Board of Health to indicate what their decision is likely to be.
I should like now to say a few words about the scales of relief in the mining industry. I believe I am right in saying that the Poor Law authorities are concerned with destitution, but they are not concerned with industrial disputes. If a person is destitute that person has to be relieved. It is not right that the guardians should use the power they have to withhold relief with a view to bringing pressure to bear upon somebody in some such way as will end an industrial dispute. This point is a very important one, and need not necessarily be limited to the miners. There is a certain organisation, a certain solidarity, among the trade unionists. Supposing in any area the people are thrown out of work and ironworks close down because there is no coal to go on with, if the guardians take the view that by withholding relief from the sufferers who are locked out from the iron-works because there is no coal there they may somehow get an impression to bear upon the miners' union to stop the dispute, what then? Would that be a reasonable ground for refusing relief? The Minister will say that it would be most unreasonable.
Supposing, again, the guardians come a little nearer and endeavour to put pressure upon the women and the children of the miners by withholding relief in order to bring an impression upon the miners to stop the dispute in a certain
way? is that reasonable? The point, I say, is very important. It is very important to know what view the Minister takes of action like this of guardians. The position of the Minister is very much stronger than it was a week ago. Every board of guardians knows that if they do not please him there is always the danger of certain contingencies because he may override their jurisdiction. I have here, for example, a cutting dealing with the Walsall Guardians. One of the members said:
Many of us have to make sacrifices, but we must take cognisance of the Minister's warning. We have seen what has happened in other parts of the country.
The Walsall Guardians had apparently in mind West Ham, and what had happened in connection with that board of guardians. Some of the relief appears to have been withheld with a view to bringing pressure to bear upon the industrial struggle. I have another ease, for example, that of Stoke and Wolstanton Union. Here the guardians are working in co-operation with the education authorities, and the school children have free meals. Where this obtains 3d. is deducted for each meal given to a miner's child from the amount allotted to him. It is legally right, I know, but is it morally right, which is a very different thing? Is it defended by the Minister of Health?
There is another class of case. Relief is given on loan: and in yet another case before the loan is afforded, the applicant is required to undertake that the loan shall be repaid by deductions from the wages. Is that reasonable? Is it a fact that the guardians have to get a garnishee order to be laid upon the man's wages and that the Court has to go into the questions of his means and of his capacity of pay? Is it right that when a man or wife who are destitute come forward and ask for relief that their need should be taken advantage of? One cannot help coming to the conclusion that those concerned are using the power given to them to meet destitution in order to produce certain industrial effects which they desire.
Finally, I want to say a word about the Lichfield Guardians. Here we have a recommendation of the finance, committee of the guardians that the scale of relief of these families should he reduced by one-half during next week—these families being the dependants, I think, of the miners who are locked out—and again reduced in the following week, and then discontinued. That is to say that the board of guardians declare that they are going to cease to do what, I understand, it is their statutory duty, namely, to relieve destitution. The Minister does not apparently challenge the facts. This hoard of guardians have announced that they intend to cease to discharge their statutory functions. Fortunately the Minister is fully armed to deal with cases like that. I do not know whether the Bill to deal with defaulting guardians has been passed by the other House, but no doubt it will secure, under Closure, a rapid passage. If the Lichfield Board of Guardians pursue the line which they announce they are going to pursue, is it the intention of the Minister of Health to supersede them? This is a very important point. He has got the power to supersede them. He has declared that he need not wait, in fact, he cannot wait, for proved default, that he must always act in anticipation. When Amendments were moved to the Bill to provide that he must wait for proved default, the answer of the Minister was, "That is useless: immediately I see or anticipate default T must have powers to act." Therefore I should be grateful to the Minister or to the Parliamentary Secretary if either of them would say specifically whether these powers are to be used merely in order to grade down the scale of relief, or whether it is intended to use those powers, in a case like that at Lichfield, to enforce on guardians their statutory duty of relieving destitution.
Dr. VERNON DAVIES:
listened with very great pleasure to the speech of my right, hon. Friend the Minister of Health, and with more admiration, perhaps, to that large part which dealt specifically with public health and disease. I could not help admiring the versatility of the right hon. Gentleman, because he spoke on these medical subjects as to the manner born. I could not detect any technical flaw in his statement of his argument. I would like to refer more particularly to the subject of tuberculosis, and to deal specifically with that form of it which affects the respiratory system. I do not know whether I misunderstood the Minister, but I seemed to gather the impression that he thought the position in regard to tuberculosis was very good, that he was more or less satisfied with the condition of affairs when he contrasted the improvement in the ease of tuberculosis with the great increase in the incidence of cancer. It is true that for the last 50 years there has been a very happy and steady decrease in the rate of tuberculosis—with the exception of the war years, 1913 to 1918, when for temporary reasons there was an increase—but although the rate of tuberculosis has decreased I would draw attention to the face that consumption is still our great white scourge, that it takes a terrible toll of life every year, and that the toll of life is amongst younger persons, from 15 to 25 or 30 years of age, and not, as in the case of cancer, among persons in the later periods of life.
May I give the Committee some of the recent figures? In 1923 59,000 fresh cases of consumption were notified. In the same year there were 32,097 deaths from consumption. That is a very, very serious state of affairs. In 1925 the deaths numbered 32,690. When we see that the number of deaths is growing, and know that they are deaths of people in the younger decades of life, we must feel that, however great the improvement has been, we are still faced with a vital and important problem. May I, for a short time, draw attention to the apparatus or machinery which exists for dealing with tuberculosis, that we may consider whether it is the best that can be found, or whether any improvement might be suggested. We start, of course, with that fundamental basis of all the medical services of this country, the panel doctor. We often hear this poor individual maligned and abused, both inside this House and outside, and yet the Committee must recognise that the first and essential thing in the train for the treatment of disease is the panel doctor. I recognise that in some cases the panel doctor is, perhaps, inefficient or careless. If so, he should be punished. There is no excuse for any panel doctor being inefficient or careless to-day. Recognising the importance of this first line, we should not do anything to discourage the panel doctor or to make him think he is thought ill of or thought little of by the com- munity generally, but that he is a man who can be looked up to, is a man whose opinion is valued, and is a man who can be trusted to do his duty.
Consumption is an extremely difficult disease to diagnose in its early stages, and so the Ministry have supplemented the panel doctor by a tuberculosis officer, who is expert in the diagnosis and treatment of consumption. I would like to pay a tribute to the excellence of these officers. They are extremely clever at their work, and of the greatest service to the panel practitioner, and are only too anxious to help with the diagnosis of these cases. So we have our panel doctor and our tuberculosis officer; and then the poor patient who has been sent to either one or both, and whose case has been diagnosed as suspicions or, perhaps, as one of early consumption, is for the time being, perhaps, given dispensary or domiciliary treatment. That is, the patient may go to a dispensary and have the attention of the tuberculosis officer, or the tuberculosis officer may say "Stay at home. Your own panel doctor will come to see you and treat you until we can send you to a sanatorium." In an industrial community the homes are not very suitable for tuberculosis cases, but for a certain length of time—it may be weeks or even longer this patient is waiting for admission to a sanatorium. Ultimately he gets there, stays there for a certain time, and then is sent home again, but not cured. The disease may be arrested, but in a great majority of cases it is not. Then begins that great tragedy in which we see a patient who has bad the benefits of sanatorium treatment. gradually losing ground, sinking week after week, until ultimately he goes to bed and finally dies.
We find that there are in certain cases adjuncts to this sanatorium treatment. First of all, there are the village settlements, to which I shall refer later, the industrial settlements and the after-care committees. We are well off—on paper; there is an extremely efficient group of services for the treatment of the tuberculous patient. We have in this country, or we had in 1924, 360 tuberculosis officers, 457 dispensaries, and 460 institutions, including sanatoria, with more than 20,000 beds. In spite of having 20,000 beds it was found on the 1st April, 1925, that only 17,000 of them were occupied. There seems to be a tendency to prefer to go to a sanatorium in the nice weather—in the summer—and rather to avoid going there in the winter.
What is ale cost of all this? In 1923–24 the gross cost to the local authorities was more than £2,600,000, of which 19 per cent. was dispensary cost and 81 per cent. residential or sanatorium cost. That means that in 1923–24 we spent upon sanatoria and other residential institutions for the treatment of tuberculosis £2,176,000—an enormous sum, practically £50,000 a week. Are we getting a satisfactory return for this huge expenditure? In passing I would like to correct a statement of the Minister, which I am sure he made in all innocence, when he referred to the fact that of the patients who had been in a certain sanatorium 78 to 80 per cent. were alive 10 years after discharge. That is perfectly true as regards the Frimley Sanatorium, but it refers to the very early cases. If we take the middle cases of tuberculosis we find that after 10 years only 38 per cent. of males and 49 per cent. of females are alive; and if we take the advanced cases we find there are only 10.4 per cent. of males and 10.8 per cent. females. Statistics are also available for Lancashire, where they found the survival rate per thousand 10 years afterwards was 22.4 for those who had positive sputum, who were definitely tuberculous, whereas with a negative sputum the percentage was 63.5. In Birmingham we find a survival rate of 65.3 per cent. and in Shropshire 40.2 per cent. The peculiar thing about these statistics is the way in which they vary. They range from 40 per cent. to 70 or 80 per cent. But the one thing that stands out above all others is that to get the full benefit of sanatorium treatment cases have to be taken in hand early.
What are the faults of sanatorium treatment, as they seem to me? I think the principal one is the admission and the retention of unsuitable cases, eases too far advanced. Secondly, there is the unwillingness of patients to enter sanatoria or to stay there long enough after they have gone. Thirdly, comes the lack of facility for early diagnosis and the early selection of suitable cases for treatment. Another thing is faulty management, generally due to a faulty medical officer
and last of all faulty after-care treatment. These are the principal causes of failure. What are the essential principles of sanatorium treatment I I do not think I could do better than read the principles laid down by Sir George Newman, the principal officer of the Minister of Health, who put them very admirably in words which I shall not attempt to improve upon. In his 1920 Report Sir George Newman said:
The arrest or cure of tuberculosis is a matter of prolonged and persistent endeavour in which success can only be attained by maintaining selected and suitable patients under satisfactory hygienic conditions of life for a long period.
The whole thing is early diagnosis, prolonged treatment. Afterwards treatment should comprise drugs, medicine, food, graduated exercises, and after-care. I think, if I were criticising the Ministry, I should say the great failure in their system is lack of village settlements. The Minister referred to the settlement at Papworth under Dr. Varrier Jones, a man of expert knowledge and whose word can be accepted on tuberculosis. What does Dr. Varrier Jones say in his report? He says:
The family is the unit to be dealt with in dealing with consumption.
He even goes further, and in the 1924 report says:
We save a very considerable sum each year which will increase in amount because the individual members of the family do not contract this disease, and they escape becoming a charge on public funds.
Here you have an expert with knowledge and experience saying it is absolutely wrong unless you treat the family, and the only way to do that is by a village settlement. The important point to bear in mind is that out of 70 children who are members of this colony, not a single one has showed the slightest sign of tuberculosis, which shows that under certain conditions the children and the wife of the person affected with tuberculosis can live without danger of infection. I hope the Minister will take this question in hand and give a lead and say to these people. " We like your sanatoria treatment but without a village settlement it is useless and I, as Minister of Health, will do all I can to support you in establishing these village settlements." Tuberculosis is a dangerous disease not only to the patient but to the community, and the people are entitled to protection. It is the duty of
the Minister of Health not to follow public opinion on this subject but to lead it, and do this in anticipation and. not wait fox the public to tell him what to do.
I would like to suggest that the first essential for the Minister of Health is to divide the cases of tuberculosis into two classes, those which can he cured and those which cannot. The sanatoria, should be kept. absolutely for the cases which can be cured and no other cases should be allowed to go there. Cases once there should not be allowed to leave until they are cured. Under the present system they are not cured, and after discharge they break down again and all they have had is a six months' holiday at the expense of the State, They should be kept in the hospital until cured, afterwards proceeding to the village settlement. There are a large number of cases of these people who have developed the disease so far that they cannot be cured, and they should be removed from their homes. You have the Poor Law hospital where you might set aside one or two wards and keep them for advanced tuberculosis cases until they die. You cannot send these people to their families because it is absolutely wrong and uneconomic to allow these patients to die in their own homes, and gradually infect all the people living in the same house.
I understand that next year the right hon. Gentleman is going to deal with the Poor Law, and, I should like him to bear in mind that in these Poor Law hospitals he has suitable places which could readily be utilised satisfactorily for dealing with advanced tuberculosis cases which are bound to die, and by separating the curable and the hopeless cases there is some hope that eventually we may he able to stamp out this disease. I visualise that the ultimate remedy of tuberculosis will he some kind of vaccine treatment. There arc at the present time seventy diseases which are being prevented by the use of vaccine, and the trend of discovery is to prove that in future consumption will be prevented or cured by vaccine. I am afraid I am treading on rather delicate ground, hut I feel it is my duty to this House to give my own experience in a very limited way with the vaccine treatment—I refer to the Spahlinger treatment.
It is perhaps within the recollection of this House that five medical Members of this House went to Geneva to investigate the Spahlinger treatment. Four of those Members were absolutely strangers to Dr. Spahlinger, but the fifth had met him before. They made a very careful investigation of Dr. Spahlinger's work and his treatment of patients, and they ultimately gave it as their opinion that they thought a prima facie case had been made out for his treatment, and they sent to the Minister of Health a Report to that effect. The Minister of Health knows that this is not merely a matter of our opinion, because the Ministry have in their possession records which will bear out everything I say as to what Dr. Spahlinger has done. Whether it is due to his serum or good luck, we cannot say, but all we know is that certain cases in a very bad state were sent to Dr. Spahlinger, and they have been cured, and 80 per cent. of his patients have been cured. Under these circumstances, what is the difficulty I may as well say that the difficulty is Dr. Spahlinger himself. As a man he is one of the most charming men it is possible to meet. He is the very soul of honour, and a wonderfully clever scientist who is working upon strictly scientific lines, and his sole object is the alleviation of distress amongst his fellow creatures. He is a man without the slightest desire to possess money, and I am told that he refused an offer of £250,000 to sell his remedy. Therefore, no one can say that this man is a money grabber, but, on the contrary, he is undoubtedly a scientist working on true scientific lines, and yet we find a difficulty in tieing him down to any legal agreement because he will not sign it.
Dr. Spahlinger and his family have spent the whole of their fortune, amounting to nearly £80,000, on these experiments for the good of humanity, and as a matter of fact they have no money at all. At the present time Dr. Spahlinger is living by taking odd patients who afterwards give a donation to the funds of his institute which is being kept going by those donations. And yet there is a possibility that this man has in his possession a remedy for this disease. I think it is a great pity that no means can be found to bring Dr. Spahlinger's remedy to the notice of the world in general. At the present time we are in a kind of vicious circle. Dr. Spahlinger cannot increase his material because he has not the money, and he is living from hand to mouth, producing only a very small quantity of serum. The one essential thing is for him to get money in order to enlarge his laboratory and that is the difficulty. That is why I appeal to the Minister of Health on this question.
I know the right hon. Gentleman is not without courage, and if he forms an opinion that something is right he goes for it whether it pleases or not. I appeal to him to look up the record of the cases Dr. Spahlinger has treated, showing that there is a prima facie case that something can be done, and then take his courage in both hands and say, "We vote a certain amount for research; we do not ask whether any profit is going to come from it; we give thousands of pounds to the cancer fund in the hope that a cure will be found, but here is; a case where you have actual proof that a large number of patients have been cured. I will ask the House to vote £250,000 or £100,000 to Dr. Spahlinger to be handed over for the purposes of research in order to see what can be done." What is £100,000? It is only the amount we spend on tuberculosis in this country in a fortnight. I am sure the Minister of Health has the courage, if he has the desire, to bring this matter forward. It is unnecessary, I think, for me to say that my sole object in bringing this question forward is for the sake of humanity. I have only met Dr. Spahlinger twice, and I have no interest in this matter except the interest of humanity. I hope the right hon. Gentleman will decide to break away from all the red tape of his office and adopt a bold policy and say, " The thing has not been clone before, but I am so impressed by what I have been told that I am willing to take this gamble."
It. may be a gamble, but suppose you lose £100,000, what then? On the other hand, suppose you win; suppose, you find Dr. Spahlinger has a treatment and for the expenditure of £100,000 you will be able to restore life to millions of people, then you raise hope in cases where no hope has been before. I wish I were the Minister of Health for 24 hours for this one purpose only. I do not envy the tremendous amount of work the Minister of Health has to do, but he has the power to prove that the Spahlinger treatment is either a fraud or a success. I hope he will give this question his serious consideration and in this way help us to stamp out tuberculosis in this country.
I listened with great attention to what the Minister said as to the operation of the Poor Law, and I must compliment him on the advances he has made, but I noticed that during his statement he made no mention of one most objectionable feature of the Poor Law, namely, what is known as the casual ward labour test. I speak feelingly on this subject, because I happened, in my early days, to be subjected to the labour test myself. I will not repeat myself, because I have given this illustration in the House before, but I should like to impress upon the Committee my view that this labour test in the casual wards is a chronic injustice. I may be told that, although it is the law, its operation is practically obsolete. That may be so, but it is not altogether so. Let me give a typical case which recently came before my notice, because I do want, when the Poor Law Reform Bill is before the House, to see such cases receive very careful consideration. The case to which I refer occurred during the present lock-out. The Minister cannot absolve himself from responsibility, because of the recent legislation which was introduced in regard to unemployment benefit.
