Orders of the Day — Ministry of Health.

– in the House of Commons on 30th June 1942.

Alert me about debates like this

Motion made, and Question proposed, That a further sum, not exceeding £50, be granted to His Majesty, towards defraying the charges for the Ministry of Health and other related services for the year ending on the 31st day of March, 1943, namely:

Civil Estimates, 1942.
£
Class V., Vote 1, Ministry of Health10
Class X., Vote 5, Ministry of Health (War Services)10
Class IX., Vote 1, Exchequer Contributions to Local Revenues, England and Wales10
Class V., Vote 2, Board of Control10
Class V., Vote 3, Registrar-General's Office10
£50

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

My colleague the President of the Board of Education rightly claimed a little while ago that his Department should be regarded as one of the major Departments of State. The same, of course, is true of the Ministry of Health, and one glance at the figures for which I am responsible as Minister of Health will show that the Chancellor of the Exchequer certainly takes that view, for the Estimates which hon. Members may consider to-day come to a grand total of £266,500,000. In round figures the net Estimate for the Department itself and its services is £26,000,000; the net block grant is £46,000,000; for war services there is a Vote of Credit of £60,000,000; for National Health Insurance, inclusive of Exchequer grants, £46,250,000; for contributory pensions, that is to say, pensions to those under 70, which are payable from the Pensions Account, £53,250,000; and for contributory pensions, pensions payable to those of 70 and over, £35,000,000. Together they make a grand total of £266,500,000. I have brought these figures together because they show what extraordinary efforts have been made in recent years by this nation to develop what are known as our social services. The fact is, in analysing the details of this great sum, that very few of my colleagues can perform their war-time duties without coming in one way or another to the services of the Ministry of Health and the local authorities, working in co-operation.

There have been several Debates in which various aspects of the work of the Ministry have been discussed. There have been discussions on our war-time services, evacuation, emergency hospitals, rest centres, war-time nurseries, pensions and insurance, and recently we had a discussion on hospitals in which suggestions were made from various quarters as to the way in which we should guide our steps for the future. I do not wish to say anything about these subjects to-day—the Votes are all open—because I have been asked to address myself to the problem of the health of the nation as such. I wish, however, to take this first opportunity to remove any misapprehensions which may have been caused by recent published suggestions to the effect that it is the intention of the Government at the end of the year to call up for employment in industry married women with young children. My right hon. Friend the Minister of Labour authorises me to say that there is no foundation for such a statement. It is not the policy of the Government to require married women with young children to undertake employment, although we are only too willing to have them if they volunteer—but they will not be compelled, as has been suggested in other quarters.

Important as all these war-time problems are, I want to meet the wishes of hon. Members by discussing in the main what, of course, must always be the chief theme of the Ministry of Health—the state of the public health and the health of the nation. I want quite frankly to refer to some things which seem to be causes for sober gratitude on the one hand, and on the other hand to be causes for concern, although not for alarm. I am sure that on that basis we shall have a Debate with real social bearing.

I would presume at the outset that the state of the public health is always a matter of interest to the Committee, and ought always to be a matter of interest to the country as a whole and to every man and woman in it. The last thing I mean by this is that we should sit brooding over the state of our insides, or get alarmist over the possible spread of this or that infection—that way lies depression and neurosis—but that we should take a lively interest in those things which promote positive health, study them ourselves and propagate them among our fellows. The Committee will have noted with interest that the Chief Medical Officer of the Ministry of Health, Sir Wilson Jameson, has done a good deal to inform the public mind positively as to the things which make for good health. I believe that interest in positive health has been steadily increasing since the outbreak of war. It has been a definite factor in the unexpectedly good record of the general health with which we have been blessed so far, and which has made so important a contribution to the national effort all along the line on the home front. I think it is true to say that the interest in health as a positive blessing, rather than something associated with dyspepsia and a bottle of medicine, is steadily increasing through the progress of education and together with increased appreciation of fresh air and out-of-door pursuits. During the last 2½ years there are a number of people who have not had time to be ill because they have been too busy. I know that I shall have the sympathy of any predecessor of mine who may be in the Committee to-day, when I say it is very difficult positively to state good health, because good health, like peace, does not make headlines. It is war and diseases which provide sensations.

During the last 18 months I have gone North, South, East and West to talk with those responsible for maintaining the public health. I have been to every type of locality and talked with medical officers of health, with health visitors, with hospital superintendents, with matrons and nurses, and with that fine body of women—district nurses and midwives. My reports from North, South, East and West show that after a thousand days of war the health of the nation is in many respects even better than it was in peace time. There are certain exceptions, and I shall put them quite bluntly to the Committee, because we ought to face them bluntly, but, taking the picture as a whole, after a thousand days of war I am sure that those who were looking ahead a few years ago would not have anticipated the present general state of positive good health. Of course, as I have hinted, we have no adequate statistical tests of positive good health. The Minister of Health can never give, nor can the local medical officers of health give, detailed particulars of the number of people who are positively well. We have now as always to take the normal customary tests. We have to base our accounts on the evidence we have as to births and deaths, but I do want to make this clear. Amidst all the discussion on epidemics, on contagious diseases, on infectious diseases and all these other matters which are bound to be subjects of discussion because they are inherent in the normal test figures, I would like the Committee to have the assurance and to tell the world that the health of our people, in many respects, is remarkably good.

Turning to the customary and normal tests, I begin with the birth-rate, which is an interesting subject just now. The birth-rate has recently been a subject of discussion, not merely as a rate of increase but as a great spiritual, social and national problem. It has been argued that the course of events in the future can be predicted with mathematical precision, and different mathematicians who have sought to do so have produced different results, as is quite usual in such cases. To-day, I propose to stick to the things which have already happened, although I would say that the Registrars-General have produced a basis for informed, adequate and reasoned discussion of this great and vital subject. The birth rate for 1941 was 14.2, as compared with 15.1 in 1938 and 20.9 in 1916.

I should add that, to-day, generally speaking, I propose to take the most recent figures with just one or two exceptions. I am taking those for the year ended 30th December, 1941, those for the last year before the war and those for the third year of the last war. I did not select the last year of the last war, because, as the Committee will remember, in that year there were two particularly heavy epidemics. I have already given the birth-rate for 1941 compared with that for 1938 and that for 1916. For the first quarter of 1942 it was 15.5, and that is the highest birth-rate in any March quarter since 1931. That is fact No. 1.

Turning now to the mortality rates, I take, first, infant mortality. The infant mortality rate for 1941 was 59, as compared with 53 in 1938, and 91 in 1916. The rate for the first quarter of 1942 was 61, and that was the lowest March quarter rate on record. The only previous years with rates under 70 for this particular quarter were 1935 and 1938, with a rate of 68, and 1939 with a rate of 65. The maternal mortality rate for 1941 was 2.77, as compared with 2.97 in 1936 and 4.12 in 1916. These figures will show that while over a long period of time the birth rate has been falling, over the same long period the survival rate has increased. Perhaps the Committee will be interested in the crude general death-rate. That rate was 12.9 in 1941, as compared with 11.6 in 1938—which was the lowest on record—and 14.4 in 1916. I would like to add one thing to that statement of vital statistics, namely, that, on a different statistical basis of comparison, Dr. Percy Stocks, in the current issue of the "British Medical Journal," has drawn up a very interesting and valuable balance-sheet, covering not merely the vital statistics but also the epidemic diseases, about which I now propose to say something. This is a supplement and a very valuable supplement to the lay-out which I have prepared for the Committee.

Photo of Mr Rhys Davies Mr Rhys Davies , Westhoughton

Could the right hon. Gentleman tell us whether the death-rate to which he has referred includes those who died as a consequence of air raids?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

As I said, this is the crude general death-rate, and that means, of course, the total number of deaths. It is the simple rate, irrespective of any refinements, as applied to the total population of a particular area, and it includes all. So the Committee will recognise that it is a very interesting and instructive figure.

The risk of epidemics is a matter which calls for close care at all times, but especially in war time. Two years ago there was a great deal of discussion about epidemics, and I tell the Committee frankly that when I came to the Ministry of Health I did as I had done when I was at the Scottish Office. That is, I discouraged mere talk about epidemics. I do not think that mere discussion is helpful in a matter of this kind. The preparation of plans, the taking of practical steps, making constructive contributions in terms of health hints or medical action—those are the means whereby we can help to defeat epidemics or potential epidemics. This is all-important in wartime. Dislocation of natural conditions of ordinary life, the congregation of all sorts and conditions and ages of people in billets or in shelters, the risk of damage to water supplies by enemy action are new factors in our situation. In fact, our statistics show that in 2½ years of war the rate of infectious disease has been normal and on the whole, with certain exceptions, are, indeed, below the average. The fact is that after centuries of fatalistic suffering we have found ways of mastering epidemic disease, and I have no doubt that, with our practical approach to these problems, we shall succeed in finding more ways of mastering them. Mr. R. McNair Wilson, in that delightful and brilliant book in the series "Britain in Pictures" which is entitled "British Medicine," pays this tribute to our people: The English, contrary to general belief, are the most scientific-minded of all peoples and so careful and exact with their observations that medical progress owes more to them than to any other race of mankind. Then follows a very fine analysis making good that claim. He points out that this success depends on another fact—that it is worked out in the home, in the hospital and at the bed-side. He says, I think truly: Medicine stands or falls by its practice. It is clinical or it is nothing and the work done at the bed-side is the foundation, as it is also the measure of success. I would add to that sentence one of my own. I addition, I am quite clear that health education, which has occupied a great deal of the activities both of the Ministry of Health and of all concerned with the profession and of those responsible for public health in our counties, cities and towns, has also had a great place in making good practice well known.

Let me take the chief examples of infectious diseases. I exclude tuberculosis, because I wish to give special attention to it, and I would ask the Committee and the general public and my Welsh friends especially to-day to give it special attention. I take, then, infectious diseases, excluding tuberculosis, and I take first the one which shows the chief rise in wartime—indeed the only one, except tuberculosis, which does so—and that is cerebrospinal fever. This is, of course, a serious war-time disease. In the last war we used to say, though not on expert grounds, that it was a disease of over crowding. That was only a rough indication of what was thought by the ordinary man about it, and my own experts would probably put it in a more scientific manner. In 1916 there were about 2,000 cases; in 1938 and in 1939 there were 1,300 and 1,500 respectively; in 1940 there were nearly 13,000, and in 1941 over 11,000. In the first half of this year there have been, approximately, 4,000—a decline for the half-year, as compared with 7,000 in the first half of last year and with 8,000 in the first half of 1940. Although, of course, this fever is essentially a disease of war-time, it is true that a less marked but progressive increase has been taking place since 1935, and even before the war it was thought that a period of epidemic prevalence might possibly be approaching. But here is an interesting sign of progress. The fatality of the disease has been greatly reduced. Of the 2,000 cases notified in 1916 60 per cent. were fatal, and a similar percentage continued through 1931–1934. They were years of high prevalence, and in 1935 the fatalities rose to 69 per cent. But 1936 to 1940 mark how the fatality has declined—63, 61, 50, 34 and 20 per cent. which is very remarkable. So we are having success on the side of treatment. Now our task is to approach the other end and prevent what was a rise in pre war days being accelerated in the period of war.

Next I will take a disease which is a special danger to children, diphtheria. Between the ages of four and 10 diphtheria is the chief killing disease. Its incidence has fluctuated to some extent though not widely during the last 25 years; there were 53,000 cases in 1916 and 50,000 in 1941, but the number of deaths has fallen from 5,300 in 1916 to 2,600 in 1941. During the last year or so the Ministry have been pressing a campaign for the immunisation of children against diphtheria as a long-term policy for reducing mortality and as a more immediate precaution against the risks of war-time conditions. We have both in mind. Medical opinion is overwhelmingly in support of this course, and the experience gained in other countries, which have been in advance of us on this question, has shown conclusively the reduction in the incidence of diphtheria, and even more strikingly the reduction in mortality among the immunised child population. I give it as my own considered lay view on the evidence put before me that the publicity campaign should be pressed, and I mean to press it. This form of protection to the child should be brought to the notice of parents and the necessary facilities for effecting it made available to them. The administrative arrangements are in the hands of local authorities, but the Ministry has been mainly responsible, with the co-operation of the Central Council for Health Education for publicity about the campaign. I pay my tribute to general practitioners, school teachers and welfare workers in disseminating advice and information. By the end of 1941 one-third of the child population under 15 in England and Wales had been immunised. My right hon. Friend, the Secretary of State for Scotland has done better and, naturally, I am not satisfied. We are going to press our campaign. We must, since experience justifies the hope that if three-quarters of our children at each year of age below 15 can be made immune, diphtheria ought well-nigh to disappear as a fatal disease for children. We cannot afford to ignore that deadly enemy, diphtheria. It killed more children in this country last year than the Germans did with their bombs. It made us use doctors, nurses and hospital accommodation which we can ill spare from the war effort. On an average day, no fewer than 4,000 beds are occupied by diphtheria cases. If all parents will help us, including parents in the House with young children, we can defeat diphtheria.

Photo of Major Sir Derrick Gunston Major Sir Derrick Gunston , Thornbury

Has the right hon. Gentleman sufficient powers to see that the local authorities immunise?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

There is no doubt that the campaign can go right ahead. We have not, of course, any actual statutory powers, but we use our influence with them, and I have no reason to believe that we are being held up. In the main it is a story of co-operation, but I want quicker co-operation. The difficulty has been not so much with the local authorities as to get the co-operation of the parents. It is their good will and cooperation that we want.

I only mention scarlet fever—predecessors of mine have had to do it at great length—as a scourge of the past. We all know how it swept away whole families in the middle of the last century. In 1916 there were 130,000 cases, but the mortality had already fallen to 2,100. In 1941 there were 59,000 cases and only 133 deaths.

I turn to enteric (typhoid and paratyphoid fevers). They were natural sources of anxiety in war-time, with the risk of disturbance of our water supplies by air attack. We have done much to protect these supplies, to take preventive action against risk of pollution, as those of us who are water drinkers know by the taste, and our medical officers of health were prepared to offer inoculation against typhoid. [Interruption.] That was a late reaction. I hope the reaction of the parents to immunisation will be rather more rapid.

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

It should be made compulsory.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

I should not like to impose my tastes upon other people. Medical officers of health were prepared to offer inoculation against typhoid if circumstances called for it. Actually there were in 1941 under 5,000 cases and 148 deaths, as compared with 6,000 cases and 1,100 deaths in 1916. It is an interesting fact that not one of those deaths in heavy bombing years was due to pollution by water-borne infection. That is a very remarkable statement of our comparative freedom from typhoid fever in a time of continuous bombing. It is a corner of our general health picture at which American medical visitors to this country marvel. They have expressed it to me over and over again. [Interruption..] The noble Lady will speak for herself. I will speak for myself. Responsible American medical officials, doctors and nurses have come in a stream to help us, as well as to inquire—for we have a number working with us at the Ministry in the war on these problems. Only this week Dr. Blatz, a great Canadian doctor, with a team of Canadian women teachers, has come to help us on questions affecting the child life side. During his travels in this country he has been astonished that, in spite of evacuation and all the other abnormal conditions, we had not only been able to avoid serious epidemics among the children but to keep them looking so extraordinarily well. If I had said that, I might have been charged with being complacent, but this is a Canadian observer, a skilled expert, and that is his latest report on the matter.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

Would the right hon. Gentleman be willing for Dr. Blatz to go and look at the children under five and report what he really thought?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

It is not a question of being willing. I have arranged for Dr. Blatz to examine this problem. He and his helpers will be free to go everywhere to study child-care work, and the noble Lady can be assured that they will. If she wishes to give them any guidance, I have no doubt that they will be glad to have it.

Let me mention one of our most dangerous killing diseases, one that is with us in peace and war—pneumonia. The number of deaths from pneumonia is greater than that from all infectious diseases combined, except tuberculosis. In 1941, 50,000 cases were notified, and there were 26,000 deaths, as compared with 23,000 deaths in 1939 and 29,000 in 1940. Pneumonia was not notifiable until 1919, so that I cannot give the number of cases before then, but there were 38,000 deaths in 1916, and the figure rose to 59,000 in 1918, the last year of the last war. It is a matter of common knowledge that new methods of treatment have been adopted for this disease, and we need not be without hope of continued improvement.

The health services, preventive and curative, which have been built up in the last two or three generations to cope with infectious diseases have stood up remarkably well to the conditions of war, but we need continued vigilance, and we shall have it. We cannot afford to relax any precautions or to neglect any safeguard. By our positive propaganda we are continually adding to that body of maxims or axioms which represent the ordinary experience of common folk. It is the desire of the Chief Medical Officer of Health, and it is certainly mine, to get expert knowledge as to how health can be maintained put over in language, sometimes bright language such as "Coughs and sneezes spread diseases", which ordinary people may make part of the common discussions in the home, the bus, the tube, the railway train and the ship.

There are two other special problems to which I must refer. An increase in venereal diseases was not unexpected, in view of the conditions of war-time, and I am happy to say that it is not anything like so great as in the last war. There is an increase, but it is not so high as it was then. Steps were taken at the outset of the war, to expand the existing services and see that adequate supervision was available. We are continuing propaganda, and we have developed it along the lines which we consider are most likely to be effective. It has always been on teaching and education that we have relied for success in coping with this problem, with a large measure of success, as the figures during the last 20 years show. Nevertheless, it must be admitted that our work in limiting the spread of infection is hampered by the lack of powers for dealing with those persistent individuals who are unwilling to submit themselves to examination and treatment and who are known to infect numbers of others. The best way of tackling this limited but very difficult and complex problem, which is a very vital and human problem, is engaging us actively. While the increase in venereal diseases has not been so serious as might have been expected, judging by the experience of the last war, its control as a problem of health and because of its effect on the war effort must clearly continue to receive close attention.

Before I come to tuberculosis, I want to deal with one other disease, that is, scabies. There is no doubt that scabies, which had been declining for a number of years, was already on the increase before the war. It has continued to grow during the war, and with the redistribution of population which has been a result of the war it has become more widely spread over the country. Scabies is not merely disturbing to the individual—it is that—but its incidence means a substantial loss to the productive effort. It is really a household disease. The investigation of home conditions and the following-up of contacts are essential measures in a campaign to limit the spread of infection. Last year I took powers to that end, and these powers were accompanied by improved methods of treatment, of which I gave some information in the White Paper which was issued in May last. They are facilitating the task of the local health authorities, who have been naturally much exercised, especially those in rural areas which had known very little of the disease, by the resurgence of the disease and its appearance in districts where it had been almost unknown. We cannot give any accurate or comprehensive figures as to the incidence, but the latest impression is that the increase has been checked, and I hope that by the continuance of all the special measures open to us we shall find a decrease.

Photo of Mr Edward Williams Mr Edward Williams , Ogmore

I trust the Minister will bear in mind that scabies is not only a household disease but that where there are large factories and many persons are employed it is seriously affecting output and the people living in the district.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

I thought the hon. Gentleman would have gathered by my reference to production that I realised that fact. Those of us who are old soldiers know that it is likely to happen also in camps where large numbers of men sleep under one roof.

I should like to say a word on mental health. Whether the Germans will be glad to know it I do not know, but this country will be glad to hear it. The institutional service has its own war-time difficulties. A number of institutions were surrendered at the beginning of the war to the needs of the Emergency Medical Service, with consequent overcrowding in others. In many of them, as in other hospitals, there have been, and are, serious problems of nursing and domestic staff, but the point I wish to bring specially to the notice of the country is the gratifying decline in the number of new cases requiring admission to mental hospitals. At the beginning of the war it was feared—and feared by specialists—that the strain of war conditions, particularly under aerial bombardment, would lead to a serious increase of mental disorders. The contrary has proved to be the fact. In 1938 the number admitted to mental hospitals was 30,000, and it was the same in 1939. In 1940 it fell to 28,000, and in 1941—these are the years that covered the big bombings—to 26,000, that is, 4,000 fewer than in the years of peace. That seems to me to be an eloquent testimony to the nerves of the nation, and it should assure Hitler that his attempt to break the nerve of our people by the terror by night has failed. He will not fret the fibre of our resolution or break our nerve. I do not think any prophet would have prophesied that our crowded populations would have stood the test of nerves so well.

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

Will the right hon. Gentleman clarify the figures? Do they include certified and voluntary patients?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

They include all new cases requiring treatment.

Let me turn now to a problem which is causing me some concern—tuberculosis. I will try to give the figures slowly. It seems to be my fate as a Minister to have to use a great many figures, and I think that I have given the House more figures than the Chancellor of the Exchequer in the last few years. The number of deaths from tuberculosis in 1941 was 28,669, which compares with 28,144 in 1940, being roughly the same, and with 26,176 in 1938. There was a jump in 1938–39. Unhappily, we have not been able to get it back, but happily it has not gone further. I say that to keep the problem in perspective, for it does not cause us alarm, but it does cause us concern, and I use that word in the sense in which the Friends use it, with a very real meaning. In 1916 there were 53,858 deaths, and we are now at the figure of 29,000. There had been, happily, a steady fall which had been a feature of the 20 years of peace, the fruits of hard, active labour by the central Ministry, by the medical profession, by nurses, by hospitals, by public health authorities and by other bodies such as the remarkable Welsh National Memorial Association.

It is obvious that in war-time there exist conditions which predispose to T.B. I need mention only overcrowding and the black-out. All reformers were sad at the beginning of the war for many reasons and for one in particular, namely, that we had to cease housebuilding, for at root this is a problem of wiping away the dirty, rotten, unwholesome small dwellings, and I shall be happy when my times comes to say about housing, "Forward with speed." But the black-out and overcrowding and the cessation of housebuilding have made our progress difficult. [Interruption.] Oh yes, the black-out has a lot to do with it—ventilation as, also, the absence of sunlight. Here I want to say a few words on my own behalf. Looking at the problem as a whole—and I have had 18 months in which to do it—my view is that we need to review our general approach. We need to give greater practical effect to the necessity for early diagnosis. In the past we have tended to concentrate on treatment rather than on early diagnosis, but the developments in miniature radiography during the last few months seem to give us a new and useful weapon for detecting those persons where more detailed examination should be undertaken. As I told the House recently, we now have the opportunity of getting British-made machines. Up to recent months there was no possibility of obtaining British-made machines, and I think the fullest possible advantage should be taken of the new situation. I have ordered a number of sets of equipment through the Ministry of Supply both from America and from makers in this country, and when they are secured we shall make them available for local authorities as part of their tuberculosis scheme. Already we are taking steps to see that trained teams are available for handling those machines, because without teams the machines will be valueless, and I hope that towards the end of the year we shall be able to begin to use them on a carefully planned basis. In this way I hope that we shall be able to detect and treat tuberculosis in the early stages, when we can, by a period of suitable treatment, restore a man to health and self-sufficiency with the shortest possible interruption of his normal life.

My second point is that we have to give even greater attention to the problems of after-care. I do not want to belittle the valuable work done by local authorities and by voluntary effort, because we want a great deal more of it, but the problem of after-care, of rehabilitation, and securing the gradual return to suitable and productive employment ought, in my view, to be tackled on much more comprehensive lines. I have no doubt that both these points, with others, are engaging the attention of the Committee of the Medical Research Council which, as I mentioned to the House some time ago, I asked, immediately on hearing of the rise in the figures in 1939, to undertake a speedy investigation into things which we might do as a matter of immediate practical reform.

Photo of Mr Ernest Shepperson Mr Ernest Shepperson , Leominster

Will the right hon. Gentleman consider the extension of the opportunities for those at tuberculosis colonies to remain there while also doing a few hours' work?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

My hon. Friend will notice that I used the word "comprehensive." If we are to provide adequately for the treatment of tuberculosis we must have the necessary number of beds both in hospitals and sanatoria, and we must have the necessary medical, nursing and domestic staff for such number of beds.

Photo of Reverend George Woods Reverend George Woods , Finsbury

Is the Minister aware that his own Department is placing obstacles in the way of local authorities which are anxious to extend those facilities?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

No, I am not aware of that, unless in a particular area there is some war effort demanding special services. I am much too old an administrator to be led into admissions of that kind without having myself analysed the facts. If my hon. Friend will bring before me any facts which he has I shall, as always, be ready to receive them.

Photo of Mr David Adams Mr David Adams , Consett

Does the Minister, in looking into the causes of this disease, intend to ignore the milk supply?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

We shall do all we can—in war conditions—to make sure that the milk supply is as clean and pure as our powers permit us to make it.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

One wants to be comprehensive and not selective. As I told my hon. Friend the Member for Consett (Mr. D. Adams) last week, the recent scheme does not interfere at all with the powers of medical officers of health.

I am now on this vital matter of practical immediate urgency, and I want to serve two purposes in the present statement. I want to give a picture of the general nursing situation as well as dealing with this question. Although at the beginning of the war we made some calls on the accommodation for tuberculosis patients in order to prepare for the anticipated needs of casualties, our present difficulty in increasing accommodation for T.B. lies not in providing the beds but in finding nursing and domestic staff. The moment I got the figures of the rise I gave orders that beds were to be made available out of the emergency hospital pool, and we shall make those beds available. I should like to say a word about this problem because it is in the true sense of the word an exquisite problem. A Service man to whom I was speaking recently said, "I do not know that I should like to be nursed by a compulsory nurse," and that must be the general view. Therefore I use the word "exquisite" deliberately. It is a problem that wants a lot of care and thought. No one wants to use compulsion in the case of such staffs. We have sought to secure the necessary staff through propaganda, persuasion and through the good will of the professional organisations, and we have that good will, and on the domestic side my right hon. Friend the Minister of Labour and National Service is willing to direct women to service of all kinds in hospitals.

My problem is nursing. There are many calls on the nursing profession in war-time. The House may not realise that the number of State-registered nurses at the end of April, 1939, was 94,200, and in April, 1942, it was 103,700. I mention those figures because there is an impression that there has been a decline. On the contrary, there has been a rise. At the same time the civil nursing reserve has decreased its part-time numbers, but it has maintained 100,000, roughly the same as the number after the enrolment after the war began. There is another encouraging feature, and that is that entries for the preliminary State examination, which were 19,100 in 1940, rose as the result of our campaign in 1941 to 22,500, so women are coming forward. Indeed, it is really a difficult problem for propaganda, because it is true to say that there is no national shortage of nurses, but that there are particular shortages of nurses in particular places and especially a particular shortage for particular services.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

This is very important. If there is a shortage in certain areas, but there is not a national shortage, then presumably there is a margin over requirements in some areas. Could the right hon. Gentleman explain that?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

There may be a margin, and in some cases there is, and that explains the stress which we have put in our speeches and propaganda on the necessity for getting mobility. To break up the immobile pool is really the essence of this problem now. It is much more a matter of movement than otherwise.