This was the case of a young miner who was out of work and was living with his parents, and, because the income of the family was 50 per cent. of what was ordinarily earned, that young man, although he had paid his contributions all his life, was absolutely cut off from unemployment benefit. What happened? He either had to sponge on his parents or to go on relief, and he went on relief rather than sponge on his parents. He came hack in a fortnight, and went out looking for work, but heaven knows where a poor chap can get work nowadays. He got a. few pence here, and a night's lodging there. Then he went to a casual ward, and there occurred what I admit is one of the rarest of incidents. He was, I assume because he was a miner put on to the labour test in the morning—an unfamiliar task which he was altogether unfitted to do, although an old chronic tramp could have got through it in no time. He was discharged from the casual ward at an hour in the forenoon when it was too late to look for a job elsewhere, and so he repeated that process day after day and night after night. This law ought to be altered. I have no sympathy with the man who is chronically in that position, but the existence of this particular phase of the law is a bounty to the chronic tramp in this country. I hope that the Minister will take this question into serious consideration when the Bill is introduced next year.
After the exciting Debates we have had during the last few days, it is a relief to enter upon a discussion on a subject on which all parties are agreed, namely, the preservation and safeguarding of the health of our people. I should like to join with my hon. Friend the Member for Royton (Dr. V. Davies) in offering congratulations to the Minister for the interesting and able speech that he made in introducing this Vote. In that speech, and particularly in that portion of it which was devoted to the modern views on the causation of cancer, he displayed a knowledge of scientific detail which is very rarely to be found in a layman. I could not help thinking that the whole range of the Ministry of Health is much too great. It seems to me that in the very near future it will be necessary to divide the Ministry into two portions, the one purely administrative, dealing with insurance, housing and the Poor Law, and the other dealing purely with matters connected with the public health.
The Minister touched on the question of vaccination and the increase of smallpox in this country. I remember, two years ago, calling attention in this House to this very matter, and in those two years nothing has been done. As hon. Members know, small-pox is practically endemic in this country at the present moment. Hitherto this country has been looked upon as a clean area, but now it has come to be regarded as an unhealthy and infected area; and I personally believe, although I have no definite authority for saying so, that one reason for the examination of sailors in New York, to which exception has been taken in this country, is in order that the authorities may satisfy themselves that these men have been efficiently vaccinated. I happen to know that in Brazil, and I think in some other South American countries, they are equally suspicious of English seamen, and, instead of their being allowed to go ashore, as in the past, without any examination or any certificate, special care is taken now to see that each one of these men is efficiently vaccinated. I had this information recently from the surgeon of one of the large liners trading out there.
The Minister told us that there has been an increase in the number of cases of small-pox since 1922, when we had 973 cases, to 5,300 cases in 1925. What I wish to bring to the attention of the Minister is the inefficient and lax manner in which the Vaccination Acts are administered to-day. I may, perhaps, inform the Members of the Committee, although most of them probably know, that the law, as it stands at present, says that the parents of every child must, before that child is six months old, either have it efficiently vaccinated or obtain a certificate of conscientious objection. T am not complaining of the law, although personally I have a great suspicion as to the honesty of the conscientious objector. What I do say is, that a prosecution is almost unheard of under the Vaccination Acts, and what I would ask the Minister to do is to see that those Acts, as they are at present on the Statute Book, are firmly administered. I do not ask for any amendment of the law; I do not ask for any new legislation but I would ask the Minister to see that the present law is carried into effect. Otherwise, I believe, that in the not distant future we shall have in this country an epidemic of small-pox, which will take thousands of lives, and destroy the usefulness of the sight and hearing of thousands more of our people. The history of small-pox shows that, after a series of small epidemics of scattered cases of a mild nature here and there, the disease eventually breaks out into a severe epidemic. I have gone through two or three epidemics of smallpox, both in this country and abroad, and I would ask the Minister, from my experience of this terrible and loathsome disease, at once to take steps to tighten up the administration of the present Vaccination Acts.
My hon. Friend the Member for Royton, in discussing the question of tuberculosis, stated his opinion as to the inadequacy of the treatment in sanatoria. My personal opinion of sanatorium treatment for tuberculosis is that, at the best, it is a mere palliative. As a. curative agent, I believe that the sanatorium is of little if any use. As my hon. Friend has said, many of these cases improve remarkably in the sanatorium, but the moment they return to their old surroundings they rapidly get worse, and most of them die. We are, as my hon. Friend said, spending £2,000,000 a year on sanatoria, but I believe that the cure for tuberculosis, whenever it comes, will be in the form of a vaccine, and not in the form of palliatives. The only way in which it can be cured will be by absolutely destroying the tubercle bacillus by means of some serum or vaccine; and I would ask the Minister if he does not think it would be wise to devote at least £50,000 or £100,000 to exploring some other method of treatment.
The sanatorium, at the best, only claims 14 cures per 1,000. Personally, I think that is a very much higher figure than is justified, but there are other methods of treatment, and particularly the method of Dr. Spahlinger at Geneva. where there are many authenticated eases of cure. I myself have investigated them, and have seen the records of between 400 and 500 cases which show a. definite recovery rate of 80 per cent. on the most conservative estimate. I think that it will be a tragedy if that great work is allowed to go west and disappear as it will within a short time unless assistance is given. I have been interested in this work for the last four years. I had the opportunity of reading the remarkable Report which was sent to Lord Curzon, when he was Foreign Secretary, by the British Consul at Geneva, and, after reading it, I went to Geneva and personally investigated the whole matter; and I have not the slightest hesitation in saying, as my hon. Friend the Member for Royton has said, that a prima facie case has been made out for Dr. Spahlinger. I have seen at least 30 or 40 people recently as regards whom, when I saw them four years ago, I was definitely of opinion that two or three weeks would see their end. I have seen them recently enjoying the best of health, and in some cases following their ordinary occupations. This has been entirely owing to the use of the Spahlinger serum, followed by the Spahlinger vaccine. But the tragedy of the whole thing is that the serum really consists of a mixture of 22 different sera, and at the present moment only seven or eight of these are in existence, the reason being that at the present time Dr. Spahlinger, instead of having 10 bacteriological assistants, as he had at one time, has to-day, I think, only one. He is making a brave struggle against difficulties, and is keeping his place going, but I do hope that the Minister will, as my hon. Friend has suggested, take a little risk. Let him put down, say, £100,000, and risk it. It would not be really wasted even if it were lost.
You must. have a. specific method, that is the introduction of some serum of vaccine which will destroy the tubercule bacillus. I have followed this matter for four years. I spent an enormous amount of time, I made journey after journey to Geneva and other parts of the country, tracing those eases. I am afraid that unless something happens, something will happen to Spahlinger. There is only one other question to which I wish to refer and that is the question of the health of the miner. Mining, as I said in this House some weeks ago, is, on the whole, a healthy occupation. Young lads go down the pits without any medical examination corresponding to that in other occupations. I hold this to be a very serious omission. I have known boys suffering from valvular disease of the heart sent down the pits to work. Had there been a medical examination before those young boys went to work, they would have been detected and prevented going down. In the circumstances it. is remarkable that mining is so healthy an occupation as it is. If public health services, vaccination services, and other services were co-ordinated in one Ministry, a Ministry of Health, we then might have some hope of matters such as I have mentioned being remedied.
I want to raise two points, and first I want to refer to the question of pit lads. Can you treat as strikers persons who are excluded from an industry? It is now rather more than a month ago since those matters were put to the Minister. I then raised the matter on the Adjournment. We were told that this was a legal question and that the opinion of the Law Officers of the Crown would be asked. I feel always a great respect and a great timidity before the members of the legal profession. Still, common sense has its rights, and I cannot understand how any Judge could have laid down that a person was a striker who had never taken part in an industry. I cannot understand, having read the Merthyr Tydvil Judgment five or six times, and having used what sense I possessed upon the question, how a person could have ceased to work in an industry if the industry never admitted him into it. There is a case quoted of a pit closed two years up to February, 1926. It then reopened with a small number of people. The bulk of the boys under 16 never were able to get a footing in the industry at all. They were, and they are, unemployed persons. That very simple question was put to the Minister a month ago. Week by week I have been pressing for news and asking will the Law Officers decide? At last I came to the conclusion that the Law Officers of the Crown have not got to their exalted posts without using a little prudence and discretion and that they are very unlikely to answer a question so inconvenient to the Government until the present Session is at an end. I hope I do those learned gentlemen no wrong, but I cannot understand why, except for reasons of self-preservation, they have not given an answer to that question.
The Minister is now taking power to be Judge and jury and executioner over every single board of guardians in the country. Some of the boards of guardians are defying the Minister and are giving relief to those young children who have never been employed at all. We have heard that they are receiving severe scoldings. The Minister cannot have it both ways. Either it is a commonsense thing which he can settle for himself, or else it is a disputed point of law. Is he to deprive all those boys of the ordinary relief, to which every citizen has a right, on a question which is too difficult for the Law Officers to report upon? Anyone can see this question of the boys is nothing more or less than a deliberate attempt to weight the scales against the miners. I despair of getting an answer. I have very little doubt that the Session will come to an end before the Minister answers. I should like him to tell us whether he is prepared to give an answer or not. I do not ask an answer to-day. I ask whether the Minister is prepared to give an answer?
I now come to my second point. I am alluding now to what the Minister said about the housing question. He gave us statistics of the new houses which have been built, and intimated that it might be necessary to slacken off in house building. What I want to point out is that the bulk of those houses are called subsidy houses, and nearly every one is a house which has not been let, but has been sold on a system of instalments. That means that there is, I will not say a vast distinction, but a very important distinction. Private enterprise is housing the lower middle class, and a very good thing too. Subsidy houses are housing the working class, but hardly anybody is housing the poorer wage-earning section of the community. The Minister said, with some approval, that people were buying their own houses. These people are buying their own houses in very much the same unwilling way that much richer people are buying houses—because nobody will rent them houses. They are buying them on terms which put them quite above the level of the poorer wage-earning class. In my own borough of East Ham between 12,000 and 13,000 subsidy houses have been built by private enterprise. In the same town the borough council have produced between 30 and 40 tenements, and are projecting 30 or 40 more. 1,200 new houses in East Ham! People pay a. deposit, first of all, and then they are paying 27s. and 25s. a week buying those houses by instalments. Look at the money. Nobody can bind themselves to pay 27s. a week unless they have an income of something about £5, or, at any rate, an income which is perfectly assured. So those houses are being filled up with people of the rank of school teachers and clerks, and well-to-do working men. The 27s. a week puts those houses out of the reach of the £3 a week casual labourer.
From the district I represent I get letters weekly from people who want houses, people below the £5 limit. They ask me to find them houses week by week. What am I to say? I can tell them that there are 40 tenements going up in the borough and they can take their chance. I have to tell them they have not a chance of getting any of the houses which the county council is putting up at Dagenham, because they belong to another scheme. I see week after week, year after year the congestion in those streets of the poorest people getting steadily worse. The supply of houses available to that class is decreasing, because whenever a tenant dies or is evicted, the house automatically passes out of the rank of controlled houses to that of uncontrolled houses, and the rent will jump. People of that income are getting week by week more closely packed in their dwellings. I know of no hope for them at all except the building of an increased number of houses. In the old time, when local authorities had slum clearances, they hardly ever built for the tenants they displaced. They built for the slightly superior class of person, knowing that for those moved out other and worse types of houses would he available, for the poor. That is not so now. When the superior people move out into the superior houses, the houses they leave, because of the holes in the Rent Restrictions Act, pass away from the poorer people and rents are raised. What they are doing in England generally, and what is above all being done in the place I represent, is that housing is being provided quite satisfactorily for the lower middle class and the superior working class, but it is making the lot of the poor working-class man worse and more overcrowded.
I have heard two hon. Members speaking with enormous knowledge and great sympathy on the question of the cure of tuberculosis. These gentlemen are medical men, and they are speaking about cure. They speak from knowledge. What everyone of us can see and know is that, while people are talking about cure, and money is being spent on cure, infection is going on in a very great proportion of those overcrowded places. I am speaking from letters I have, the pitiful letters they write to me, saying seven in two rooms and one has tuberculosis. Over and over again I get those letters. Our pressing need is not so much the question of exploring cures for the disease as the question of giving a decent amount of house space which will prevent the afflicted person from automatically and almost, necessarily infecting the other members of the family.
The Wheatley Act is very good indeed where it is being used, but what I was after was the speech of the Minister in which he quoted the total number of houses, subsidy and Wheatley together, as a proof that we are overtaking the arrears of housing. I say you have to discount all the subsidy houses when you are talking of overtaking arrears of houses for the really poor section of the population. The subsidy houses hardly touch them at all. The 27s. a week, which is what you pay when you are buying a house by instalments, is something that puts the subsidy houses altogether out of the reach of the miserably poor and the miserably overcrowded, and when we are talking. as we are talking to-day, of slackening off in housing we must put on one side all the subsidy houses when we arc talking of housing the people who are the most overcrowded. There is very little being done for them at all. Hon. Members have spoken of those who come out from sanatoria and relapse. Nine-tenths of that is the housing question. We see cases go away vastly improved, able to do their work, but they are not strong men and they go back to these conditions of crowding which breaks down their already impaired stamina. From the point of view of tuberculosis and from the point of view of family life and the extremely cruel overcrowding from which the poor section of the population are suffering, we have not yet done nearly enough. What we want, without relaxing in housing, is a very much greater proportion of Wheatley houses and houses to be let at a low rent.
I came to the House just after the War, and I have seen a number of housing schemes tried. We began with the Addison scheme, then the Mond scheme, then the Wheatley scheme, and now the Kingsley Wood scheme, and what I said at the beginning has been proved right. There was only one solution for the housing problem, and that was to tackle it as a great national problem, and provide houses as we provided munitions during the War. The breakdown of the housing of our poor people is the great indictment of private enterprise and modern capitalism. The whole thing has broken down, and what the hon. Lady says about her constituency I can say about mine. The people who are being selected for the new houses cannot afford to pay the rent. The whole thing is top-heavy, and will collapse unless the nation takes it over. It is not too late even now. If I had my way I would pay the Minister of Health and his staff according to results. When the death rate went down and the health of the people improved, their stipend would go up. When the health of the people went down and the death rate went up, down would go their stipends, and then we should get a move on.
I have risen, not to talk of housing at all, but to make a present to the Parliamentary Secretary of the cheapest and most lasting and excellent way in which you can help the health of the people. Hon. Members have told us of the ravages of tuberculosis and pleaded for after care, or they should have done —I missed that—after they come out of the sanatorium. We have heard from the hon. Member for Withington (Dr. Watts) about the great benefits of vaccination, and we have had learned medical addresses. The hundreds of thousands that the hon. Member for Withington wants to spend on sanatoria would be far better spent on playing fields in our great industrial centres. The remedies of medical men do not matter. More people are killed by them every year. The remedy that is needed is open playing spaces for the people. If the Minister of Health could collaborate with the Minister of Education to see if proper playing fields for the children of the poor could be provided, as the children of the better-off have, if he would go in for the very cheap and easily erected open-air swimming bath, which can be put up at very small cost, it would be a tremendous benefit in all our great centres of population, and would do far more to prevent tuberculosis and to im- prove their physique than anything else. That is what the Minister of Health ought to concentrate on now. He cannot get money from the Chancellor of the Exchequer for housing schemes but he should encourage municipalities to provide more means of open-air recreation. A good deal is being done. Games and pastimes are no longer the perquisite of the rich. Other sports, like dancing, are good exercise. [Interruption.] I never heard that the Noble Lady had joined the ranks of the kill-joys where dancing is concerned. May I ask the hon. Gentleman to consider the encouragement of open-air dancing? It would be an excellent thing to encourage local authorities to open parks and other spaces for open-air dancing. In the golden age in England it was one of the things for which this country was noted. We have it, but there is not enough of it. You have stick-in-the-mud local authorities who are not progressive enough and they are the people the Minister could shake up, and he could do it at very little cost. I believe that sort of encouragement for open-air playing fields, swimming baths, tennis courts and means of getting exercise in the open air in the long evenings will do more to prevent disease than all the serums and vaccination and everything else that the two learned Members have treated us to a learned discourse upon. I make a present of that to the hon. Gentleman and I hope he will act upon it and that the House will support him if it becomes necessary to get a few scores of thousands of pounds from the Chancellor of the Exchequer.
It is rather bad luck on a comparatively new Member to have to follow the wonderful outburst of oratory we have just heard. I want to refer to the remarks of the Minister in opening the Debate about new methods of building. I want to mention a method which in my opinion is a real and solid contribution to the solution of the rural housing problem, and not only to the rural problem, but the hon. Member for Caerphilly (Mr. Morgan Jones) pointed in an interruption to the difficulty in the mining areas. About a year ago, in my anxiety to try to do something in a very humble way to assist the housing problem, I called a meeting of all the officials of our local authority to discuss the matter. The meeting was attended by a certain Mr. Nash, and he put forward a type of house which he thought would help the problem very materially. This type of house was erected, and one was built for demonstration purposes. We have not made any great attempt to bring it before the public until we were quite sure that it was a really solid and effective attempt at a solution of the housing problem. Neither Mr. Nash nor I have any interest whatever in the scheme, or I would not bring it before the Committee. After 18 months of very hard work, and after surmounting many difficulties, we have succeeded in building a house, and all the results of our research, all the costings, plans and details of all kinds are at the disposal of anyone who wishes to make use of them, and the result of our work is entirely at the service of the public.
We have had two sets of people to overcome. The first was the local authority with their by-laws. We have at last convinced them that old by-laws do not apply to new methods. We then got the officials of the Ministry to come and see it. They have been down several times and they are so far satisfied with the result of our efforts that they have passed the house for subsidy. The cost is £250 and it can be built for slightly less than that. It has a kitchen-parlour, three bedrooms, bathroom and inside lavatory accommodation and a scullery and larder inside. The method of construction is rather a new departure but I will not enlarge on that. It is enough to say it has been completely approved by the officials of the Ministry. We have been able to standardise all the different parts of the house in the same way as the parts of Ford cars were standardised so that it can be erected by unskilled labour, and we have up to date about 20 of these houses erected round about the place where Mr. Nash lives. They have been erected by farmers with the assistance of two unskilled labourers and they have completed the job quite satisfactorily and have got the subsidy.
The £250 does not include roads or connection with sewers or drains, as the case may be. I have given the figure of £250 as the outside figure, and I am anxious not to make a
wrong estimate, but one house that has recently been finished cost £220, and the total cost for everything, except the land, came out at just about £250. We have got the price down so low that it may vary £10 or £20 in different districts. I want to bring this to the notice of the Committee, because I believe it is a real solution of the rural housing problem. I have here many testimonials from different people, and, if the Committee will allow me I will read just two of them. One is from an architect, who states:
Mr. Nash, with great public spirit, has made a most interesting new experiment. He seems to have broken all the accepted canons of building, with satisfactory results …. The walls can be constructed by unskilled labour. The experimental house, if erected in considerable numbers, must result in very cheap building. I consider the house an important contribution to the solution of the housing problem, and as such, it should be studied and watched with great interest.
The only other one that I will read is from the Engineer of the Stanton Iron-works, who writes:
I have visited the house built by Mr. Nash, and must say that (after upwards of 15 years' experience of concrete work), I have never seen anything quite like it in concrete before. Mr. Nash has departed from all previously accepted theories, and, as a result, has not only cut down the price by about a half, but has succeeded in building what appears to be a perfectly sound construction, free from condensation on inside, without cost of lining same. I admire the method very much.
I have some booklets here, and I shall be very glad to give one to any bon. Member who might like to see it. It is contended that any ordinarily intelligent man who can use his hands, if he will study this book carefully can build a house for himself. I wish to repeat that none of us have any financial interest in this matter whatsoever, and that any work which we have been able to put into it is offered solely and entirely for the public service.
I have listened for several years to the Debates which have taken place in this House on the Vote for the Minister of Health's salary, and I must confess that I have never listened to a more interesting contribution than that to which we have just listened from the hon. Member for Chislehurst (Mr. Smithers) and to the speeches which have been delivered to-day by members of the medical profession. In fact, it seems to me that the problem of the health of a community is not as party political as it used to be, and I trust that in the realm of public health we can for a time, at any rate, leave party politics out of the question. The Minister of Health in introducing his Vote, was quite right when he said that the field of operations of the Ministry is so vast that he could touch upon only just a few of the subjects. I would like to make one suggestion to the Minister, and that is that before we debate in any future year the administration of his Department we might get the Ministry's Report for the previous year. It would have helped our Debate to-day very much if we could have had the Report for 1925 before us.
I take rather a keen interest in the work of the Ministry of Health. but I propose to dwell on a subject, which has not been touched upon so far. Before I do that, however, I would like to say a word to supplement the request of the hon. Member for the Royton Division of Lancashire (Dr. V. Davies) in relation to the case of Mr. Spahlinger. I have had the privilege of visiting his laboratory in Geneva. I am a layman and know nothing of the scientific side of his work, but I know Mr. Spahlinger personally, I know too well his failings in the realm of commercialism and business, and I know that the Minister of Health has taken an interest in his work, but I feel that the right hon. Gentleman might, at any rate, pursue his investigations into the work of this gentleman, to see whether his production of serum might be utilised in this country for the benefit of our own people. I feel sure he will be able to tell us something later this evening on this very interesting question.
I would like to touch on another subject too before I come to the administration of the National Health Insurance scheme. The Minister was quite right in rejoicing in the large number of claims which had been dealt with and met under the new Widows' Pensions scheme, but one thing he has not told us yet. I understand that the number of claims already received is about 160,000 and that the Ministry is still receiving them at the rate of 250 claims per week. I understand that the rate of the old claims is 250 per week, but the new claims number about 2,000 per day.
Yes. I know the division as between the first half of this year and the second half; but what the right hon. Gentleman did not tell us was how many claims have been rejected. I think that would be a very interesting figure to have before us. The right hon. Gentleman congratulated himself and the Department, and presumably the Government, because £1,750,000 have been saved on the rates by the introduction of this new pensions scheme. Let us analyse that statement for a moment. It may be true to say that there has been a saving to the rates of £1,750,000 per annum by the introduction of what is commonly termed the Widows' Pensions scheme, but what has happened? The cost has been transferred to industry, and in fact, instead of the money being paid from the rates by the whole community, this sum, by way of pensions and allowances, is now taken from the wages of the working people themselves. So far as I am concerned, I confess that I do not see very much in that fact upon which to congratulate ourselves.
The Committee has already dealt with housing and the administration of the Poor Law, and it has touched on many other big issues of importance, but I submit that the administration of the National Health Insurance scheme, covering about 14,000,000 of our population, is quite as important as any other subject that has been touched upon to-day. The right hon. Gentleman was good enough to pay a tribute to the staff which he employs in his Department to deal with Health Insurance and the new Widows' Pensions scheme. I think he was quite right; and I would like to supplement what he said, when he observed that they have done their work excellently well. I have heard no criticism at all against the Department in this connection. The criticism that I have heard has been against the scheme itself; and, if I might say so, many of the defects of the Widows' Pension scheme which have now come to light in its administration were pointed out last year on this side over and over again, but the Minister declined to accept the Amendments which we proposed, and which would have avoided all the difficulties with which we are now confronted in this connection.
I wish, however, the Minister would tell us something more about the Report of the Royal Commission on National Health Insurance. So far as I understand the Report, it divides itself into two parts. We must not on this occasion touch upon one section of the Report; that is, the part relating to new legislation, but if the Minister will turn to some pages of the Report, he will find out, as he has doubtless already done, that there are many things in it and many suggestions made there that can be dealt with by administrative action, and I am wondering when we may expect the statement from the right hon. Gentleman that all the proposals of the Majority Report of the Commission on the administrative side will be put into effect. I noticed that the right hon. Gentleman was rather delighted with what he termed the philosophic reservations of two members of the Royal Commission. I am not so sure whether the two members to whom he referred are two employers of labour who are becoming rather afraid that we are spoon-feeding the population too much—
A professor may sometimes speak the minds of employers. I am glad that the right hon. Gentleman spoke in terms of praise of the administration of the approved societies, because there are many wild charges of maladministration levelled against these great institutions. I want to say that, so far as my knowledge of these institutions goes, the form of collecting contributions and of paying away benefits under the National Health Insurance scheme is the cheapest yet known, and I would add my word of praise to what has already been said on that score.
The main reason, however, why I desired to address the Committee on this subject. was that I did not want to see this huge institution, which collects millions of pounds in contributions every year and pays away approximately £28,000,000 in benefits per annum, become merely a piece of automatic machinery. I want, if possible, to give it a little life, and I will put to the Minister one or two questions in connection with the administration of National Health Insurance. First of all, I understand the right hon. Gentleman is in some difficulty with regard to some of the insurance committees. I am not so sure, for instance, that the insurance committee for the City of Manchester have not had something to contend with in administering their affairs and in trying to conform with the Regulations of the Ministry of Health. It would be very interesting therefore if we could know, before we close this Debate, what is going to be the position of the insurance committees of this country in the near future. So far as I understand the position, they will retain their present powers unless legislation is brought forward to wipe them away, but I would like to know whether, by any administrative action at all, the Minister is endeavouring to change or limit their functions in any form.
Then there is the question of the dentists. The Minister knows full well that there is in existence a Committee appointed by himself to inquire into the claim of the dentists for greater payment in respect to the work they are doing for insured persons. I am sure I am right in saying that I can speak on behalf of the insured population of the country when I protest against what seems to be an attempt by the dentists to exploit National Health Insurance Funds. I trust that, when the Committee which is now sitting gives its advice to him, the Minister will see to it that the dentists who, I agree, ought to get a fair payment, should not be allowed to exploit the approved societies merely because certain funds are available for this work. I am sure that the approved societies themselves will have a word to say on this subject later.
Not so very long ago we dealt in this House with the Army and Navy Fund. We were told then that the Ministry of Health, through the National Health Insurance scheme, was to confer certain benefits upon the men who came within the scope of the Army and Navy Fund. I would like to know if the right hon. Gentleman will tell us whether any Regulations have now been issued in connection with this fund, and what are the additional benefits payable under these Regulations—whether, in fact, the glowing promises then made have actually matured.
I will now touch upon a small item of administration, which may not appear important to some Members of this Committee, but which is of considerable importance to the insured population. There has already arisen rather a serious difficulty between some approved societies, the panel doctors, the opticians and the ophthalmic surgeons. The ophthalmic surgeon is entitled to a fee of £1 1s. in respect to each insured person who goes to him for advice. In view of the fact that it can be proved that not more than 10 per cent.—I give the maximum figure—of the insured population, who go to the opticians, suffer from diseases of the eyes, the other 90 per cent., at any rate, ought to be dealt with either by the panel doctor or the optician without reference to the ophthalmic surgeon at all. If all insured persons who think that they are suffering from any disease of the eye are to be sent automatically by the panel doctors to the ophthalmic surgeons and the ophthalmic surgeons are to receive £1 1s. for each case, then the funds of the approved societies will soon be depleted.
My last point is as to whether the Minister has added any additional benefits to the old list of benefits which are to be found at the end of the 1924 Consolidated Act. I am very anxious, too, that all the funds available for additional benefits shall be used. I would not like to see, in consequence of the second valuation, what transpired in connection with the first valuation. In relation to nursing benefit, for instance, there was a sum available for England in 1924 of £152,000. Only £6,000 of that was spent by the societies. I trust the right hon. Gentleman will be able to tell us that, in respect to the funds available on the second valuation, those funds will be spent in accordance with the schemes agreed upon between the Ministrly and the approved societies.
I would like to say a word on the question of tuberculosis. I have had a little experience in administering the affairs of an approved society, a very small one by comparison, and it has made me really sad to see cases of men and women, mainly young men and women, who have failed to find places in sanatoria in this country. I was very sorry when the Coalition Government, I think it was, abolished the legal title of the insured person to sanatoria treatment. It. was promised then to the approved societies that the local authorities, because that legal title was abolished, would find ample accommodation for our consumptives. That promise has not been carried out, and I add my word of appeal to the Minister on that score. This is perhaps the great division of opinion between us. All Members of the Committee, of all parties, agree with the curative side of the treatment, but we on this side of the House are anxious that some of the money now spent on sanatoria and kindred institutions shall be available on the prevention rather than the cure of this terrible disease.
I would like, if I may, to look at another aspect of public health in which I take a great deal of interest. But, before I turn to that, I want to clear up a statistical point. The Minister, when making his speech, quoted some statistics with regard to housing. He told us that 173,000 houses had been built in the 12 months ending 31st March. I asked whether that was for England and Wales, and I think the Minister then said it was England, Wales and Scotland.
Thank you very much. I want to deal with the question of infantile mortality, in respect to which we have in this country achieved remarkable results. Compared with most Continental countries with large populations, I think we are entitled to praise ourselves for the success we have achieved. If you look back to the early days of registration, in 1840, you will find that, between that year and 1900, practically speaking, there was no progress made; if anything, the reverse was true. Infantile mortality ranged between 130 and 160 per 1,000. But, with the beginning of this century, a complete change came over the picture. There was a steady annual decline, interrupted by an unfavourable season. Broadly speaking, there was a definite downward movement in the incidence of infantile mortality. The average has dropped from 160 per 1,000, the figure which prevailed at the beginning of the century, to 75 per 1,000 at the present time. I have often, when speaking at meetings, described that as one of the greatest miracles of modern times, and I think it is not an unfair description; but I am not satisfied that we even now know why we have achieved these results. It is perfectly true that better sanitation and better water supply are important contributory factors in improving the health of people of all ages. It is no doubt the case that valuable service has been rendered by infant welfare centres, and that in most towns it has become the habit of mothers to visit the centres regularly to obtain instruction as to feeding the children and as to their general care and cleanliness, and everything that is likely to be healthful. In passing, I may say that I am a little perturbed at the domination over the centres which appears to have been obtained by certain manufacturers of patent foods. I do not like to see these centres dominated by certain well-advertised foods.
If, 10 years ago, one had discussed infantile mortality with an expert, he would have said that if we had a hot summer we would have a high infantile mortality due to a large number of cases of infantile diarrhoea. I believe it is true that that heavy mortality has not occurred during any of the recent hot summers, and it is also true that nobody knows why. I have heard it attributed to the motor cars. The elimination of the horse so largely from our street has meant the elimination of horse-dung which, was a favourite feeding place of the fly which afterwards walked on to the counters of the green-grocer and on to the barrows and infected the food which afterwards infected the children. Whether that is true I cannot say, but it is true that there is great doubt as to what is the cause. I would submit that, if something has taken place and you do not know the cause of it, you are not living in a great state of security. because the cause may be transient and you may find a reaction to the bad days. I want to appeal to the Minister to see if rather more cannot be done to co-ordinate the valuable information which is obtained in their work by the medical officers up and down the country. When we speak of research, we are inclined to think of something mysterious that is done in laboratories which the ordinary layman cannot understand. I do not know much about medical research, but I do know a little about the researches in physical and engineering laboratories, and I know that the engineer and the physicist have some advantages over the medical man, because they are experimenting with inanimate matter, and it does not much matter what happens to it; but, on the other hand, the doctor is rather cramped in regard to the subjects upon whom he can experiment. Nevertheless, the general medical practitioners are securing a great deal of valuable information, and I hope that this information will he sifted and tested and co-ordinated so that we may get some ideas as to what are the things which lead to certain results.
I have urged in this House already the desirability of what I have called mass research. I know it is an ideal; but, if you could only get a million people to keep an accurate diary of everything they did and the consequences upon their health, you would gain an immense amount of information. Some of the diaries, I am afraid, would have to be anonymous. After all, each person knows more about. himself than anyone else, and even the doctor can know only a little about the person he is examining. If we could only add a little more to this knowledge, I think we would be making more progress than we are doing. I happened to look, in view of this Debate, at the paragraphs relating to the death of infants, which appears in a report, which I hold in my hand, relating to certain towns. This report shows that out of 100 infant deaths during the last year, 66 occurred among male infants and only 34 among female infants. I know it is generally true that the male has the less chance of survival than the female, though more males are born.
When you get twice the mortality in a particular town among male babies than among female babies, one is inclined to ask why; and if the female baby has survived, can we not find out the cause of the survival and deal with the male baby so that it can survive to the same extent? We are all pleased at the immense drop from 160 in 1910 to 70 to-day. In New Zealand it is indicated that 40 is a level to which we may reasonably expect it to be reduced. There are many causes of infantile mortality, but the preventible causes are still such that there is no reason in my opinion why we should not in time halve the existing mortality. But we shall not be able to halve it until we know the causes of infant mortality. I do not profess to have any technical knowledge on the subject. Mine is merely the knowledge of a layman who has devoted some attention to the question, but I believe that if we set to analyse the great mass of information annually collected by medical officers throughout the country we might do a great deal to diminish infant mortality which causes so much sorrow in the homes of this country.
I have, as the Minister knows, asked questions also about the insects which bite people and occasionally cause death, but very frequently cause considerable suffering. My constituency has rather a plague of these insects. They are not disease-carrying insects but are poisonous and very often their bite leads to very painful swellings. They are really Bolshevists. I am told—and it is my own experience—that the prevalence of these insects is on the increase. The Minister of Health has published certain pamphlets about the keeping down of the breeding of these insects, but I would ask him to do more in that direction. There are certain districts in the neighbourhood of London which are infected by them. I have not. the faintest idea what the insects are but my impression is that they are smaller than. the mosquito. I do not know what their names are, but occasionally I get bitten. They are insects that fly; they neither jump nor crawl; they are outdoor and not indoor insects, and it is in the Summer time that they are most active. They are bred, I think, on open waters.
The other point I want to mention is in reference to the Pensions Act. Quite frankly, I think the Department has done very well in bringing the new Pensions Act into operation, but Government Departments have methods of slowness which are not the characteristics of ordinary private businesses. In all Government Departments, in all ages and in all countries, it takes longer to do things than really seems necessary. I have had some letters of complaint from some of my constituents about the time it takes before they can get their pensions. Government Departments are inhabited by ordinary human beings, and I believe that criticism is good for us. We get plenty in this House, because we criticise each other, but I think a little friendly criticism against the Civil Service will make them realise that it is a worrying and anxious time to these women when they have applied for their pensions and think they are going to get them right away, that they should have to wait six or seven weeks and sometimes do not get them at all. I do not make these remarks in an unfriendly spirit, because I think the Civil Service has done very well, but I do not think it will do any harm to let them know that there is a little friendly grumbling.
I congratulate the Minister of Health on the Report he has submitted to the Committee with regard to the various activities concerning disease. I was impressed by the experiments which have been carried out, and I trust the work will extend and that we shall solve that problem by those means. I also congratulate him on the report that the various regional town-planning schemes undertaken in the past few years are progressing favourably, but I would say that as far as South Wales is concerned, while many of the local authorities have shown commendable public spirit in taking advantage of the scheme, a large number of them are still rather backward, and I hope the Department will speed up these backward authorities in that part of the country. I was very interested to hear the right hon. Gentleman say that in the new East Kent coalfields the local authorities appear to be aware of the need of regional and town-planning schemes and that he himself proposes very shortly to pay a visit to these new coalfields. This is very good information and is welcome I think to everybody in this House, because the coal industry of this country is the basic industry and we are the pioneer coal country in the world and we ought to learn many lessons from the mistake of the development of the existing coalfields. Surely the East Kent coalfield, a coalfield situated in the garden of England, should be given special attention. We ought to be able to avoid most of the serious mistakes which have been made in the existing coalfields because of the lack of public spirit. I want to draw the attention of the Minister to the result of my own experience in a visit to the East Kent coalfields over a month ago. As one interested in town planning, and in the securing of proper social conditions for the mining population, I spent some days in that coalfield and went from place to place and saw the collieries and the houses provided for the miners. It was regrettable to discover that in this new coalfield mistakes are being repeated. I found a number of cottages near to a colliery, which is a mistake. The colliery is closed just now and may not reopen for some time, but whenever the colliery reopens I trust the Minister as well as the local authorities in East Kent will keep an eye on the housing needs and see that no more cottages are built so near a colliery.