Photo of Mr Edward Williams Mr Edward Williams , Ogmore

There are undoubtedly a large number of vacant beds in hospitals to-day, and nurses are doing domestic work. I heard my right hon. Friend's reference to the Minister of Labour, and I am hoping that that will be a kind of general direction, in order that beds may be filled as quickly as possible.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

That is one of the difficulties of the problem, and that is why my right hon. Friend has agreed to help. People are finding out that cooks and those who work in the kitchen are really great servants, servants I mean in the real sense of the word, servants in the same sense as Cabinet Ministers are described as His Majesty's servants.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

Not the same as regards wages.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

That may be so, but my hon. Friend will know that we are really considering the whole problem of hospitals and staffs.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

But wages are the essential problem.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

We shall have to come to that. I am not sure that the wage problem for domestics is as difficult as for nurses—not by any means.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

My hon. Friend can make his own comments. I am not so sure about that.

Photo of Mr Kenneth Lindsay Mr Kenneth Lindsay , Kilmarnock

Is there or is there not a total shortage of nurses?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

Over the whole field of the nation I estimate that I could do with another 12,000 nurses. When I said there was difficulty in national propaganda I meant that I might make a big appeal in one locality where at the moment there might be sufficient, or even some in hand. That is the difficulty. There is a shortage of about 12,000 over the whole field. I will link up with that a statement I had intended to make later which has a bearing on it. I may be asked what is the problem in regard to nurses in sanatoria. Our problem is that at the moment there are 2,600 employed in sanatoria and that we require about 600 more. There are also beds in the emergency hospitals, and we estimate that we require another 600 nurses there, so that for tuberculosis we need an immediate enrolment of about 1,200 nurses. That is our national problem.

While I am on that subject, perhaps I may tell my Welsh colleagues that the number of beds in sanatoria belonging to the Welsh National Memorial Association is 1,952. The waiting list—that is, the number of persons who have been waiting for more than 10 days on the date of the return, not including Service cases—is 400. The number of nurses employed in sanatoria is 429, and the additional number of nurses required for the civilian service is 82. That is a vital and important, but at the same time surely a manageable, problem. May I appeal to my Welsh colleagues to make a call to nurses who may be in other services which are not fully occupied to come forward and volunteer to help us fill the beds which are vacant? My hon. Friend the Parliamentary Secretary was recently in Cardiff and Swansea on this matter, and I am grateful that there was some answer to her appeal.

I want to say more than that and to call attention to a very interesting experiment which has been made by the London County Council. They have attacked this problem within their sphere of action by making periods of work within the sanatoria a regular feature of the work of nurses, and I am informed by them that they have achieved a measure of success. I think that is a hint that is worth considering. It is a procedure which might be more widely followed, although I realise that it is not free from difficulty. The ultimate problem is this. We cannot afford to fail in the treatment of tuberculosis because patients cannot be nursed. In the last resort, we may have to consider a wider exercise of our powers of direction than hitherto, but I do not think it ought to be necessary. If the needs of the situation are properly understood by all concerned, I do not think we shall fail to get the response from the nurses. It is clear from the figures I have given that our young women are coming forward in large numbers to join this vital war-time and peace-time service. The figures I have given are comparable, and of course take account of those who have left the service as well as those who entered. The Civil Nursing Reserve figures are even more remarkable, because a great many of those have become part-time workers in Civil Defence, and we have a total figure of 100,000, which is roughly similar to that with which we began the war. I am afraid I have spoken longer than I meant to do, but hon. Members have been kind enough to interrupt with questions, and that has made a larger draft on their time than I would have wished to do.

There are three further things I wish to say. Nursing, like medicine, is a profession which has its special risks, and we well know that those risks are willingly faced. I want, however, to say advisedly that there is no ground for the belief that nursing in a sanatorium need involve any greater risk of contracting tuberculosis than nursing in other hospitals. I want to underline that. I have given a summary of some of the main factors which have affected the health of the nation in wartime. The figures I have referred to show a comparison with two other years, the last year of peace and the third year of the last war. We ought not to forget—I do not forget, nor do my advisers—that it was in the last year of the last war that a sharp rise took place in the incidence of tuberculosis and pandemic influenza. We must therefore be on the alert and must not lack for energy or insistence in seeing that action is taken in order to prevent that catastrophe happening this time.

We are bound to recognise that the amount of medical attention for which the civilian population can ask in wartime must be less than in peace-time. It is time I said that, for I do not know that the public have been generally warned. I want to warn them. The medical profession have had to meet very large calls for the needs of the Forces, and I pay my tribute to the work of the Central Medical War Committee and the District War Committees, and to that admirable medical priorities committee presided over by my hon. Friend the Member for Norwich (Sir Geoffrey Shakespeare) which has done admirable work in assessing the relative allocations for the Forces and civilian needs.

Photo of Mr Arthur Woodburn Mr Arthur Woodburn , Clackmannan and Eastern

Would the right hon. Gentleman in this connection appeal to patients to advise their doctors before the early morning passes, and so avoid the duplication of calls?

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

Let me tell the House what I had decided to say if my hon. Friend had not risen. The fact is that there is a shortage of doctors for the civilian population. As a nation, we must do what we can to get along with less medical attention. The Government cannot ration doctors. They cannot limit everyone to two visits a quarter, but we can all make sure that we do not call on doctors for services which are not really necessary and, when the doctor's services are required, we can give him as full notice as the case permits, so that he can organise his daily rounds economically. I hope that that will satisfy my hon. Friend. I appeal to the public to recognise the difficulties of a grand and hard-working profession, and to do what they can to help them carry out their essential duties.

We must indeed, in the wide range of services for which we are responsible, suffer from an increasing drain on our man-power and woman-power. The staffs of local authorities, their medical, nursing, administrative and technical staffs, have made, and continue to make, large contributions to the Services. We are bound to recognise that this must be so, but at the same time we must all recognise that there is a limit to the extent to which an increasing range of services can be discharged by a decreasing number of skilled staffs. It is our object to concentrate on the effective maintenance of those essential services which are vital to the health of the nation. As I said at the beginning of this speech, in a number of respects it might have been anticipated that the conditions of the present war might have been prejudicial to health, for there has been a great disturbance of normal life for a considerable period by air raids and by many long nights in shelters, beside the more extensive movements of workers where the needs of war production have called for them. On the other hand, it may very well be that by the evacuation of children from the crowded cities we have provided for them the chance of a healthier life in more open conditions.

Also, we may very well look with thankfulness to the nutrition situation in June, 1942, as compared with that of June, 1917. The new science, as it is called—though I am not sure that it is new, for in 1785 the British Navy gave lime juice to sailors who were lacking fresh vegetables—has made great progress, and, as the Committee and the country will know, the Minister of Food has the practical job of providing food, while my Department is responsible for advice on nutrition policy. We are working in effective co-operation with the Ministry of Food and with the President of the Board of Education, and we have put the babies and the children first. We regard it as important to watch the food situation from the health point of view, and have made arrangements to secure accurate and prompt information to check the results of our joint work on standards of nutrition throughout the country. This work is carried out by Regional Medical Officers, the Emergency Hospital Service and by special local surveys. These surveys have been undertaken with the help and guidance of expert medical officers supplied by the International Health Division of the Rockefeller Foundation. It is a work which represents a useful piece of international co-operation between my Department, the Medical Research Council, the University of Oxford and the Rockefeller Foundation.

As I said, I do not intend to review in any detail the war-time services, but I would like to say a word about first-aid repair of houses damaged by air raids. I regret that here I am inhibited by security reasons from giving an all-round figure for the number of houses dealt with, but I can indicate the policy, and I want to make it quite clear that we have never drawn a narrow definition of first-aid repairs. We have said to local authorities that they should look at their local needs and, if they were too large for them to tackle, to call on the Emergency Works Service of the Ministry of Works and Buildings directly after the raid. After that, they had to deal with their windows and roofs first and, as labour and material were available, to make the people as healthy and as happy as possible. The lack of Questions on this subject in the House throughout this period is a remarkable tribute to the way in which that very free manner of dealing with this problem has enabled the local authorities to do a remarkable job of work. I would like to pay a comprehensive tribute to them and to their officials throughout the country, as well as to the volunteers who have turned out in time of need.

We have a very big task before us. We have to think not merely of the thousand days of war, but of those vital first thousand days of peace when we have won the victory. In that connection I have only one or two things to say. We have, as the Committee knows, started a hospital survey. I have examined with interest the draft report of the British Medical Association, which has now been circulated to its branches for discussion throughout the country. Under Lord Rushcliffe, the two committees on nurses and on midwives are, I am informed, making great progress. We are also preparing our plans so that the moment the labour situation permits and material is available we may resume our onward march in housing. The Ministry of Health is also playing an active part in connection with post-war relief in Europe which is being considered by an inter-Allied committee on post-war requirements under the presidency of Sir Frederick Leith Ross. The technical aspects of medical relief and nutrition are to be examined by expert sub-committees. We are especially interested, and a good deal of preliminary work has already been done on the requirements of essential drugs in the immediate post-war period and on plans for the campaign against epidemics, notably typhus and malaria, which became such a menace after the last war. In addition, diseases directly due to malnutrition are being studied.

It is a joy to realise that in all these social questions we all go forward together or we all go back as one people. It is a people's issue, and I can assure the Committee that the Ministry of Health will do its share of the work which is necessary to realise that motto which is surely our national motto: "The whole man, spirit, mind and body, the whole man healthy."

Photo of Mr Clement Davies Mr Clement Davies , Montgomeryshire

We have had, as we have learnt to expect, a very full, instructive and comprehensive statement from the right hon. Gentleman, and he has reminded us that during the 11 years he has occupied a Ministerial position we have heard from him facts and figures, rolled out with such ease and accuracy that in our minds "still the wonder grew" that "one small head" could contain them all. [An HON. MEMBER: "What is the size of his head?"] The size of an ordinary man's, six and seven-eighths. I want not only to congratulate him, but to thank him. The most significant remark he made was made early in his speech when he said that now that we are getting to the end of the third year of the war the health of the nation is better than it was before the war began. That is due, obviously, to better feeding all round and better conditions in many cases.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

And 10,000 doctors are away from the people, in the Services.

Photo of Mr Clement Davies Mr Clement Davies , Montgomeryshire

One ought to pay a tribute to the local authorities and their advisers, and to the medical men and the nurses, for the way in which they have carried out their work at a time when more services are being required of them and more responsibilities are being thrust upon their shoulders. In the main, however, one has to pay a tribute also to the fact that there has been a wonderful distribution of food, and that there has been no real shortage anywhere. I do not often pay many tributes to His Majesty's Government, and I think that some things might have been better done, but I would like to pay my tribute to the Ministry of Food and to the Minister for the way in which a very difficult situation has been handled.

But above all I think that tribute must go finally to the Merchant Navy and to the Royal Navy for the way in which they continue to bring food to this country and maintain this wonderful standard of living. The figures which the right hon. Gentleman gave us are very significant, as is the statement he has just made about the improvement in health even during the war, but it is rather significant that at a time when we have had compulsory education for over 70 years we still require to have so many hospitals and so many curative establishments when the fact is hitting us in the face that better food and housing conditions would help to a very considerable degree in making them unnecessary. Over £300,000,000 a year is being spent, apparently, on our health services, including amenities such as housing and sanitation, National Health Insurance and such matters. But of this £300,000,000 two-thirds, or nearly two-thirds—over £185,000,000 was the figure in 1939—is being spent on cures and hospitals, on doctors and nurses, and only one-third is being spent upon the preventive side. When the time comes to write the history of the past 50 years they will wonder that we have done so much, but they will wonder still more why we stopped when we could with one further step have carried reform so much further, and that in spite of all we have done in the way of education and so on we did not take the other necessary steps which would carry us to perfect health.

With regard to food, before I come to its effect on children, I would like to refer to an interesting experience I had only yesterday, when I met a shipbuilder from the North-East coast. He paid a very well-deserved tribute to the work that was being done in the shipyards by the men, that they worked so hard that they often collapsed and had to be taken home. This, he added, was before there was a canteen in the shipyard, but since the canteen has been brought in there was no need to take anyone home. At once my mind went back to the inquiry I had to hold in 1937 and 1938, when one heard doctor after doctor attribute the diseases from which the individual suffered to the failure to give the child proper nutrition. Quite obviously we can largely attribute the good figures with regard to diseases and epidemics and so on to the better feeding of school children throughout the country. The annoying thing is that it required a war to wake us up to the grim necessity. Some of us have been preaching this year in and year out. Some of us drew the distinction between the child in the industrial area and one in a rural area. The child in the industrial area, in spite of his surroundings and by unemployment of his parents, was far healthier because of his midday meal than the child in the rural area who went from morning to night with so little food.

May I turn away from the general position to the particular one? I am glad the Minister devoted so much attention to tuberculosis. Twenty years ago, at the end of the last war, tuberculosis was killing people at the rate of 1,000 a week. It stood at the head of that dread list of diseases. As the Minister says, there has been a very great improvement, but it is still the cause of more deaths between the ages of 10 and 14 than any other disease. Tuberculosis is a disease caused by poverty and bad conditions—bad housing, bad sanitary conditions, both in the home and immediate neighbourhood, in the factories, in the mines and in the quarries, which so deplete the resisting power of the individual that the germ has an effect which otherwise many would be able to withstand. There is a tremendous difference between the position to-day and what it was even 20 years ago, but even now the cost falling on local authorities for the cure—and it is only the cure to which the cost relates—is £4,500,000 a year. I hope that the Ministry will reconsider the whole question of the treatment of tuberculosis when they have the opportunity. Here is a disease which affects us all from John 0'Groats to Land's End, and it is difficult even for the man himself to know where the boundary of one authority ends and the boundary of another begins. But the germ knows no boundary. It is extraordinary that here we are still treating diseases caused by these germs as a local matter for the local authority instead of as a national matter. What is the result? We get these varying standards. One county will go all out to deal with the matter," another will not do so much.

May I refer straight away to an instance which has just occurred to me? I want to deal more fully with after-care in a moment. But just to show the differences there are between these local authorities, let me give this illustration. We in Wales are far more fortunate than any other part of this country in dealing with this dread disease, for this reason: At the time when the National Health Insurance Bill was introduced at that Box there was no authority in England dealing with tuberculosis. Fortunately in Wales, thanks to the generosity of Lord Davies and his family, we had started what has now become the splendid Welsh National Memorial Association. That Association was brought into the Bill, with the result that we had one association dealing with the problem on behalf of the counties in the whole of Wales and Monmouthshire.

I was asked when conducting the inquiry to recommend that the Association should undertake after-care on behalf of the authorities. I refused to do so as the Association could not do all the work, but I recommended that each of the Authorities should undertake after-care and suggested a standard which should be followed by all. To my horror I discovered that up to a few weeks ago five counties in South Wales and two county boroughs had not adopted a scheme for after-care.

That is all wrong. The health of a man or woman should not depend on the accident of geography—that because they happen to be in one place they shall get treatment denied to them in another place. Therefore I am anxious for that standard to be general. I ask on behalf of the whole country that the system started in 1911 should be reviewed. Cannot we have one standard of treatment for England and Wales? The Minister referred to the difficulties that arise because these cases are not notified soon enough. The Welsh National Memorial Association have recently issued a document which I think deserves wider circulation. It has been extraordinarily well done. It has been circulated throughout Wales, and I should recommend its circulation, with slight additions, throughout Scotland and England. It says: In 1939, 12,079 chest cases were referred to the Welsh National Memorial Association. Out of every five of these, only one was found to be tuberculous, which shows that the profession as a whole is fully alive to the importance of referring actual or suspicious cases to the Association. On the other hand, during the same year, 1,887 patients died from tuberculosis. Of these, 18 per cent. suffered and died unknown to the Association.…Of the 1,395 fatal cases that were referred to our tuberculosis officers, 18 per cent. died within the following three months. Then comes this comment, which I think should be noted: This means that to one of every four patients who died from tuberculosis in 1939, the Memorial Association—a national organisation expressly established 30 years ago to control tuberculosis throughout Wales—might just as well never have existed 1 Cases of tuberculosis of the lung, by far the most important form of the disease, are classified into three groups—"early," "intermediate," and "advanced." … Again taking the figures for 1939, 2,156 new cases referred to the Association were found to be suffering from pulmonary tuberculosis; out of every five of these, only one was an early case; two were intermediate, and two advanced. 1,161 of the 2,156 cases had tubercle bacilli in the sputum (i.e., were tuberculous without a shadow of doubt and infectious as well), and of these when first seen barely one in 15 was an early case, while more than half were advanced. I have recited that because I want the Ministry, in addition to the appeals which they have made in regard to nursing—which I know will be responded to—to make every effort to make these figures known to the public. I listen to the broadcasting that is done, though I can hear the wireless, unfortunately, only on rare occasions. Usually it is nearly midnight, when I am waiting for the last news. I am appalled at the decadent stuff which is put across to our people at that hour. Why cannot that time be used to tell our people of the dangers which they run? It is time that they realised the tremendous cost to the nation of an unhealthy person, and the wonderful asset that health is. I think it would be a good thing also to tell them that in the last war 41 per cent. of the people called up were C 3—a terrible reflection on our system of social services in the past—and that, even in 1935, 63 per cent. of those who volunteered failed to reach the quite low standard of the Army. Why cannot the Government use every means of propaganda in their power?

It was suggested to me by the Association that they should take over after-care, because so many of the local authorities fail to do anything. The Association saw the tragedy of the patient coming to them and then, because of his anxiety about what was happening at home, leaving the sanatorium before he was fit to do so, going back to the slum house, which was probably largely the cause of his having had to go to the sanatorium at all, and there spreading his germs among those dearest to him, his own little children. The trouble was that they had not got, and could not be given, sufficient powers. As the Minister said, one of the main causes of tuberculosis is the horrible slum dwelling, the inhuman conditions in which these people have lived. To deal with that, the Association must have housing powers. Therefore, I had to reject their claim, and to say that the local authorities must do the work. At present, some are doing it and some are not. Unfortunately, under Section 132 of the Public Health Act, 1936, the county councils have power to take such steps as they think fit with regard to after-care, but it is purely a matter for them. All that the Minister can do at present is to use persuasive methods to induce them to do more. I have mentioned what is happening in regard to Wales. Out of the 17 authorities, 10 have after-care schemes: the seven others, up to a few weeks ago, were doing nothing.

I want to refer to Section 173 of the Act. It is an extraordinary thing that, under the public health schemes, assistance cannot be given to the families of tuberculosis patients while the patients are in sanatoria, unless the patient has been ordered into the sanatorium by a magistrate's order. Such orders really are only made when people are living in the most horrible conditions. In those cases, the patient's family can be maintained. If the man goes there voluntarily, there is no power to give any assistance to his family, except of course public assistance—and that is the thing which people object to above everything; this is a matter of health, not of assistance under the Poor Law. Some of the local authorities are doing something, and are risking being challenged. Will the Minister throw out some suggestion that the challenge will be taken up by the introduction of legislation to meet the difficulty that is preventing these patients going into sanatoria? As long as these people remain outside, they and their: families get certain conditions; but when they go into sanatoria, the conditions change.

I will conclude on the question of the shortage of nurses. The position in Wales is that, prior to the war, we had a waiting list, and it is a very agonising fact, when men are willing to go into a sanatorium—and it is difficult to persuade them sometimes—and have been told that it is the only hope for them, to find that there is no room for them. It is heartbreaking. You see these people and their families suffering because of the lack of accommodation. There were,' when I inquired in 1938, 360 people waiting, and now the number has gone up to 540. There are about 130 ex-Service men waiting for sanatorium treatment. Beds are empty to-day and cannot be used. In Glamorganshire there are something like 500 beds and about 300 or 400 in Monmouthshire which could be used but which have been empty all along. Think of the tragedy of men waiting for the opportunity which would perhaps restore them to life and health, so that they could live again with their families instead of being outcasts. I know that the trouble is nursing and domestic science.

A committee was appointed in 1937 or 1938, which heard evidence for a long time and reported in full. Why have not the recommendations of that committee been carried out? I understand that a new committee is now about to be appointed. What is the use of it? What is the real reason why nurses are not coming forward? One can easily find out. [Interruption.] If they are coming, then, there is no shortage. You cannot have it both ways. You say at one moment that the beds are empty because there are no nurses, and then you say that you have nurses. It is a question of bad pay and bad amenities. I have known of nurses having to sleep above a laundry working during the day. I would not like any relative of mine to have to work under such conditions. Over crowding is another drawback. You ought to give a girl her own room, if possible. There are moments when a girl is perhaps all the better for being able to go quietly to her room and have a good cry. There are no amenities in some of these places. No wonder there are nurses in certain places and no nurses in other places. You will have to put all this right if you want the nurses. That is a problem which the Ministry itself can solve. I myself do not like compulsion, but it is better to use compulsion rather than let these poor people suffer, waiting and waiting.

There is one thing I could never understand; it shows the attitude of mind of our ancestors. All our laws are for the protection of property and not for the protection of health. If somebody steals a loaf which he badly needs and nobody is any the worse for it and the fellow him self is all the better for it, he has committed a crime, but if he goes about spreading tuberculosis germs in trams or trains or anywhere else he is not interfered with. When are we going to change our outlook in regard to poverty? I beg of the Minister to do what he can, and we will do our best to try and encourage nurses to go into these sanatoria. There is less danger for nurses in the tuberculosis hospital than there is in the general hospital, for the very good reason that they are under the eye of specialists. We will do our best to get nurses for the tuberculosis hospitals, and I believe that we could put the whole matter right by putting the amenities right.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

I am sorry that the Minister has now gone out of the Chamber, because I would like to congratulate him on his speech. He has the right to be proud of the good health which the country has maintained since the war broke out. I, like many other Members of Parliament, do not like criticising the Government just for fun. This is no time to criticise the Government, with the battle in the Middle East going on. We feel that we ought to be a united nation, and we are, I think, united. But I would like to find out from the Government—and this is a question for the House of Commons—what is their policy for the children under five. All of a sudden, a tremendous interest is being shown in juveniles. It has taken a war to do this, as it took the last war to discover what you could really do with young people. The discovery was made by that remarkable woman, Margaret Macmillan, in the East End, with very little help and money. She cared so desperately about children that she evolved a system that, had the Government since then really paid much attention to it, the health of this country would have been far better than it is now. The point is that the country really did not care very much. There are very few people who really are deeply interested in this question, yet there are a good many people talking about it. It is a difficult question. Those of us who have always been interested in this matter do not think the Government are handling it in the best way. I was interested the other day to read the Debate in another place. The Noble Lord who spoke was very much interested. He said that we ought to have 5,000 nursery schools, and he com pared our position with Germany in that respect.

Photo of Mr Dennis Herbert Mr Dennis Herbert , Watford

I would remind the Noble Lady that she must not refer to Debates in another place.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

I forgot that. Many people advocate the provision of 5,000 nursery schools. The totalitarian governments have always tried to begin with the children. The reason in their case is revolting because they educate them solely for the purpose of fighting, but I would rather we educate the children for better purposes in life. Some of the papers have taken up the question of 5,000 nursery schools. We have not the equipment and staff, and it is not practical politics. If it were, and we had children from two to five only the saving on the building would be £10,000,000, and the saving on staff salaries would be £3,500,000, and also a saving in woman- power of 31,000 a year, and the Government need woman-power. The provision of 5,000 nursery schools would accommodate 280,000 children. This is what I want the House to realise. The saving of £3,500,000 on staff salaries alone would enable the State to give £24 a year to 145,000 women with children under two. That is 9s. a week, almost twice the amount suggested for family allowances. But, of course, it is not practical politics, and the Government will not do it. We shall be very pleased if they build 500 on the right basis. The Minister of Health says he is responsible for the under fives and that he does not want women with young children to go into industry. He wants them to be the last. But that is not the Minister of Labour's policy. Quite frankly he says he wants all women with children——

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

May I interrupt, because this is rather important? A statement was made last week which caused some misapprehension. Perhaps the Noble Lady did not hear my right hon. Friend's statement at the beginning of the Debate, when he said, on behalf of the Ministry of Labour, that mothers with young children will be the last to go into work and will not be directed.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

I am very grateful, because that makes my task much easier. If that is the case, we can save thousands of pounds and much labour. The cost of nurseries for 40 children from o to 5 is £65 per head. If the Minister of Health would have children for the same hours—it is no good the hon. Lady writing. I know what she is writing.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I am writing that the Noble Lady's facts are not correct.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

The hon. Lady knows that these facts have been worked out by a woman who knows more about this question than anybody on the Front Bench could learn even if they worked for a great many years. Let the Committee judge. As I have said, nurseries for children from o to 5 cost £65 a head; if they were built for 50 children from two to five, they would cost £24 a head, so that the capital saving on 500 nurseries would be nearly £1,500,000. If a mother can possibly stay at home with her child under two, she ought to do it, because she can take a certain care that no nursery could do. I hope the Ministry will remember that. For the children from birth to five years it would mean one adult for every four to five children. If the children were from two to five, one adult would be needed for every nine or 10 children. That would mean a saving in woman-power of 3,000 annually. Maintenance costs, excluding domestics, would be £27 per head. Cost of nurseries for children from two to five would be £12 per child per head. I know that the hon. Lady feels that there is not very much difference between a child of two or three months and a child of a few years, but I can assure her that there is a very marked difference. A child under two. needs entirely different treatment. Children from two to five are better under a qualified teacher who can amuse them, interest them, and keep them happy. If I could take Members to see the difference in nurseries for children from birth to five years and those for children from two to five, they would be astonished. I would almost rather these children stayed at home than that they were put into these mixed nurseries.

The other day I went to see one of these nurseries which the Minister boasts about. It is an Army hut, with windows high up, and all the equipment was for grown children. Anybody who knew anything at all about it would never have passed it. There was no place in which they could play, although there was a bit of grass outside. The matron, an able woman, said, "You are quite right', Lady Astor. These children ought not to be together." The din and noise were terrific. Children under two are apt to cry, but children from two to five hardly cry at all. Our local people started to put children from birth to five years together, but fortunately there was a well-run Margaret Macmillan school, and they saw the difference. Not only was it half as expensive but it was twice as good. We ought to insist on children from two to three being under a qualified teacher. The other day I went to a nursery school where the matron confessed that she had never seen a well child. It was pathetic to see those children. I wish I could show the Committee the prefabricated huts at Guildford and Amersham. The Ministry of Health's hut plans are not on the lines of comfortable up-to-date nurseries. I do not want to be personal, but until we get a Parliamentary Secretary to the Ministry of Health who really knows and cares about this subject, we shall never get it straight. We had a conference the other day, and the hon.' Lady talked to the experts there as though they could learn something from her. I say this, because I care so much about children. It is not that I dislike anybody personally. [Laughter.] It is past a joke. If you want to get this thing straight, we ought to have one Parliamentary Secretary whose duty is nothing else but child care. People who come from abroad and inquire about child welfare, say there is no one to whom they can go and ask what is happening to children in the country, because no one knows.