I visited also a new colliery and the villages surrounding, and I regret to say that here again I discovered a large group of houses built on a very bad site very near the colliery. The chief objection is that these houses are on a site between two railway lines, and the junction is close to the houses. They are practically out of sight because of these two railways. I visited these Houses with other people, and similar houses in the Snowden area, and I regret to say that while the houses and the general appearance were satisfactory and while they may not be bad examples of building as such, the general planning was not satisfactory from the point of view of the comfort and convenience of the people who live in them. One point I want to stress is that in all our coalfields the miners, as a result of generations of habit, are very fond of a coal fire. You will always see in the miner's kitchen a substantial coal fire. The miner, generally speaking, gets household coal cheaper than other people, and he is never sparing with his coal. I discovered in this new coalfield that in all these houses, while they give provision for a little scullery behind the kitchen for a bath, the chief objection is that there is a boiler behind the scullery which means that the miner's wife has to light a separate fire, perhaps for each shift living in that particular house and they have to wait for the water to boil to supply the bath. That is an absurdity, especially in the miner's home where they are never short of coal. It ought to be made compulsory in all houses in the mining districts for the boiler to be placed behind the kitchen fire, so that the house can have hot and cold water supplied all the year round. I suggest to the Minister that when he visits East Kent he might give a hint to the housing committees that they might all see that this fault is not repeated. Unfortunately that fault is not confined to East Kent, but there is no excuse for East Kent because it is a new area and because the Government has given a guarantee of £2,000,000 to a very go-ahead firm, Messrs. Dorman Long, to develop the coalfield.
I want to draw the attention of the Minister to the fact that this stupidity is going on in various coalfields. We have a lot of it in South Wales, and some, I regret to say, in my Division, where there are two housing schemes. In one of these the local authority, on the whole, has made everything quite all right. Across the valley there is another housing scheme which is being run by the Powell-Duffryn Coal Company, one of the richest and, in some respects, one of the most progressive companies in South Wales. Unfortunately, this company has made the mistake of building cottages too near the pits. They have repeated some of the blunders to which I have referred. Not only that, but this coal company, which is spending a huge capital outlay, is already working the coal quite near to the pit bottom, with the result that subsidences in these new cottages have already set in. I and another hon. Member have visited the site and have seen the results of the subsidence. A large number of comparatively new houses are falling down. There are huge cracks in the walls and windows of the houses, due to subsidence. Many inhabitants living within half a mile of this colliery are not able to sleep at night in comfort, solely because of the fact that the heavy machinery that is at work vibrates so much and shakes the windows and doors of all the cottages quite loudly and persistently throughout the night. Consequently, the people who live in the houses are robbed of a proper night's sleep.
That is not something that is happening in old collieries and old villages, which have been built 30 or 40 years. These are new collieries and new villages, and I suggest that the time has come when the Minister of Health should bring definite pressure upon the collieries concerned and the Housing Committees and put a stop to this kind of stupidity and lack of foresight and lack of study for the interests of the inhabitants who have to live in the district, particularly in the case of a company like the Powell-Duffryn Company, who are receiving money from the Government by way of guarantee under the Trade Facilities Act. I am glad to be able to pay a tribute to the right hon. Gentleman's Department and to say that their South Wales expert on the subject of mining sites for cottages has very definitely turned down one proposed site suggested by the local authority, on the ground that it was liable to subsidence and that it lies low on the river bed level and is not a healthy site. The Department have backed up their expert and have put a stop to that proposal. I mention this to show that the right hon. Gentleman's Department can do a great deal in the direction of avoiding these things taking place.
There is one further matter to which I would like to refer, which is not quite so pleasant. I refer to Circular 703. The policy of this Circular is obvious to all of us. Its object is to cut down the scale of relief throughout the Poor Law union areas in the country where there is any serious poverty due to the present national stoppage in the coal industry. In South Wales for years past we have had six, seven or eight Poor Law union areas which have become necessitous areas in the broad sense of the word, in common with many similar areas up and down the country. These areas are in real need financially, through no fault of their own, and not because of the lack of any proper policy or of the wasteful expenditure of the monies at their disposal. Their poverty is due to the fact that these necessitous areas are either mining areas, dependent largely upon the export of coal, or engineering, iron and steel areas, which are also dependent largely upon foreign trade. These areas are necessitous through no fault of their own, but due to the wave of world trade depression.
I want to draw special attention to the case of South Wales. We have been badly hit owing to the fact that we are largely an export coalfield, and we are still suffering from some of the effects of the stoppage of 1921. The hon. Member for Abertillery (Mr. Barker) will tell the House of the tremendous burden which has been put on his particular area. In the Pontypridd Union area we have suffered very heavily during the last 12 months owing to a local mining dispute and the closing of a colliery employing 5,000 men, and also owing to slack time in other collieries. These causes have helped to make the area very necessitous. Now that we are faced with the national stoppage, there is no prospect of the distressed districts raising money out of the local rates to meet the enormous expenditure in relief due to the coal stoppage. Apart from the coal stoppage, we were suffering through a high level of rents and the high cost of living, and many local authorities were heavily in arrears with their revenues for the previous half-year. In the present half-year, owing to the present condition of affairs, these local authorities in South Wales may try to get their rate revenue, but they cannot hope to collect 20 per cent, of the total. Therefore, they are not in a position to meet the normal expenditure incurred in connection with education, health services and various other things which local authorities have to undertake. They are in such a position that they have very heavy overdrafts at the bank, and very heavy loans which they have incurred by sanction of the Ministry have been spent to the last penny. My own authority with a number of others are seeking an interview with the Minister of Health in regard to these matters during the next few days.
It is obvious that none of these necessitous areas can possibly out of current revenue meet a tithe of normal relief which is arising as a. result of the coal stoppage. I look upon Circular 703 as a policy on the part of the Government to try to bully these mining area authorities into cutting down the scales of relief ruthlessly. That is taking an unfair advantage of the financial difficulties of these authorities. I hope that the Minister of Health will consider sanctioning large loans, as far as there is evidence that they are needed, for long periods, so that these authorities may be tided over their present difficulties. The policy laid down in Circular 703 is very unsatisfactory, and is causing a great deal of anxiety not only to the people who are concerned personally, but to the members and officials of local authorities who are faced with heavy financial responsibility. I suggest to the fight hon. Gentleman, respectfully, that his scale of 10s. a week for the wife of a miner and 2s. per child is much too low, and is inhuman treatment of these people. No woman in a mining area, with the high cost of living to-day, can possibly feed herself with the bare necessities and keep in health on l0s. a week, and she certainly cannot keep her child on 2s. a week.
I want to strengthen the appeal made by one of my hon. Friends this evening with regard to the case of the boys. The boys come under two categories. We have boys in the coalfields, from 14 to 16 years of age, who were employed in the mines up to the period of this stoppage. They have had no voice in deciding that the stoppage should take place, or in deciding to reject the terms offered by the coalowners or the new Act offered by the Government. These boys are not responsible in any way for the stoppage. Nevertheless, they are refused poor relief. We say it is illegal and unfair to deprive them of that relief. The second category of boys from 14 to 16 years of age consist of boys who, in normal conditions of improving trade, might have found employment in the mines, but did not, and have never started to work at any trade. These boys could not, by any stretch of imagination or language, be said to be responsible for the stoppage. They have never worked. They have not been members of the federation, and have had nothing to do with the dispute, and we say that they ought to be relieved, like the younger children in necessitous areas. That, briefly, is the kind of information I want from the Minister of Health. I hope, when he meets us on these points, he will try and appreciate the difficulties, and the feeling there is in the coalfield areas that the Government is lending itself by this policy to the suspicion that they are taking sides in this dispute, indirectly, by seeking to use the wives and children of the miners as a lever for crushing them into accepting what they consider most degrading terms of employment.
I do not propose to follow the hon. Member who has just spoken in his denunciation of Circular 703, but I propose to follow him in his congratulations to the Minister of Health on the progress which has been made in town planning, particularly in regional town planning, throughout the country. We have certain problems in regard to housing in London which are different to those of the rest of the country, and as a representative of a division of inner London I wish to put the problem which confronts districts like my own before the Minister of Health. In our case we are particularly affected by the vocational aspect of the problem. We have a working population who have to live in the area where they work; by reason of long association they are attached to the neighbourhood. It is for that type of the working class that we have to make some special provision. That is a short statement of the problem of inner London in relation to the general question of housing. A great deal has been done, especially in the Metropolitan area, in the direction of housing estates on the outskirts of London. These housing estates, to which the London County Council has given great attention, do comparatively little to relieve the problem in the areas to which I refer. Our people cannot live at Bellingham or Becontree and get to their work. There is a lack of transport, and there is also the cost, and the time, and the exertion involved, in travelling long distances to their work. Becontree and Bellingham are too far away, and I think even Barnes would not help us, and there may be other districts beginning with the letter B which are also too far away.
Neither of these two great schemes will be of much help to us in solving our particular problem. If there were not these difficulties of transport it would be much easier to deal with the problem. But the question of transport is also affected by the occupation of the person we desire to transport. A man who has to spend his days in a sedentary occupation, which makes no great physical demand on his frame, can easily walk a mile or two to his home; but if a man is engaged in vigorous physical work, possibly out of doors, or work which makes a considerable physical demand on his system, a convenient method of trans port, which shall not take too long or make too great a demand upon his strength, is essential if his living conditions are to be regarded as satisfactory. Take an extreme case. One cannot expect a bricklayer who may be working on house-building in bad weather to view with any satisfaction the necessity of having to travel long distances on the top of an omnibus on a cold autumn evening. That is bad for the man and for his health, and one can hardly expect him to welcome conditions of that kind or make the sacrifice of leaving the area where he is living at present in order to go further afield, in spite of the undoubted advantages which it might present. When we consider our problem in inner London we are faced with the necessity for finding house accommodation on the spot for a large number of people who, from the practical point of view, cannot live elsewhere; and certain trades impose that condition more than others.
As a rough estimate it is true that about 30 per cent. of the population of inner London are obliged by the nature of their vocation to live near their work. In a district like mine, and in many others in that part of London, we cannot easily build new housing estates because there is not sufficient space. What we have to do is to rebuild the already built on areas, and I hope the Minister or the Parliamentary Secretary will be able to give us some encouragement in the direction of applying town planning to these areas. I should be out of order if I progressed far on that subject because it may involve legislation, but there we have a problem in which we hope the Ministry of Health would be able to assist local authorities in London in solving for themselves. What we require to do is by replanning certain of these areas to make a better use of the space than is the case at present, a more economical use of the space, and also free some of it for open spaces. We have to rebuild the small houses on a larger scale in blocks and tenements, not because everyone desires a tenement but simply because they present a more economical opportunity for utilising the space. You have only to compare the rows of small houses in the East of London with the latest London County Council buildings in Southwark, where you have better accommodation and at the same time free a considerable amount of space which can be devoted to gardens and open spaces. The Minister touched on a point of interest to anyone concerned in the question of housing. He alluded to the research in the questions of ventilation, heating, and materials of construction. I was very pleased to hear that research was being directed to ventilation and heating, and they can be effectively dealt with when we build on a larger scale for tenement purposes.
There are two main obstacles in the way of achieving these results, in addition to lack of space. One is the cost of the sites, and that is a direction in which the Minister might favourably consider giving assistance to local authorities as some substitute for the present subsidy. The other is the great difficulty any local authority is faced with, that in order to rebuild an area you have to accommodate the people at present there and persuade them temporarily, or permanently, to leave their present abodes and live elsewhere. It is difficult to bring any large amount of pressure to bear. You may get a closing order, but, even so, you have to accommodate the people elsewhere and everyone knows the difficulty which that necessity presents. Another problem which arises is that unless you are very careful you will find the area which you have reconstructed filling up rapidly, and it is difficult to control the problem of overcrowding. Unless the area is destroyed you are apt to get overcrowding there again, owing to the permanent demand for accommodation within the inner circle of London. One would be inclined to suggest as a possible remedy a system of control by local authorities which would prevent the population from other districts crowding into a district where the local authority had done good work and improved the conditions, but one hesitates to make that suggestion because once we further restrict the movement of the labouring classes, the more difficult we render their task of finding employment. Though one would like to see something of that sort done, one would like to see it done by some more humane method than actual compulsion.
Another great advantage which will undoubtedly result from the effective application of the principles of town planning and regional planning, is that, we shall have main arterial roads laid out and their use defined. We shall not find it any longer necessary to build byroads on the same scale of expense and probably of ultimate maintenance as main roads. One of the handicapping disadvantages of the past has been that owing to the cost of road-making, frontages were restricted. Everybody had to construct roads of the same uniform standard and the frontage of each house has been restricted to the minimum. From that has resulted the design of, what I call the ill-shaped house with a narrow frontage where we should be much better with a wider frontage, and a considerable depth where sunlight and air would be much more readily accessible were the house shallower in depth. These are problems which can be solved, because we see them tackled in the London County Council estates, where by-roads which are merely intended for communication between one house and another and not for through traffic, are built on a narrower width and of a lighter type than the main arteries of communication. I think one may join in a tribute to the Minister of Health for the great services which the members of his staff have rendered to town planning. In connection with town planning schemes for the areas immediately around London, most admirable work has been done for which present and future generations will owe a great debt of gratitude to the staff of the Ministry. In Kent and all round London, these town planning schemes are being prepared—as the Minister has told us, may thousands of acres are being planned in this way—and, in the future, our successors will have the advantage, without a doubt, of living under conditions far better than those which prevail to-day. They will have conditions of housing and communication which have been too often neglected in the past: above all, they will have open spaces and visions of the country and the sky and the beauties of nature of which our people, unhappily, have long been deprived.
I have had the pleasure and advantage of listening to this Debate for five hours and I think it has been very instructive and profitable. I
regret that the Minister of Health, in his very excellent speech, made no allusion to the question of the health of underground workers in the mines, and I feel indebted to the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle) for raising this matter in his interesting speech. It would appear that, apart from figures as to the deaths of miners and accidents, the health of the miners has deteriorated during the last few years. The number of accidents has somewhat diminished, and within the last 10 years there has been through stone dusting a decrease in the death rate from explosion. But, to whatever cause it may be due, there has been a deterioration in the health of the miner. In the Coal Commission Report some interesting remarks are made on the health of the miner. On page 192 I find the following passage:
At present rates of accident and disease, therefore, it may be expected that in 20 years among the 100 men in round figures two will be killed, nine will suffer fracture of the head or limb or other serious injury, eight will contract nystagmus, and eight more 'beat hand, knee or elbow or inflammation of the wrist,' a total of 27 out of the 100 who will suffer at one time or other from these more serious dangers.
This is a very serious matter for the underground workers. At present, there is no health test as to ventilation. A standard is laid down that there shall not be more than 2 per cent. of noxious and inflammable gas, but that is laid down with reference to the prevention of explosion, and has nothing to do in intention with the health of the miner. I should like to see the Ministry of Health interest itself in this matter, and I feel sure that the health of the mining population would be improved if some standard were laid dawn with reference to the ventilation of the mines. The hon. Member for Withington (Dr. Watts) made a curious suggestion with reference to this matter, namely, that lads before entering the mine should undergo medical examination. It is obvious that this would not make the mines more healthy and it is a very absurd way of looking at the problem with which we are dealing. It is seldom that anything is said in this House with reference to the health of the miner.
Questions are asked in reference to accidents and the death-rate in the mining world, but very little is said of the health of the miner, who, at the end, is very often broken down by bronchitis and half blind owing to the inferior light of the mines. I think the Minister of Health ought to turn his attention to this very serious matter appertaining to the health of the miner.
The Minister, in his opening remarks this afternoon, referred to the problem of housing in necessitous areas. He said that the Ministry were finding a difficulty in discovering a solution of the problem in these areas. I am sorry to say that part of my own constituency has been placed in this category. There is one important point in reference to these areas with which I am more immediately in relation, and of which I have knowledge at the present time—the excellent transit facilities that we have allow our men, who can do so, to find employment in one area and to live in another area. I am sorry to say that the Minister, in relation to the miners housing, would seem to have overlooked this very important fact, because we have been trying to get the Minister to grant us a loan to improve housing conditions in the Blaenau area, and we can only get permission from the Minister to build 20 houses. I have here a special report of the Monmouthshire County Medical Officer, Dr. Roeyn Jones—and there has been very little improvement made in this area of recent times. Dr. Jones says:
The Nantyglo and Blaina area is one of the oldest industrial districts in the administrative county, and the housing conditions now prevailing are in the main a legacy of the past, and to which both the industries and local authorities of the previous century have contributed by the lack of a proper communal vision of health.''
Further on in the Report the medical officer says:
The reports revealed the condition of affairs as being far from satisfactory, and the position has not improved with the passing of the years. On the contrary, matters have become steadily worse. A house to house inspection at the present Time unfortunately reveals conditions of overcrowding and dilapidation that are a reproach to our modern civilisation, and this in spite of the fact that the Council have erected 100 houses under their new housing scheme. No wonder the incidence of certain infectious diseases has been so high during the last 4½ years. Scarlet fever, -pneumonia, tuberculosis, and erysipelas are
propagated in such hovels and breeding places of disease.
A little later he says:
From the foregoing it will be seen that almost one-third of the houses are overcrowded, and that there are about 3,000 too many people housed in the district.
I should like to ask the Minister to pay some attention to this very grave report, because the position is very serious. I have also been trying to get the Ministry to receive a deputation on housing but up to the present have failed. I will, however, say that the Ministry have sent down special officers on two occasions to make investigations. As a result of these visits, the Ministry have agreed to the erection of 20 houses. But 20 houses, the medical officer says, are entirely inadequate, for we need very much more than that. We are able as hon. Members of this House to bring these matters directly to the Minister.