The Minister let child minders go by. I was asked to go to Southport to urge women to send their children to minders. Needless to say, I did not accept. This scheme has failed completely, and everybody knows it. I had a case in my own town. There were three women doing very good work in the dockyards, and they sent their children to minders. It was not satisfactory, and so we lost those three skilled women. When the Parliamentary Secretary went to. Plymouth, I doubt if she even asked whether anyone in the dockyard wanted nurseries for their children. The Ministry ought to find out in the industrial parts of the country whether there are these provisions for the children. But what matters is the future. It will not be possible to change this policy so quickly after the war. If only the Ministry would say that from now on these nurseries are to be built for children between two years and five years, it would save a great deal of money, as I have explained, and then after those children had been absorbed, if more mothers were needed in industry, nurseries could be built for the children under two.

I hope that the Minister will believe me when I say that many of us who care desperately about this matter are truly alarmed. We see nurseries being built which are completely unsatisfactory, as anyone who knows anything about the subject will realise, and we know at the same time that now is the time to get nurseries on the proper lines and to care properly for the children. The Ministry were supposed to have solid plans, but when it came to the point they had no plans for children. They handed over the evacuation of children to voluntary, people. When the children had to be evacuated from Plymouth, the job was handed over to a very nice group who wanted to help their country. A lady came down, with qualifications from the Ministry of Health, to get the children out. Naturally, she did her best, but she knew very little about it, and it was months before anything was done, and even then it was not done on correct lines. I hope and pray that hon. members will insist on better care of our children under five years, and see that the problem is faced intelligently. It is a very difficult problem, but our children are precious to us. Every time this country has a defeat in the field, people want an inquiry. I think there ought to be a real inquiry into the policy of the Ministry of Health—whether it is right, whether it is doing what we want to do, whether it is wasting money, whether it is wasting young lives, and whether it could not be improved. I beg the Minister to be guided a little by some of us who for years have studied this question and really know what we are talking about.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

My hon. and learned Friend the Member for Montgomery (Mr. Clement Davies) said that we were grateful to the Minister for the review he had made and that we had cause to be gratified with the state of the nation's health in this third year of war, as portrayed by the Minister. I entirely agree that, having regard to our having stood the strain, stress and worry of the war for three years, there was much in the Minister's statement to cause gratification. I think it is right to emphasise that this is in no small measure due to the fact that, for the last generation, we have in this country built up a system of social and public services the dividend on which the nation is now receiving. I hope this will be remembered, not only in war-time, but after the war, when possibly there will be an attempt to do what happened at various stages in the inter-war period, namely, to cut down severely the amount of money spent on social and public services. I think the nation ought to be made aware that the growth of social and public services, nationally and locally, is now one of the greatest assets of this nation, because it has made possible a statement such as the Minister has made. In Debates such as this, the best contribution we can make to the "Subject of the Debate, the preservation, maintenance and improvement of the health of the nation, is not to spend all our time in discussing and praising what we have done, but to give some attention to the outstanding problems that still remain to be tackled, and on which I shall now offer a few observations.

I should like to say a few words about children. I do not want impertinently to butt into the discussion of what became almost a family squabble between the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) and the Parliamentary Secretary. I know that the care of children under five is a question of supreme importance. We welcome the statement made by the Minister, on behalf of the Ministry of Labour, that it is not proposed to direct into industry mothers who have charge of young children. But they will go there without being directed.

Photo of Mrs Mavis Tate Mrs Mavis Tate , Frome

I think I am right in saying that, although the Minister says he did not intend to direct into industry mothers of young children, he did in the next breath say that if they liked to volunteer, he would be only too pleased. I think the Ministry should not be pleased to see those women volunteer.

Photo of Mr Dennis Herbert Mr Dennis Herbert , Watford

I would remind hon. Members that they may not discuss in this Debate the policy of the Ministry of Labour.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

The Minister said that he was asked to make an announcement, and I am discussing only the consequences of that announcement, which concern the Ministry of Health, and not the Ministry of Labour.

Photo of Mr Dennis Herbert Mr Dennis Herbert , Watford

I was not referring to the hon. Member.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

The position is that we are exactly as we were before the rumour spread that it would be compulsory. But when the women volunteer, it is permitted, and therefore, we must accept the consequences, and ought not to escape responsibility by saying that these women are not compulsorily directed into industry. If they go into industry, as they do, what happens to the children is the concern primarily of the parents, certainly, but also of the nation. There are certain things we can do. We ought to make provision as a community to accept responsibility for the care of the children under five if their mothers go into industry. I have heard it argued before, as it has been in the Debate, that the mothers' would rather have their children looked after by relatives and friends than put them into nursery schools, and that they feel that if they put the children into nursery schools with a large number of other children, the possibility of their catching contagious diseases will be very much greater. I can quite appreciate the women's feelings in this matter, I can understand their feeling that, rather than send their children to a nursery school, they would prefer a relative to look after the children. But we ought not to leave the matter there. There is the danger of that kind of thing growing into a system of baby-minding and baby-farming, which would be very dangerous. I hope very great care is being taken about that. In any case, these things ought not to be used as an excuse for not making provision for the children in real nursery schools.

I want now to say a few words about the health in war-time of a section of the community which so far has not been referred to specifically by the, Minister or any other hon. Member who has spoken in the Debate. I refer to this because I have some experience of it owing to a post which I am privileged. to fill. For two years now I have been the chairman of the Advisory Committee on Youth in Wales of the Board of Education. We have had a good deal of experience in this field, particularly in the case of boys and girls between 16 and 18. We recently had a registration of boys and girls between the ages of 16 and 18. After the registration interviews took place, and I had the privilege of seeing a summary of some of the things which were revealed. I wish to put it very strongly to the Ministry that they ought to take an interest in this matter. The question of the health of the adolescent is even more important than that of the child of five. It is at this stage that the great transformation takes place. There is a revolution in body and mind. There is definite evidence that the strain of work which is being put upon the youth of the country is reaching the point when it is becoming overstrain and is undermining their health. May I be permitted to give the Committee one or two figures to illustrate this? I do not know what relationship there is between the Ministry of Health, the Board of Education and the Ministry of Labour upon this problem of youth service, particularly from the health aspect, but I urge the Ministry to look into it.

I wish to quote from official sources the results of the registration and interviews which took place in Wales. In one county town in West Wales, out of 198 boys and girls between 16 and 18, 81 were working such long hours every day of the week, Sundays excepted, that they had no spare time left. In one factory in a county in Wales, which is represented by one of the most well-known Members, the hours of work began at 7.30 a.m. and ended at 7.15 p.m. for five days per week, in addition to six hours' work on Saturdays. In a group of other factories, the hours worked were not so long. In this case there was a working day of eight hours, but large numbers of the boys and girls spent from two to four hours travelling in trains and buses before and after shifts. Hon. Members could give other examples, but these figures I have quoted give an indication of the problem. We are placing an enormous burden on the youth of the country, and unless the health aspect is cared for, there will very quickly be a big breakdown of health among the young people. So far I have not seen the Ministry of Health taking an active part in the problem. They ought to have their representatives on these committees, because, let us remember, it is these boys and girls who may have to win the war for us, and, if they survive the war, it is they who will have to build the new world and the new Britain. These boys and girls have no time left for play, and no time for recreation. They are working long hours under artificial conditions, and, as I have said, the Ministry are not taking a very active part in dealing with the problem. I think they ought to be censured for not taking a more interested part, and I urge the Parliamentary Secretary to ask the Minister and his advisers to do so.

The Minister devoted most of his speech to the problem of tuberculosis. Tuberculosis is the surest index to the health of a nation. If the health of the nation is declining, the tuberculosis rate goes up, and, if it is improving, the rate goes down. The most serious thing to which we must devote our attention is that tuberculosis is increasing among the young and among women, and that it is continuous. The Minister gave us a series of figures comparing 1916, 1938 and 1941. He gave us the figures for infectious diseases for the first quarter of 1942. I did not wish to interrupt him at the time, but he did not give the figures for tuberculosis for the first quarter of this year. I do not say that the figures were purposely not disclosed, but perhaps we may have them before the Debate is concluded. May we be permitted to have the figures separately for Wales? I am not asking this for national reasons. Incidentally, I noticed that when this Debate began all the Members taking part from the other side represented Scottish constituencies, but since the Leader of the House has taken his place on the Front Bench the damage has been repaired.

My right hon. Friend has quoted from the memorandum of the Welsh National Memorial Association. The memorandum is a careful survey of the problem by a competent body, and is a first-class piece of work. I believe it will be of interest and of value to local authorities everywhere. Let me begin with one minor point. They are disturbed about the number of doctors being taken away for the Armed Forces. The medical services in most of our industrial communities are being far too much depleted. We all want to see the men and women who enter the Services given the best possible medical service, but I have been told there are medical officers in the Army who are not finding sufficient to do to fill in the whole of their time. That aspect of the matter ought to be investigated. General practitioners are being seriously over worked because of this depletion. The basis of our medical service is the general practitioner, and if we weaken our health service nothing we can do in the inter mediate and other stages will repair the damage done. The Welsh National Memorial Association is the authority responsible for the treatment of tuberculosis in Wales. They are deeply concerned because some of their tuberculosis officers have been called up.

Let me quote a figure from this document. The memorandum indicates the trouble is that in most of the cases damage was already beyond anything before the sufferer from tuberculosis was reported as a case for treatment. Dr. Cox, one of the officers of the Association, made an examination in Wales in a typical industrial and typical rural area, in order to discover where this gap was—the failure to bring the patient quickly under the care of the Association where he could be treated. In this typical industrial and rural area, which is a fair sample of Wales, 36 per cent. of the patients who eventually came to them had waited for eight weeks after the first onset of symptoms before seeing their doctor. Something ought to be done to shorten a period like that. It is a problem of education, and I do not think the Ministry is doing enough in the way of education to stop it. Thirty-three per cent. of the doctors waited for eight weeks before reporting a case to the tuberculosis officer. That is an enormous period of time, and it is of tremendous importance. The result is the melancholy figures that the right hon. Gentleman referred to.

Photo of Dr William Thomas Dr William Thomas , Southampton

The hon. Member does not understand the extreme difficulty of diagnosing a case or coming to a conclusion for some considerable time.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

I am quoting from a report of Dr. Cox who is responsible in this matter for all the people in Wales, and he indicates that as being part of the problem. I blame a doctor if he suspects tuberculosis and does not report it. Does the hon. Member deny the veracity or integrity of Dr. Cox?

Photo of Dr William Thomas Dr William Thomas , Southampton

I objected to the way the hon. Member put it.

Photo of Mr James Griffiths Mr James Griffiths , Llanelly

I put it as a problem, and I have found by experience that, if you want a problem attended to, sometimes it is better to state it in rough collier's language than in Harley Street language. Now we come to the other point. There are at this moment in Wales 498 tubercular patients waiting for sanatorium treatment, including men who have been in the Services in this war—whom we called to the Services. There are two hospitals in South Wales and a sanatorium in North Wales which have had to refuse admission when we have a waiting list of that kind. If we do nothing else to-day, we must urge the Ministry to do something about what is becoming a great-problem. There are over 100 empty beds and nearly 500 waiting for them. The beds are empty and the patients waiting because there is a failure to get nurses and domestic staff. The conditions, wages, hours and amenities of both the nurses and the domestic servants are not such as will attract them. The Minister has been urged to approach the Ministry of Labour to get powers to direct women to this work. When the State begins to direct women to work, it must be sure that the hours, wages and conditions are such that they can do it. No one will suggest that now. Therefore, I urge that attention shall be given to the problem. Some of these hospitals and sanatoria are in very out-of-the-way, inaccessible places. When we ask young women to go out into the wilds of the country to render this great national service, we are responsible for catering for their amenities. Everyone who serves in that way ought to have the privacy of her own room in a really good nurses' home, and I urge the Minister to look into that problem. There is a very general impression, which so far very little has been done to remove—I have had experience of it in the last 10 years—that girls are reluctant to go to these places because they are afraid that they will catch the disease, and the fear is accentuated when they hear about nurses living crowded together in their rooms and dormitories. Fear is related to the condition. I think something ought to be done about this. If you invite a young woman to be a nurse or a domestic servant in a sanatorium and tell her she has her own room after her day's work is done where she can have her own standard of cleanliness and look after herself, that will do a great deal to drive away the fear.

The right hon. Gentleman said that his Department was giving attention to the question of what is going to happen to all these health services after the war. He said nothing about health insurance. The man who is worst off under our social services is the man who is ill and cannot ascribe his illness to anything. That part of our reconstruction plans may not be of a kind that can be implemented until after the war, but there is no reason why we cannot start implementing a real health policy now. When Sir William Beveridge reports very shortly I presume that he will report on the health services of the nation. I hope that the House and the nation will sit down to plan a real, national health service. That very fine body which has done so much work for the nation on political and economic planning, in their book on health services estimated that the cost of ill-health, which could be prevented by giving good food and plenty of it, decent houses, social services and public amenities, was £300,000,000 in cash each year. Who can measure the cost in human happiness? I hope that we shall now begin to build up in this country a read national health service from the beginning right up, an all-embracing comprehensive scheme to bring all that modern medicine can bring on the preventive and curative side within the reach of everyone. Looking back over the last 25 years we can say that we have earned a big dividend from the national health services. Let us go from that and build up a big comprehensive system.

Photo of Sir Francis Fremantle Sir Francis Fremantle , St Albans

We have had a very interesting discussion so far, and I hope that the rest of the Debate will be as interesting. It is difficult to get up without paying a tribute to the Minister and giving support to a good deal of what he has said. Those of us who are particularly concerned with the health service much appreciate the immense amount of trouble which the Minister has taken in his work since he took it on and the energy and sympathy which he has shown in it. This is a stocktaking after three years of war, and as we have had it to-day it is on the whole extraordinarily favourable. The health of the civil population deteriorates in war. It deteriorates from three points of view and it is worth while distinguishing between them. There is, first, the statistical deterioration because the healthiest parts of the population are away serving. Those who are left are naturally the less strong and healthy and many of the statistics refer to them. Secondly, there are the epidemics, and we have largely avoided them. Thirdly, there are the other natural causes which are generally referred to under the general heading of sanitary causes, which are naturally diverted a good deal during war; the difficulty of nutrition, which is bound to be felt during war; and the psychological effects which cannot be sized up although a good many of us recognise how they affect health in those people who are less fully balanced than most Members of this House are.

Photo of Mr Andrew MacLaren Mr Andrew MacLaren , Stoke-on-Trent Burslem

The hon. Member is begging the question.

Photo of Sir Francis Fremantle Sir Francis Fremantle , St Albans

I very often do that. It is marvellous how the health of the nation has kept up in the war. This should mean better health after the war. If we make use of the experience of this war it should be, as the hon. Member for Llanelly (Mr. J. Griffiths) suggested, the basis of a great improvement in health after the war. War mixes up all classes of people and as it does that it opens the eyes of many of us to the possibilities of action and experience to which we were blind. War brings new ideas, new methods and new apparatus, and a good many of those things will help us after the war. When we say that, however, let us beware of complacency. There was a natural tendency on the part of the Minister of Health to-day to leave us in rather an air of complacency and with the impression that everything is being done that can be done and that, although we have to go on pushing ahead, we can be satisfied. He rather minimised certain things that are really serious, and I want to direct the attention of the Committee to them. Most men who denounce complacency in other matters are completely complacent as regards health, at any rate, as regards their own health. Most Members, I think, are complacent about their own health and do not worry about it until it worries them. Similarly, as regards the health of the nation. One of the most extraordinary things which any intelligent observer of the present generation notices is how little real understanding and interest there are in the health of the nation. It is almost as important to the winning of the war, and still more to the winning of the peace, as questions relating to the Army, which fill all the seats in the House. To-day, however, we have only 40 Members present for this Debate—really a large attendance for a health Debate. The ordinary Members of the House are not interested; they take these things for granted, but they should not be taken for granted.

I would ask the attention of the Committee to one or two points of importance which the war has discovered for us. There is, firstly, the shortage of beds for maternity needs. That is a serious thing, for people in all classes, especially in the working-class, are finding how much better it is for them to have institutional accommodation for their confinements. Attention has already been given in the Debate to the shortage of institutional beds for tuberculosis. These things cannot be remedied easily during the war. Secondly, the war has directed our attention to the shortage of personnel. That is natural enough, but it is more important than the shortage of institutions in the problem of tuberculosis. The question of pay has also been referred to. The Athlone Committee, on which two or three Members, including myself, were glad to serve has gone into hibernation during the war, but it issued its interim report before the war. It has been able to get one of its important recommendations adopted with regard to the pay and conditions of nurses that were so inadequate. As in a similar problem in education, which has been settled by referring it to an independent committee, the Burnham Committee, so in this case the Minister of Health has set up two committees, one to deal with the pay and conditions of nurses and the other to deal with the pay of midwives. They are under Lord Rushcliffe, and he tells me that a great deal of hard work is involved. It is very difficult work, but I think that a great deal may be expected out of that development.

Then the war has brought home to many people what we in the profession have constantly been urging on people generally. That is the necessity for early treatment. We can see that by the way in which people bring their children or relatives for early treatment. We must, however, remember the difficulties with which workers are faced. If, for instance, a man who is suffering from tuberculosis is asked why he did not seek treatment earlier, he may reply, "How could I? I have my wages to earn and my family to keep, and I thought I would work until I dropped." It is essential for early treatment that some arrangement should be made by which men who sacrifice their wages can be paid while they receive treatment, and so that they can be prevented from struggling on until they come to a stage which is certain to end fatally. That introduces the financial problem, which it would be out of Order for me to speak on now, though it is essential to the case.

The war has brought the public generally to recognise the importance of rehabilitation. A certain number of us, not too large a number, in the profession itself have recognised it, and have sometimes been brave enough to preach it even to Harley Street, but they have been inadequate in their understanding of the question. They start with disease as it is when a patient comes to them and as it is when the patient leaves them. They forget the roots of the disease, its causes, which are often to be found in our social conditions. They forget all that. They say, "That is another question; that is a matter for the medical officer of health." They do not even deal with it in their ordinary textbooks, do not start with the social conditions which give rise to diseases—except perhaps in passing and by devoting just a few lines to it. Students are trained to deal with diseases but are not trained to look into the conditions which prevail in factories and in the homes of the people, the conditions under which the illnesses have arisen. They start with the disease as they find it when the patient arrives in hospital.

The real explanation of this is that the medical service has started as a trade, practically speaking, in which the doctor is concerned to treat the disease or the pain. As soon as he has done that, that is the end of the matter for him. That is what the doctor was trained for. Harley Street was trained on those lines, and although they have got beyond it to a certain extent, the real terms of reference to the medical profession are that the doctor should deal with individual needs. Some of us think that the public really want disease to be prevented, and want to have the institutions to which they can go, and all the rest of it. But they want it if it can be supplied at other people's expense, out of the public purse. If they really had to pay their share then however well they were paid, even if they were paid good wages—and even if we included those members of the public who are people of leisure and well to do—I do not think we should find that the public were prepared to pay their share of all these different reforms. Therefore it really comes back to this: that we want the public to realise more fully how much they depend upon prevention and rehabilitation and how necessary it is for them to pay their way. Incidentally, they should have wages which will enable them to pay their way. That is the eventual economic goal to be aimed at.

Rehabilitation is coming on a good deal. We recognise it as among the things in which our profession has been behindhand, but the need for following up cases after they have left hospital is now being more widely accepted. It is seen that it is useless to turn a man out of hospital to go straight back to his work—because men will go straight back-to their work, just in order to keep their end up, whether they are fit for it or not. We ought not to send them back at once to the conditions which were the original causes of their illness. What is the use of having separate organisations dealing with the same case: a hospital to give medical treatment, and then a follow-up organisation, under the municipality? We ought to link them together. The doctors, the nurses who work in the hospitals and the nurses who work outside and do such magnificent work in their districts, and the health visitors ought all to be linked up organically. A good deal is going on in the matter of rehabilitation, but it will have to be done by arrangement with industry. It is no use introducing organisations for dealing with rehabilitation unless it is done in accordance with the ideas of industry and of the people who are engaged in industry.

I want to end my remarks by dealing with two further main points. We have to plan ahead a good deal, but we must not plan too precisely, because those who will have to work the plans are not represented in our councils to-day, as they are serving overseas in one capacity or another or are serving in industry and cannot take part in our discussions. Therefore, we ought not to commit ourselves to a too definite plan. The British Medical Association Commission's Report is a step in that direction but only a step; it is not a complete scheme. It has come from doctors, of whom I was one, in all parts of the profession, with all sorts of different ideas, political, theoretical, academic, from country doctors and from town doctors. They have issued an interim report which is to be regarded as a basis, as something to make people think, and the views of the British Medical Association will be known only after the annual representative gathering has considered the subject this Autumn. It is for those of us who are considering the future of the medical profession in all its bearings, medical practice and hospital practice, to study the report, and then we shall see, to whichever side we are inclined, the pros and cons of that side set forth and the other suggestions which have been made.

Various committees have been set up. There is, for instance, the Committee on Nutrition set up by the Ministry of Health, the Goodenough Committee, which is to report on medical training, a subject which goes to the very bottom of the whole question of medical service. There is also the question of the shortage of doctors. I am the only Member of this House who has had the privilege of serving on the Central Medical War Committee since, the beginning of the war. It is a matter for tears almost when one reads the appeals which come before us concerning medical men who are being called up for service and those who are being left behind to carry on the work. Doctors point out how the keen, young, active, vigorous men are being taken away, partners on whom they had relied to do the dirty work, the night work, the calls far away, the men they relied upon to go over the Welsh hills and mountains in the middle of the night. These are the men who are being taken, and their aged partners are left to carry on. Some of the cases put before the Committee have been piteous—the actual conditions, quite apart from the money side of the question, because very often they are out to lose all that they have put into a practice.

I agree with what the hon. Member for Llanelly (Mr. J. Griffiths) said about the general practitioner as being the basis of the medical service. We have been left short of both general practitioners and tuberculosis officers by the requirements of the Services'. But I do not follow him in saying that these doctors are not required in the Services. He suggested it, and it has often been suggested, but I can only feel that in existing conditions we must have regard to the needs of the Services. They are decided by the priority committee. I must not state publicly the actual numbers of doctors who have been called up, but at any rate we have had this much stated generally. Up to last January no less than 20 per cent. of our general practitioners had been called up, that is one. in five of our doctors, and those the healthiest, the youngest and the keenest of the general practitioners. Since then 1,400 more have been called up. It is a tremendous inroad into the profession and into the health services as well.

I commend the appeal which has been made to the public to help the doctors who are remaining in practice. We have gone ahead in recommending the concentration of practices, and we must ask the public generally to realise that in those circumstances they will often have to put up with the services of someone who is not their favourite doctor. It is a difficult matter, because many old ladies, and many old gentlemen too, and not only old ones, object very strongly to having to be attended by Dr. B when they have been used to Dr. A, especially when Dr. A is quite prepared to come to them but they have to be told that for the general welfare they must have Dr. B. We have had to accept different standards in many other matters, and we cannot expect to maintain the old standard in this respect. We may need the power to transfer doctors compulsorily from place to place. I hope that will not be necessary, and it should be done only in the last resort, but it is suggested that there are some places from which doctors might be transferred, though I do not think there are many places which are over-doctored at the present time.

May I make one appeal on a subject which is hateful and distasteful to all of us but which, as Members of Parliament, we must recognise, and that is venereal disease? As in the case of tuberculosis, there has been a considerable increase in venereal disease since the war. The increase may not have been so great as in the last war, as the Minister has told us, but there has been an increase. In 1940 there was an increase of 12½ per cent. The figures for 1941 we do not know. If we include Service infections there has been a total rise in one year of 23 per cent. Here is a most serious problem. For many years many of us have tried to bring this subject to the attention of Parliament since it was taken up officially by the Government in the last war. As a member of the Labour Government the much beloved Mr. Willie Graham interested himself in the problem in Edinburgh and brought me into it, and we asked Parliament to give power to compel those who had sought treatment to continue their treatment. It was found, after they had received treatment, that as soon as the symptoms had abated they went out again and spread the infection.

Why should we not deal with venereal disease as we deal with other diseases? We have powers to deal with smallpox and other contagious diseases and why not give similar powers in this case? I think the time is past when that would, give rise to a serious outcry against infringing the liberties of the subject. Men and women are going about infecting each other, and it is no use for us to lie back, shut our eyes and preach morality. We should preach morality in the long term view, but that does not meet the immediate needs of the case, and we are not justified in shutting our eyes to them. We must compel people to undergo treatment. I do not know whether any hon. Members have been to a little house which is called by the pathetic name "Sunshine home."

I have seen little children there, born blind by the fault of the parents, conscious or unconscious, and that is what I want to stop. I want to stop it in the only way you can stop it, by compelling those people to go for treatment. Other countries do it. Objections were made in the old days that it might drive the disease underground, but it has not been so in other countries, I believe, and I want the Government to have power to compel treatment. Do not let us be complacent about this disease. Do not let us be complacent about health in any way. There are a few things like the increase in tuberculosis, like the slight increase in infant mortality, the questionable subject of nutrition and this question of venereal disease, in regard to which we are not satisfied. We do not blame either the Minister of Health or anybody else, but we must not be complacent. We are not sure that the health of this country will not deteriorate still further, and these are definite points on which we can focus attention. I hope we shall focus our attention on them to some effect by making sure that the necessary powers—drastic powers in some cases and adequate powers in all cases—are available to reduce the appalling amount of preventable ill-health.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

If I were not in the House, I should almost be tempted to address the last speaker by the term of "Comrade." It is rather a strange coincidence that in every Debate on public health he Has either preceded me or followed me, and I have never heard him make a speech of greater appeal. Before I go on with my speech I must refer to what was said by the hon. Lady the Member for the Sutton Division of Plymouth (Viscountess Astor). I wish to refer to the question of child welfare. It seems to me that one is attempting to make capital out of a very difficult set of conditions in comparing war-time nurseries with nursery schools. When you are dealing with nursery schools, obviously the purpose is to deal with the children. Wartime nurseries are not, objectively, to deal with the children, but with the parents. You want the parent to go into a munition factory; the parent cannot unless you make some provision, and so you make what provision is possible. If there is criticism of the use of an Army hut for a nursery, in view of the fact that it is very difficult to get anything at all, one has to accept it.

I must, however, admit that I have been round to some of these war-time nurseries, and have felt very pleased indeed with what I have seen. I do not know whether any other hon. Member is familiar with those which I have visited, but I should be glad if the hon. Lady would permit me to conduct her to some of these very well-equipped war-time nurseries. There I can say that those in charge have a sufficient understanding of the problem to take the children in groups and to deal with those plus-two and those under two, and accomplish the very purpose which the hon. Lady had in mind in her speech. It should not be allowed to get abroad that the children of munition workers are not being as well treated as they possibly can be in our war-time nurseries. I do not intend to say anything further on that, but I thought it necessary for somebody who had had experience to express that point of view.

I want to turn back now to the question of tuberculosis. As hon. Members who have done me the honour to listen to me before well know, I am deeply concerned in it. I agree with what was said from the Front Bench on this side to the effect that the barometer of the health of the country is to be found in the figures of tuberculosis, and therefore we have to consider this disease not merely as part of the general public health question but by itself also. You cannot regard the patient waiting for a bed in a general hospital as being in the same category as a tuberculous patient waiting to go into a sanatorium, the reason being that the longer the latter is outside the more difficult it becomes to treat him and the greater is the risk of the infection of those with whom he comes in contact. For those two reasons, if for no other, it is necessary that it should receive fresh consideration.

I have read the Minister's Annual Report, and I do not quite see in that report what he is going to do about the situation. From 1937 to 1938 there was a sharp incline in the curve both of new cases and mortality. It seems to me that something should be done to meet the situation in which local authorities whose own hospitals and sanatoria are full are being told by private sanatoria authorities to remove their cases because they have not sufficient staff to look after them. In one report made to a public health committee the authority was requested not to send any more bed cases to a sanatorium but only walking cases who could look after themeslves, because they had not sufficient staff. In the Minister's own report it is stated that the campaign to recruit nurses for infectious disease and tuberculosis work there were 900 applicants, of whom 450 were considered suitable. The number was finally further reduced by selected suitable applicants not continuing with their applications. It is wrong that there should be beds empty while there are patients waiting to get into them. I cannot reconcile that with what the Minister said about there being no shortage of nurses. The truth is that there is a great shortage of nurses; there is no surplus of nurses in any part of the country. All that can be said is that there is a more adequate supply in some parts than in others. Nowhere will he find a surplus of nurses over and above the needs of the area.

How are we to meet that? There has been some response to the recruiting campaign for student nurses, but also unfortunately some have left the service. I agree that you do not get the best service from a nurse who is compelled to remain in the service. I do not think that I would care to be nursed by somebody who did not like the work, because I should be the reason which tied her to the ward when she would prefer to be doing something else. I am sure that the possibility of anyone making herself a nuisance for the express purpose of getting the sack would not appeal to me if I were sick, and it is a possibility. We know that under the standstill order there are many cases of people who cannot leave a job and who do what they can to get dismissed from it. While that may be all right in some things, it certainly would not be a good thing so far as nurses are concerned. There are, however, certain aspects of the shortage of nurses which have not yet been referred to. At the present time a girl who intends to take up nursing as a profession has to look forward to four years' training starting at the age of 18. Look what you are doing. You are losing two years of the girl's life, between 16 and 18. You are saying to the girl who leaves a secondary school at the age of 16 that before she can take up this profession—and they do not take it up unless they like it—she must wait two years. In those two years she goes out into industry and either acquires a fresh interest or becomes efficient in some other job; in any event she begins to earn money, and when you are ready to take her as a nurse you have to ask her to put aside the £3 a week she may be earning and accept £40 a year. That in itself is not a very inviting comparison.

There is another aspect too of the problem, and I think it would be well if the members of the Government who are members of the General Nursing Council would consider this. We are wasting an immense amount of good nursing ability in administrative work. A nurse becomes a ward sister, and after that she cannot look forward to any further promotion unless she leaves actual nursing, for the next step in promotion for the ward sister will be an administrative post. She will have to be either a home sister, a. sister-housekeeper, a sister-tutor, or an assistant matron. At any rate she has to leave the actual work of nursing, and I think it is true to say that a vast amount of administrative work is being done by nurses which might just as well be done by others. If however it is suggested that those posts should be given to somebody else, you are at once telling the nurse that no further promotion is open to her. That problem must be faced, and I suggest that the Minister of Health might give it his attention.

If the shortage of nurses is a contributory factor to the waiting lists for tuberculous patients, attention must be given to the solution of the problem, which would perhaps best be achieved by offering inducements stronger than those which at present exist. Some reference has been made to amenities. Progressive local authorities are not wedded to the old idea that all their nursing staffs should be resident. There is something in the idea that a nurse should be allowed to live a normal life. She is a normal woman and is entitled to hours of recreation. The value of nurses' work cannot be over-estimated at the present time, and as health treatment becomes more and more complex, clearly the type of woman you want for a nurse must be one which justifies the assumption that you have to deal with someone rather different from the glorified domestic some people think she is. You have no right to compel a woman between 28 and 35 years of age to live in the nurses' home attached to the hospital, to be in at 10 o'clock at night except with a theatre pass, when the matron grants one. You cannot deal with grown women like that nowadays, and I think you might. go some way to meeting the problem by relaxing those conditions. I agree that student nurses should be resident. As a general principle, I do not think that young girls coming from decent homes into a hospital should not be taken care of in their out-of-work hours. I think that the student nurses should be resident, but I see no reason why the staff nurses and sisters, beyond the administrative sisters who are compelled to be there, should not be allowed to live outside the hospital. In some places that is done, but there is still an idea in the minds of many people responsible for the control of hospitals that somehow it is quite a wrong thing for a nurse to live outside the boundaries of the hospital.

I wish to make some reference to care. I did make a plea in a speech previously, and I think that there is some substance in that plea. Tuberculosis is something special. Why cannot we deal with tuberculosis cases as we have dealt with the blind? We arrived at a stage in the relief which we gave to blind people at which we recognised that their poverty was due to their blindness. We said, therefore, "We will not only regard your poverty; we will regard the cause of your poverty, and in future therefore you shall not go to the Public Assistance authority, nor shall your dependants. We will take you out of Poor Law and put you under a special scheme." At the present time if a man is poor and also blind, he gets his maintenance outside the Poor Law. So do his wife and their children. Why cannot we say the same in cases of tuberculosis? A man is poor, not because of a fluctuating poverty due to the rise and fall in industry and commerce and consequent unemployment, but because he is tubercular. His treatment will take a a long time, running into years. At present his wife, every month she wishes to see him in the sanatorium, has to go before the appeal committee of the Public Assistance Committee to get the fare to go and see him. The allowance she gets is only just sufficient to keep the person concerned alive. It does not include sufficient to pay for fares for a journey of 15, 20 or 30 miles.

The Committee must excuse me if I draw on my own experience. Month after month the appeal committee of which I am a member have before them a woman who says she wishes to appeal against the assessment on the ground that she wishes to visit her husband 20 miles away, and the fare costs 3s. The man in the sanatorium is not helped in his recovery by that. Rather is the day hastened when he will take his own discharge and be a greater danger to the community thereby. We have gone so far in some places as to let a patient go in without any assessment, but there are some authorities who still assess tuberculosis cases, which I think is wrong. There ought to be a general direction. Every tuberculosis case should be encouraged to have treatment as soon as possible and to continue that treatment as long as possible. And we ought to continue in our work for those cases after they have been discharged. To give the Committee an example, a man discharged from a sanatorium came to see me only last Friday evening. He and his family are living in two rooms, and as he refuses to sleep in the same room as his wife and two young children he drags out every night a truckle bed in the one room which is their living room. Those conditions will not help him, except to get back to the sanatorium. These are not the conditions likely to prevent the figures for tuberculosis from going up.

It would be interesting if we had, in that Annual Report, in addition to the new cases and the figures of mortality, the figures of readmission also. It would be very interesting if we could know how many cases there are which, after a period of sanatorium treatment, have gone back to the sanatorium, because I hold that you are really wasting your efforts if you spend all this public money in treating a man and then send him back to the very slum from which he came. He should be sent back to conditions which will give him an opportunity for complete recovery. I am not a medical man, but I have been told by men in the medical profession that we cannot be sure about the cure of a tuberculosis case until five years have elapsed—there have to be five years with out there being a positive sign. A chance of that five years is not being given unless those concerned are given a decent environment. I do not know how far that can be done under the present tuberculosis scheme, but it is quite wrong to expect success unless the conditions under which these people live are changed.

In the report there is much with which one would like to deal, but I feel that if one concentrates on one subject it enables other Members to have an opportunity of putting their point of view, and one can speak at greater length on the one point one has selected than would otherwise be possible. I hope that this rise which is showing itself in the figures for tuberculosis will not be maintained, but that when next debating public health we shall be able to get an assurance in this respect from the Minister because of the steps which have been taken. Not enough is being done in research. The Government ought to do more. I know that a committee is sitting on it. Research, prevention so far as possible, the highest possible efficiency in care and after-care will mean perhaps that we shall have more lives saved that might have been lost, and to the extent that that happens we shall have been justified in this Debate.

Photo of Major Sir Derrick Gunston Major Sir Derrick Gunston , Thornbury

I am sure that we have all been interested in, and are deeply grateful for, the extraordinarily interesting speech we have just heard. I agree with almost every word which the hon. Member for South Tottenham (Mr. Messer) said about the nursing profession. I think they are the most important profession in the country, and the worst paid. I am not sure, however, whether I quite agree, if I understood the hon. Member aright, that nurses should not do administrative work. In all professions one gets into administrative work after one has completed one's specialised study. If that is not done, you will not get your matrons and leaders from the nursing profession itself. But I do agree with everything else he said about the nursing profession. I have never understood how it is that-we can spend so many millions on health services, and yet spend so little in paying our nurses a proper wage, which must be a very small percentage of the total cost of our health services. I hope that the lesson we have learned from this war will be remembered. I know that the Minister and the Parliamentary Secretary are most anxious to put the nursing profession on the pedestal where it rightly belongs.

I would like to refer for one moment to the Minister's speech, which I thought was encouraging. I should like to reinforce what the hon. Member for St. Albans (Sir F. Fremantle) said about more drastic measures to deal with those who spread venereal disease. Why should we burk doing what is necessary to stop the spread of this scourge? I am sure that the old days of false morality and false modesty have disappeared, and that the House of Commons will give the Minister all the powers he wants. On the subject of tuberculosis, may I ask the Minister whether he has started a campaign to diminish the daylight black-out in this country? As a Home Guard officer, I have occasionally to sleep in a Government building. I sleep in a room where men work during the day. For three years no daylight has entered that room. That must be the case in places all over the country. I believe that shutters, which could be taken down, would not only save electric light and coal, but would have an enormous effect on the health of those who work in Government or private offices. I do not think the Minister has been active enough in that matter.

I want to say a few words about the children under five. Would the Committee forgive me if I explain why I am particularly interested in the subject? My wife and I happened to be in the East End during the blitz, and we were impressed with the necessity of getting the children out of London. We approached the Minister of Health who gave us every assistance. Gradually an organisation grew which is now known as the Anglo-American Relief Fund with the object of removing children from blitzed towns such as London and Plymouth. Most generous assistance has been received from the British War Relief Society of America, who have given valuable grants, and this has enabled us to take even large country houses after they have been requisitioned by the Minister. We have many hundreds of children in these homes; and, naturally, I take a great interest in the subject but I am no theorist and I was quite new to the problem when this scheme started.

I do not think that the speech of the noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) was very helpful. She is apt at times to be bound by theories. This is a wartime measure, and I would thank the Minister not only for the help he has given but for the practical manner in which he has allowed these experiments to be made. The noble Lady, although she has the best intentions, has a bee in her bonnet about the children of over two and those of under two. She seems to think that directly a child reaches the age of two it goes through some extraordinary physical transformation. That is not our experience; nor is it the experience, I believe, of anybody who has to deal with children. There was a conference in the East End the other day, at which many experts on this subject were present, and one lady who is a great authority on child psychology said that children should not be graded according to age groups, as inter-action of ages is essential to their growth. I cannot think why the noble Lady wants to separate those over two and those under two.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

For one reason, we want the mothers of children under two to be the last to be called up for industry.

Mr. McNeil:

Since when have mothers of children under two been called up?

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

The Minister knows that all these nurseries are built for children from nought to five. The other day we had a woman at one of them with a child three weeks old. Is that what the country wants?

Photo of Major Sir Derrick Gunston Major Sir Derrick Gunston , Thornbury

We had a child of little more than three months, who was for three days buried in her dead grand mother's arms. If the noble Lady had her way, we would not take in any child of that age. At the moment, mothers of children under two are often engaged in industry. Are we not to look after their children? The noble Lady has painted a lovely picture of the home.

Photo of Major Sir Derrick Gunston Major Sir Derrick Gunston , Thornbury

She said that the mother is always the best person to look after the child. The mother to-day is often working in industry. She has not the time to give the attention that she should to the child. It is much better that children, with their parents' consent, should be put into these places, and looked after. The Noble Lady has painted an awful picture of these homes.

Photo of Viscountess Nancy Astor Viscountess Nancy Astor , Plymouth, Sutton

I do not want it to go out that I said, or even hinted, that if mothers of children under two are working, the children should not have homes to go to. They should have such places. What I said was that those women ought to be the last to be called up.

Photo of Major Sir Derrick Gunston Major Sir Derrick Gunston , Thornbury

Many of these mothers cannot live in blitzed cities, like Plymouth and London, and they have to look after their homes. It is very difficult to look after their children too. Should not those children go away? Of course they should. Let me say why I think the hon. Lady is a theorist. She wants to separate the children of under two and the children of over two. In these nurseries you will find children of the same families. I know cases where you get a child of one, a child of two and a half, a child of four, and a child of five, all belonging to the same family, in a nursery. The parents, when they come down, can see all their children at once. There is enormous affection between the children under two and those over two. The Noble Lady would separate those children, but I think it would be the greatest mistake. I am not speaking from any theory, but merely from practical experience. The great value of these homes is that in many cases they have been able to keep all the children of one family together. The Noble Lady said that she had heard of some home where the nurses, or the matron, did not know a well child, because nurses are not accustomed to well children. With the greatest respect, I would say that that is absolutely nonsense. Nurses deal not only with sick children but with well children, and they understand both well children and sick children. If the Noble Lady had her way, she would put them all under nursery school teachers. All our experience shows that children under five do not want to be in the care of nursery school teachers, but in skilled medical care, with skilled nursery school teachers, where possible, to help in their education.

I do not think that any greater harm could be done than to try and cause a row between the education and health authorities. I do not believe that the Minister of Health and the President of the Board of Education are fighting at all but are working on complementary lines, though I believe that the Minister of Health is a long way ahead of the Board of Education because some of the problems that have to be solved in war-time had been well foreseen by the Minister of Health. I would like to pay a tribute to one of the Minister's officials, Mr. Lowndes, who has had so much to do with war-time nurseries. Mr. Lowndes is not a medical man but an educationist who has written one of the most brilliant books ever written on the history of education; he is working in the Ministry of Health. That shows the good relationship that there must between the two Departments. Let us all do all we can so that the children of this country will come through the war under the best possible conditions and be made good citizens.

Photo of Mr Henry Charleton Mr Henry Charleton , Leeds South

I wish to raise in this Debate the question of the Board of Control. When I mentioned the fact to a fellow Member the other day he wanted to know what I knew about boxing, so obscure is the function of the Board of Control. This Board succeeded the old Commissioners in Lunacy, and they are responsible for supervising both mental deficiency work and mental illnesses. On the principle that it is the last straw that breaks the camel's back, I want the Minister to push the Board of Control overboard and himself undertake wider duties than those with which they are endowed. The Minister was very eloquent of the way in which the general medical services were working to prepare for a great move forward after the war, but mental services are often forgotten. The hon. Member for St. Albans (Sir F. Fremantle) has taken part in this very good work, and he will support me when I say that in the last war numbers of young men were shot for cowardice but that the same type of men to-day are deemed to have been suffering since early childhood and are specially treated and put to suitable jobs. Quite recently people who were mentally ill were put into asylums, where they were looked after, but to-day they are put into mental hospitals, where some attempt is made to bring about a cure. Progress has been made with the treatment of general paralysis of the insane, schizophrenia, paranoia and melancholia. This sort of thing is being carried on all over the place but is not organised. It is being carried on, I am afraid, in some cases by young men with an eye to promotion who start research, and as soon as they get a new job that research ends. I was brought up in a narrow school of thought that believed that we were free agents, but the more I am associated with the work of mental deficiency and mental illness the more I believe that we are not such free agents as we think we are. I hope that the Minister will look very seriously into this matter and start something which will be worthy of the time in which he lives and of the office he holds. If he does, posterity will bless the name of Brown.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

They have done that before.

Photo of Mr Henry Charleton Mr Henry Charleton , Leeds South

I have heard other people say it. I want to speak more strongly on the question of mental deficiency. The Board of Control, according to the Act, are appointed to exercise general supervision, protection and control over defectives and also to supervise local authorities. Speaking as the chairman of the London visitors, I discovered that the defectives in the County of London were not being attended to and visited as they ought to be. I wrote to the Board of Control, who answered that they were visited but that the visitors were not signing the book. They were causing their visitors to break the law, so I thought I would ask the Minister a Question. I asked him how many visits the Commissioners' inspectors made to mental defectives in the County of London during the year ending Michaelmas, 1939, and the answer was 133. The number should have been over 550, which means that they were not visiting the people whom they ought to have visited. A subsequent reply pointed to Article 83 of the Regulation, and I want to examine that position. The Act says that, without prejudice to their powers and duties under any regulation which the Secretary of State may make for further or more frequent inspection—I hope the Minister will note that fact—they shall visit every defective under guardianship at least twice in every year, and the Minister may order more visits. To show the seriousness of that and how the Minister regarded it of the utmost importance that it should be done properly, the Minister, in the reply, said that Article 83 of the Mental Deficiency Regulation, 1935, permitted but did not require visits by the Commissioners. What does that matter? The Act says that they must visit The regulation emphasises it, because it says: Every dwelling in which there is a patient under guardianship may at any time, by day or night, be visited by any one or more of the commissioners or inspectors. The visits of the commissioners and inspectors shall, unless there is reason to the contrary, be made without previous notice… This shows how seriously the Ministry and Parliament regarded these visits to mental defectives. This shows that the answer to my Supplementary Question was most misleading. What is my experience as chairman of the London Visiting Justices? I was out visiting yesterday, and in the first case I went to the Board of Control had not been there for five years. In the next case they had not been there for three and a half years. How can they exercise general supervision, protection and control over these defectives? There are a number of these girls working in houses run by religious bodies. I went to one accompanied by a lady doctor who is also a fellow visitor. The papers in the case showed that the lady running the establishment was supposed to be the guardian, but when I asked her if she was, she said, "No, I am not. Miss So-and-So was the guardian, but she went away several years ago." I asked the woman whether this lady had passed the guardianship on to her and she said, "I do not know. Another lady has been here between times." There were two girls there, practically sentenced to slavery for life. They do the dirty drudgery work for which they are allowed money from public funds. They are not allowed outside the place alone, they never go to a cinema and they never talk to anyone of the opposite sex. The Board of Control should have visited them, but they did not. Is this carrying out their job? I am sorry to say that in many houses in London there are girls who are simply cheap slaves, incarcerated in these places and not allowed outside the four walls.

Photo of Mr Daniel Lipson Mr Daniel Lipson , Cheltenham

Is it not the duty of a committee of the London County Council to send health visitors to visit these places?

Photo of Mr Henry Charleton Mr Henry Charleton , Leeds South

Yes, but their duty is rather confined to seeing that they are well fed, clothed and warm. But the Board of Control has to supervise them. Occasionally we report to the Board of Control that we think a lad ought to be released. Yesterday two of my visits were to lads in their twenties who are earning £4 10s. and £5 a week respectively. One is under the guardianship of his mother, and the other is under the person who took him in. These lads rather resent it when they are getting on and are able to look after themselves carefully. When we recommend for discharge, if the Board of Control did their job under the Act, they would know whether the case was worth considering. What do they do? They write to the local authority, which may be the petitioner in the case and which may have asked earlier for the boy to be certified because he was feeble-minded, and may have pilfered some small thing or got among bad companions. Sometimes when we have recommended discharge we visit just before the period of five years, or whatever it is, expires. Perhaps the order does expire, but the Board has not the courtesy to write back and tell us. I have evidence that we asked for a discharge in October but that it was not until the following July that the person was discharged. If a business or firm was run as the Board of Control's affairs are run, it would be out of business in a fortnight.

I ask the Minister to take serious notice of this. The time has long since passed when this Board of Control should be allowed to exist. The position of these girls all over London is a grave scandal. I know that there are different grades and that it would not do to turn out every girl, because of what may happen to her, but there are these homes and other places which are interested in keeping these girls working and letting them be paid by public money. These girls are not being educated or having the social amenities that are provided for. We are drifting back to the beginning of the nineteenth century, and I hope the Minister will look into this and if necessary cause an inquiry to be held. Let us have a fresh start and make the lives of these people brighter than they are at present.

Photo of Mr Henry Willink Mr Henry Willink , Croydon North

I hope it will not come amiss if I offer to the Committee one or two observations, not based on long experience or on any theories, but on five months of fairly concentrated attention to this matter of wartime nurseries, which has been dealt with particularly by the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor). It is reasonably obvious that I am neither a mother nor a nurse, but five months ago my right hon. Friend the Minister of Health asked me, as a side line to the work I was already doing, if I would keep an eye on the provision and arrangements for war-time nurseries in the London region. Since then I have seen a good deal of it, and in these circumstances the observations I shall offer to the Committee will be of an objective and factual, and not an argumentative, character and I hope may prove of some little interest.

I found this task most puzzling when I started to look at it, because the whole policy is inevitably full of apparent contradictions. In the first place, there was nothing more painful than to find children under five in certain parts of central London. On the other hand, large numbers of children under this age were there, and their mothers were desirous of working. The next conflict—and one to which I found an echo in my heart—was that a number of medical officers of health did not like to see very young babies being put into these nurseries and their mothers going to work. Still, their mothers were going to work or desirous of working, either for economic, or more frequently for patriotic, reasons. Consequently, there was for this great Metropolitan area a need to be met. I found in the nature of things that it was extremely difficult to find proper accommodation in many areas. Only gradually are we getting that straight, extracting nursery schools from the National Fire Service and the Civil Defence Services, and in other ways. Local authorities proceed at very different rates. When I began to look into this question I found that there were 25 nurseries open in the London region and 42 schemes approved. Now I am glad to say that in five months those figures have risen to 129 nurseries open and 71 more approved. In addition to these two classes, open or approved, at the earlier date there were and at the present date there are 80 or 90 further schemes in preparation.

There has been a wave of publicity during the last 10 days or so on this subject, and I think it may be convenient if I state one or two clear and simple facts with regard to war-time nurseries in the London region. I have seen it stated that the number of places available or shortly to become available in the London region is 6,827, apart from nursery classes and other schemes of that kind. I had found that it was wrong only to take on the roll the number of children for whom there was actual accommodation, because at all times of the year there are sickness and casualties affecting either the mother or child, either of which may mean that the child is not taken to the nursery. I found that it works out satisfactorily if you take 50 children in a nursery in which there are 40 places. On that basis the figure is 10,500. In the same material in which I found that figure of 6,827, I found it stated that the population of the area with which I was dealing was 10,000,000, whereas in fact it is more like 7,000,000. The joint result of those two errors is that the provision in proportion to the population is more than twice what it is stated to be.

I should like to say a few words about what seemed to be the main point of the speech of the Noble Lady the Member for the Sutton Division of Plymouth, who keenly desires—I am not quite sure that I am right in saying this, in view of her interjection a few minutes ago—that nurseries set up by the Government should not cater for children at all ages from o to 5. A moment or two ago, however, the Noble Lady said that in the case of mothers with children under two who desired nursery accommodation, there should be nursery accommodation. Those two statements put together present an extremely difficult proposition, because it would mean that there would have to be a very much larger number of establishments. I myself think that in the matter of the children between o and 2, there has been considerable misconception. Frankly, I approach this matter as a war-time measure. It is not part of the general development of schemes for the welfare of young children. Its purpose is to make the very best provision which will give facilities and confidence to mothers who desire to work in national industry. On that basis what one does, of course, is to keep in the closest touch with the Ministry of Labour. Those who do the detailed work are in daily, if not more than daily, touch with the Ministry of Labour as to where nurseries should be opened. Consequently, I hope that the projected nurseries are in the right places.

But what are the results, bearing in mind this question of whether those between 0 and 2 and those between 2 and 5 should be separated? The remarkable thing is that, taking 71 nurseries, all of which have been open for some little time, and taking the figures of attendance in the month of May, the average attendance at the nurseries only fills them to the extent of 70 per cent. I have not heard in the Debate, although I have not been able to be here all the time, any attack upon the adequacy of the provision, but it is curious that, however the nurseries may be distributed, they do not seem to fill very easily or very rapidly. What is more important with regard to the age distribution is this. I need not, perhaps, trouble hon. Members with the total figures for the 71 nurseries, but I have reduced them to a proportion of a typical nursery of 40, and the average, brought down to proportions of 40, is as follows: if every nursery were a nursery for 40, on an average there were present in it, during May, nine children under two and 18 children between 2 and 5, leaving 13 blank places. There is no reason to suppose that if the children between 0 and 2 had been excluded, the figure of 18 would have gone up; there was plenty of space for more than the 18, in spite of those between o and 2 being admitted.

One has to remember that there is a very short distance limit within which mothers will bring their children to the nurseries. I feel that the case for the nursery for all ages between o and 5, for this particular purpose, is completely made out in urban areas. Mothers may bring children of 0, 1 and 3, I feel that when a mother wants to bring three children, she is really taking as much labour to care for her three children as she is providing by going to work. But that cannot be helped in certain cases.

The other criticism which has been made concerning bringing the children together is, surely, erroneous. I had the privilege of being a member of a large family, and in that family those between 0 and 2 and those between 2 and 5 were mixed. It has been said, during the last week or so, that in the nurseries all the children are assembled in one room, with great strain upon them. That has never been so. There were always two rooms, and in the new huts which have just been designed, there is one room for the babies, one room for those in between—I gather they are called the "tweenies"—and one for the oldest class, which are called the toddlers. I cannot think that it would be a wise policy for the future to try to separate those ages to any greater extent.

I should like to mention one or two other indications of this, and one or two other experiments we have been making. In the County of London, the Metropolitan Boroughs are the maternity and child welfare authorities, but the London County Council have been offering their assistance, and one experiment is already well established and another is coming along. One result of the heavy bombing was that a year ago London had a large number of equipped rest centres with staff, and it has been most desirable in periods of lull that the staff should be used. I am glad to say that there are 20 prefects, 12 of which are completely in operation, of war-time nurseries in the rest centres. Those nurseries are only for children between 2 and 5, because there is not any special staff. But there, too, the attendance is only 70 per cent. of capacity, so that again one gets a similar indication. This policy would have gone very much further but for the difficulty of accommodation in the London area, which I have mentioned already.

There is very great pressure on school accommodation, and in many places where one had hoped to be able to establish nurseries, the education authority has had to put its foot down and refuse. Consequently, we are developing another plan for building huts in school playgrounds—and I hope this will go forward—with this very great advantage, that they will be small units for 30 at a time, they will be, in the nature of things—because they will be where there are schools—in places where there are large numbers of the population who are likely to use them, and they will be well distributed. I feel that that is a promising line.

I have kept closely in touch with that most useful body, the National Society of Children's Nurseries, and I am also making a special attempt to get into close touch with the school-leavers from the secondary schools at the end of next months because, whether or not the pay is enough, whether or not it leads directly to a career, I can imagine few more beneficial occupations for girls of 16 or 17 than working in a nursery of this kind.