There is another matter—Circular 703. The Circular has been thoroughly exposed as a sham, a fraud, and an engine of oppression, as far as the industrial districts are concerned, by one hon. Member. There is no provision made for single men over 16, nor for married men who are destitute. Suppose a general stoppage takes place in an industry and there is no work in that industry until there is a general resumption. That is very important, because it means that there are many thousands of men who are absolutely unable to find employment. Consequently, they are left to be supported by charity. In my own area we have been responsible for 2,000 meals per day for those who ought to have been relieved by the board of guardians or otherwise by a loan or grant from the Ministry. There are thousands of men who are getting only one meal per day. The Government are not keeping the ring fairly in this dispute—not by a long way. They have deprived the men of the benefits of the Unemployment Insurance Act, for which they have been regularly paying because they will not undertake employment at a very low rate of wages. They have also shut down access to the Poor Law authorities. I understand that the Bedwellty Board of Guardians are in the black books of the Ministry. I myself do not know what the guardians have done. I was on the board of guardians for three years, and I know not why the men and women there who have given their time and labour freely without any reward, should be treated in the manner in which they have been by the Ministry of Health. The only reward they have is to get turned down by the Ministry in disgraceful circumstances and for the service they have rendered to the community! I am told that the Bedwellty Board are in danger of being treated like West Ham. Whether it is true or not I do not know, but it would be a very grave reflection upon the Ministry if there was any truth in the allegation of what they propose to do.
The Bedwellty Board of Guardians have spent fully £500,000 since 1921 in relief of unemployment alone. This fine ought not to have been imposed upon that area but ought to have been a burden upon the whole nation. Now, because of the poverty of the area, because of its unemployment, because of its economic position, it is likely to come under the ban of the Ministry, as I understand it and a penalty is likely to be imposed upon it. There is great distress in that area. I attended an education meeting the other day, and the education officer reported there were many children in the area unable to go to school because they had no shoes. I was at another education meeting one afternoon, and I heard a teacher say that the parents had to stint themselves of food, so that they might send their children to school. The rates in this area have been 37s. 6d. in the £. They are now down to 20s. But there are many hundreds of people who are unable to pay these rates. This is an area that ought not to invoke the anger of the Ministry. It should be otherwise. Thanks should be given to the guardians for the way they have conducted their public work during the last five years.
Some reference has been made by the, Minister to small-pox and vaccination. He said he had appointed a Committee to go thoroughly into this question. I do not want to enter into a controversial question like that. Personally, I have been vaccinated four times, but I have no faith in it at all. In every case I was vaccinated under compulsion. With reference to the Committee which has been appointed, I want to say that I hope it will go into this vexatious question impartially and judicially and I hope there will be some anti-vaccinationist medical officers on it, so that both sides of the question will be thoroughly investigated. The Government remember, I suppose, the result of the famous inquiry held some years ago. An hon. Member of this House named G. R. Taylor, who represented Leicester, was president of that inquiry. He believed in vaccination when the inquiry started, but became so convinced of the futility of it that he afterwards spent the whole of his fortune in opposing it. I hope that in an important matter which affects the health of many thousands of children and the consciences of their parents we shall have an impartial investigation, and I hope we shall get more humane administration from the Minister. I hope, further, that the rumour I have heard about the chastisement, if I may use such a term, of the Bedwellty Board of Guardians has no foundation in fact. I trust, also, that we shall have more humane administration of Acts of Parliament, and more charity shown to men who are the victims of what I cannot term other than an outrageous stoppage of work, and that these men will be provided for as they ought to be under the Poor Law administration of this country.
I intervene to deal only with the question of tuberculosis, which was raised earlier in two interesting speeches by hon. Members on the other side. They brought up the question of the Spahlinger treatment, about which there has been considerable controversy. I have paid some attention to the question of the Spahlinger treatment. While I think it may have a certain value, it is also quite definitely plain that Dr. Spahlinger himself will not enter into any kind of undertaking, of any sort or description, with anybody, or at any time, so that from the standpoint of a Ministry, whether it be composed of hon. Members on this side or on the other side, it is really quite impossible to grant public money to Dr. Spahlinger. I want to say that from this side because I am quite convinced that any responsible group of men or women who had to consider this matter would come to the same conclusion. I quite believe Dr. Spahlinger's work may be of value, but this is very emphatically an occasion for private enterprise and not for public enterprise. I think it is a very good opportunity for private enterprise, and I hope something may be done. But may I say, and I think I can safely say I am speaking for the medical profession as a whole, that the real way of dealing with tuberculosis is by the preventive method and not the curative method. The real way is to raise the standard of life of the population as a whole. If we look at the statistics of consumption over a period of years there is no doubt that as the standard of life has risen so the number of deaths from consumption has gone down. A relationship has even been established between the number of deaths from consumption and the price of corn, in times past—a very important relation. While I am quite willing to believe that Dr. Spahlinger's treatment, and many other treatments which have been brought forward, and which in certain cases are valuable, may be useful in special cases, I am a thousand times more interested in promoting measures which will make any such elaborate treatment altogether unnecessary. If, for instance, we could make such an improvement in the standard of life of the people that everybody, every day throughout the year, had an adequate amount of food and did not do an excessive amount of work, consumption statistics would fade almost out of existence.
I want to snake one concrete suggestion. I admired the hon. Member opposite who, in an airy way, asked the Minister of Health to give £100,000 to make an experiment with the Spahlinger treatment. He spoke of it in a way which rather reminded one, I might almost say, of offering the odds on the course, indicating that £100,000 one way or the other was not very much. I am afraid I cannot take that view. I think £100,000 a large sum of money, and I believe we could do more with it in other ways than we should do by spending it on a scheme of that kind which has, after all, been investigated and which is known to have a certain amount of value. The difficulty there arises from Dr. Spahlinger himself.
But there is another scheme. It is quite true, as has been said, that the sanatoria for tuberculosis have not been of very great assistance, and it was pointed out, I think by the hon. Member for East Ham (Miss Lawrence) that that was very largely the fault of the bad economic con ditions to which the people returned after sanatorium treatment. It is a question of economic conditions and of workshop and household condiions. I believe that if the Ministry would experiment, using perhaps a small portion of that £100,000, in making a workshop in which men could be trained after discharge from consumption sanatoria, where they could learn how to take up again the ordinary work and the ordinary life which they will have to lead, it would of very great assistance in helping .them to get back into ordinary life without relapsing into a- condition of actual tuberculosis.
A valuable experiment of that kind has already been carried out in London. A special workshop has been set up in the Borough of Holborn, where they have shown how men can he trained for ordinary work under ordinary factory conditions, living the ordinary life of men who are working in factories, but exercising such a degree of self-control and such a discipline of their lives as enables them to maintain health under normal conditions. If the Minister would take up that experiment, and initiate similar experiments in other parts of the country, we might get much more value out of our sanatoria. Finally, I would say there is no doubt whatever that the way to deal with consumption is by peventing it, and she way to prevent it is by gradual steps towards improving the general health of the population, and particularly the standard of life. Housing contributes to that, but even more important than housing is the amount of food people cat, that is to say, the amount of wages they receive. The Minister of Health cannot deal with the quest ion of the wages people receive, but he can undertake health propaganda to tell people how to choose the conditions of life, how to choose food and how to choose health rat her than disease: and I hops the Committee will agree that we should not try to find some elaborate and possibly rather costly method of curing disease, but rather should concentrate on preventing it.
I am going to enter into this Debate from a point of view winch has not been touched upon this afternoon. My appeal is on behalf of people who probably do not receive enough to eat, and certainly do not receive enough money to buy the necessities of life, and who live in very poor surroundings—I refer to the ex-service men. I would like to draw the attention of the Committee to the fact that since the War no less than 55,000 men suffering from this terrible tubercular disease were discharged from His Majesty's Forces. It may be of interest to learn that over 21,000 of these men who were discharged have already died. We have now some 34,700 men in receipt of pensions or allowances, and only 1,789 are receiving in-patient treatment. In 1919 an Inter-Departmental Committee was set up to go into this question, and they recommended the expenditure or £1,000,000 for the purpose of setting up village settlements. We have medical men in this House who are naturally able to speak with much greater authority than myself as to whether village settlement treatment or any other treatment is the best for the people suffering from this disease. I think, however, they may agree with me on the whole that sanatoria treatment has undoubtedly done a great deal for the people suffering from that disease, and who are living under conditions which do not help to make them any better.
So far as that £1,000,000 which was recommended is concerned, only £20,000 has been spent. I quite realise that in these days the Minister of Health has to study economy just the same as every other Minister in our great spending Departments, but I do think it is altogether wrong that economies should be practiced to the extent of not permitting these men who have contracted this disease in the service of their country to either get better or prolong their lives. May I draw the attention of the Committee to the fact that over £2,500,000 has been spent by the Minister of Pensions upon sanatoria treatment for these cases, and in my humble opinion that money has been practically thrown away. As a. matter of fact what happens? A man is sent for sanatorium treatment. He stays there perhaps for six or 12 months. He is certainly better as the result of the treatment, but after the six or 12 months he is put to work for which he is not at all suited, and he lives under housing conditions which only tend to make him worse, with the inevitable result that within a very short time that man is worse than he was before, and that is emphasised by the fact that 21,000 of these men have already died. We have some of these village settlements in this country, and they have been carried on with a considerable amount of success, in fact I would say with very great success.
The one I have in mind is at Papworth in Cambridgeshire. The men there have undoubtedly benefited as the result of their stay in that settlement. These men on the report of the doctor are put to suitable work; they live in the open and receive good food, and are able to take a far greater interest in life because they are at work. They accomplish extremely good work and they are paid trade union rates of wages, and the results of their labour are sold in competitive markets. What has been the result? These men's lives have been prolonged and they are living with their wives and families in a certain amount of happiness, even in spite of the fact that their days are numbered. The British Legion has only recently taken over a similar settlement jut Kent, and there quite a number of ex-service men suffering from this disease are living with their wives and families, and although it is only within the last 12 months that we have taken charge of this village settlement, we are at the present moment just managing to pay our way through the sale of the goods manufactured by the people who live there.
In view of that fact it should riot be a very expensive undertaking as far as the Minister is concerned, because before very long under a proper business control these village settlements will be able to pay for themselves. We have in this country to-day many Government factories which were erected during the War irrespective of cost. At present they are unsaleable and unletable, and they might easily be utilised to set up village settlements without very great cost to the country. May I for the moment refer to what the Parliamentary Secretary said? Speaking at the Ilford Isolation Hospital, about 12 months ago, he said:
The cost of this disablement and sickness in England and Wales was £1,500,000 a year. If we could wipe out tubercular disease it would add £1,000,000 a year to the National Exchequer.
The Minister of Health himself, answering a question on this subject last year, said:
The average cost for an inmate in a sanatorium for the year 1923 and 1924 was £130.
Dr. Verrier Jones, who is in charge of the Papworth Institution, informs us that £55,000 has been spent in settling 150 men with their families, and that it cost on an average £336 to settle a family for life. I consider that we owe something to these ex-service men who are now suffering in the way that they are, and I would urge the Government to tackle this village settlement scheme, not only for ex-service men, but also for the civilian population. We are not selfish in the British Legion, and we not only want to do something for the ex-service men, but we also want to do something for those who, perhaps, had not the fortune to serve in the Forces. I think that, if a practical move in this direction could be accomplished, we should do something to build up a C3 nation into an Al nation, and make the lot of those who are suffering from this terrible disease a little brighter and a little happier.
I should like, in the first place, to add my congratulations to those already expressed to the Minister for his very interesting introductory speech in the Debate this afternoon. He is very often criticised from these benches, but there are many here who admire the gifts of expression and the technical knowledge which he shows in connection with the work of his Department. A good deal has been said this afternoon about tuberculosis, and quite rightly, because it is one of the most important diseases. I am not going to say anything more than has been already said about the Spahlinger treatment, except to associate myself with the hon. Member for Withington (Dr. Watts) and the hon. Member for Royton (Dr. V. Davies) in my appreciation of the results which I have seen of Mr. Spahlinger's work. I recognise, of course, that there are considerable difficulties to be faced, but I would like the Minister to keep an open mind in regard to any possibility of acquiring this treatment for those who suffer from tuberculosis. While it is quite true that it is preventive medicine that we want, we must not forget, when we are considering the prevention of new cases of the disease, those who are already suffering—many thousands of them—and who are ready to snatch at any prospect of cure, just as a drowning man would clutch at a straw. I do agree, however, that, apart from any new method of treatment, or as a supplement to it, supposing it were available, something on the lines of the Papworth colony is the proper general plan of dealing with this disease.
I associate myself entirely with the hon. Member for Stourbridge (Mr. Pielou) in regard to tuberculous ex-service men. While there have been from time to time in this House criticisms of the British Legion, I think that some credit is due to them for the initiative they have taken in this matter of village settlements, and I was interested to hear from the hon. Member that, once these colonies are established, there is evidently a possibility of their paying their way commercially, which, of course, is extremely important. Therefore, I hope that the hint which the Minister threw out to progressive municipalities and councils to treat their civilian patients in the same way will be taken up, and I am glad to think that the Ministry will give encouragement to local authorities who show such initiative.
There is one point on which I would like to ask the Parliamentary Secretary to reply in connection with tuberculosis, and that is in regard to light treatment. It has been very clearly demonstrated that treatment, either by sunlight or, as is almost necessary in this country, by artificial sunlight, has a very great effect on certain types of tuberculosis, especially on that form which we call surgical tuberculosis. I think there has been some misunderstanding of the position of the Ministry in this matter. There is an impression among local authorities that the Ministry does not encourage their setting up these installations. I believe that that is a misunderstanding of the position, and I should be glad if the hon. Gentleman could clear that up, because I think it can safely be said that light treatment for tuberculosis has long passed the experimental stage, and that the Ministry should urge local authorities to proceed with installations of that kind.
Then, again, in cases of rickets and in connection with child welfare schemes, some very remarkable results have been obtained by the use of light. The cost, of these installations is not very serious, and I believe that a moderately long view would show that ultimately economies would be effected. The time of treatment for suitable tuberculosis cases would be shortened, and, in the case of children treated for rickets and debility, it would be found that resistance to the ordinary infectious diseases would be so increased that the expenditure in connection with these would be appreciably reduced. I should like very much to have some information from the Parliamentary Secretary as to the attitude of the Ministry towards light treatment. In connection with the same subject of tuberculosis, I should like to say a word about milk. We know that, at least up to last year, roughly 8 per cent. of the milk used in this country was tuberculous. The seriousness of that was realised, and, since September last, power has been given to local authorities to destroy animals which show serious signs of tubercular infection. We know, however, that the milk supply of this country is not yet free from tuberculosis, and is by -no means what we would wish it to be; and we are yet far behind the standard of the United States of America in this respect. I do not like to be behind the United States of America in any of these matters, and I hope that the Ministry will pursue the course which it has already entered upon, and try to eliminate tuberculous milk altogether. We consume, per head of the population, far too small an amount of milk, but really we cannot conscientiously urge mothers to give their children more milk unless we are absolutely sure that it is safe. A suggestion has already been made to the Ministry, as to which I should be glad to hear something from the Parliamentary Secretary, that at least the Ministry might urge on local authorities that their sanatoria and hospitals should only be supplied with tuberculin-tested milk. That would give a certain lead, and would set up a local standard which would ultimately induce people to buy more largely the tubercle-free milk produced under licence from the Ministry of Health.
I should like to say just a word with regard to cancer, with which the Minister dealt very interestingly. He pointed out what, I think, is now generally admitted, namely, that cancer is assuming very serious proportions and has become one of our greatest diseases. Of course, we must remember that possibly a certain increase in these figures is due to better diagnosis, and I think that there is not the cause for alarm that we might feel in simply looking at the increase in the figures. There is no doubt, however, that it is a very serious disease. The Minister spoke with appreciation of the efforts which have been made in research in this connection. We were all pleased to hear of the results of Gye and Barnard's work, and while there has been considerable criticism of their results, and we are not quite sure yet what the outcome of it will be, at any rate they have thrown some fresh light on the problem, and I have no doubt the ultimate result will be helpful. We have raised a great deal of money in this country for research on cancer, and I would like to see, in this connection a little more broadmindedness in the distribution of grants. In my own city we have Dr. James Young working on the cancer problem from a new angle, and while this is not the place to pronounce on the merits of his work, I would like to see a little more sympathy and a little more financial assistance given to people like him, scattered all over the country, who may be somewhat revolutionary in their ideas, but who are working steadily and conscientiously in their endeavour to throw light on this terrible scourge. While we are waiting on the results of research, the Minister rightly pointed out that early surgical treatment was of great value, and I would like to ask the Parliamentary Secretary if the Ministry has done anything in the way of suggesting to local authorities the issue of some advertising matter, pamphlets or leaflets, indicating the first signs of the onset of this disease. That has been done a good deal in America, and some local authorities have done it in this country. It is extremely important, because all who know anything about the subject must realise that one of the greatest tragedies is to see cases of this disease coming to hospital far too late; cases which might have been saved and cured, because early surgical treatment can undoubtedly cure a very great number of those cases. I would like to suggest to the Minister that he should urge local authorities to issue leaflets showing, in regard to men, the danger, e.g., of sores in the mouth, and, in the case of women, especially the danger signs in connection with the reproductive organs. I think that would be very valuable. The Minister spoke of vaccination, which is a very interesting subject. My colleagues around me are nearly all, I think, anti - vaccinationists. Perhaps there may be one or two who still are orthodox in that connection. Of course on these benches we tend to unorthodoxy, and anti-vaccination would naturally attract us more than vaccination at any time, apart from the merits of the case. I must admit that while I have the same tendency, I cannot but say that on a conscientious examination of the facts and figures I think there is no doubt that the case for vaccination is proved. At the same time I think we must admit that there is a growing public opinion in this country against infant vaccination. There are a good many members of the medical profession who arc not now so enthusiastic about infant vaccination as they used to be, and there have been suggestions that possibly a better method would be to, wait until there was some outbreak and then establish a cordon round the area and provide vaccination for those within the reach of infection. In any case, I am sure we will await with great interest the report of Sir Humphrey Rolleston's Committee.