Those are the observations I wanted to make. The vast majority of these small children whose mothers are at work are being, and I am sure always will be, looked after under private arrangements. War-time nurseries are making in London, and I expect elsewhere, a very valuable contribution, but it is only a contribution, and I cannot think that wartime nurseries really call for quite so much publicity as has been given to them recently.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

I should like to congratulate the Committee on the high tone of this Debate. There has been a desire, not to indulge in carping criticism, but to try and make helpful criticisms. I am hoping that, as far as this Debate is concerned, we shall see some real results in the coming year. I should like to congratulate the hon. Member for St. Albans (Sir F. Fremantle). I never heard him better, and I was almost going to say to him, "Come over on this side." Someone said, "Don't do that," but I was delighted with his speech. I was also delighted with the speech of my hon. Friend the Member for Llanelly (Mr. J. Griffiths) when he was talking about tuberculosis. Although I am not living in Wales—I am a naturalised Welsh Yorkshireman now—I am very much interested in this subject. I am still interested in the tuberculosis conditions in South and North Wales. I want to put to the Minister a matter which will bring about a great increase in the incidence of tuberculosis among young women unless something is done. I want to cite the case, which came directly under my observation, of a young lady who was living at my home up to three months ago. She was called up, and we have now to manage ourselves—some times I have to turn to washing the pots.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

I can manage it very nicely. I have been doing it for over 40 years. As I was saying, this young lady has been called up, and her case gives an outline of what ultimately will increase the incidence of tuberculosis among thousands of these girls. She gets out of bed at 4.30 every morning, and has to make three changes in buses to get to work. She gets back home at 8.40 at night. She has been doing this work for three months—bed and work—and she is not alone. There are thousands of girls like her, and I am pleading here to-day for them. They cannot stand this continuous strain, and, unless something is done, the increase in tuberculosis this year will be nothing compared with what it will be next year.

I want to speak about another class to which no reference has yet been made, and I do not know why the Minister did not refer to them in his speech. I want to speak about diabetics. I am receiving letters from diabetics all over the country, and I have one in my hand from Prestatyn. I was asked this Sunday to visit one of my own people who is taking 120 units of insulin every day. The price of a bottle of insulin has increased from 2S. 10d. to 3s. 10d. since the beginning of the war. It means that this poor woman, whose husband is a surface worker at a coalmine, has to pay 32s. a week for insulin if she is to live. The increase in price is 8s. a week. She said to me on Sunday night, "George, can you do anything about it? Is it possible to stop this increase in price?" I have had an interview with the Parliamentary Secretary, and, although she was favourably disposed, she told me the Ministry could not touch the matter. I am making an appeal for the 300,000 diabetics of this country. Cannot something be done to prevent this increase? I hope, if the increase is necessary, that the Government will subsidise the price of insulin for these people. Some of my colleagues may point out that these people are State-insured, but this person is not State-insured, although her husband is. If her husband had the complaint, he would receive insulin free. I have pleaded before, and I shall continue to plead until I reach my goal, that not only shall State-insured persons have the benefit of insulin, but also their wives and children. If that could be done, they would be relieved of all financial worry. It is true that not all of the 300,000 diabetics are taking insulin, but a good proportion of them are, and, while some of them get it free, others do not. I am speaking feelingly on something I know, and not on something which I have read in a book. I take insulin myself every day, and there is only one thing in my life for which I am sorry, and that is that I have never been able to shake hands with Sir Frederick Banting and thank Almighty God that he was able to discover insulin for diabetics.

The hon. Member for St. Albans spoke about rehabilitation. I saw a rehabilitation centre at Mansfield, Nottingham, on Monday, and I wish that every hon. Member could have been there. This centre deals with accident cases among workers in the mines. We want rehabilitation centres for everyone for whom they will be of benefit, instead of confining them only to men working in the mines. I visited this centre with the Parliamentary Secretary to the Ministry of Pensions, and we saw there men suffering from fractured spines. When I was a boy, my brother came home, 53 years ago, with a fractured spine. They brought him home in a farm cart—there were no ambulances in those days. He is living today, but he is unable to do the same work as the men at this centre. I saw men at this centre playing football, net-ball, and acting about and wrestling with one another on the lawn. These men work for six hours a day exercising themselves. This is not a convalescent home, and it is not a hospital; it is a centre which helps men both mentally and physically. The men are there enjoying it. They do six hours' work a day for five days, and then go home at the week-end. On Friday nights they go back to their wives and children, and return on Mondays. Of the men at this centre, 66 per cent. of them return to the work they were doing before they met with their accident. I was told that, if a thing impressed me, it might impress someone else, and, therefore, I want to put this across. The doctor at Mansfield Hospital told us that of the 500 cases, both minor and major, which he had had under his observation, 475 had returned to the work they were doing before they were hurt, and 22 to light work. There were only two cases where the men had not gone back to work—one passed away, and the other was paralysed in the arms and legs.

That is a great saving financially to the country, from the point of view of compensation, among others. It is also a great inspiration to the man and his wife and family to feel that he is working for his living. I hope the right hon. Gentleman will not forget the young woman who gets out of bed at half-past four and comes home at 20 minutes to nine; and I hope I shall touch, not only his head but his heart, in the matter of the price of insulin and that it shall be free not only to insured persons but to their dependants. Then I feel that there will be some joy in living. It has meant life to me. I am not speaking from a book but from experience, and I want everyone who has been gripped by this complaint to get the same joy out of life that I get every day.

Photo of Dr William Thomas Dr William Thomas , Southampton

I always feel that in these Debates we indulge in a form of dialectic materialism and do not actually discuss health at all. We incline to debate ill-health the whole time. People speak as if they had some vested interest in disease instead of regarding health as an inheritance natural to us all. Nearly all children are born healthy. There are exceptions. Some have congenital disease and some are perhaps deficient, but, on the whole, they are born completely and absolutely healthy. Even the children of under nourished mothers come into the world healthy and strong at the expense of the body of their mother. I know it from experience. I think the Minister should use that as the foundation of his view of the national health. Health is, and will be, maintained if there is sound nourishment, good housing and working conditions and healthy exercise. I believe the old Greeks were right in believing in a perfect balance between mind and body. We are constantly being attacked by the enemy at our gates. Germs are ever ready to attack us—and we are often the victims of bad feeding. Nevertheless, I am quite sure that, if we are fortified with good food and good housing, we shall not to any great extent become the victims of disease.

The children of to-day will have to bear the whole of the post-war burden. There will be a great National Debt around their necks, there will be an increasing number of old age pensioners whom they will have to keep by their productive capacity and we shall be a debtor country working hard for our essential raw materials and in order to fill the food gap our farmers cannot fill. We must see that our children are maintained on the highest possible level of health so that they will enter the struggle well equipped to bear the burden. There was a time when quite young children worked for their livings. Defoe tells how when on a journey from Blackstone Edge to Halifax he saw children scarce above the age of four spinning in the cottages. But, when we started to become an industrialised country, they worked in the ill-ventilated factories. The country, rightly, rebelled against that and deprived them of the opportunity to earn their living, but I am afraid that since that time we have not paid the respect to them that we should. In ancient Rome I believe children were looked upon as the most important part of the State. The Romans regarded them with great respect as the future citizens of the race. They clothed them in the purple toga, the toga praetexta, the toga of the magistrates.

Mr. McNeil:

My history is not as good as the hon. Member's, but my recollection is that the Roman system was than any new-born infant needing medical aid was left outside to die.

Photo of Dr William Thomas Dr William Thomas , Southampton

I do not think so, and I do not wish to go into the morals of the Romans, but they regarded the children as the most important element of the State. Looking at it from the point of view of industry only, it is essential to maintain them in good health. It was found at York that of 15,577 men over 21 only 3.9 per cent. had families of more than four or five, but they were responsible for 25 per cent. of the children of the City. On Merseyside 25 per cent. of the children were found to be below the poverty line. A doctor in West Sussex found that 72 per cent. of the elementary school children were living below the line of nutrition laid down by the Children's Minimum Council. I shall not say that they were living amidst eggs, milk, cheese and butter, because anyone who knows anything about British agriculture between the two wars, knows well that that could not be so. Let us, therefore, look at the condition of the ill-nourished child. We have all seen him with his pale, flabby face and red nose, with no overcoat and his hands tucked into his sleeves going to school on a cold winter's morning after his breakfast of tea, bread and jam. Closer examination by anyone—it does not need any medical knowledge—would show that he often has nasal catarrh, breathes badly, is flatchested and knock-kneed. He is a common sight—dull and listless at his lessons and slow at his play.

Unfortunately, malnutrition is difficult to assess because there is an absence of positive health on the one hand and an absence of disease on the other. Doctors disagree on what is malnutrition and what is not. The only way in which one can decide is that the child who is under nourished has poor resistance to disease and that when it contracts disease, it is unable to throw it off quickly. Every doctor who has practised in an industrial area knows that malnutrition is a common thing and that although children look fairly well in summer they go down at the first shot in winter. Instead of just a short common cold, they develop bronchitis and broncho pneumonia. That occurs year after year, and yet these children hold on to life tenaciously when at 17 or 18, they have to bear the whole burden of industry. It is remark able to me that they behave so well and keep the laws of the land as they do after having had such a bad start.

The Chief Medical Officer of Health of the Board of Education in 1938 examined 1,674,000 school children. He found that only 14.5 per cent. were in excellent health; 74.2 were in what he called normal health; 10.8 per cent. in subnormal health; and.5 per cent. in bad health. That does not appear as if many were in bad or in sub-normal health; but actually it meant that 189,165 were in indifferent health. In regard to those who were in normal health we should consider that every young child should not be in so-called normal health but should have excellent health, with rosy cheeks and should be romping round and asking questions in a way we always associate with a healthy child. An interesting point in the problem of nourishment was brought out by Sir John Orr when he made an experiment at Christ's Hospital. I give it in adulation not in condemnation of these schools. This is not the richest of public schools but it has a great tradition. It is associated with professional people and most of the boys come from excellent homes. He found that at the age of 13, boys at Christ's Hospital were 2.4 inches taller than boys of 13 in elementary schools. Boys of 17 at Christ's Hospital were 3.8 inches taller than boys of 17 in industry. Although height is not an indication of health the figures are interesting. Dr. Corry Mann in 1938 gave 41 out of 102 boys in an industrial school a pint of milk a day above their normal diet. He found that the boys who had the milk were ¾ inch taller at the end of the year than the remaining 61 and they were more than 3 lbs. heavier. In addition, and more important, he found that the boys who had the milk had hardly any illness at all while among the others illness was all too common.

Leaving the story of the under nourished child I come to the ill-effects of under-nourishment on the father and mother. Men who are under-nourished recover from illness very slowly. A tremendous amount of work is lost per year owing to slow convalescences after illness because of lack of nourishment. That is usually associated with large families. Some years ago Sir Robert McCarrison experimented with monkeys by giving them the same diet as was usual with people living in poverty and he found that they developed gastritis and colitis and similar diseases. It is curious that 12 per cent. of the insured population suffer from these complaints. If national ill-health costs the country £300,000,000, what an opportunity there is to apportion some of that money for better nourishment and housing of the people. When we come to the woman, the real head of the family, the story is often desperate. We all know how the buxom young woman starts out in life, full of hope, happy with her husband, and how they look forward to building their home. They look forward to their first child with joy. The second child comes, and then the third. Her daily work mounts up, there is more washing, more mending and less food to go round. A fourth and fifth child arrive and she is drained of her lime and iron. The buxom young woman becomes lean, stringy and bad-tempered—the only unpaid worker in the country. At last she is unable to control her family, the house becomes desolate, she is unable to prepare proper meals—incidentally, too many of our young women are unable to cook as they should—she is unable to cope with the situation, and her husband in despair at the discomfort, finds his way to the street corner with his single sixpence and puts it on the dogs in the hopes that he will become rick quick and end his misery.

The Technical Commission of the League of Nations laid down what should be the minimum daily diet of a woman carrying a child. According to this body, she should have each day a quarter of a lb. of meat, 8½ ozs. of potatoes, 3½ ozs. of green vegetables, ½ oz. of root vegetables, 2 pints of milk, I egg, I oz. of cheese, besides cod liver oil, sugar and raw fruit. But these foods, which contain essental vitamins, proteins and fats, are expensive. The national health should be considered therefore from the angle that good food is the basis of good health. It should also be considered from the point of view of better housing although this alone is not the entire solution of the problem. It has been found on the Tyneside that so long as the standard of nourishment is low, tuberculosis remains stationary. Many of the infectious diseases on which we spend so much money and labour, if looked upon from this angle, would largely disappear. We are born healthy and we should continue healthy.

I should now like to turn to a different subject which is intimately connected with the health of the nation—the medical profession. The theme is constantly coming up. We have recently had a Commission which has made recommendations; schemes have been brought up by a movement called P.E.P.—we have had one plan after another. In fact, we are living in days of planning. I have always regarded planning as in some degree an excuse for tyranny. Some people are so much disposed to direct the lives of others.

If it could be arranged that I could have some idea before birth as to the kind of planned world I should have to expect and I could choose whether I should come into it or not, I think I should decide not to do so. So let me ask the right hon. Gentleman to consider carefully before he embarks upon any of these schemes. He already has a great Act which has been in operation for many years and on which he can, with care, successfully build.

The National Health Insurance Act—and I was only a small boy when it was passed—created a revolution in the practice of medicine in this country. I have heard the story of the old methods of practice. The country doctor had to struggle along, making his fees out of the richer patients while frequently attending the poorer ones for nothing, and there was also a club system under which small sums of money were collected and doctors did their best under the worst circumstances possible. Then the National Health Insurance Act came into force. There were some abuses—everything is liable to be abused—but bit by bit they were being eliminated, and before the war I believe a large measure of co-ordination had been attained between those who work the Act and the hospitals.

The ordinary general practitioner is a man for whom I have great respect, because he is in the front line of the battle, and if he makes an error all the rest is in vain. If he is unable to diagnose a patient's appendicitis, or to suspect serious trouble, nothing can undo the damage. Before the war, general practitioners were therefore fast co-operating with the hospitals. If one of them was in any doubt about a diagnosis he could send the patient to hospital and the hospital would send a report back to the doctor. The same thing happened with regard to tuberculosis. This was a big step forward. If the doctor suspected that the patient was suffering from tuberculosis, he sent him to the tuberculosis officer and all the machinery provided by the public services was put into action. That was why I interrupted the hon. Member for Llanelly (Mr. J. Griffiths) who quoted a figure but left the bare figure only before the Committee. It was very unfair to the medical profession for the hon. Member to quote a figure for the time between when the patient showed the first symptoms of the disease and the time when the doctor had sent him to the tuberculosis officer. To say that that amounted to 33 1-3rd per cent. and leave this figure unexplained was grossly unfair, because tuberculosis is one of the most insidious diseases. Very frequently a patient suffers from no more that lassitude, and he may consult his doctor on a hot summer's day when we are all feeling very much the same and to make the diagnosis in the absence of other evidence is well nigh impossible without scientific aid.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

In the absence of the hon. Member for Llanelly (Mr. J. Griffiths) may I ask whether it is not a fact that he did not blame the doctor but merely mentioned the fact?

Photo of Dr William Thomas Dr William Thomas , Southampton

I agree, but I want to clarify the matter. I have a great respect for the hon. Member for Llanelly. What I would say to the Minister is that already he has the National Health Insurance Act, which has improved things as the years have gone by and under which things were improving rapidly before the war. It is on that Act that the Minister should build in the future. But there is one lesson which he ought to learn. He had a system of regional medical officers who went round to inspect these doctors' re- cords —a warning of the danger of what might occur under a State medical service. I cannot discuss that now, but I believe it has been the practice for the members of this service to put the screw on doctors more and more in order, perhaps, to justify their existence. Some of the older doctors kept records but others did not, because they know their patients, and only kept a record of the diseases which were of importance. But these regional medical officers said, "You must put a tick on the card every time your patient calls upon you." At last, before the war, it had become a fine art to call on these doctors in order to see how many times they had seen their patients. They were not concerned with the illnesses, but were wholly concerned with the number of times the doctor had seen a patient. They developed things even further, getting at last to the point where they claimed that they could estimate the statistics of any particular neighbourhood. They were but little concerned whether the doctor was a good doctor or not—the forms and figures mattered more than the patients. I mention this as one danger of a bureaucratic service, in which the interests of the patient will be forgotten in the red tape which surrounds the whole business.

Photo of Dr Hyacinth Morgan Dr Hyacinth Morgan , Rochdale

Are not statistics of attendance either at the home or the surgery very important from the point of view of occupational diseases and their relation to the general health of the country? That is not bureaucratic medicine; it is ordinary, common or decent medical practice to keep a record of your patient's illnesses.

Photo of Dr William Thomas Dr William Thomas , Southampton

The hon. Member is right. It is essential to have certain records and statistics, but one can carry all these things too far, and a doctor can forget his patient by worshipping at the shrine of the statistics of bureaucracy, and I warn the Minister, before he makes any changes in the future, to consider carefully the great and solid foundation which has already been laid in this country and to be careful to see that he does not alter the old relation between doctor and patient which is cherished by the people. It was my intention to go further, but there are many other Members who want to take part in the Debate. I trust, however, the Minister will keep in mind the two points which I have made. The first is that the good health of the nation rests on good nutrition, good housing, whole some conditions of work and good healthy exercise. In the past we have been concentrating upon disease and disease only. Let us concentrate on good health. My second point is that the Minister should hesitate before he brings in some new system which might be disastrous to medical practice in this country with its resulting effect in the battle against disease, which, in spite of all, will in some degree persist.

Mr. McNeil:

I do not mean to follow the hon. Member for Southampton (Dr. Thomas) along the whole road which he has gone. I am very much impressed by his argument, and I certainly would not deny that if he could guarantee wholesome nutrition, good housing and wholesome occupation disease would very largely disappear. My hon. Friend the Member for Maryhill (Mr. Davidson) whispers to me that we should also arrange that the sun should keep shining. I am not clear, however, why the hon. Member for Southampton did not pursue his argument further and tell us which occupations he did not regard as wholesome. The hon. Member for Llanelly (Mr. J. Griffiths), whose arguments he criticised, would I am certain tell us that mining was never meant to produce good health. I do not know whether the hon. Member for Southampton meant to cut out mining and many other dangerous industries. At any rate, I was much impressed by the dexterity and the mental arithmetic of the hon. Member in demonstrating that there is so much disease in this country to which, plainly, he wants us to shut our eyes.

I want to bring the Debate back to some figures which the Minister has placed before us, particularly those relating to tuberculosis. The figure of 29,000 deaths in the current year is one to which not even the hon. Member for Southampton can shut his eyes. I am sorry that the Minister confined himself to deaths and did not tell us the number of notifications. I should like to know the relation between notifications and deaths in 1940, 1941 and 1942. I am sure the Minister did not want to conceal anything from us, or to slip any argument across us, and that he will be delighted to quote the number of notifications to us at the end of this Debate. I do not make this merely as a debating point, because in a recent White Paper dealing with mass radiography in the Services we were given some very interesting figures. Using this method the Navy managed to re-examine roughly 100,000, and in that number they found that only.3 per cent. were infected with tuberculosis. The Air Force applied similar methods to new intake men, numbering 46,000, and found in that sample.2 per cent. infected. In the Army, which took the smallest sample, 10,000,.1 per cent. were detected as suffering from tuberculosis. A committee recommended against the use of this method not because it thought that the Services would not benefit by radiography but because they did not think it practicable.

I am sure this Committee will join in congratulating the Minister of Health in pushing ahead to overcome the practical difficulties in the way of the application of radiography. The report of the Committee to which I have referred concluded, rather smugly, that since the figures showed that only.3 per cent. of men for the Navy.2 per cent. of men for the Air Force and.1 per cent. for the Army were rejected as infected with tuberculosis, we were missing only one to two cases in a thousand. That is the kind of arithmetic in which my hon. Friend the Member for Southampton delights. But there is another way of putting the same figures. You can, from the same figures, argue that the boards are missing two, three or four tuberculosis sufferers out of every 15 examined by the Services. That is a fairly savage proportion. These conclusions are relevant to this Debate because, plainly, we can expect an even higher miss in industry seeing that the Services are taking the younger and fitter men. I submit that it is a reasonable proposition, that even if we could have everyone in industry examined by the ordinary methods, we should still be missing a good many sufferers. Therefore I congratulate the Minister on his intention to apply mass radiography to the general population, and I congratulate him on his assurance that he is organising a pool of radiographers capable of undertaking that work.

I do not think there is any hope of quickly applying that method in the mass in the near future, yet no figures can provoke greater thought than those relating to the increase in tuberculosis. The Minister said it was not a figure to cause alarm but was giving concern. I sympathise with him in his anxiety to avoid the use of the word "alarm." I agree readily that, except as regards tuberculosis, venereal disease, cerebro-spinal meningitis and scabies, he presented a very good picture to the Committee and he deserves every congratulation for the work he has done.

I had hoped—if I may diverge for a moment—that the right hon. Gentleman might have attempted to tell us how far in those other fields this comparatively satisfactory standard of health was related to industrial and school feeding. I know it is exceedingly difficult to obtain figures in this matter, but I think it would be well worth the effort to try to show what the relationship is. There are many people living pretty sadly now because of rationing difficulties, but there are thousands of people enjoying a much better nutritional standard because their purchasing choice is fairly narrowly confined to foods of recognised nutritional value. The psychological effect is important here, but despite the comparatively satisfactory picture, there is this tuberculosis figure which, if it does not cause alarm, at any rate is a matter creating great anxiety not only in this Committee, but in technical circles throughout the country.

I have argued that I do not think it possible to achieve earlier diagnosis by mass radiography. I think the only possible alternative—and I insist that the Minister, however great the difficulties, must find an alternative—is education, or to use a word which we do not like so much, propaganda. He must focus opinion in order to attract the worker to come earlier to his practitioner or, wherever possible, to the industrial medical service. When the Minister was handing out credit to the various organisations which had assisted him during the last year, I regret that he missed the Press. He also said something with which I disagree. He said that war and diseases still get the headlines, but peace and health do not. I fear that that is one sweeping generalisation which I cannot accept. There has been an increasing tide of popular literature on preventive medicine; the Press has a great and real sense of responsibility, and has constantly urged any positive idea which the Minister wants to spread in this country, as for example, his own campaign on diphtheria immunisation, which was based completely on the support of the Press. He might enlist this kind of support again to tackle the problem of bringing potential tuberculosis sufferers earlier to their doctors.

One of the walls he has to smack down is this abiding idea that there is something rather shameful in being ill with tuberculosis. It is a reflection on this House that there have been 29,000 deaths in the current year, but it is no reflection on the man taken from school into a high-pressure industrial machine, forced to live near that machine, and forced to buy only such foods as his pay and education permit. But such a man does think it rather shameful when he suspects that he is afflicted in this way. The Minister must make it clear to young people between 16 and 25 that there is no shame in it; that it is a scar of the industrial battlefield which we cannot escape. Our figures in the last war led us to expect this rise, and although we cannot escape it, we can provide an early opportunity to deal with it. I hope most earnestly that the Minister will try this educational approach to the problem. It must be done through the Ministry of Labour. There is a great field which can be developed, particularly where there is an industrial medical service, by the use of posters and talks and by arming the industrial first-aid corps in the factories with the facts.

May I add one thing in connection with the Minister's speech? We are all aware of the very great difficulties we have had in providing adequate nursing personnel for sanatorium treatment. I think it is proper that a tribute should be paid to the very fine work undertaken by the Parliamentary Secretary, the Minister's colleague, on this subject. I am not going to take up the time of the Committee by pursuing this subject any further. The Minister himself pointed to the L.C.C. rota scheme. I wonder whether the Minister could consider making beds immediately available, thus getting over his labour difficulty in some measure, by setting aside a limited number of wards in each of his E.M.S. hospitals for tuberculosis treatment. Those E.M.S. hospitals, which are built on a modern plan, are extremely suitable for this because they have the one-floor pavilion type of wards, grouped in twos or fours. If, in each E.M.S. hospital, two or four wards were set aside for tuberculosis treatment, and if nurses were placed on a ward rota, it could be taken as part of their training and would help to overcome the fear of tuberculosis nurses being grouped together. It would also be possible to initiate a fairly effective advertising campaign by pointing to the new E.M.S. hospitals and saying that there is no overcrowding there, no under-equipment, no dull wards, but fresh air, good living room, and pleasant associations. I know that it is not a radical step forward, but I think it might make some contribution towards a solution of the labour difficulty which must be dealt with in attempts to tackle the tuberculosis problem.

Photo of Mr Ernest Shepperson Mr Ernest Shepperson , Leominster

I should like to congratulate the Minister on his review of the health situation of the country, and I should also like to inform him how very pleasant it was to listen to that statement of what he is going to do to preserve the life of humanity when we have had to give so much of our time, thought and energy to matters connected with destruction. A tiger is let loose upon Europe to-day, and all our energies, efforts and thoughts must be harnessed to destroying that tiger. When it is destroyed then we shall be dealing with the microbes of the diseases which threaten us. The tiger probably has devoured more of Europe than it need have done because, it has been held in some quarters, the forces were not available effectively to destroy it early enough. I hope that the Minister in attacking the microbe that we shall later be called upon to destroy will not be found wanting in the efficient preparation of the means for that destruction.

To-day the Minister has given the highest possible praise to British medical men and British scientists. It has been asked of me when these great medical men and scientists will be harnessed to give medical assistance not to a few hundreds of our population who can go to Harley Street but, by engaging in scientific and medical research work, to the service of many thousands of our fellow-countrymen. I would like to see generous grants from the State for research work to enable these great scientific brains to give their lives to the study of and the search for cures for our various diseases.

I myself suffer from osteo-arthritis of the hip, as do hundreds of thousands of people in this country and, I believe, two or three of my colleagues in this House.

We have tried all methods and have consulted many people, but not one of them has been able to say what is the cause of our trouble. I have had doctors who have said to me, "You had an accident in your youth." Of course I had an accident. I have fallen off a horse many times. I have fallen while skating or while ski-ing in Switzerland. Some, not so sympathetic, have said to me, "You have been in the House of Commons for 20 years; what more can you expect?" From all the treatment we have had and everything that has been said to us we have come to the conclusion that the various doctors do not know what the cure should be. I would suggest to the Minister that if in the past more of the great brains of the medical profession had been engaged in research work, we might be better off than we are to-day. I would like to see grants made by the State for more and more research work.

I will apologise to the Committee for relating a personal experience. I have a daughter, who was at school, apparently very healthy. She went from school to Newnham College, Cambridge, where she had measles and later developed a cough. At Cambridge she was X-rayed. T.B. was indicated. Immediately she was sent to the T.B. hospital and colony at Papworth. She has now, after some nine months, returned home practically cured; my wife and I say, and say very sincerely,"Thank God for Papworth." What Papworth has been able to do for my daughter I want to be available for everybody's daughters. I do not desire to see "possibilities" which will enable my daughter to be cured without similar possibilities being available for all my fellow men.

The Minister has said he is prepared to consider mass radiography—mass X-ray. If he does adopt this, and I sincerely hope he will, at the same time it will be essential for him to establish other Papworths throughout the country to absorb these people whom they have been found to be affected with that disease, far in the cure of it, I understand, they are given light work, light productive work, for a short number of hours—four to six hours a day—gradually increasing but always under the observation of the medical attendant. I suggest the establishment of other Papworths throughout England, not kept by voluntary efforts but organised and paid for by the State in order to help our fellow men.

I do not want to detain the Committee. I would only like to say in conclusion that I hope that the Minister will fully realise that now is the time in which we can make ourselves efficient for the post-war preservation of life. Now is the time when we can carry on that essential research work, so that when we have "slaughtered that tiger," and are at peace, we can put into action the knowledge we may spend years now in obtaining. In the past there have been scientists and clever medical men in all the countries of Europe—Germany, Austria, Italy, Czechoslovakia and France. I would like the Committee to consider how many of these Continental countries will be able to spend any time in the future or have any men among them capable of helping and the curing of diseases in the future. This country and our Allies, will have to take our place not only to win the "war against that tiger," but to win the war of the preservation of life for humanity. It will rest upon us to develop those many cures which will be essential. I would appeal to the Minister to take every course possible now to do whatever can be done to forward essential research work into these various diseases which have been so heavy a burden to humanity.

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

The hon. Member who has just spoken has urged the Minister to address himself to this problem of tuberculosis, and I wish to add my plea. I, like many other Members here, listened to the Minister's statement, and was duly impressed. But those of us here who belong to the medical profession were probably conscious of the fact that the Minister, probably through lack of time, omitted many very important details, and I am sorry that he did not deal with tuberculosis perhaps a little more fully, for that is the black spot on our health services. As a matter of fact I felt that he seemed a little too complacent, if I may say so. He said that this was not a matter for alarm but only for concern. As a doctor I feel that that is just a quibble with words. Surely tuberculosis is a matter for alarm if it can be proved that it is increasing in this country? I agree with many Members who have said that if there is any increase in tuberculosis, that in itself is an indication that the health of the country is far from well. Of course it is; tuberculosis does not just mean that an individual is subject to infection from a tubercular patient. It means that there are hundreds of thousands of individuals in this country so lowered by low wages, overwork, bad housing, perhaps rationing, that they are subject to the disease wherever it may be found.

On this point may I entirely disagree with the Minister's statement that nurses who work in tuberculosis sanatoria do not run a greater risk than those who work in general hospitals? I am not quoting my own views. My colleague on my right, who has a wide knowledge, agrees with me, as does my colleague on my left, who is the chairman of a public health committee. I am quoting some of the experts of the country when I say that of course these nurses run a greater risk. The Minister should not for one moment consider discussing with the Minister of Labour this matter of having girls directed to tuberculosis sanatoria. The conditions should be improved as, incidentally, should the pay. The girls should be allowed to know the danger. Why not? Knowing that danger, I am quite sure they will volunteer if the conditions are improved.

I particularly wish to address myself to a matter which I know will be controversial. The Minister of Health mentioned the returns of the Registrar-General. Many of us read these returns and are capable of interpreting them in entirely different ways. Doctors know, and Ministers know, that when they want to present a case they can perhaps interpret the figures of the Registrar-General in entirely different ways. I dislike intensely quoting figures, but I would like to bring this to the notice of the Minister: In 1941 the rise in the death-rate from tuberculosis was twice that of 1916, which was the second year of the last war, and of course since then 25 years have elapsed, during which there has been a great deal of research. The other point I wish to bring to attention is that in 1916 there was no increase in tuberculosis in young children on the pre-war figures, but in 1941 the increase was from 45 to more than 100 per cent. on the peace-time figures. The point I wish to make is that during this war for some reason the increase in tuberculosis in young children has been very great, whereas it was not in 1916 in the last war.

Furthermore, many children suffer from non-pulmonary tuberculosis. I asked the Minister last week how many cases of non-pulmonary tuberculosis had been notified during the war. He told me that the number was 13,000. I think that, on a conservative estimate, 40 per cent. of the cases of non-pulmonary tuberculosis cases are due to infected milk. It is so easy for people to accuse one of having a bee in one's bonnet, but this is not a bee in my bonnet. What are the circumstances that have changed in the country during the last year or two? First, we have had evacuation from towns to country districts. We did not have that during the last war. Secondly, we have had cheap and free milk, and have encouraged the population to drink milk, with the result, I am told, that more milk was drunk in the country last year than ever before. At the same time, we have had an increase in tuberculosis among our children by 45 to 100 per cent. on the peace-time figures. This is not just a coincidence: these facts are related. I do not want to say "I told you so," but I believe that during the first two or three months of the war we had a Debate on evacuation, and I asked how the children who were evacuated from the towns to the country districts were to be protected. In London the Express Dairies, the United Dairies and other combines, and the co operative societies all supply pasteurised milk.

Photo of Mrs Mavis Tate Mrs Mavis Tate , Frome

I have tried very hard not to interrupt. The hon. Lady has given most interesting figures, but one figure she has not given. What proportion of the milk that was drunk from 1914 to 1916 was pasteurised?

Photo of Mr Charles Williams Mr Charles Williams , Torquay

Going back to 1916 is getting far from the Estimate. The hon. Lady is getting very near the borderline of agriculture.

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

Did not somebody say recently that health was married to agriculture? It is a little difficult to avoid agriculture.

Photo of Mr Charles Williams Mr Charles Williams , Torquay

Certainly the hon. Lady may refer to agriculture, but I was warning her that she was getting very near the borderline.

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

I beg your pardon, Mr. Williams. I will keep as far as possible from the borderline. I have been impressed with the spirit of the speeches made to-day, particularly the speech of the hon. Member for St. Albans (Sir F. Fremantle) and the first part of the speech of the hon. Member for Southampton (Dr. Thomas). If these speeches had been made at a gathering of the Socialist Medical Association, they would have evoked great applause. Perhaps they reflect the new spirit in medicine to-day. There is now a desire to approach medicine from the preventive, rather than the remedial, angle. That is why I am stressing this point. Although I agree that Papworth is an excellent place, my hon. Friend will agree that if we can do something of such a character that it would make Papworths unnecessary we should have cause to congratulate our selves. I want the Minister to consider these figures very carefully. Non-pulmonary tuberculosis, which is in at least 40 per cent. of cases of a bovine origin, has increased in young children. These children of ours, who were protected with clean milk, are in places where they get milk from producer-retailers, who have no purification plant. It is a little difficult for me, although I am trying not to encroach on agriculture, to refrain from mentioning what has been done by the Government on this question, because pasteurisation and the prevention of tuberculosis are, of course, related. All that the Government have done on this question has been for the Ministry of Food to issue a White Paper about two weeks ago——

Photo of Mr Charles Williams Mr Charles Williams , Torquay

I really must ask the hon. Lady to relate her remarks more approximately to the Estimate now under discussion.

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

I am very sorry. The hon. Lady the Parliamentary Secretary knows exactly which places I refer to, because I have raised this matter in the House several times lately. I am afraid that the Minister of Health will wash his hands and say that these things do not concern his Department. I ask him to co-operate with other Departments in dealing with these diseases. There must be frequent discussions with those Departments if we are to have a comprehensive service. Also, when other Members discuss the lack of propaganda, I cannot help thinking that non-pulmonary tuberculosis affects the most helpless section of the community. The children are quite incapable of helping themselves, and their parents are just as ignorant. What propaganda have we ever had on the radio for the prevention of T.B.?

Photo of Mr Ernest Shepperson Mr Ernest Shepperson , Leominster

Is it possible to test by X-ray for non-pulmonary tuberculosis?

Photo of Dr Edith Summerskill Dr Edith Summerskill , Fulham West

You can test for it by X-ray and by other methods; but you can also test the milk. The question of tubercle-infected milk, and of children suffering as a result will never be reported in the newspapers. There is probably not one paper which will have the courage to talk about the non-pulmonary tuberculosis with which the children are suffering, because of the strong vested interests in milk in this country. If we are to prevent disease, the Minister must be bold. He must disregard those interests, and realise that his job is to improve the public health of the country. I, like many others, am growing impatient at the delay in issuing the report of the Committee which has been set up to inquire into the growth of tuberculosis. The Committee was set up months ago. We asked questions about it, and we were told that the report would be forthcoming. Mean-while people are becoming infected, sanatoria are filling up, and still the report is delayed. I would like to ask, what relation have low wages and long hours to the rise in tuberculosis? Unless this question is approached, we can have no perfect picture. I should also like to know the relation that rationing has to tuberculosis, and how many of those people who use canteens—particularly the girls—still have tea and buns. This question has been raised in the House. We know that there are many girls, underpaid and overworked, still feeding on buns and tea at our canteens.

I should like to know what proportion of women are insured, because T.B. is increasing among women. My hon. Friend the Member for Hemsworth (Mr. G. Griffiths) discussed insulin. He was quite right. Every married woman in the country, unless she works, is uninsured and, therefore, cannot have an early diagnosis of her tuberculosis if she happens to develop it, unless she has saved enough money out of her housekeeping allowance to enable her to consult a doctor. I was very impressed by the hon. Member for Southampton (Dr. Thomas), who told the Committee of an expectant mother who could have a certain amount of meat, eggs, milk and so on, but whether that is excessive or not, the fact is that the only woman in the country who is expected to keep two individuals on one ration is the expectant mother. I wonder how much of the increase in tuberculosis can be related to pregnancy, to confinement and to the nursing of the child. These are some of the questions which I would certainly like to have answered. I ask the hon. Lady the Parliamenetary Secretary to press the Minister to adopt a really bold policy. This is a question about which we know everything. The hon. Member for Leominster (Sir E. Shepperson) told the Committee of his osteo-arthritis, and every Member, I am sure, feels the greatest sympathy with him. We have to say that we know very little about that complaint, and we know very little about cancer, but we know practically everything about tuberculosis. Therefore, why are we not applying our knowledge? We have an opportunity of stamping it out of the country, but I feel that we are not taking every measure possible.

The other point I want to raise—and it has not been raised at all by any other hon. Member—is something in which I have a great interest. I want to ask the Minister of Health whether he will make it compulsory for local authorities to teach their midwives to administer anæsthetics. When I first came to this House four years ago the first question I asked was. How many local authorities in the country are exercising their powers in this respect? Every local authority now has a midwifery service, and it can, if it cares, teach midwives how to use anæsthesia. It is a portable apparatus and is quite harmless, but it is left to local authorities to decide, probably to the chairman and the welfare and maternity committee, whether midwives should be taught. I asked the question four years ago, and to my surprise I was told by the Minister that there was no record and that a return had never been made by the authorities, and he assured me that in future he would ask local authorities to make an annual return. I felt very grateful. I had a feeling that in the first week of my being in this House I had done something, but after four years and the reply I received last week, I find that I had not done as much as I thought. I hope that if a medical officer of health was asked to make a return of that kind, his conscience would prick and he would say to himself, "Here am I, and every minute of the day some woman is suffering the pangs of childbirth and it is in my power to relieve her." I believed that within a year, if such a report had been made, every local authority in the country would have adopted this humanitarian reform. Four years have passed. I put the same Question down last week, asking how many local authorities were now teaching their midwives, and I found that only 66 out of 188 are using their powers.

I ask the hon. Lady to remember that it is 100 years since Simpson gave a woman anaesthesia at childbirth, and still in this country we adopt what I consider are barbaric methods of midwifery. Here you have it in your power—you can do it almost overnight—to make one of the finest reforms. You could make this compulsory, and I feel that no individual, man or woman, who demands an anaesthetic for his or her own operation should be satisfied that a woman should endure the pangs of childbirth without some relief. This is a reform. The Minister will not have to go to the Treasury, and he will not be able to say that it will cost £100,000,000, and that we must consider this very carefully. Already there is a safe apparatus on the market, and 66 progressive local authorities have introduced this reform, and I ask the Minister to review this matter and to introduce something which is simple and inexpensive and will save countless mothers from unnecessary pain.

Photo of Captain Sir George Elliston Captain Sir George Elliston , Blackburn

Although none of us can hope to get all the assurances for which we have asked from the Minister to-day, all of us would wish to congratulate him upon being able to report to this Committee that it has been possible to maintain the health of the nation at such a high standard in these difficult times. The vital statistics we have been given today, the freedom of the country from the incidence of sickness and disease which used to be associated with war time, and the precautionary measures devised to meet any possible emergencies have won the admiration of our Allies and have been taken as an example by neutral countries. It is a remarkable record and a credit to the Minister, to his advisers and to every medical officer of health, who has been carrying on during the war, short-handed and with every possible difficulty of administration which he can expect to encounter. It is indeed a matter of great pride for the people of this country that we have stood up so well to the strains and stresses of war time.

The Minister's survey was so complete that I propose to deal only with some of those matters where I feel he has not given us all the information that we should like. In the matter of diphtheria immunisation, it must be admitted that the result of the appeal to the country has been very disappointing. The Minister told us that 33 per cent. of the children had been immunised up to the end of 1941. That percentage compares very unfavourably with the target of 75 per cent. which the Ministry recommends to the country as the lowest figure likely to give results comparable with those obtaining in Canadian and American cities. We must secure a very great increase in this immunisation if it is to give us anything like the security we ought to have. The Minister has done well to entrust this matter to the Central Council for Health Education, but I would like to point out that it is not only necessary to educate parents and guardians, but it is equally important that this subject should be brought directly to the notice of councils, because until they are stimulated to act you will not get the general acceptance of this immunisation, which should be common in the area of every local authority. Not until councils realise more clearly that with the adoption of immunisation there is not only less loss of life, but also less heavy charges for hospital services, will they be eager to act on the advice of the Ministry of Health in this matter. The number of deaths from diphtheria last year was 2,600. I think that is shocking. I have heard it suggested that every death from this disease should be made the cause of a coroner's inquiry. We should then know whether it was due to the failure of local authorities to provide facilities or whether it was due to parents and guardians not taking advantage of facilities. We should know why this wastage of life is taking place. The result would be that before long there would be a realisation that we have a serious responsibility for the protection of children against this killing disease.

There is another matter which, curiously, the Minister did not mention, but for which I think he can obtain great credit, and that is the advice given to the Ministry of Food and other bodies with reference to nutrition. The Ministry of Health is charged with a most important function in that connection. It is quite remarkable, in spite of our shipping troubles and loss of supplies from all quarters of the world, that we have been able to maintain a diet for the people which, apparently, is maintaining their health and strength. One realises, of course, that great vigilance is required, and one is glad to know that in this, the third, year of the war there is no reason for any immediate anxiety. But the Ministry are rightly exercising great vigilance because none of us can tell what delayed effects may arise as a result of the changes and deprivations of diet we are now undergoing.

The Minister made some reference to scabies, but he did not tell us how many authorities and voluntary organisations have urged that this disease should be made compulsorily notifiable. There has been agreement among the most experienced authorities that notification is no good unless you can guarantee ample means of treatment, and I should like to thank the Minister for his decision to authorise the use of gas decontamination centres, with shower baths, as cleansing centres. There is reason to hope that that will provide a very effective means of securing control of this distressing condition.

The Minister devoted a great part of his speech to the subject of tuberculosis. It is unnecessary to go over again what has been discussed with so much knowledge by Members in the course of the Debate, but I think we are all gratified that the Ministry are accepting the value of radiography as an effective means of detecting early cases. The gravity of the problem is that there are so many victims among people who are at their danger period in the late 'teens and early twenties, especially the millions of young women who are taking an effective part in our munitions campaign and producing weapons of war. It is a tragedy to think that these girls should be allowed to drift into disease. If by means of radiography and so on there can be an earlier protection, then, indeed, we shall have taken a great step forward in the control of tuberculosis.

Personally, I welcome this mass radiography for another reason. I suppose there is not a Member in this House who has not had pathetic appeals from ex-Service men who have become victims of tuberculosis. They write to say that a year or 18 months ago they enlisted in the Forces as robust men and were accepted as being in sound health. Now, after exposure, hardship, rough weather or hard lying on active service, some latent infection has flared up and they are invalided out with tuberculosis. When they apply for a pension they are told that their tuberculosis does not arise from military service. This is causing grievous indignation, because these men who so recently were to all appearances sound in wind and limb, are now incapacitated by disease. It is true that in every case the condition may not be detected at the time of enlistment, but it is equally true that a considerable percentage of these men would have been rejected by the doctors if they had had the advantage of radiographic examination on enlistment.

I would like to deal now with the shortage of nurses and domestics, which is making it necessary to close wards in so many sanatoria and hospitals for tuberculosis. I am told that 705 beds in institutions are definitely out of use for that reason. The Minister told us to-day that although he realises this shortage of nurses, or their maldistribution, he is not willing to apply anything in the nature of compulsion to women to undertake tuberculosis nursing. I cannot understand that attitude. If there is any class in the community which is accustomed to discipline, and to doing any kind of work which is allotted to them, it is our hospital nurses. In any of our big hospitals the nurses are liable to be told by the matron any day of the week to go over to the surgical, medical, eye or other departments, and the nurses go without question, although they may be leaving work which specially appeals to them. Surely these nurses would be willing to serve in tuberculosis hospitals. They would accept it as part of their routine work. It has been said by experienced observers that the reason why nurses do not go into sanatoria or institutions of this kind was because they find the work less glamorous than that of looking after members of the Forces in the ordinary hospitals. Another reason is that it has been generally accepted that nurses in sanatoria are more liable to tuberculous infection than other nurses. Despite what has been said by distinguished medical Members in the Debate, I have been told quite recently by leading authorities on tuberculosis that this is a fallacy. Complete investigation has shown that there is no greater incidence of tuberculosis among nurses in sanatoria than among nurses in other hospitals. I believe I am reporting this correctly, because I heard it said at a recent conference by persons of great responsibility.

Tuberculosis organisations have asked the Minister to release himself from the pledge he gave to the Civil Nursing Reserve that nurses joining up should not be required to go into sanatoria. The Minister, naturally, was reluctant to withdraw that pledge; in fact he definitely declined to do so. I cannot help thinking that he could do it with a clear conscience. Conditions have changed since the assurance was given. The country is now up against a much more desperate proposition. Our men have been taken into the Army day by day, and nobody has asked them what they wanted to do, whether they wanted to be gunners, sappers, signals, or anything else. Surely in these days of our extremity we might fairly ask the women to accept any job which the needs of the nation require?

I should like now to refer to the control of venereal diseases. It was a little disappointing that my right hon. Friend devoted such a small part of his speech to that very important subject. The prevalence of venereal disease is a serious matter in peace-time, but it is a matter of life and death when we are considering the health conditions of munitions workers, soldiers, and sailors. Therefore, it seems to me that we have to take every measure necessary, particularly to avoid inheriting such a legacy as awaited us after the last war, when there was a heavily infected population, with many married women the innocent victims of infection, with children born with the germ of syphilis in their bodies. That must not happen again if it can be avoided. It is true that the Minister told us that the prevalence of venereal diseases has only risen slightly and that it does not give cause for extreme alarm, although, of course, it is occupying his close attention. At the same time, there is a great volume of human tragedy that can be avoided, and there can be avoided also the cost of years of institutional treatment to maintain deaf and blind children and adults suffering from heart disease, paralysis and insanity, the aftermath of V.D.

We know what has been done in this connection by the Navy, the Army and the Air Force, and I believe what is being done by these Services is very efficient; but will the Minister assure us, before the end of the Debate, that adequate measures are being taken on the civilian side for the protection not only of civilian workers, but of the members of the Forces with whom they come into contact? Even in peace time there was a shortage of early and continuous treatment of this condition, especially in Wales and the South Western and Eastern areas of England. Sufficient provision for treatment was not available in those areas. Now, with the redistribution of the population, local authorities hesitate to incur the necessary expenditure to give prompt treatment to those in the munitions works, the barracks and hutments which are dumped in those areas. Perhaps the Minister will tell us what inducement there is to the authorities to make adequate provision for treatment. It is particularly important that the clinics should be available to workers at convenient times. One afternoon a week is no good in war-time. The shift system also complicates things, as the workers can go to the clinics only at certain times of the day, and owing to the stigma which still attaches to this condition, they are unwilling to ask permission to leave their work in order to go to the clinic during working hours.

For some years the British Social Hygiene Council has been urging the provision of Clinics for the Ailments of Women, where gynaecological disorders would be treated side by side with venereal diseases, so that the general public would not label a girl as being affected with venereal disease if she were seen going to or coming from the clinic. The provision of these clinics for the ailments of women would do a great deal to prevent the spread of venereal disease, for at present attendance of women at clinics is a great deal below the attendance of men. I should like to hear my right hon. Friend say that he proposes to give approval to the scheme for the establishment of such clinics for the ailments of women which is proposed by several important local authorities. The Minister has entrusted the education of the people with reference to venereal diseases to the Central Council for Health Education. That is a very important decision. The work is difficult and unpopular, very little outside help is obtained, and very little support is to be expected from the newspapers, for the subject is an unpleasant one to discuss. The Central Council for Health Education will have to adopt every possible means—lectures, leaflets, posters, films, and exhibition—if they are to put this matter across to the public. It will be expensive work, and if it is to be well done, it will be necessary for the Central Council to receive adequate allowances for the purpose. They should not be dealt with in any niggardly spirit.

I conclude by saying again that, whatever shortcomings may have been mentioned in the Debate, generally speaking the country has good reason to be proud of the health conditions of the people at this time, and great credit is due to the Minister, his advisers and the local Health Departments which are maintaining essential services all over the country, and thus securing the fitness of the people for their share in our war activities.

Photo of Mr David Quibell Mr David Quibell , Brigg

I want to refer to one or two matters, and particularly to the question of milk. The question of milk, as you, Mr. Williams, have pointed out to one hon. Member, is very much allied to the question of agriculture, but it is not entirely divorced from this Vote, as the number of inspectors, which is two, is mentioned. I want, if I can, to relate the question of milk to the Rivers Pollution Act, 1939. Recently, I went to an important part of my constituency where there is grazing land. About two miles from the place where I was, there was a sugar beet factory. Numbers of cattle, scores of milking cows and store beasts, which had no other source of water supply than a filthy, polluted stream that one could not stand within 500 yards of for more than five minutes at a time. Many of us sat in Committee on the particular Measure to which I am referring and the previous Minister of Health, who is now Chancellor of the Exchequer, promised that as far as he was concerned the provisions of the Act would be rigorously enforced to prevent the pollution of our streams. I say, without the slightest fear of contradiction, that that Act is not being administered as it should. Farmers and agriculturists, and those of us who are interested in the health of the people and in maintaining and cleansing these streams, have seen them go from bad to worse. Streams which were once full of fish are now full of filthy sewage.

Photo of Mr Charles Williams Mr Charles Williams , Torquay

I hope that the hon. Member, when he is dealing with streams and various other agricultural matters, will make his point about pollution and its effects on health, because he is not in Order in going into these matters in any great detail.

Photo of Mr David Quibell Mr David Quibell , Brigg

I was not intending to go into the matter at great length, but, on page 106 of the Civil Estimates, reference is made to the Rivers Pollution Prevention Act, 1876. I want to see rigorous enforcement of the provisions of the Act, and I beg of the Minister to see that this is done.

Photo of Mr Charles Williams Mr Charles Williams , Torquay

I am afraid that page 106 has reference to Scotland.

Photo of Mr David Quibell Mr David Quibell , Brigg

I can only say that I sat on the Committee which dealt with a Bill to prevent the pollution of these streams so that cattle might have a cleaner supply of water. That Act, upon which great stress was laid, was designed for that purpose, and its provisions are not being enforced. Surely, if beasts are kept healthy, that has an effect on the health of the people. I do not know whether the provisions with regard to inspection of milk supplies are being enforced. Perhaps I am old-fashioned and out of date, but I think that the value of pasteurisation lies in the fact that you take dirt out of milk which ought never to have been allowed to get into it. Proper inspection of cowsheds and dairies would be infinitely superior to any pasteurisation of the milk supplies.

The Ministry are now giving grants to hospitals for emergency medical services. I should like to see this extended. Much has been said in this Debate with which I entirely agree. I believe that nursing should not be a casual, blind alley occupation as it is to-day, but should be made, as far as hours of work and wages are concerned, an attractive employment. There are two sides to this question—the voluntary hospitals and the public authority hospitals. I visited a public authority hospital recently, and I told the Chairman that I was not very proud of his hospital. "I am surprised, David, you did not say you were disgusted," he said. To some extent I have had experience of voluntary hospitals. I am a vice-president of one. Having taken a big interest in hospitals for a very long time, I have come to the conclusion that the best managed hospitals are not all on the public authority side. I asked the Minister to go a little further in his scheme of grants to voluntary hospitals, providing they will conform to a certain minimum standard as far as hours of work and wages of the nurses are concerned, with proper inspection, as there is in the case of the rest of our health services. I believe that a very radical improvement would then be made in the conditions of our hospitals. In some voluntary hospitals the wages and conditions are equal to local authority hospitals, but I want to see an examination and inspection applied to all hospitals, dovetailing them into a State system.

We are all very pleased with the Minister's efforts in trying to maintain the services of the hospitals under trying and difficult circumstances. I would, however, give a warning in regard to the policy which is being pursued, not by the Minister's Department but by another Government Department, in taking nurses from hospitals and employing them in steel works. This is a very sore point. This policy has made our task of obtaining nurses far more difficult. Even trained maternity nurses are being transferred into industry to render first-aid, which hitherto has been done by the first-aid organisation in each of the works. A nurse is taken from a hospital and put into a steel works to do nothing, because there is nothing to do. Obviously, if there is an accident, the first thing to do is to render temporary aid, and then to send the patient as quickly as possible to the hospital. That kind of policy ought to be stopped. The place for a nurse is in a hospital, where she can treat the injured workman. Some consideration might be given to restricting that kind of thing, which has created very great difficulties for the local authorities and the hospital with which I am acquainted.

A great deal with which I agree has been said about tuberculosis, but I should connect a good deal of it with bad housing—old, badly built, damp, ill-ventilated houses. There are still thousands in the countryside with little casement windows no bigger than the box on the Table of the House. I was brought up in a house with a roof window, but got out of it as quickly as I could, and I survived, but I know boys in my village who lived in similar houses, and whole families where one after another has become afflicted and has been nothing but a burden to the community and a worry to the parents. It has chiefly been due to the fact that the bedrooms were low and crowded, and the water supply was from old surface wells, and, as for ventilation and light, one would imagine that those who built the houses were under the impression that the window tax was still in operation or was about to be re-enacted. Tuberculosis is worse in some villages than in some towns. It is not due to the fact that they have no fresh air or fresh vegetables, but it is due to the sanitary conditions, water supply and bad housing conditions generally.