My last point is that of infantile mortality. We were much interested in the speech of the hon. Member for Reading (Mr. H. Williams) who dealt with a great many subjects and who spoke, especially, of infantile mortality. He seemed to be in great doubt as to the cause of infantile mortality and of its diminution. I think there is no mystery about it. There are many causes, of course, but one of the main causes is the housing of the people. I do not care what town you take, if you can show me a chart of the town and I can put my finger marking the most congested part of it, I can say that is the place where, there will be the greatest. infantile mortality as well as the greatest amount of tuberculosis. The greatest cause of infantile mortality is premature birth and congenital debility. It is on the figures of children who die under one month that we cannot make any impression. As the child gets older we have a much better record. The real reason for that is the condition of the mother before the birth of the child. The child is either born too soon or is born in so weakly a con- dition that it cannot survive contact with its new surroundings. I am confident that, if housing is attended to—and we were glad to hear of the progress made—infantile mortality will go steadily down. The mother is all the time in the house, and is much more affected by the housing conditions.
I was pleased to hear the Minister encourage regional town planning and town planning generally. until that is made compulsory we will not get on very fast, because optional schemes have not been well taken advantage of. Regional town planning offers great advantages for the future if carried out. I was very much interested to hear the Minister's advocacy of this, as it was Professor Patrick Geddes, of the Outlook Tower, in Edinburgh, who was the real pioneer of town planning in this country. It is very pleasant to me to hear a tribute paid this afternoon, not to him personally, but to the value of his work.
I would like to join with the last speaker very cordially on this question of the use of ultraviolet rays. I think the expenditure would be well made if the treatment were made available for all classes. The sun is the life of all of us physically, and if you can replace the absence of it in a country like ours" especially in the town parts and in occupations like mining were they do not get access to the rays of the sun, you could do an enormous amount of reinvigorating. It would be interesting to know how many private installations there are in this country. I believe many people have them. They are quite inexpensive and they lead to great invigoration of those who have them. Medical advice is required so that it will not be overdone. I also agree with the hon. Member for North Southwark (Mr. H. Guest) that preventive medicine is very important for all diseases. I wish to bring to the attention of the Minister of Health—and I do not want to say it unkindly—that there are plenty of instances of preventive medicine where he should not entirely rely on the skill, belief and orthodoxy of the medical profession, because the medical profession is a little like my own profession. You do not get reform in law and legal procedure from lawyers. The reason is perfectly simple. It is because those who have arrived at the head of that particular profession naturally think that the system under which they arrive must be a very good one indeed, and they cannot conceive of any other. The same belief, to a great extent, prevails among the medical profession, whom I have no hesitation in calling the most conservative of all professions or occupations, and whose fanatical trade union principle might make every Member on the other side of the House a moderate man. [An Hoar. MEMBER: " They never strike! "] At the time the National Health Insurance Bill was introduced they all threatened to strike against it. It was a great pity they did not, because it was a great pity that nefarious Act was ever brought in.
I wish to call attention to a matter which I think I should like the Minister of Health to investigate and not be too much advised by the medical profession. I allude to a great discovery made by an American doctor and introduced into this country by Sir James Barr, an eminent physician in Liverpool. He said this was the greatest discovery that had ever been made in medicine. I allude to what is known as the electronic reactions of Dr. Abrams of San Francisco. It is one of the most extraordinary discoveries that has ever beer made. The medical profession as a whole uniformly condemn it. They have not examined it. Nine medical men out of ten immediately say " Quackery " and will not listen. They examined it but they did not go into the question of the cures. They did not take it from the point of view of scores of people suffering from very serious chronic complaints, which were reported by medical men to be serious chronic complaints and were completely cured. They said, " We must understand this." When they started and found they could not understand it they proceeded to condemn it. The point of view of many members of the medical profession is that if you are suffering from a chronic complaint and a medical man attends you for a long period of years and does you no good he has been a very good doctor, but if he cures you he is a, quack. I have had a good many cases of that kind in my own personal knowledge of chronic complaints which have been cured. The classic case was that of an Indian Judge who came to this country condemned to die by four medical men in India of considerable eminence. He took advice in this country and it was confirmed that he had only a few months to live. Someone put him on to his particular form of treatment and in five weeks all traces of his complaint had disappeared and he was back at his job in India. He sent an account to a daily newspaper but it was suppressed. He then sent it to "Truth," where it appeared.
I desire the Minister to inquire into these eases. I ask him to read the book which has been published by Sir James Barr giving several scores of cures of these chronic diseases. I ask him not to be weighed down by the bias of the medical profession, because 1 myself have experienced the benefit of it, and I have called attention to it in the Press. Hardly a week passes but I get letters from grateful people who say their lives were saved by it. One medical man wrote at once and said the cure I had undergone was purely psychic, and he once cured a patient of psychic paralysis by giving a raw potato morning and evening. I told him he had better send a couple of bags to every member of the British Medical Association. There is a case where inquiry and investigation ought to be roads, and the Minister of Health should take it up. He should get this book and investigate the cases of these scores of cures. All medicine is empirical. A doctor gives a patient a particular drug. Experience has taught him that a certain reaction takes place. What more is there in medicine than to find out that after a certain form of treatment there is a response to it? There has been a tremendous set against this treatment in. the United States. Certain.' newspapers have laid themselves out to slay it. There was a newspaper campaign in this country, but, fortunately, it was defeated, and the people who were ill were cured. If the Minister will read the " National Review " he will see an article by William Bosanquet. If this treatment is undergone by members of the public—it is not a dear treatment—it will prevent an immense number of diseases that arise from impurity of the blood. Every man has to be more or less a doctor for himself after he reaches the age of 40. I object to the blank wall which is being erected against this particular thing by certain members of the medical profession, and I ask the Minister of Health to take his courage in his hands and investigate it.
There is another point on which the public requires education. There has been talk about the amount of food consumed. The real education of the public is largely needed in the preparation of food. There is far too little knowledge about the preparation of simple foods which are nourishing and good. It is not the most expensive foods that are the best. I notice, among all classes of people, there is far too much ignorance in regard to the preparation of food. Similarly, if you take the question of clothing. Why is it that there is such a great improvement in the health of the rising generation of young women? It is very largely due to the fact that womenkind now clothe themselves sensibly. It is unfortunate that our sex, with a few distinguished exceptions, are so far behind in general knowledge that in tropical weather we go about sweltering. The Minister of Health could do nothing better than to send out general instructions as to the proper clothing to be worn.
I wish to raise three points which deserve the very careful consideration of the Minister of Health. I cannot claim, like my hon. Friend, to be an exponent of the new hygienic clothing either in this House or out of it and I must ask the indulgence of the Committee for one who has not arrived at his eminence of independent thought along these hygienic lines. In the last day or two several questions have been asked of the Minister .of Health with regard to the administration of the Widows', Orphans', and Old Age Pensions Act. It is in reply to those questions that the House has been informed that the number of pensions granted is very far below the actuarial calculations on which the finance of the Act was founded, and to-day, I asked the Minister whether, in these circumstances, he would not, as far as he could administratively, relax some of these very hard and impervious conditions for the granting of pensions to what are known as existing widows. I refer especially to the 104 contributions that must have been made immediately before the death of the person who leaves the widow, and to the fact that the widow must have some children. I cannot explain the position better than to give one example, which I have already referred to the Minister of Health for his consideration, and about which I do not know his reply.
It is that of the widow of a soldier of 30 years' service, who re-enlisted in 1914 and served throughout the War. He became sufficiently disabled, due to malaria, to be unable to follow his pre-War occupation when he was disbanded from the Army, and he, therefore, had to seek some lighter occupation that he could carry on. He was not successful in obtaining a pension for himself, from which the pension for his widow would have followed from the Ministry of Pensions. Consequently, he was not a contributor at the time of his death. The widow has three young children, five, eight and 14 years of age, and although she complies with every condition in regard to having young and dependent children, she receives not a farthing from the Ministry of Pensions or under the late Act. I hold that where there can be such cases under that Act, beneficial as I admit it is, it is not a perfect Measure, and although I should not be in order in suggesting Measures that the Ministry could take if they found themselves administratively bound, I will suggest that the remedy is in their own hands when they find that the expenses of administration have not anything like equalled the actuarial calculations on which the finance of the Act was based.
The next question to which I wish to call attention is this: Earlier in the Debate the Minister deplored the increase in the cases of small-pox. I would call his attention to the fact that there is another disease, just as deadly. I refer to venereal disease, which is only being dealt with with the gloves on. I ask him to take the courage of his opinions, for I know they are his opinions, in both hands and deal with the terrible scourge of venereal disease from every point of view. A few days ago I asked a question of the Secretary of State for War as to the results in the last three years in the Army in the matter of the incidence of venereal disease, and he told me that, whereas three years ago it was 74 per 1,000, it has now been reduced to 47 per 1,000, and that the military medical service consider this great reduction is due, in the main, to the successful preventative measures adopted in the Army. What right has the Minister of Health to withhold from the civilian population the preventative measures, authoritatively prescribed, which have been found to be of such immense service in the Army?
In the Home Command the figures are even more startling. I have not got this in answer from the Secretary of State for War, but I know from inquiries that I have made that, for instance, in the Aldershot Command, the incidence of venereal disease, entirely due to preventative measures, is practically negligible at the present moment. Four years ago we had a Report from a Committee that was set up, under Lord Trevethin, in Clause 14 of which the Committee made a definite recommendation to the Ministry of Health. Two deputations have gone to see him, and the Minister said to those deputations that the present state of the law, upon which he had consulted the Law Officers of the Crown, was that any chemist was entitled to sell any preventative he chose, provided it was accompanied only with verbal instructions, but that there was no means authoritatively to state what were the preventatives that were proved to be most efficacious. Nobody supposes that any one of them is absolutely efficacious, but we have had great experience in the Army and Navy. He said there was no authority which could be set up, and that a chemist was not entitled, in the present state of the law, to sell a proved preventative if it was accompanied by any written or printed instructions. What is the use of setting up Committees and their reporting to the Ministry of Health? What is the use of our having a Ministry of Health, if it cannot take a Measure of that kind, which would be of incalculable benefit to future and unborn generations, and which would remove an enormous incubus from the taxpayers of this country, and untold misery and suffering from young children growing up malformed, blind, and mentally deficient, kept in a miserable state of existence, at enormous expense to the State I say that the Minister could set up half-a-dozen authoritative Committees to settle this question to-morrow if he desired to do so, and I ask that he shall deal with the matter without further loss of time.
The last question I want to put to him —and it is very closely analogous—is this: I want to know what is going to be done about that Resolution which was passed in another place the other day, on the motion of Lord Buckmaster, that maternity centres and child welfare centres should not be debarred from giving to married mothers the necessary instructions to enable them to limit their families in cases where there was no possibility of their bearing children which would be healthy and of their bearing children without serious detriment to their own health. Beyond and behind that, there is the question of the venereally affected prospective fathers. I say that in cases of that kind we have got maternity and child welfare centres, and that this is the very thing that we ought to facilitate in every way that we can, so that we may limit this terrible inheritance of posterity from venereally infected persons, who go on breeding and breeding, and the Ministry will not allow the medical men in charge of these centres to give the necessary instructions to mothers. I want to know what is going to be done about that, and I hope the Minister will deal with that question, which was raised earlier in the Debate by the hon. Member for Londonderry (Sir N. Macnaghten). I promised him that I would impress on the Minister, if I got the opportunity, that this question is a vital one, and we want to know what is going to be done about it.
I think the Minister of Health must have been wondering very much at the turn of the Parliamentary kaleidoscope, and must have been saying to himself: What great evil have I done that all men speak well of me? For, I suppose, hardly any speaker in the Debate to-night has not paid some tribute to the right hon. Gentleman for his speech and for the one side of his personality which has stood out well in reference to his Department. I am also quite willing to pay my meed of tribute to his speech and to the work he has done in certain directions. I only wish it had not been necessary to criticise it in certain other directions. I want, however, to say one thing with regard to a point raised in the wonderfully interesting and informative speech by the hon. Member for the Royton Division (Dr. V. Davies), with reference to his request that a certain sum of money should be devoted to help Mr. Spahlinger in putting his treatment on the market. I do know that the Government which preceded this one tried to come to terms with Dr. Spahlinger, and, I believe, were prepared to give as much money as was requisite. I know that there have been deputations from this House of medical men, who have seen that eminent scientist and endeavoured to bring him to reason, but it seemed impossible to do business with him, and that is the difficulty more than anything else. I believe that is the real reason for the failure to make this cure as widely known as it might be.
Now I want to turn for a moment to Circular No. 703. The Ministry of Health seems to take some credit for it and they referred to the conditions of the arrangement which was made in 1921. Is there anything that the Ministry can plume itself upon in regard to the scale issued in 1921? I remember that, following that, there was a scale issued by a distinguished recruit to the party opposite, the right hon. Gentleman the Member for Carmarthen (Sir A. Mond) who was then Minister of Health. It was known as the Mond scale. It was then considerably criticised. It was immensely superior to the scale of 1921, which is now more or less looked upon as a standard. The scale of 1921 laid down that a man and wife should receive 25s.; the first child Os. That was then and is now considered inadequate in every respect to supply the ordinary necessities of life. Now we have got the new scale, and particularly in its application to the districts affected by the present coal stoppage it can only give any fair-minded Member the impression that the Ministry are joining with one of the parties in the dispute to bring the pressure of starvation on the other side. Where you have a man on strike, his wife can receive 12s., which is 5s. in respect of herself and 7s. as a special allowance, and the children will receive 4s. respectively, so that you will have the case of a woman and three children receiving £1 a week. I suggest that, at this time of day, whatever may be the merits on either side, to come before the House of Commons and suggest that that can be defended on the grounds of humanity is trying the credulity and patience of the Committee more than they should be tried.
I turn to some of the figures and statements made in regard to certain diseases in regard to which investigations have been carried on. 1 gather from the figures that, during the last 50 years, the death-rate from tuberculosis has fallen from 240 for every 100,000 until it is now 80 for every 100,000. But it is not the slightest bit of good going in for all these curative measures and then turning the people back again to the conditions which have brought about the trouble. I say that in order that we may get same statement from the Minister that there will be no reduction in the subsidy so far as the building of houses is concerned. That has a very vital bearing on the question of tuberculosis. If anything is to be done to diminish the amount of building that is going on, that is bound to upset all the good results. I make no apology for calling attention to some of the facts of housing at the present time, from a quarter which has never yet been brought to the attention of this House. I have here a Report of the medical officer of health of a district which is half-an-hour's car ride from this House, revealing conditions which even the Report of the Commission of 1840 cannot parallel with anything so bad. I am hoping that the Minister will apply some pressure to this council, the Camberwell Council, in order that they will go in for some scheme of housing. The council that preceded them was a Labour council, who set out on a big scheme of re-housing. They acquired a considerable amount of land, and they erected a large number of houses, but directly the present council came in they shut down the housing scheme and there has been nothing done, though there are conditions of housing there which cannot be paralleled in any civilised city in the whole world, I believe. Here is what the medical officer says in his report for 1925, which has just been issued:
In many cases the floors of the ground-floor rooms are below ground level; the main walls delapidated or bulging; the staircases are not lighted or ventilated to the external air. Many of the rooms in the area are unfit for human habitation, owing to the dampness arising from the
ground or the delapidated condition of the main roofs. Most of the dwellings represented in Bowyer Street are so overcrowded that the wash-houses are in use as living rooms, and many of the bedrooms are verminous. Some of the houses have back bedrooms of a capacity not exceeding 400 cubic feet. In all the houses dealt with there are no water fittings within the buildings and no washing-up sinks provided. Mayhews Buildings, in Wyndham Road, consist of a block of hack-to-back houses built almost entirely of wood. The ground floors of these houses are much below ground level and entered from a common yard by doors, in some cases only 4 feet 6 inches high. The staircases are narrow, winding, insufficiently lighted, and ill-ventilated. The floors of the rooms are worm-eaten, and the plastering of the ceilings and internal walls generally delapidated. These houses are without coppers and washing-up sinks, and have no water fittings within the buildings, and are provided with only one water closet and one water stand for the use of two houses.
I suggest that a state of affairs like that is a disgrace to any community and to any civilisation, and that is a reason why there should be no going back on the subsidy, but that everything must de done so that conditions like these may be removed. I could take the right hon. Gentleman to one house in Camberwell, an eight-roomed house with 40 people living in it—not bad people, but decent people. That is more or less the condition prevailing throughout at least one section of that borough. Any talk about doing anything to limit the efforts which would enable us to get on with building would be wicked and nothing short of murderous.
I now turn to another point. I want to ask the right hon. Gentleman about it. It is a point I have raised before, and that is with regard to encephalitis lethargica to which reference has been made. It is a matter I have brought before the House on several occasions. I believe the last time it was brought to the attention of the House the Minister made a statement to the effect that arrangements have been made, in cooperation with the Ministry o Health and the London County Council, to provide a certain amount of treatment at Winchmore Hill. The weakness of the scheme I pointed out is that it provides for dealing with young persons up to 15 years of age. One of the troubles connected with the disease is that it does not impair the young people so much mentally. Very often they are more alert on that side than the average, but it has an extraordinary effect on the moral side of their character, and comment has been made by learned Judges and magistrates that they are placed in an awkward position by such cases. They have to send them to prison or condemn them as lunatics, when really they should not go to the lunatic asylum or be adjudged criminals. But they are placed in this invidious position. That being the position, it emerges that what is needed for these young people—and this is on expert authority—is proper treatment and care with which they can be cured and turned out as proper citizens. One of the chief difficulties in dealing with the case of young people up to 15 years of age is that you are not only dealing with cases of theft, but with cases of sexual offences. It is wrong that after the age of 15, when all these emotions and passions are surging in the young people, that they cannot be dealt with in the period of adolescence. I am told this disease has declined, but the figures seem to show that it is going up more rapidly than it did a year or two ago. I know that the matter is one which will receive the sympathy of the Minister of Health.