I have not yet heard cancer mentioned. I have interested myself in the matter, and I hope the Minister will encourage local authorities to get together to, provide treatment for some of those who suffer agonising pain and death. I think it is the worst of all the diseases that human flesh is heir to. We know now how to deal with it. It may be expensive, but some of us have seen the terrible cases that come into our hospitals and the agonising deaths of these poor people, and I urge the right hon. Gentleman—I am sure he will have the fullest sympathy with it—to encourage other authorities to do what some have done under the Cancer Bill and provide treatment for the unfortunate victims of the worst disease from which mankind ever suffered.

Photo of Sir Godfrey Nicholson Sir Godfrey Nicholson , Farnham

I rise to support with all the emphasis at my command the plea put forward by the hon. Lady the Member for West Fulham (Dr. Summerskill) for the universal provision of anaesthetics in childbirth for all who desire them. It is a subject about which I feel very strongly indeed. It is a merciful provision of nature that the pain of childbirth is partly forgotten in a few months, hut it is a very severe pain indeed. I do not want to attack the Minister of Health, for whom I have the deepest esteem, but, if I were in his place, I should feel ashamed if at the end of my tenure of office anaesthetics were not provided for every mother in the country. I hope his term of office will long continue, and that when there is a similar Debate next year he will be able to report that he has made real progress in that direction. I earnestly beg him to push on as hard as he can.

The other subject I wish to raise is a tricky one, because there is nothing more menacing than the amateur doctor or scientist. A matter has come to my notice which seems to disclose a regrettable state of affairs. I want to ask the right hon. Gentleman whether there is any machinery at his disposal for the dissemination and general adoption of any advances in surgery that may be made. I should like to give an example. There is a certain doctor who is well known as a children's surgeon. He is not an ambitious man. He is not hankering to put up a plate in Harley Street. He may be described as a noble servant of humanity. He has developed a type of operation dealing with a certain congenital deformity which many children suffer from. He has carried out this operation hundreds of times and has had about 98 per cent. success. I may be right or wrong in saying that it has been successful—I am not a doctor—but he is the only surgeon in the country who carries out that operation, and not a single other surgeon has taken the trouble to learn from him or even to investigate it. I do not want to give the impression that he has a grievance. He is not out for personal honour or glory, but it grieves him, and everyone who knows about it, that hundreds, perhaps thousands, of children are born every year with this congenital malformation, and have to go through life with it, or are treated by surgeons who have not made a special study of it and cannot cure the condition. It seems to me that the Minister ought to have at his disposal, and use, some form of machinery for investigating statements, such as I am making now, about new methods which are alleged, or are claimed, to be successful, and, if they prove to be beneficial and successful, he ought to be able to see to it that they are generally adopted and applied. I have given him this example and hope it will be looked into. I am not bringing it up at the desire or request of this particular surgeon but merely on my own from what I have been told. It seems to me an absolute scandal that through the jealousy, narrowness, ignorance, or busyness of the rest of the medical profession a thing like this, which is known to them, is not investigated and if necessary adopted. I would stress again the need for anaesthetics in child birth. It is a disgrace to the nation that such a vast amount of unnecessary pain should be allowed to continue.

Photo of Dr Hyacinth Morgan Dr Hyacinth Morgan , Rochdale

The Debate has roamed over an extensive area, and it is not possible to cover it in a day, much less in a few minutes. I should have liked to deal with the point of the hon. and gallant Member for Farnham (Captain Nicholson) with regard to new operations. I think he will find that all cases of new operative procedure in surgery, if done in recognised institutions, will receive proper attention. I am the medical adviser to perhaps the most influential workers' organisation in the country, and bricks of this kind are often thrown at me from the medical and surgical points of view. The more you deal with this kind of thing, the more you realise that if a man complains that he cannot get recognition for some new cure, there is something wrong with the procedure or the substance in which he is interested.

I would have liked to follow my hon. Friend the Member for Brigg (Mr. Quibell) in some of his remarks. I will only say that he is mistaken on principle in advocating voluntary hospitals against local authority hospitals. I have worked, taught and lived in voluntary hospitals and seen some of the finest work in the world done in them, but they are unrepresentative and undemocratic organisations. In spite of the good work done by them, sometimes great tragedies happen in them, and you cannot get proper investigations. If they take place in a local authority hospital, somebody will spill the beans to a representative of the local authority, and there will be a proper inquiry. I know a case recently where a doctor, walking into a voluntary hospital in the Midlands, found the porter giving the ansæsthetic. He said that he had been doing it for 20 minutes. There was, however, no inquiry. In one of the finest children's hospitals in the world where I was resident as a young man I saw a surgeon castrate a young child by an alleged mistake. When an inquiry was demanded the medical staff met and they would not allow a public inquiry.

There is another objection to voluntary hospitals. The firm of Ford subscribe heavily to St. George's Hospital, Edinburgh, and they used to have the medical officer of the firm as one of the consultants. The consequence was that workmen's compensation cases coming from the firm went into the ward of that doctor and the men could not get adequate reports. Even now they cannot get adequate reports from voluntary hospitals.

Photo of Mr David Quibell Mr David Quibell , Brigg

It is not a question with me of voluntary hospitals versus public hospitals. My point is that voluntary hospitals cannot comply with standards of wages and hours of employment and general surgical efficiency as they should be able to, and I want them to have grants subject to certain standards of efficiency and management being complied with.

Photo of Dr Hyacinth Morgan Dr Hyacinth Morgan , Rochdale

That is where we differ. We should have one unified national system of hospitals. It is ridiculous to have two systems, one undemocratic and unrepresentative with a so-called voluntary management, "voluntary" meaning nothing except that the members are self-selected and self-elected; and the other a system of local authority hospitals with increasing experience, better equipment, and under representative managements responsible to the people who receive treatment. I am sorry that the Minister passed the buck against the municipal hospitals when he announced his policy in answer to a question some time ago. I hope we shall have an opportunity of debating that policy. Municipal hospitals are to be treated in a way that will give an advantage to voluntary hospitals. The Minister is sheltering behind those which are attached to teach- ing schools. They should not be treated differently from the ordinary hospitals of the country. I have every respect for the knowledge I learned at my teaching school; I was taught in Glasgow, a very good school, and I have no complaint against teaching schools; but there is no reason why the voluntary hospitals attached to teaching schools should not come under a national authority subject to this House.

I do not want to deal with the old question of rehabilitation. I was glad to hear the hon. Member for Hemsworth (Mr. G. Griffiths) refer to Berry Hill Rehabilitation Centre at Mansfield, for my original report on that institution led to a visit to it from various people. If the Minister is sending visitors round he might send one to Hoylake R.A.F. Rehabilitation Centre, which is much more enterprising even than Mansfield. The Ministry of Health, so far as rehabilitation is concerned, is dead, and I do not want to rattle the bones any more. I have done my best to awaken the poisoned corpse, but I cannot do it.

I want to address my remarks particularly to the problem of tuberculosis and to ask the Minister what national comprehensive scheme he has to deal with it. My hon. Friend the Member for South Tottenham (Mr. Messer) put the idea in my head that when a tubercular case comes before the Public Assistance authority it should be treated as a case for diagnosis of poverty. What national scheme has the Minister for the four essentials in a good tuberculosis scheme-early diagnosis, treatment, cure, prevention? What really national scheme have we to deal with it? Is it not a fact that even now, with their war powers, some local authorities have powers to deal only with prevention and others powers to deal only with treatment? The, excellent report of the chief tuberculosis officer of the Lancashire County Council emphasises that some local authorities have powers to deal only with the problem of prevention and others to deal only with treatment.

Let us suppose there is a case of tuberculosis. You talk about your mass miniature radiography. Say that you discover in the general population one per cent. of symptomless tuberculosis—that is, tuberculosis in the very early stages without any symptoms at all. When you have discovered those cases, what are you going to do? Send them for treatment? Where? You have not got the beds in your sanatoria, and you have not got the necessary number of sanatoria. Are you going to give them domiciliary treatment under the social conditions in which they originally got the infection? And suppose you do manage to send a few cases away to a sanatorium or an institution, say at Papworth or Preston Hall. In that case what will you do with their wives and children? What drives a tuberculous man back from a sanatorium before he is fit? He has not the means to support his home. His wife and children are there, and he feels a pressure to get back to work before he is fit. The Ministry are simply playing with the problem, because they will not really set about devising a national and comprehensive scheme under which people would be entitled to medical service irrespective of their social position. The British Medical Association are considering a new system of medical service, not however without payment, so that the man who has money is in a favourable position compared with the man without. The man suffering from tuberculosis cannot get proper treatment because he has to go to Public Assistance and to submit to an inquisitorial test, a means test.

What is the good of trying to discover people with early tuberculosis who are showing no symptoms of it, apart from those you can detect with symptoms, apart from those who are infecting others, when nothing is being done to provide proper facilities for treatment and adequate nutrition? I would like to call attention to the statistics of tuberculosis for the three quinquennial periods of age from 15 to 20, 20 to 25 and 25 to 30, the three most dangerous periods of life. The figures for males show that of those between 15 and 20, 25 per cent. of the total deaths are due to tuberculosis; between 20 and 25, 31 per cent.; and between 25 and 30, 32 per cent. The figure as regards females are even worse. From 15 to 20, 48 per cent. of the total deaths—nearly half—are due to tuberculosis; from 20 to 25, 43 per cent.; and from 25 to 30, 37 per cent. Those are the figures of this rampant disease due to early infection from infected milk, due to bad housing conditions, due to poor nutrition and poverty generally.

We have a Minister of Health whose good will everyone will admit. He is a Minister of Health who, I think, is willing really to handle the problem, and in his Parliamentary Secretary he has a fine, hard-working and energetic assistant. But what can they do? They have been left with a damnosa hereditas of bad housing conditions and slums. They cannot suddenly breathe over the whole scene and wipe it out. I know that the solution of the problem will be slow, and that is why I want the Minister to sit down and devise a decent comprehensive scheme under which local authorities will have powers for the prevention, diagnosis, treatment and cure of disease, and do what he can to see that the barometer of illness in this country, bad as it was in peace-time and rising as it has been in war-time, will not become a calamity which will bring such ruin in this country as will certainly happen on the Continent of Europe. I am very sorry that I could devote myself only to this topic. I have a lot of other things to talk about, but I felt that as tuberculosis had been thoroughly thrashed out, I should give it a final whipping.

Photo of Mr Daniel Lipson Mr Daniel Lipson , Cheltenham

I am very glad that my hon. Friend the Member for Rochdale (Dr. Morgan), in spite of the dissatisfaction which he had to express with many features of our national health, was able to pay a well-deserved tribute to the Minister of Health and to the Parliamentary Secretary, because I think we all agree that whether or not everything that ought to be done is being done, we are satisfied that both the Minister and the Parliamentary Secretary have a very good record, and it is only right that we should recognise it. I think that if we appreciate what the Minister and his Parliamentary Secretary have done, perhaps they will pay more attention to us when we urge them to do still more. I do not think my right hon. Friend can complain about the course which the Debate has taken. Proper recognition has been shown of the very fine record of the nation's health during the war which he was able to put before us. He has been urged from all sides of the Committee to do more in the way of preventing illness. If ever there was a time when the views of Samuel Butler that ill-health is a crime could be justified, surely it is in time of war, when we want all to be making their contribution to the national effort and certainly not to be a burden on the community by calling for services which otherwise they could do without.

My right hon. Friend indicated that he is engaged to some extent in preventive work as regards diphtheria. I understand that a fresh campaign is to be inaugurated by him to urge local authorities to be more active in this matter. I should like to know how it is that some local authorities have a much better record in the matter of diphtheria immunisation than others, why when the advantages of immunisation are so great, when the number of deaths from diphtheria is so great, and when diphtheria cases take so many beds and occupy so much of the time of nurses, we have had to wait for the third year of the war before a really vigorous campaign is undertaken throughout the country.

My right hon. Friend will recognise that in being able to present such a good record of public health he has been fortunate in the allies he has found in other Ministers. I think he will be one of the first to acknowledge the contribution which has been made, for instance, by the Minister of Food in providing a balanced diet for the people of this country and particularly his fine work on behalf of the children. Food is not the only important factor in maintaining good health. We have heard very little to-day about housing. My hon. Friend the Member for Brigg (Mr. Quibell) referred to its importance as a factor in good health, and when I heard him describe the kind of house in which he was brought up I realise that it was an example of the survival of the fittest that he should have developed into the physically strong man he is. I would ask the Minister whether it is his settled policy that local authorities shall not build any more houses during the war. I ask that, because the two black spots in his health picture of the nation, tuberculosis and cerebro-spinal fever, are both largely due to bad housing, and in any estimate of the health of the people after the war he has to take into account the effects of bad housing and overcrowding.

From what I know of conditions in my constituency, the housing position is far from satisfactory. Even before the war there was a great shortage of houses. Since the war the population has increased by something like 40 per cent., and no new houses have been built, and the conditions under which a good many people are living are most unsatisfactory. Houses that had been condemned and basements that had been condemned are being used once again, and young children are being brought up in many of them. There is extreme overcrowding in those houses. That is bad for the health of the people and also, I submit, for their morale, and it is also bad for their efficiency as workers. The Minister of Health should regard himself as being the Minister of happiness also. We cannot expect the proper efficiency from workers if they are living under the conditions in which many in my own constituency have to live, and I have no doubt the conditions are not peculiar to my own constituency.

Photo of Mr John Tinker Mr John Tinker , Leigh

The hon. Member mentioned that there had been an increase of 40 per cent. in the population. Could I ask how that has come about? Is it from outside sources, or by growth in the district?

Photo of Mr Daniel Lipson Mr Daniel Lipson , Cheltenham

The answer is that before the war there were 50,000 people there. The population now is about 70,000. The additional population is composed of people who have come to the district for one reason or another, mostly for reasons which do them credit and which would be welcomed by this House, and no new houses have been built. The extra 20,000 people have had to crowd into the existing houses in a place where even before the war there was a very great shortage. I therefore hope, in view of the fact that the war looks very much as if it will last for some time, that the Minister will consider whether the ban on the building of new houses during the war cannot be removed. I press this on him also for this reason, that a good deal of the building for war work which has been going on must now be reaching completion, and I think that on the grounds of national health and also on the grounds of the effect of bad housing will have on production he ought to make claims to the Minister of Labour and to the Treasury for the necessary facilities for a modest building programme in the areas where the need is great.

I also want to say a few words about another aspect of the housing problem to which I have drawn attention in a question which I have asked, and that is the failure of the Minister to control prices at which houses are being sold. I do not know what would have happened to the prices of food in this country if the Ministry of Food had adopted the same attitude towards a rise in prices as the Minister of Health has adopted towards the great increase in the prices of houses. Quite clearly, there is a racket going on in this matter. It is not confined to one area only. From correspondence which has reached me since I put down my Question, it appears to be extremely widespread. This is an actual instance of what happened: a house was put up for sale about a fortnight ago and was sold for £1,025. That was a price very much in excess of its value. The man who purchased it did not go and live in it, but a few days later offered it for sale at a price of £1,500. There are other instances where houses which before the war were valued at about £800 or £900 are being sold at £2,000 or over, and I submit that it is the duty of the Minister of Health to step in.

Just as he has controlled rents, he should control the prices of houses. I would remind him, too, that these people get away with the profits which they make; none of it comes back to the State in the form of Income Tax or Excess Profits Tax. It is sheer profiteering, and it is time that it stopped. The answer given me by the Parliamentary Secretary was that the Ministry was watching the situation. I do not think that answer meets the situation. Perhaps answers of that kind given by Ministers are one explanation of why the Government lose by-elections, because there is considerable feeling throughout the country on this matter, and people are asking why the Government do not take action. If the attitude of the Minister is that he will continue to watch the situation, it is another way of saying that he will do nothing, and I am sure that those who are profiteering in house property must pray every night for the Minister and his Parliamentary Secretary to remain in office, if that is their attitude to this question. Personally, I am content that they should remain in office, but I ask them to give this matter further serious consideration, because the position has deteriorated considerably in the last few weeks.

It has been apparent from the speeches made to-day on all sides of the Committee that if, even during the war, the Minister of Heath were to take up a much more offensive attitude towards health problems and, not being content merely because the war is on to carry on with things as they are, if he would be much more positive in his action, he would receive considerable support from all sides of the House. The request has been made that the Minister should spend much more money on research and other means of preventing disease, and this aught to be an encouragement to the Minister which I hope he will accept as such; and I trust that next time he presents his record of the health of the country he will be able to assure us that he has succeeded in reducing still further preventable disease and thereby earn the gratitude of the people.

Photo of Mr Kenneth Lindsay Mr Kenneth Lindsay , Kilmarnock

I rise to make one main point. I shall not speak to-night about nurseries because they have been discussed already and I despair of any changed policy. I can only say that my views are not in any way altered by what has been said either by the hon. and gallant Member for Thornbury (Sir D. Gunston) or the hon. and learned Member for North Croydon (Mr. Willink).

The Minister of Health has given us reason for great encouragement about the health of the country, and while I know it is not easy to get research done into the reasons for this amazing maintenance of health—specially at a time when many doctors and many school teachers are away—I would ask the Minister to try to have such research made. Nobody will attribute the present position purely to the Minister of Health. It may have to do with food, with evacuation, the simpler life, and many other things such as the absence of concentration by people on themselves. Those are problems about which we know very little at the moment. There is, however, one particular aspect of the health problem with which hardly any hon. Member has dealt except the hon. Member for Llanelly (Mr. J. Griffiths). Children are looked after better and better in the schools. They have their three clinical inspections. People have talked to-day about tuberculosis and about the age groups where its incidence is greatest. I am not clear which age groups are the most seriously affected——

Photo of Mr Kenneth Lindsay Mr Kenneth Lindsay , Kilmarnock

That fits my main point, that it is nobody's business to look after the health of the young people of this country between the ages of 14 and 18. I must apologise but I shall keep on at this until we get a real charter for youth. I will attack every Minister until we get it. Some time ago we had a Debate on the hours of work among young people, and the hon Member for Llanelly gave reports to-day which could have been reproduced two months ago. He said he had received serious reports from Wales. Night after night I have interviewed these people and I could tell the Minister personally of these reports. Others speak as follows: Lincoln, "Hours beyond the capacity of juveniles"; Surrey, "Boys tired, jaded and lacking in physical tone"; Yorkshire, "Mentally and physically exhausted." I have sent the Minister of Labour examples from many local education authorities three months ago. You cannot continue with this, because as my hon. Friend the Member for Hems-worth (Mr. G. Griffiths) said, the evidence must be seriously considered. I am not talking about post-war reconstruction schemes. These people will go into the Army, the Navy and the Air Force within the next two years in many cases. I particularly want to call my right hon. Friend's attention to the question of teeth. I put a question to him about the Cambridge pioneer scheme, and he said he would look into it. What I wanted him to say was, "Yes, here are some people who have done splendid dental work and I will do my best to spread it over the country." That would have been more in keeping with war-time administration. Perhaps he has done so, although it has not been indicated in any circulars that have come to me. There are only two authorities' areas in the country, Guildford and Cambridge, where this has been done.

If we mean anything by "equality of opportunity," if those phrases have any meaning, what is the good of nine years' work in the schools being thrown away between the ages of 14 and 18? Here is a letter from the dental surgeon at Cardington writing to the dental officer at Cambridge expressing appreciation at the sound condition of the teeth of three of his boys who went there for dental inspection prior to entering the Air Force. What have they done? They ask the parents to sign a form. They provide for regular six-monthly appointments—the common experience of every boy whose parents can afford it. The young people pay 2s. every six months and get it back if there is no treatment needed. They have secured the co-operation of employers and they recommend at the final school inspection all children to go to the dentist. Up to date 508, or three-quarters, have enrolled, and 896 attendances took place in 1941. The following figures are perfectly well-known Before the war 96 per cent. of the Navy recruits required dental treatment; 98 per cent. of the Army recruits required dental treatment; every recruit to the R.A.F. required 5.1 fillings. All this was due to the gap between the ages of 14 and 18.

This is a problem which can be attacked in war time. It is something which can be done in the coming 12 months. My excuse for bringing it more strongly at this moment before the Minister is because when he sees that a thing can be done and puts the energy which is so characteristic of him into it, there is a sporting chance of action. If he acted now, he would be doing something of great benefit to future generations. Never before in the history of the country have so many boys between 14 and 18 been gathered together in groups in the A.T.C., in youth clubs and so forth. Why cannot he seize this opportunity? Why cannot he work through such groups, as is being done at Guildford, and achieve something really practical during the coming year?

Photo of Reverend George Woods Reverend George Woods , Finsbury

I have waited patiently for an opportunity to speak. In the later stages of the Debate we have got right away from the Minister's speech. It may be because so few of the speakers were in a position to criticise what he said. Those of us who did listen to the speech feel that it will give some degree of satisfaction, not only to the Committee but also to the country. But I am very glad that a few who have spoken have expressed some degree of misgiving at the picture the Minister gave of the black balanced by the lighter shade. Those of us who know him well will discount that as his natural exuberance and not take it as an indication of his personal satisfaction with the statement he was making. I would like to point out to the Minister the points upon which he could not only speak with satisfaction but could also give comfort throughout the whole country. First was the eloquent tribute he paid to British doctors and scientists, and the contribution they have made to medical science. I think it should be emphasised that we have the men of that quality and temperament who can apply themselves to the scientific discovery of causes. They should be recognised far more than is the case.

The other thing to which the Minister could point with a considerable degree of satisfaction, and which I think is one of the sources of satisfaction to the country, is that in the case of disease after disease, although the numbers may not have been brought down, the mortality statistics have been brought down, some almost to disappearing point. He quoted the amazing reduction in fatalities from cerebrospinal fever. There is the inoculation for diphtheria, with which many more lives might have been saved. There is the case of anaemia. We have made beginnings in connection with many diseases to which he has referred. Last week I was speaking to a man, older than I am, who is in a most responsible position in business. To my amazement he told me that he was suffering from pernicious anaemia but instead of dying, as he would have done a few years ago, he was going periodically for an intra-muscular injection. He looked as healthy as I have known him for years. I made inquiries about the method which he told me had kept him alive and carrying on today. It was a British scientific research worker who discovered the possibility of saving the lives of victims of pernicious anaemia, and enabling them to carry on and that method is available now to all those victims.

The real satisfaction to be derived from the Minister's speech was in his testimony to the capacity of research workers and the fact of the reduction in mortality and the increase in health due to their work. In spite of that, the Minister made no reference to what the Ministry is doing to encourage research work. You cannot control research, but you can encourage it. The summary of the report was published early in the year. Naturally, it is taken up largely with immediate aspects of the war. The Ministry of Health, in itself, is doing nothing in a responsible way. I notice that my right hon. Friend the Minister lifts his eyebrows at that statement. I say that the Ministry is itself doing nothing, though it is getting the Chancellor of the Exchequer to make a few parsimonious contributions to various institutions. The Ministry of Health, the Board of Education, the Ministry of Agriculture, the Ministry of Food, the Ministry of Labour, and other Departments are beginning to discover that there is such a thing as scientific research. Instead of leaving things to happen in an ad hoc way, and evading the moral responsibility for encouraging scientific research Ministers should realise that, on a purely financial basis, such research is the best investment that we could make as a country.

I know that there is a committee of the British Medical Association inquiring into the matter, but its terms of reference are very restricted. There are research undertakings attached to the universities, the medical schools, and various commercial organisations. There is a vast body of research students. The work of many of them overlaps, and they are very restricted when they try to apply themselves to research apart from commercial matters. Many of them are engaged in work for organisations that batten on ill health. They are employed by those who make claims for quack remedies. The reward of the research worker is not sufficient to encourage him to settle down to such work. Some of the finest men, who have contributed to the international reputation we have won for our contribution in this sphere, have had to go to America or other countries for the facilities they need and the remuneration which their services merit. We have not recognised the research worker, or given him the apparatus which he needs and the assurance of a comfortable livelihood.

We have dealt in this Debate with hospitals, from various angles; we have dealt with the nurses; we have dealt with the doctors—they have disagreed as usual—we have dealt with accommodation; and we have dealt with the culinary staff at the hospitals. We have dealt with almost everybody except the patients; we have not had time to deal with them. Being a minister of religion, I have seen a good deal of our voluntary and public hospitals. One thing which has sickened me is the way in which patients are treated almost as if they were a nuisance. They are told to be there on Monday morning. They know that the hospital opens at a certain time. They find the out-patients' department and other departments cluttered up and have to sit and wait about. This used to be true of practically the whole of the hospital system of London and of most of our big cities. There has been a vast change in a number of hospitals but there are still some that carry on as though the patients exist for the hospitals instead of the hospitals existing for the patients.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

I do not think that it ought to go out that that is true generally. A system of appointments has now been adopted.

Photo of Reverend George Woods Reverend George Woods , Finsbury

I am not saying that this sort of thing occurs in up-to-date public hospitals where they have officials and workers like the hon. Member for South Tottenham (Mr. Messer), who just asks for a thing and will not take "no" for an answer, and says that it has to be done. There have been improvements, but there are many hospitals, especially voluntary hospitals, where they still operate under the medieval system and where the hospital is the thing that matters and that the patients are just queued up and have to wait patiently, and are sorted out and then told to go home. I have had a case only this week of a patient being notified to come at half-past two on Monday. A taxicab was obtained to bring the patient from three miles out. The mother of the patient, who is on responsible work, had to apply for leave to bring her daughter to the hospital, where they were told to come again on Thursday at a quarter-past six. The probability is that every moment's delay in the treatment of this patient will mean endangering the possibility of her survival. I mention this case because there is an opportunity for the Minister of Health to see that the hospitals function in the interests of the patients in a much more sensible and kindly way than many of them have done in the past. He could, in collaboration with his colleague the Minister of Labour, have special inquiries made at some of these hospitals which are not up to date, about the amount of time lost from actual war work because of the attendance both of the patients themselves and their relatives. There would then be the possibility of bringing all hospitals up to the standard which some have already attained.

One final point is that a number of very fine doctors have come from America to see what they can do to give service in this country in the war effort. Those who have made contact with these doctors appreciate their reaction to our own hospital system, as compared with standards in the United States of America. If the Minister made an unofficial inquiry he would find a number of generalisations about which all would agree. One is that there should be a general standard of efficiency so that no time was wasted. A second is that most of these doctors are absolutely appalled at the extravagance (with which we use bandages, dressings and so forth just as if they fell from the sky. Nearly all the American doctors agree that there is gross extravagance in the use of bandages, splints and dressings and that there ought to be a very substantial economy. I mention this so as to try to convince the Minister that it is worth his while to get a first-hand view of their opinion about our hospitals, not that we should adopt all their methods.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

Not only have we had regular and frequent contact with our American friends, but at this moment a very distinguished doctor has, for months, been working with us in our own Ministry.

Photo of Reverend George Woods Reverend George Woods , Finsbury

I am very glad to hear that. We were not told that when the Minister spoke.

Photo of Mr Ernest Brown Mr Ernest Brown , Leith

I could not tell the Committee everything.