There is just one other question to which I want to call attention, namely, the provision of maternity centres and the treatment of mothers and infants. I believe I heard the Minister say that expenditure under this head shows a large increase, which indicates that something is being done. But it is as well for us to realise that a great deal more remains to be done, particularly when we have regard to housing conditions such as I have brought before the House. The possibility of training and rearing children into decent citizens is going to he very difficult. What Parliament must do is to provide means whereby expectant mothers can be provided with conditions which will give her little ones some chance of life. The figures before us are very alarming, despite what is being done. Figures, which I have before me, show that in 1924 the birth-rate was the lowest recorded since ,1917–19. Yet the infantile death-rate was higher than in 1923, which was the best year, for it showed a death-rate of 69 per thousand, and it rose to 75 per thousand. These figures show that 54,557 babies, that is children under one year, were lost, of whom more than 32,000 died in the first three months, and the greater part of these in the first month, and of those who died in the first month the greater proportion died in the first week.
The terrible commentary is that those qualified to know say that these children need not have died and that under proper conditions, had the mothers been given a chance to rear them, they could have grown into useful citizens. This means that the community is guilty of condemning to death every year something like 55,000 potential citizens who would have grown up into healthy men and women. We have no right to consider the mere question of pounds, shillings and pence when we are brought up against problems of this sort. While I do not in any way depreciate the work that has been done by the Ministry in this connection, I urge upon them that there is ample room yet for further work in this connection. A good deal more can be done with regard to clinics, and giving mothers more instruction in modern midwifry and general health. In this direction the Minister I think can give considerable help and a considerable lead, and I hope that this and other points which I have brought before the Committee will be included in the reply with an assurance in regard to them. I hope also that we shall have an assurance that, before any attempt is made to interfere with the subsidy for housing, we shall be given an opportunity of discussing it in all its bearings and implications, and that during the time Parliament is in Recess no alteration will be made in regard to it. Conditions such as I have indicated are far too serious to be allowed to go on. It might happen during the Parliamentary Recess that some change might be made. I do not know that it is so, but there are rumours, and we should be fully apprised of any decision before any modification is made, so that this House should be able to discuss it.
I am sure my right bon. Friend the Minister of Health would desire me to thank so many Members of the Committee for their very kind expressions in regard to many aspects of the work of the Ministry of Health. I myself have been present during recent years at almost every Debate in connection with this Department, and I think I can confidently say that on no occasion has there been so little criticism of the work of the Department, which covers so many aspects and is in such close connection with our social life, as has been expressed to-day. I made a note of the many questions which have been raised in the course, if I may say so, of a very excellent Debate, and if I were to reply to all of them I am afraid the Committee would be very resentful. Housing has been raised, Poor Law, tuberculosis, playing fields, open-air dancing, the Spahlinger treatment, vaccination, birth control, town planning, necessitous areas, maternity and child welfare, the health of the miners, the block grant system, sleepy sickness, and last, but not least, Abram's box. That gives some indication of the variety of the work of the Ministry of Health. I was surprised when I heard the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle) suggest that more work might be given to the Ministry of Health. I agree with another doctor, the hon. Member for Withington (Dr. Watts), who said that the range was almost too great already I will deal with what I regard as the more important issues that have been raised.
Amongst the first I put the problem of housing. With the exception of the hon. Member for East Ham North (Miss Lawrence), a general tribute was paid to the great progress that has been made in connection with the supply of houses during the last two or three years. In that connection, the Ministry of Health make no special claim because, undoubtedly, a great deal of credit is due to the local authorities and, above everything else, to the work of private enterprise. I was amazed to hear the hon. and gallant Member for Central Hull (Lieut.-Commander Ben-worthy) deliver an indictment, in his short, breezy speech, against private enterprise in connection with our housing progress. I venture to correct the figures with reference to the total number of houses that have been built in this country since the Armistice up to the 1st April. I find that 648,513 houses have been built in that period. If I had the figures up to date the number would have been bigger. Two remarkable features of these figures are well worth the attention of the Committee, and especially of hon. Members opposite. Of the 648,513 houses, 391,508 were built with State assistance and 257,005 without any State assistance: a very remarkable record.
When we come to the question of private enterprise, we see a more remarkable position, because of the 648,513 houses, 233,674 were built by local authorities and 414,839, the great majority of which were what we call working class houses, were built by private enterprise. I often wonder when I hear hon. Members opposite denounce private enterprise and all its works, what numberless people in this country would have done in connection with housing but for the efforts of private builders up and down the country. There can be no doubt about it that the corner has been turned as far as housing is concerned and that, at last, we are beginning to catch up the shortage. Reference was made by the hon. Member for Nelson and Colne (Mr. Greenwood) to the Wheatley Act and he emphasised the advantage it was to the country. At any rate there can be no accusation made against the Minister of Health, an accusation which has been made in certain quarters less responsible, that the Wheatley Act has nor been given a chance by the Minister of Health. He has pursued in this connection a national policy of calling upon all sources which would aid and help housing, and he has worked the Wheatley Act to the best of his ability.
It should be observed, especially having regard to the observations of the hon. Member for East Ham (Miss Susan Lawrence) that the Chamberlain Act, as we call it, gave a subsidy of £6 per house for 20 years, whilst the Wheatley Act increased that to £9 for 40 years, and if you take the rough figures you will see that the Wheatley Act means an increase of between £75 and! £80 over the Chamberlain subsidy. I was surprised to hear the hon. Member for East Ham speak with approval, so far as rents are concerned, of the Wheatley houses, because it should be known that in spite of that Act, which was started to provide houses to let at rents below those of the Addison houses and the Chamberlain houses, that hardly without exception—and this can be ascertained by hon. Members opposite—local authorities have not distinguished in any way between the Addison houses, the Chamberlain houses or the Wheatley houses, and, therefore, notwithstanding the larger subsidy the rent of the Wheatley houses is practically the same as that of the Chamberlain and Addison houses.
I am afraid that does not help the hon. Lady. In the case of the Addison scheme the position is that the rents in the first place are fixed by the local authority itself, and if there is any dispute with the local authority the matter goes to an independent tribunal, who adjudicate between them. In the case of the Wheatley and Chamberlain Schemes the Ministry of Health has no part in the matter at all.
I am only speaking of England. So far as there is a comparison between the Wheatley and Chamberlain houses, I have stated the position perfectly accurately. Then, on the question of the subsidy. The hon. and gallant Member for Leith (Captain Benn) quite rightly expressed the anxiety of a large number of local authorities as to what was likely to happen in October, and he naturally desired that, if possible, some conclusion should be arrived at before that date. Before discussing the terms of the Section in the Act of 1924, let me assure the hon. Member for Camberwell North (Mr. Ammon), who gave a description of housing in Camberwell which we all deplore, that there is no question of any variation in the terms in relation to the clearance of slums. That is not affected in any way, and the Minister of Health has no intention of interfering with the financial arrangements. The only matter which is affected is that, under the provisions of the, Housing (Financial Provisions) Act, 1924, which hon. Gentlemen opposite will recognise—
My point was that, by stopping the housing scheme which the Camberwell Council formerly had, you prevented withdrawal from the slum areas, and prevented them being pulled down.
I am. glad to give the Committee the assurance that there is no question of interference with the financial provisions in connection with slum clearances. Section 5 of the Housing (Financial Provisions) Act is very clear and we have given a good deal of consideration to it with a view to seeing if it was possible to indicate any earlier, any decision that might be made in connection with the revision of the subsidy. The Section says:
In the year nineteen hundred and twenty-six, after the first day of October in that year and in each second succeeding year, after the first day of October in such year, the Minister and the Scottish Board of Health shall take into consideration the expenses which are likely to be incurred in the period of two years from such first day of October.
On the reading of that Section, in the way in which it is expressed it is very difficult to see how it is possible to come to a decision before the first day of October.
Does the hon. Gentleman not see further difficulty which he gets into if he adopts that argument? Ho has to make the change, if change is to be made, by Order and the Order cannot be laid without a positive Resolution of the House of Commons. On the first of October the House probably will not be sitting and, if he refuses to come to any decision before then, he leaves himself with a gap during which apparently no subsidy will be payable.
In putting this point I was very careful as to the words I used. The point I raised was that, in the two years' run, if, some time after 1st October a decision be taken, then the new rents—if they are altered in any way—become operative, and the House of Commons then should have an opportunity of discussing it. It does not matter to us whether it is November or December.
I agree that that must be met if possible, and there is some considerable difficulty in the way suggested by the hon. and gallant Member for Leith. I wish he had been more vigilant and that I myself had been more vigilant in 1924 in directing more acute criticism to the actions of hon. Gentlemen opposite.
I wish I could make it possible, but if the House is not sitting in October or November that is one of the difficulties of the situation. If it is at all possible, my right hon. Friend would naturally be desirous of hearing the suggestions and criticisms of the House on this particular matter. In regard to the fears and apprehensions which have been expressed, I suppose there is no one in the House of Commons—if I may put it so strongly—who is more desirous of maintaining the housing record of the present Government than my right hon. Friend, and we shall do nothing to diminish the undoubtedly fine record which we can present to the country to-day. We must have regard to the increase in cost which hon. Gentlemen know full well has taken place during the last year or two. 1 was comparing the figures of March, 1924, with those of March, 1926, and in the case of the non-parlour house, for instance, I find that in March, 1924, the price was £418, and in March, 1920, it was £442. Therefore, we must have regard to a matter of that kind, and especially would I ask the hon. Member for East Ham North (Miss Lawrence) to help us, and to remember, in regard to cost, low rates have their effect. I hope she will use any influence she may have with the people with whom she is particularly connected in this matter of housing, that is, those who actually build the houses. I should like to say a word it two now on the question of the Widows', Orphans' and Old Age Contributory Pensions Act, about which one or two matters have been raised. I do not propose to reply in detail to all the questions that have been put by the hon. Member opposite—I will not have time—but my replies to him will cover the question put by other hon. Members. The question of the administration of the Act has been raised. It has now been some six months on the Statute Book, and I venture to say that the Act, in its administration, has proved even more successful than was originally anticipated. It was not proved that " most heartless and fiendish fraud " ever perpetrated on the people; on the contrary, during the last few months my right hon. Friend has had to consider many applications, especially from those associated with hon. Members opposite, to admit more people to the benefits, and to extend them. The reports of the inspectors of the Ministry show that so far from insured persons resenting paying the extra contributions or in any way to objecting to the contributory principle, employers and other people have gladly paid. One of the most satisfactory things in connection with the scheme has been the demand for voluntary insurance, and the Estimates which were recently given to this House, so far as we can judge at the Ministry of Health, have already been greatly exceeded, and we anticipate a large number of people who, undoubtedly, are wishful to join the voluntary side.
A matter was raised by the hon. Member for North Camberwell (Mr. Ammon), that will be in the memory of those who heard the discussions on the Bill, as to what has happened in reference to the Army and Navy Insurance Fund, and as to the Chancellor of the Exchequer's action on the Economy Bill. I find that a report issued yesterday shows that extra sickness benefit, over and above the ordinary, has been increased by 3s., making a total of 1.8s.; disablement benefit has been increased by 1s. 6d. a week, making in all 9s. per week; while maternity benefit has been increased by 6s., making the maternity benefit payable by the Fund no less a sum than 46s. In addition to that they will receive additional benefits in the way of dental and ophthalmic treatment.
As far as we can judge, these are the average benefits which are received by members of approved societies, and it was with that in view that these benefits were fixed and I think we can say with respect to the whole administration of the Contributor Pensions scheme that without involving reckless expenditure this scheme has already brought about a great difference in the lives of a large number of women and children and old people who, through no fault of their own, were greatly in need of help.
Just a word on the question of tuberculosis and the points raised in the very excellent speech, if I may say so, of my hon. Friend the Member for the Royton Division (Dr. V. Davies). I cm sure everyone is gratified that we have been able to make extra provision in these Estimates for dealing with that very dreadful disease. When there is talk of starving the social services, I hope hon. Members opposite will always point out that in the year 1926 this Government were doing still more to grapple with that disease. Provision is made this year of a sum of no less than £1,600,000 for that purpose. I do not say the expenditure of money is always a guide, but it has something to do with the matter.
I have only one word to say on the Spahlinger treatment, because it has been effectually dealt with by the hon. Member for North Southwark (Mr. H. Guest). I have had the honour of serving under various Ministers of Health, and I believe all of them have had to face the same difficulties as my right hon. Friend has had to face in connection with this matter Directly he came into office my right hon. Friend took a step which one would expect him to take. He had heard of this treatment, he had heard a great many promises made in connection with it, and he bad heard of a certain number of eases which, it was stated, had been of exceptional interest. He made an offer to Mr. Spahlinger to send over officers of the Department to examine into the discovery and, in any way that was possibly open to him, to effect such an examination as any reasonable man should make in a matter of that kind. That offer was rejected.
I think that is true to this extent, that officers had been there and had seen certain cases, but up to this very hour, I think the hon. Gentleman will agree, no such explanation or facilities have been given as would warrant any man who is careful of recommendations he may make in a matter of this kind to bring it before the House and say a Government grant should be made. It has been through no fault of numerous Ministers of Health that no further trial has been made of this method. Offers have been made to go there, and suggestions have been made to Mr. Spahlinger that he should provide such opportunities here as would allow of a proper and careful examination, in order that we might make a recommendation. It is utterly impossible, as suggested by the hon. Member, that my right hon. Friend should make a gamble of £100,000 and ask the House to vote such a sum under those circumstances. The only other matter raised was the question of child welfare centres. This is the formula in connection with these centres. Two conditions are laid down. One is that maternity and infant welfare centres should deal only with the expectant and nursing mother, and not with the married or unmarried woman contemplating the application of contraception methods. The second condition is that it is not the f unction of an ante-natal centre to give information as to birth control, and where the avoidance of pregnancy seems desirable on medical grounds it should be referred either to the local private medical practitioner or to the hospital. An alteration of this policy has been urged before by hon. Members, but before my right hon. Friend recommends an alteration in public policy it must have a more considerable backing and more assent on the part of Members of this House than at the present moment.
In the few moments left I would like to deal with the criticisms of a more drastic nature in connection with the administration of Poor Law relief. Hon.
Members opposite must forgive me if I speak strongly in this connection, because some very serious statements have been made, especially by hon. Gentlemen opposite, who have referred to what they call the policy of starvation adopted by my right hon. Friend, and they have asserted that he has succeeded in reducing relief at the expense of the poor and those who seek relief. Reference has also been made to the circular which has been issued on this question. I think I should say that in the first place the circular is an explanation of the law, and the hon. and learned Member opposite who is an ex-Law Officer of the Crown, had no criticism to make of the statement in that circular so far as the law is concerned. A question was put, which I want to dispose of at once, with regard to boys, in connection with the interpretation of the circular, and, as the matter was put to my right hon. Friend by the Labour party deputation which attended on him, legal advice, as promised, was taken, This was the statement which was made by the right hon. Gentleman the Member for Seaham, who put the position before the Minister of Health:
The letter was interpreted by guardians as meaning that relief should not be given to a man on strike, but only to his wife and family; but there were in the mining areas many thousands of boys between the ages of 14 and 16 years who were not eligible for relief under these conditions, as they were normally employed in or about the mines.
As that question was put to us, it simply dealt with the question of being normally employed in or about the mines, and this is how I am advised in the matter. I am advised that the fact that boys under 18 engaged in the mining industry have no voice in determining whether a trade dispute shall be begun or continued does not affect the application to them of the law as laid down by the Court of Appeal in the Merthyr Tydfil judgment. The question has also been considered whether the position is any different in the case of boys under 16, who, for certain purposes under the Poor Law, are regarded as children. I am advised that the mere fact that the boy is under 16 is not a justification for the grant of relief, hut the age of the boy is obviously a fact to be taken into consideration in deciding whether he is unable to support himself. That is the answer which I have to make to the particular question that was put.
I want to answer two or three other criticisms which were made in connection with this matter, and I want, if I may, just to say very briefly what actuated my right hon. Friend in issuing this Circular. In the first place, he had to have regard, not only to the law, but to the financial position with which guardians were faced, having regard to the industrial conditions. At the outbreak of the general strike there were in England and Wales, in receipt of Poor Law relief, about 650,000 persons; but on the 19th June—and this shows how necessary it is to have regard to the financial considerations that affect guardians—on the 19th June there were no fewer than 2,305,000 persons in receipt of relief. I think my right hon. Friend was very wise in pointing out to the boards of guardians of the country the necessity, not only for administering relief in accordance with the law, but also for having regard to their financial position; and it is very interesting to give this one indication of the position so far as the boards of guardians were concerned, that it is estimated already, in connection with the general strike, taking into account only the additional cost of relief, that the general strike has cost the guardians of the country probably over £3,500,000.
It has been said that the suggestion made in the Circular by my right hon. Friend is working great hardship in the mining areas, and, in the words of the hon. Member for Nelson and Colne, people are being starved, and great suffering is occurring. It is just as well that the House should know the information which is in the possession of the Ministry of Health in regard to this matter, because one of the first things that my right hon. Friend did, as a humane man would do, was to ask the general inspectors of the Ministry of Health to inform him if there were any cases of hardship or suffering, so that, if the question arose, he would have the information and could intervene, and I just want to give to the Committee a summary of one or two of the reports which we have received at the Ministry of Health. This is the information that comes from the Divisional Food Officer of the Northern Division. He says that a tour of the area mentioned
failed to disclose outside signs of distress. The multitude of brown-faced, sturdy children seen in the school yards looked
uncommonly well fed, well clad, and happy.… Whatever those residents may lack they do not lack food. At the cooperative and other large stores the food counters are well patronised, and the carts which tour the areas are supplying almost as much foodstuffs as before the stoppage.
There is another statement which covers another district. The Assistant General Inspector reported that at the Salford Union arrangements were made to provide dinners for single strikers, and about 40 reported and availed themselves of them. On the three following days, only two men per day presented themselves. The remainder did not come because they considered the distance was too great. This seems to prove that they were not in serious want. There is another report which covers the matter raised by the right hon. Gentleman in connection with the case I think he mentioned at Lichfield:
Reports from Burton-on-Trent and Cannock suggest that instead of being starved the children are now doing better in the matter of food than they were in the lean times before the strike. This curious result is traced to the fact that numerous private persons or organisations are promoting soup kitchens, and without acquainting the guardians of the fact, and the guardians are relieving the families simultaneously.
In the communication which my right hon. Friend addressed on the 5th May to the boards of guardians of the country there is this statement which, I think, is very applicable to Lichfield. That, the Committee will remember, is where the Lichfield guardians proposed at an early date to discontinue the grant of relief to the dependants of persons affected by the present industrial dispute. This is what my right hon. Friend said to the guardians
The functions of the guardians is the relief of destitution within the limits prescribed by law, and they are in no way concerned in the merits of an industrial dispute, even though it results in applications for relief, They cannot therefore properly give any weight to their views in dealing with the applications made.
Following that statement, which my right hon. Friend adheres to, both in regard to maintaining the law in the direction of not giving relief and of giving excessive relief, a communication has been addressed to this board of guardians, which I think, effectually disposes of the suggestion that my right hon. Friend has any intention of allowing, as far as he can help, boards of guardians to disregard the law either in one direction or the other. He said on 12th July:
I am directed by the Minister of Health to state that his attention has been drawn to the statement in the Press to the effect that the guardians of the Lichfield Union propose, at an early date, to discontinue the grant of relief to the dependants of persons affected by the present industrial dispute. It is, of course, for the guardians or for the relieving officer, when he receives an application which he regards as one of sudden or urgent necessity, to determine whether a particular applicant for relief is destitute and to what extent relief, whether indoor or outdoor, is required to meet that destitution. It appears, however, to the Minister that the maintenance of a general resolution such as is reported is incompatible with an intention on the part of the guardians to discharge the functions of their office, which exists for the necessary relief of destitution, and I am to request that further consideration be given to this matter before the date upon which, if the report received is correct, the resolution referred to would come into operation.
Therefore there can be no question of the very prompt action my right hon. Friend has taken in this connection. Any accusation of my right hon. Friend seeking to strain the law either in one direction or another is entirely without foundation. After the reports I have given there can be no question but that the policy adumbrated in that circular is both wise and necessary, and not one single person is suffering as the result of it. There is not a country in the world that has done and is doing so much for people who require and deserve help as we are doing. You have only to look at the figures of the Estimates which we
have presented to-day to see what a real contribution is being made by all classes of the community to people who need and deserve assistance, and when you remember that, in addition to these Estimates, a sum of something like £308,000,000 is being provided at a time of great industrial depression on behalf of education, the Poor Law, health and housing, the criticisms which have been made by hon. Members opposite, and so frequently repeated in less precise terms outside The House, are without foundation, and I ask the Committee to reject the Amendment and give my right hon. Friend his Estimate.
The point put to the Law Officers of the Crown was the point put to us by the right hon. Gentleman the Member for Seaham. In order that there shall be no doubt about the matter I will take further steps and see that further opinion is taken on the matter, which has now been put to us for the first time.
The point was raised by my right hon. Friend the Member for Seaham at the deputation, and I have raised it twice myself, and I was promised an answer in this Debate.
|Division No. 366.]||AYES.||[11.0 p.m.|
|Adamson, Rt. Hon. W. (Fife, West)||Beckett, John (Gateshead)||Buxton, Rt. Hon. Noel|
|Alexander, A. V. (Sheffield, Hillsbro')||Benn, Captain Wedgwood (Leith)||Cape, Thomas|
|Ammon, Charles George||Bowerman, Rt. Hon. Charles W.||Clowes, S.|
|Attlee, Clement Richard||Broad, F. A.||Compton, Joseph|
|Barker, G. (Monmouth, Abertillery)||Bromfield, William||Dalton. Hugh|
|Barnes, A.||Bromley, J.||Davies, Rhys John (Westhoughton)|
|Barr. J.||Brown, James (Ayr and Bute)||Day, Colonel Harry|
|Batey, Joseph||Buchanan, G.||Dennison, R.|
|Duncan, C.||Kenworthy, Lt.-Com. Hon. Joseph M.||Short, Alfred (Wednesbury)|
|Fenby, T. D.||Kirkwood, D.||Sitch, Charles H.|
|Garro-Jones, Captain G. M.||Lansbury, George||Slesser, Sir Henry H.|
|Gardner, J. P.||Lawrence, Susan||Smillie, Robert|
|Gibbins, Joseph||Lawson, John James||Smith, Ben (Bermondsey, Rotherhithe)|
|Gillett, George M||Lee, F.||Snell, Harry|
|Gosling, Harry||Lindley, F. W.||Snowden, Rt. Hon. Philip|
|Graham, D. (Lanark, Hamilton)||Lowth, T.||Stephen, Campbell|
|Greenall, T.||Lunn, William||Sullivan, J.|
|Greenwood, A. (Nelson and Colne)||Mackinder, W.||Sutton, J. E.|
|Grenfell, D. R. (Glamorgan)||MacLaren, Andrew||Taylor, R. A.|
|Griffiths, T. (Monmouth, Pontypool)||Maclean, Nell (Glasgow, Govan)||Tinker, John Joseph|
|Grundy, T. W.||Montague, Frederick||Townend, A. E.|
|Hall, F. (York., W.R., Normanton)||Morrison, R. C. (Tottenham, N.)||Trevelyan, Rt. Hon. C. P.|
|H all, G. H. (Merthyr Tydvll||Murnin, H.||Varley, Frank B.|
|Hardie, George D.||Naylor, T. E.||Viant, S. P.|
|Hayday, Arthur||Polin, John Henry||Walsh, Rt. Hon. Stephen|
|Hayes, John Henry||Paling. W.||Watson, W. M. (Duntermilne)|
|Henderson, Rt. Hon. A. (Burnley)||Pethick-Lawrence, F. W.||Watts-Morgan, Lt.-Col. D. (Rhondds)|
|Henderson, T. (Glasgow)||Ponsonby, Arthur||Webb, Rt. Hon. Sidney|
|Hirst, G. H.||Potts, John S.||Welsh, J. C.|
|Hore-Belisha, Lesile||Richardson, R. (Houghton-le-Spring)||Westwood, J.|
|Hudson, J. H. (Huddersfield)||Riley, Ben||Whiteley, W.|
|Jenkins, W. (Glamorgan, Neath)||Ritson. J.||Williams, David (Swansea, East)|
|John, William (Rhondda, West)||Robinson, W. C. (Yorks, W. R., Elland)||Young, Robert (Lancaster. Newton)|
|Johnston, Thomas (Dundee)||Scrymgeour, E.|
|Jones, T. I. Hardy (Pontypridd)||Scurr, John||TELLERS FOR THE AYES.—|
|Kelly, W. T.||Shaw, Rt. Hon. Thomas (Preston)||Mr. Allen Parkinson and Mr.|
|Kennedy, T.||Shiels, Dr. Drummond||Charles Edwards.|
|Acland-Troyte, Lieut.-Colonel||Crookshank, Col. H. (Lindsey, Gainsbro)||Hawke, John Anthony|
|Agg-Gardner, Rt. Hon. Sir James T.||Cunliffe, Sir Herbert||Henderson, Lieut.-Col. V. L. (Bootle)|
|Albery, Irving James||Curzon, Captain Viscount||Henn, Sir Sydney H.|
|Alexander, E. E. (Leyton)||Dalkeith, Earl of||Hennessy, Major J. R. G.|
|Allen, J. Sandeman (L'pool, W. Derby)||Davidson, J. (Hertf'd, Hemel Hampst'd)||Hills, Major John Waller|
|Amery, Rt. Hon. Leopold C. M. S.||Davidson, Major-Genera! Sir J. H.||Hoare, Lt.-Col. Rt. Hon. Sir S. J. G.|
|Applin, Colonel R. V. K.||Davies, Dr. Vernon||Hogg, Rt. Hon. Sir D. (St. Marylebone)|
|Astbury, Lieut.-Commander F. W.||Davies. Maj. Geo. F. (Somerset,Yeovll)||Hohler, Sir Gerald Fitzroy|
|Athell. Duchess of||Davidson, Sir W. H. (Kensington, S.)||Holbrook, Sir Arthur Richard|
|Balfour, George (Hampstead)||Dawson, Sir Philip||Holt, Captain H. P.|
|Baintel, Lord||Dean, Arthur Wellesley||Hope, Sir Harry (Forfar)|
|Barclay-Harvey, C. M.||Dlxey, A. C.||Hopkins, J. W. W.|
|Beamish. Captain T. P. H.||Drewe, C.||Hopkinson, A. (Lancaster, Mossley)|
|Benn, Sir A. S. (Plymouth, Drake)||Duckworth, John||Horlick. Lieut.-Colonel J. N.|
|Bennett, A. J.||Edmondson, Major A. J.||Howard, Captain Hon. Donald|
|Bird. Sir R. B. (Wolverhampton, W.)||Edwards, J. Hugh (Accrington)||Hudson, Capt. A. U. M. (Hackney, N.)|
|Blundell, F. N.||Elliot, Major Walter E.||Hudson, R. S. (Cumberl'nd, Whiteh'n)|
|Bourne, Captain Robert Croft||Ellis, R. G.||Hume, Sir G. H.|
|Bowyer, Capt. G. E. W.||Elveden, Viscount||Huntingfield, Lord|
|Boyd-Carpenter, Major Sir A. B.||England, Colonel A.||Hurd, Percy A.|
|Brass, Captain W.||Everard, W. Lindsay||Hutchison.G.A.Clark (Midl'n & P'bl's)|
|Bridgeman, Rt. Hon. William Clivn||Fairfax, Caotain J. G.||Hiffe, Sir Edward M.|
|Briggs, J. Harold||Falle, Sir Bertram G.||Inskip, Sir Thomas Walker H.|
|Briscoe, Richard George||Fanshawe, Commander G. D.||Jacob, A. E.|
|Brittain, Sir Harry||Fermoy, Lord||James. Lieut.-Colonel Hon. Cuthbert|
|Brocklebank, C. E. R.||Fielden, E. B.||Jephcott, A. R.|
|Broun-Lindsay, Major H.||Ford, Sir P. J.||Jones, G. W. H. (Stoke Newington)|
|Brown, Col. D. C. (N'th'l'd., Hexham)||Forestler-Walker, Sir L.||Jones, Henry Haydn (Merioneth)|
|Brown, Brig.-Gen. H.C. (Berks, Newb'y)||Forrest, W.||Kennedy, A. R. (Preston)|
|Buckingham, Sir H.||Foster, Sir Harry S.||King, Captain Henry Douglas|
|Bull, Rt. Hon. Sir William James||Fraser, Captain Ian||Kintoch-Cooke, Sir Clement|
|Bullock. Captain M.||Fremantle, Lt.-Col. Francis E.||Knox, Sir Alfred|
|Burman, J. B.||Gadie, Lieut.-Col. Anthony||Lamb, J. Q.|
|Cadogan, Major Hon. Edward||Ganzonl, Sir John||Leigh, Sir John (Clapham)|
|Campbell, E. T.||Gates, Percy||Lister, Cunliffe-, Rt. Hon. Sir Philip|
|Cecil, Rt. Hon. Sir Evelyn (Aston)||Gault, Lieut.-Col. Andrew Hamilton||Little. Dr. E. Graham|
|Chadwick, Sir Robert Burton||Gibbs. Col. Rt. Hon. George Abraham||Looker, Herbert William|
|Chamberlain, Rt. Hon. N. (Ladywood)||Goff Sir Park||Lord, Walter Greaves-|
|Charteris, Brigadier-General J.||Gower, Sir Robert||Lowe, Sir Francis William|
|Christie. J. A.||Grace, John||Lucas-Tooth, Sir Hugh Vere|
|Clarry, Reginald George||Grattan-Doyle, Sir N.||Luce, Maj.-Gen. Sir Richard Harman|
|Clayton, G. C.||Greene, W. P. Crawford||Macdonald, Sir Murdoch (Inverness)|
|Cochrane, Commander Hon. A. D.||Gretton. Colonel Rt. Hon. John||McDonnell, Colonel Hon. Angus|
|Cockerill, Brig.-General sir G. K.||Guest, Capt. Rt. Hon. F. E. (Bristol, N.)||Maclntyre, Ian|
|Cope, Major William||Guinness, Rt. Hon. Walter E.||McLean, Major A.|
|Couper, J. B.||Gunston, Captain D. W.||Macnaghten, Hon. Sir Malcolm|
|Courtauld, Major J. S.||Hannon, Patrick Joseph Henry||Macquisten, F. A.|
|Cowan, Sir Wm. Henry (Islington, N.)||Harmsworth, Hon. E. C. (Kent)||MacRobert, Alexander M.|
|Craig, Ernest (Chester, Crewe)||Harrison, G. J. C.||Maitland, Sir Arthur D. Steel-|
|Croft, Brigadier-General Sir H.||Harvey, G. (Lambeth, Kennlngton)||Makins, Brigadier-General E.|
|Crooke, J. Smedley (Deritend)||Harvey, Major S. E. (Devon, Totnes)||Malone, Major P. B.|
|Crookshank, Col. C. de W. (Berwick)||Haslam, Henry C.||Manningham-Buller, Sir Mervyn|
|Merriman, F. B.||Roberts, E. H. G. (Flint)||Sueter, Rear-Admiral Murray Fraser|
|Meyer, Sir Frank||Robinson, Sir T. (Lancs., Stretford)||Thom, Lt.-Col. J. G. (Dumbarton)|
|Mline, J. S. Wardlaw||Ropner, Major L.||Thompson, Luke (Sunderland)|
|Mitchell, s. (Lanark, Lanark)||Ruggles-Brice, Major E. A.||Thomson, F. C. (Aberdeen, South)|
|Mitchell, W. Foot (Saffron Walden)||Russell, Alexander West- (Tynemouth)||Tryon, Rt. Hon. George Clement|
|Mitchell, Sir W. Lane (Streatham)||Rye, F. G.||Vaughan-Morgan, Col. K. P.|
|Monsell, Eyres, Com. Rt. Hon. B. M.||Salmon, Major I.||Waddington, R.|
|Moore, Lieut.-Colonel T. C. R. (Ayr)||Samuel, A. M. (Surrey, Farnham)||Ward, Lt.-Cot.A.L.Kingston-on-Hull)|
|Moore-Brabazon, Lieut-Col. J. T. C.||Samuel, Samuel (W'dsworth, Putney)||Warner, Brigadier-General W. W.|
|Morrison-Bell, Sir Arthur Clive||Sandeman, A. Stewart||Warrender, Sir Victor|
|Murchison, C. K.||Sanderson, Sir Frank||Watson, Sir F. (Pudsey and Otley)|
|Nall, Lieut.-Colonel Sir Joseph||Savery, S. S.||Watson, Rt. Hon. W. (Carlisle)|
|Nelson, Sir Frank||Shaw, R. G. (Yorks, W.R., Sowerby)||Watts, Dr. T.|
|Newton, Sir D. G. C. (Cambridge)||Shaw, Lt.-Col. A. D. Mcl.(Renfrew, W)||Wells, S. R.|
|Nuttall, Ellis||Shaw, Capt. Walter (Wilts, Westb'y)||Wheler, Major Sir Granville C. H.|
|Oakley, T.||Shepperson, E. W.||White, Lieut.-Col. Sir G. Dairymple|
|O'Connor, T. J. (Bedford, Luton)||Simms, Dr. John M. (Co. Down)||Wiggins, William Martin|
|Oman, sir Charles William C.||Skelton, A. N.||Williams, Com. C. (Devon, Torquay)|
|Pennefather, Sir John||Slaney, Major P. Kenyon||Williams, Herbert G. (Reading)|
|Percy, Lord Eustace (Hastings)||Smith, R. W. (Aberd'n & Kinc'dine, C.)||Wilson, R. R. (Stafford, Lichfield)|
|Perkins, Colonel E. K.||Smith-Carington, Neville W.||Windsor-Clive, Lieut.-Colonel George|
|Perring, Sir William George||Smithers, Waldron||Wise, Sir Fredric|
|Peto, Basll E. (Devon, Barnstaple)||Somerville, A. A. (Windsor)||Withers, John James|
|Peto, G. (Somerset, Frome)||Stanley, Col. Hon. G. F. (Will'sden, E.)||Wolmer, Viscount|
|Philipson, Mabel||Stanley, Lord (Fyide)||Womersley, W. J.|
|Pleiou, D. P.||Stanley, Hon. O. F. G. (Westm'eland)||Wood, E. (Chest'r, Stalyb'ge & Hyrne)|
|Pownall, Lieut.-Colonel Sir Assheton||Steel, Major Samuel Strang||Wood, Sir H. K. (Woolwich, West)|
|Preston, William||Storry-Deans, R.||Wood, Sir S. Hill- (High Peak)|
|Price, Major C. W. M.||Stott, Lieut.-Colonel W. H.||Woodcock, Colonel H. C.|
|Radford, E. A.||Streatfeild, Captain S. R.||Wragg, Herbert|
|Rees, Sir Beddoe||Strickland, Sir Gerald||Yerburgh, Major Robert D. T.|
|Reid, Capt. A. S. C. (Warrington)||Stuart, Crichton-, Lord C.|
|Remer, J. R.||Stuart, Hon. J. (Moray and Nairn)||TELLERS FOR THE NOES.—|
|Rhys, Hon. C. A. U.||Styles, Captain H. Walter||Major sir Harry Barnston and|