Photo of Reverend George Woods Reverend George Woods , Finsbury

I mentioned the matter because we had no indication that this sort of thing was taking place. I am glad that my point has elicited a statement by the Minister, and I am convinced that there is a lot of sound advice available which would mean, on the one hand, higher general efficiency in our hospitals, and, on the other hand, that they would be run more economically. In conclusion, I would like to thank the Minister for his statement to-day, although I hope we shall not be satisfied. The basis of satisfaction is that things to-day are not quite so bad as the worst pessimists anticipated they would be. We are all agreed that they might be better, and some of us believe that if science was properly exploited, the best brains in the country harnessed to the study of our diseases, and the mechanical side of our capacity applied to the provision of sufficient hospitals, sanatoria, training staff and so forth, the health of this country would be infinitely better than it is to-day. War should not be used as an excuse but rather as an argument for speeding up the standard of health of this country.

Photo of Mr John Martin Mr John Martin , Southwark Central

The Minister and the Parliamentary Secretary have been so magnificently enduring to-day that I promise them that I will not take up more than a few minutes of their time. I wish to dwell for a moment on a subject which has already been raised by some hon. Members—the standard of housing and its general retrogression since the beginning of the war. It is quite inevitable in war that the standard of housing should go down, and in my constituency not only have a large number of houses gone to pieces lately through lack of paint and ordinary care, but a great many have been damaged by the blitz. Many people there are living in miserable conditions at the present time. Young children and old age pensioners lived all through last winter in a perpetual black-out. Day in and day out they never saw the light in their houses, the windows of which were entirely covered with black material or trans parent material, which is almost worse, as in winter that tears easily and lets in the water and the cold. This adds enormously to the wear and tear of the burden of war, and it must bring a serious inheritance of disease in years to come.

We have not had a raid for a long time, and people are beginning to come back to London. If the war should end, as it probably will, rather abruptly, there will be a wholesale return of evacuees to our great cities, but even before that time if people come to the conclusion that the danger of raiding has greatly abated, there will be a gradual return of poeple, as there is now, to their homes or to places as near their former homes as they can get. Houses are being occupied at the present time which are far below the decent -standards at which we were aiming before the war. I will not ask the hon. Lady to reply to my points to-day, but I would ask her and the Minister to give some attention to this matter and before next winter try to obtain glass and windows for the repair of houses and to lay down some general instruction as what sort of house may in future be regarded as habitable.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I will try as briefly as I can to reply to as many as possible of the points that have been raised during what has been a rather extended Debate. I am sure my right hon. Friend is gratified by the interest taken to-day in the health services of the country, the progress that has been made, and the greater progress we hope to make in the future. Perhaps hon. Members will forgive me if I reply to the Debate in rather a scrappy way, but I think it will be easier if I reply to the various points that have been made without trying to weld them into a whole, as I had thought of doing a couple of hours ago.

With regard to housing, which was referred to by the hon. Member for Central Southwark (Mr. Martin) and the hon. Member for Cheltenham (Mr. Lipson), my right hon. Friend is anxious and has made preparations to begin, not only a small housing drive, but the biggest housing drive possible at the earliest possible moment. It is simply a case of labour and materials; as soon as it is possible for more labour to be released and for more materials to be available, the housing drive will begin; but I fear my hon. Friend the Member for Cheltenham is a bit too optimistic when he says that he thinks very shortly all the necessary building for the war effort will be finished and we shall be able to get on with house building for the future. As to repairs, I know quite well how difficult the position has been in the borough represented by the hon. Member for Central Southwark and what extraordinarily good work has been done in that borough in first-aid repairs. With regard to the great difficulties, I would say that there are now more materials, there is more glass, and there are more opportunities of making the houses more habitable. I know from personal experience that the white stuff to which the hon. Member referred not only lets in water, but also flaps in the wind and may come in on top of one, and if it is fixed up again, it makes a great deal of noise and is cold in the winter, and that the boarded part gives very little light. The difficulties arise from the lack of material, but gradually there will be, as far as we can see, more chance of getting material. The reason my right hon. Friend never laid down a definite standard was to leave the authorities free to use up to the limit of the material available.

Photo of Mr John Tinker Mr John Tinker , Leigh

Will the hon. Lady deal with the point raised by the hon. Member for Cheltenham (Mr. Lipson) about buying and selling houses?

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

The hon. Member for Cheltenham said that a short time ago he asked a Question in the House and I gave an answer which he found very unsatisfactory. I am afraid he will get an unsatisfactory answer now. My right hon. Friend has absolutely no power to deal with the price of the sale of houses. The hon. Member said that he knew of certain houses which had been sold at a profit; I could also tell him of many houses which have been sold at a loss. He said that the Government could control the price of houses in just the same way as the price of food is controlled, but we know that, as the war progresses, it all depends on where a house is as to whether it is sold at a great loss or sold at a profit. As far as we can gather—and we are getting statistics from the district valuers—the profit is not anything on a very large scale as yet, but the matter will be watched. There is, however, absolutely no power which my right hon. Friend has in this matter, and legislation would be needed to deal with it. I think the point about the different districts will show how enormously difficult it would be to regulate prices for the sale of houses. We have still rent restrictions, powers to requisition houses and powers of compulsory billeting; there is thus a good deal of control over houses at the present time.

The hon. Member for Kilmarnock (Mr. Lindsay) reminded us of what had been put forward in other speeches on the subject of the health of young people work-Sing to-day. He made reference to the long hours they may be working, and the hon. Member for Hemsworth (Mr. G. Griffiths) spoke of someone who left home at 4.30 in the morning. I would point out to both hon. Members that the industrial side of health was definitely taken by the Ministry of Labour, when arrangements were made that the various schemes under the Factory Acts should be taken from the Home Office to the Ministry of Labour. The Ministry of Labour are dealing with these particular subjects. I suggest that the hon. Member for Hemsworth should send the facts to the Ministry of Labour. Certainly, if we had to deal with such cases, I should like to have the facts. At the same time, I would point out that wherever cases come under the jurisdiction of the Ministry of Labour my right hon. Friend, as he has pointed out from time to time, will continue to deal as a whole with these particular difficulties with a view to improving the health of the nation. It would be a help if the facts were sent to the Minister of Labour.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

I brought the case up here because the results will affect the Ministry of Health.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I quite agree, and it is because my right hon. Friend is anxious about the subject that I was asking him to let my right hon. Friend the Minister of Labour have the facts. It will help my right hon. Friend in pressing the point of view on more general lines. It has been pointed out by one or two hon. Members, in discussing the progress which has been made in the high standard of health, how much had been done by the Ministry of Food and other Ministries. My right hon. Friend said so in his speech. The Ministry of Food have been able to supply or arrange for the supply of foods which the nutritional experts of the Ministry of Health have recommended.

The hon. Member for Finsbury (Mr. Woods) spoke on the subject of research. He asked what was being done on the research side. I would remind him of the valuable work which is being done at the present time by the Scientific Research Council under the Lord President, and by the Medical Research Council. The hon. Member will, no doubt, say that is not enough. In all probability he would like the research work to be carried out exclusively under the Ministry of Health.

Photo of Reverend George Woods Reverend George Woods , Finsbury

Surely the work they are doing is confined primarily to the successful prosecution of the war?

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I think my hon. Friend is mistaken. If he will examine the reports, he will see that the work is on the wider aspects of the problem. The reason I drew the attention of the Committee to this, is that throughout the Debate we have agreed upon the necessity for further research. That was brought forward in my right hon. Friend's speech. We all agree that we want to know more, and that it is worth while going on with the work, because we have seen from the figures to-day what can be done in dealing with diseases which have shown great difficulties in the past—diseases which we can not only cure, but, perhaps, stamp out. Stress has been laid on the fact that the duty of the Ministry, as my right hon. Friend has pointed out, is to keep people healthy. We have to look to a higher standard of health, and to regard the various illnesses as failures to reach that standard and therefore as subjects requiring particular attention. We can reach that higher standard and will do so if the minds and intelligence of the people of this country are really bent on these things.

That brings us to the difficult subject of the education of the people. If we know what ought to be done, how can we hand it on to the people so that they may be partners in keeping up the health of the nation? I think hon. Members will agree that a great deal has already been done. We have been able to arrange for more talks on the wireless, and great stress has been laid on the fact that it is up to the people of this country, and it is part of their patriotic duty in war-time, to see that they are fit and stay fit. We have to see that those who fall ill or are injured are restored to fitness as soon as possible in order to carry on the work of winning the war, and for carrying on the work in peace-time which can only be undertaken by a healthy and fit nation.

The hon. Member for Kilmarnock drew attention to young people between 14 and 18, and also to the problem of looking after the teeth of the people. I remember that one of the first speeches I made in this House was on the subject of teeth. It is one of my earliest recollections at school that with holidays there always came the visit to the dentist. I have connected the ideas of a holiday and a dentist ever since. We realise that a great deal more ought to be done in the matter of dental treatment, but there are certain difficulties. Both on the subject of dealing with the health services for those between 14 and 18 and dealing with dental treatment, we are hoping to examine with interest what Sir William Beveridge reports on the insurance scheme and the whole of the social services.

Photo of Dr William Thomas Dr William Thomas , Southampton

I do not think the hon. Lady realises that the secret of dental treatment is not so much the curing of trouble after it has occurred as proper feeding.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I have said that we are trying to work with the Ministry of Food in getting the best nutrition, but there is still need of treatment. One of the difficulties to-day is again educational. Of those in insurance societies where there is free dental treatment, only six per cent. use it. That is a startling fact. We want more education, but we need to educate not only the people to have their teeth examined but dentists and dental mechanics, because we have not enough. [Interruption.] I could not say the number straight away, but there is a great shortage even in peace time, and a greater shortage now, of dentists and dental mechanics. We want a very great expansion, and that is one of the things we must press for. It is no use saying everyone must get treatment when we have not a sufficient number of dentists and our education has not yet produced any interest except in six per cent.

The subject has been raised of anaesthetics for mothers, and it has been urged that it should be made compulsory on local authorities to instruct midwives in their use. My right hon. Friend has caused a good deal to be done, and progress has been made, but he has not the power to force local authorities to give that instruction. The subject can be discussed, but then it must be left to the local authorities.

Photo of Sir Godfrey Nicholson Sir Godfrey Nicholson , Farnham

The gist of the hon. Lady's reply is that the Minister is going to use his powers of moral suasion, and it is to be left like that. The next time the subject is raised a few more local authorities may have been persuaded, but nothing more. Knowing the forceful natures of the Minister and the Parliamentary Secretary, I feel sure that if they felt as keenly as I do, they would get magnificent results in a short time.

Photo of Sir Frederick Messer Sir Frederick Messer , Tottenham South

Would it not be more effective if the giving of anaesthetics was part of the training of the midwife?

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

My right hon. Friend has no power to compel local authorities, and it would need legislation to do so. Whether legislation ought to be brought in, the feeling of the country as a whole on it would have to be tested. That is all we can say on the point in the meantime. There has been a large increase of local authorities which do this, and there is the suggestion of the hon. Member for South Tottenham (Mr. Messer).

Photo of Reverend George Woods Reverend George Woods , Finsbury

Cannot the Minister notify local authorities of the apparatus, which is perfectly safe, and ask them the reason why they have not adopted it?

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

A circular was sent out two or three months ago on this subject, and we are getting in now the numbers of those who are doing the necessary training. My right hon. Friend is watching the position.

Photo of Reverend George Woods Reverend George Woods , Finsbury

Will the returns give the reasons why the others are not?

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I cannot say that with certainty. The main subject that has been dealt with in the Debate is tuberculosis. We were asked whether we could give the number of notifications in addition to the number of deaths which my right hon. Friend gave, and my hon. Friend the Member for Llanelly (Mr. J. Griffiths) asked for the figures for Wales for the first quarter of this year. In 1916 the notifications for England and Wales were 90,908 and in 1941 59,976. For the first quarter this year the notifications were 12,102, so that it looks as if the figures may be going down. For England they were 11,233 and for Wales 869. In deal-in with tuberculosis there is first the subject of early diagnosis and secondly that of treatment, including the question of a sufficient number of beds being available. This brings us to the subject of nurses in which I am particularly interested. Hon. Members are aware of the large number required now in the Armed Forces. The Army is taking an additional number each month. A large number are also required, greater than ever before, in industrial concerns. I was interested when the hon. Member for Brigg (Mr. Quibell) spoke of nurses who were trained mid-wives going into factories. We are looking into the question of trained midwives going into the Services. I persuaded one to stay at home, telling her that she would do better to stay at home to look after the sailor's wife and her baby than go into the Services to look after the sailor himself. We are looking into the question of seeing that those with special training such as midwives are left to their work and do not go into the Services.

I come to the number of nurses who are nursing in civilian hospitals, including isolation hospitals and sanatoria, which take both Service and civilian casualties of any sort. There are now over 90,000 working in those hospitals, that is, trained nurses, student nurses and nursing auxiliaries. That is 8,000 more than at this time last year. That increase of 8,000 is in those hospitals alone, apart from the increase in industries and the Services. So the number who have been coming in has been very satisfactory. I should like to see another 12,000, to get over the 100,000 mark, in the hospitals. Of course, there is a heavy wastage, the biggest wastage being due to nurses leaving to be married. Sometimes people ask me why the case of the nursing profession is always being put forward, and whether we have not got enough nurses. If we could keep all the nurses we have and there were no wastage, the answer would be "Yes," when we have the additional 12,000 for whom I am asking, but only if the present rate of recruitment for training continues shall we be able to maintain that number and to cope with the many new demands for nurses that we have to meet. For instance, nurses were sent into the shelters and into rest centres during the height of the blitz, and in one instance after another there is hardly a single part of the war effort for which we have not been asked to supply nurses. Therefore, I think that it ought to be stated that the nursing profession has done extremely well in these trying years, both in recruiting girls as student nurses or into the Civil Nursing Reserve

With the number of nurses in hospitals over 90,000, and if we can get the cooperation of hon. Members here and of the public, I feel that we ought to be able to deal with this last effort to get nurses for the sanatoria. I say "last effort," because we have done a good deal. If we could get another 1,000 or 1,200 nurses into sanatoria, we should be all right, and considering that there are more than 90,000 nurses in our hospitals, I cannot believe that we cannot get some of them seconded for this work for a short time, say for six months or a year at a time. All we want is that 1,000 or 1,200, and we can deal with the problem of nurses in sanatoria. I would par- ticularly ask hon. Members who come from Wales to see what they can do there. As the hon. and learned Member for Montgomery (Mr. C. Davies) knows, I have been to Wales once or twice and discussed this matter with the nurses, and things improved at the time. At the moment 80 nurses are all we require in the sanatoria there, perhaps 40 fully trained and 40 students or nursing auxiliaries, or 50 of the one class and 30 of the other. I have examined the figures of the nurses standing by in the Civil Nursing Reserve as they come along week by week. On 15th June there were 70 nursing auxiliaries, trained nurses or assistant nurses, in what we may call the pool of nurses in Wales registered as mobile and standing by. I know that the nurses who register as mobile in Wales do not want to come to work in England, but I think we should put the position before them—I believe I did some good the last time I went—in this way, "Will you come to work in England, because then we shall be able to release some more nurses for sanatoria; or, better still, will you in Wales, who are standing by, help in your sanatoria in Wales to look after your own Welsh people? "

Photo of Mr Clement Davies Mr Clement Davies , Montgomeryshire

I would like to thank the hon. Lady very much for the way in which she is dealing with this matter. She can be quite sure that a response will come from all my colleagues in Wales. May I suggest that we could be assisted very greatly through the services of the B.B.C.? A call to Welsh patriotism is never a call in vain.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I agree with my hon. and learned Friend. My right hon. Friend says that he might be able to do it himself. I think that the last time we went to Wales and put the case we did some good, and I feel that the case should be put again by people on the spot.

But the nursing problem has not been so bad as the problem of domestic service. I went to places where trained nurses were scrubbing floors and the matron was cooking. We cannot expect that nurses will do their skilled work of nursing and do that other work as well. It is not that domestic work is derogatory, it is not the case that nobody should scrub a floor or cook, but these particular people have had training, and their skilled profession is nursing, and they cannot do that and do the other hard work as well. It is a waste of their skill and training. There is an example of the vicious circle. We get the nurses to a particular place, and some of them are very difficult places, and they find that there is no domestic help there, and they cannot keep on with the task of both nursing and domestic work.

We are looking more and more to the Minister of Labour to see that more people come in to do the domestic work in hospitals and sanatoria. Again I would appeal to the people of Wales. It is the Welsh who must look after their own Welsh people in their Welsh sanatoria. There are skilled people in the nursing profession there, and it is up to them to give every help. It is up to them to make up their minds on the question, "Do you wish those who are suffering from tuberculosis in this country to be treated and restored to health if possible? If so, are you willing to help?" That is the point which we must put clearly to them. One hon. Member said he thought it was a pity it had been stated that those coming into the Civil Nursing Reserve should not be directed into sanatoria. The Advisory Council of the Civil Nursing Reserve has always been against directing members of the Civil Nursing Reserve to other than general hospitals when we do not direct other nurses. A nurse may have done many years of nursing and then have retired and married, and perhaps has children. She then returns to the Civil Nursing Reserve in response to the appeal made to her in war-time. Why should she be the one to be directed in a particular direction while those who are perhaps younger or are making nursing their career are to be allowed to go where they think fit? If you are going to direct nurses and doctors, my opinion is that you would have to do it to all of them, and to all the different hospitals, whether hospitals for infectious diseases, sanatoria or anything else. To pick out the Civil Nursing Reserve and to pick out sanatoria would, I think, be disastrous to the whole service, both from the point of view of the hospitals and from that of the nurses. Many are working in sanatoria, but they volunteered for the work.

There is one other point which was brought up, on the subject of training nurses for the future and the gap between the ages of 16 and 18. We are getting over it to a certain extent, and when I was in Cornwall and Devon a week ago I was very glad to find that the idea was being taken up there, that there should be a pre-nursing course in connection with the schools which the girls could take between those ages. They would then be able to take the first part of their preliminary examination before going into hospital. Everyone, I think, realises that the first year in hospital, among strange surroundings and with a good deal of work to do, is a difficult year. If they could get that first part of the examination finished and out of the way before going into hospital it would give them a better chance to settle down. I could say a good deal more about nurses, but this time I must leave it there.

Photo of Sir Joseph Lamb Sir Joseph Lamb , Stone

I do not want to prolong the Debate, but I would like to ask the hon. Lady to say a word with regard to the domestic staff. The domestic staff are as important to-day for hospitals and sanatoria as the nurses, and the shortage is worse. I was in a hospital only on Monday where only one person had turned up for the kitchen in the whole place. That was simply because the employment exchange had not been successful in providing the necessary continuity on the domestic side.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I am grateful to every hon. Member who raises this question, because I have struggled with it almost from the first day of the war. The more hon. Members who point out the difficulties to my right hon. Friend the Minister of Labour and National Service, the better I shall be pleased. We have got it put into the category of "vital war work"—I was going to use the word "essential," and I am not at all sure that it would not be a good plan to call it essential work and have it graded as such, for it is absolutely vital to the hospitals to have this staff. You might as well say that a ship could sail the seas without the stokers as that a hospital could do without its domestic staff. Do not let us forget that during the raids on London, Swansea or anywhere else, while it was quite right to praise the doctors and nurses, the people in the laundry and the kitchen also worked on. It is up to us now to see that they get help. There are a few who have struggled on; we have a badge which says that they are doing war work which they can have, and when I presented some of the badges to people who do domestic work in hospitals and found that they had been doing overtime, working night and day to keep the hospitals going and prepare the patients' food, I realised that it was up to us to see that they were helped. If people are to be sent into hospital to do the domestic work and then walk out the next day, the sooner it is made clear that they will have to walk in again the day after, the better it will be.

I am glad also that praise has been given to the district nurse, who is doing a marvellous job of work. There is not much advertisement about her work, but she is right in the home of the people and has done a tremendously good job in these difficult times. She has been a real friend to the family and has helped the morale of the people.

After-care was the other point I wished to speak about for a moment. Again I think we are all agreed. Hon. Members will realise that I can say nothing definite at the moment about the actual method of working out the scheme. We are awaiting the report on the subject of tuberculosis from the Committee of the Medical Research Council to which my right hon. Friend referred. One hon. Member said that there was too much delay in receiving that report. I can assure hon. Members that my right hon. Friend hopes to receive it very shortly, and I think that he will urge that it should be examined and discussed as soon as possible. Today we have seen the point of view of many hon. Members, and everyone seems to be in accord as to the general type of scheme that there should be in operation throughout the country. I cannot think that with the good will we have seen here to-day we shall not be able to arrange a scheme whereby people will be able to take up light work gradually after their treatment in sanatoria. I am convinced that it will be possible to launch a scheme throughout the country.

The hon. Member for Hemsworth asked one question which I have not answered.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

I am waiting patiently.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

I have had to wait too; we have quite a fellow-feeling. It was on the subject of diabetics and insulin. We have had some correspondence about the price being raised in 1941. We pointed out to him in that correspondence that, for insulin bought in a larger quantity, the increase in price is very small, but we do realise the difficulty of people who are not insured and who may be the dependants of insured people.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

It has risen since we had that interview. It was raised on 1st June.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

We will look into it again, but even with the extra rise, if a larger quantity is bought the increase is not so great. We will look into the case the hon. Gentleman mentioned again, and the position as it affects people who are not insured, including those who are the dependants of insured persons. Again, I am afraid I must say that we must await the report of Sir William Beveridge's Committee. We hope it will come in the autumn, and it will deal with the whole scheme. It is no use dealing with our health scheme and our insurance scheme piecemeal. It has been built up in bits and pieces, and from the pieces we should be able to weld a proper insurance scheme for looking after the health of the people in all the different ways we have discussed to-day.

Photo of Mr George Griffiths Mr George Griffiths , Hemsworth

Is it not possible that insulin might be subsidised the same as so many other things at the present time? Could not the Minister let the standard price of insulin in 1939 remain and subsidise it to keep it at that figure? I think that that could easily be done.

Photo of Dame Florence Horsbrugh Dame Florence Horsbrugh , Dundee

My right hon. Friend will look into it again. As the hon. Member knows, we have in various ways tried to deal with it, but we will look into it again, see what can be done, and discuss it with the hon. Gentleman. I think that is all I can say at the moment.

The other point which I have left until last—I see that the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) has left—is the subject of the care for the children of this country during war-time. I would like to bring out the fact that I never have suggested that what we can do at present for the children of this country is the ideal which we should put before us for a peace-time scheme. What we have to do at present is to see that the children of mothers who themselves volunteer to go to work are looked after as best we can. Personally, and I think the majority of hon. Members will agree, I cannot think it would be right in this or any other country not at war to suggest to a mother that her child should be left at a nursery for 12 or 15 hours out of the 24, and taken home to sleep for the remaining few hours. No one regards that as ideal in peace-time.

What is happening now is that some of these women are going to factories and working for very long hours, and we have to look after their children during these hours. We hope to get as near as possible in nurseries to giving the home side and the school side in the same place. We shall look after children, wash and feed them, look after their health, and during the time they are there we have our trained nursery teachers and assistants for the ones for whom it is suitable to have a certain amount of instruction. That is what we aim at. We do not lay down that the building must be laid out in a particular way, because so many of the children are under two years and some are over two years. We have huts of many kinds. The Noble Lady said I ought to go to Guildford and see a particular hut. I was there yesterday and saw that hut, and saw something that was very wrong with it. There must be an addition made, because there is nowhere to keep the milk. One sees another type of hut somewhere else, and by comparing the different types one may gain new ideas. The proper care of children is not an easy problem. When the first priorities must come for the building perhaps of a particular factory it is not always easy to get the nursery we want. But I do say that thanks to the interest which the people of this country will always take in the welfare of the small children, thanks to the fact that private individuals and voluntary associations have helped us, thanks to the work not only of the Ministry of Health but the Board of Education, thanks to all these, and the local authorities, joining together with good will and common sense, a great deal has been and is being done. But we do not want too much theorising.

I saw yesterday, if Members will let me detain them for a moment longer, a nursery where there was a child in a perambulator, crying. I asked whether he could not play with some other children at the other side of the garden. "Oh no," I was told, "he is 22 months old, and the other children are the two to fives." I took him out of the perambulator, introduced him to the others and suggested that should have an overall the same as the others, and that they should play together.

We want to help in some way to make up for what these children are missing—real homes with their mothers to look after them. We want to give a certain amount of guidance, and to see in future what we can do to get good homes, and, I hope, nursery schools, where the children can go for a few hours of the day and then return to their mothers. We want to provide good treatment if treatment is required, good after-care, and the best services, medical and nursing, such as this country deserves. I believe that if we can still keep the good will of all and work together we can do it.

Motion made, and Question proposed, "That the Chairman do report Progress, and ask leave to sit again."—

Photo of Mr David Adams Mr David Adams , Consett

I did not attempt to enter into the Debate until the Minister had spoken, because my experience as a back bencher is that the chance of speaking in any of our Debates when they are fresh and worth entering into is very small. The opportunity of doing so before the Minister replies is usually about zero; but I have discovered that after the Minister has replied, owing to the Rules of the House, there is an opportunity for back benchers who have not been able to make their small contributions to do so, with almost 100 per cent. certainty. Therefore, I propose to take advantage of the Rules of the House whenever it is desirable for me to do so. While I offer my respectful congratulations to the Minister and to his well-versed assistant in the declarations on public health that they have made today, I do feel that there was too much of what I might call moral chlorate of lime distributed to the Committee. The Minister was somewhat shy and diffident in referring to those who are giving such service to the country—the medical officers of health, who are keeping the machinery of our public health services so efficient, and who are, in the main, well in advance of the Ministry of Health itself.

Photo of Mr Dennis Herbert Mr Dennis Herbert , Watford

I looked for the hon. Member to get up before the Minister replied. Now the Question has been put to report Progress. If the hon. Member insists upon speaking now, he must confine his remarks to the Motion to report Progress.

Photo of Mr David Adams Mr David Adams , Consett

All I can say on that is that I would be, in my own judgment, extremely badly treated if I were prevented from making my observations on behalf of the corporation with which I am associated, and from speaking generally on the tuberculosis position in the North of England. That has not been expressed in this Committee to-day.

Photo of Mr Dennis Herbert Mr Dennis Herbert , Watford

Why did not the hon. Member rise before the Minister spoke? I have his name down and expected him to do so and looked for him, but he did not get up.

Photo of Mr David Adams Mr David Adams , Consett

The hon. Member did not rise because of his experience during the whole of last week in three important Debates. When I made requests, I was advised that on the third Sitting Day I would be called, and I was not called. Therefore, perhaps my confidence has been shattered in the promise made that I would be called.

The CHAIRMAN proceeded to put the Question,

Photo of Mr David Adams Mr David Adams , Consett

I protest against the attitude adopted.

Question "That the Chairman do report Progress, and ask leave to sit again," agreed to.

Committee report Progress; to sit again upon the next Sitting Day.

The remaining Orders were read, and postponed.

It being after the hour appointed for the Adjournment of the House Mr. DEPUTY-SPEAKER adjourned the House, without Question put, pursuant to the Standing Order.