§ Order for the Second Reading read.
§ Motion made, and Question proposed, ''That the Bill be now read a second time."
§ MR. NANNETTI (Dublin, College Green)
said he did not intend to offer any opposition to the Second Reading of the Bill, though he felt bound to tell the House that there was a good deal of opposition to its provisions in Ireland. His object in rising was simply to ask the Chief Secretary if the Bill could be sent to a Grand Committee upstairs, so that proper time might be allowed for the purpose of considering Amendments which some of his friends desired to introduce. In respect of one or two points connected with the Bill there had been a good deal of comment. Its provisions applied to every person who was troubled with tuberculosis, and when the medical officer of a district found that a person was suffering from the disease he had to report that person immediately, which meant an expenditure of 2s. 6d. per patient for the local authority. The question of providing sanatoria for these unfortunate people also came in, and there was no contradicting the fact that these establishments must cost a great deal of money. 984 He imagined that if the Bill passed, every working man who might be afflicted with this disease would, as it were, be singled out, and would be marked as an affected person. In many ways that might injure him, and more especially it might be the cause of his being unable to find employment. Other men, naturally, would not like to work in a place with a man who would be liable to spread infection, and under the circumstances he thought they should give the measure fair consideration in Committee in order to ensure that the least possible amount of harm should be done. Personally, he was in favour of doing everything that was possible to remove the danger of the spread of infection, but so many difficulties might be created and hardships caused that he thought they should be very careful how they went to work. He knew that the right I hon. Gentleman was animated by the best intentions, but it was necessary that certain precautions should be taken and that those interested in Ireland i should have an opportunity of considering the Bill in Committee with a view to inserting Amendments that would have the effect of minimising the worst results anticipated from the measure. He believed that the discussion of the Bill in Grand Committee would not take more than one day, and he appealed to the Chief Secretary to allow it to go upstairs.
§ MR. CHARLES CRAIG
agreed to a large extent with what had been said by the hon. Member for Dublin. One difficulty he had found in connection with the Bill was that whereas, as the, hon. Member had pointed out, it was rendered compulsory on the medical officer to report all cases of tuberculosis that he might meet with in the performance of his duties, so far as he could see the Bill did not state what the authorities were to do with the cases so notified beyond the very modest requirements of Section 2 of the Bill. As the hon. Member had said, the difficulty of the Bill was that it would to a very large extent mark these people down as comparatively dangerous members of the community, without at the same time insuring that any very serious steps would be taken towards curing them of 985 tuberculosis, if they were curable, insufficiently segregating them if they were in a state that was past curing. That seemed to him the fundamental objection to the Bill. Another object he had in rising to speak on the subject was that he understood that any hon. Member who took part in a debate of that kind was nearly always chosen as a member of the Grand Committee before whom the Bill would come upstairs. He was sure the Chief Secretary, who was in charge of the Bill, would acknowledge that he had given valuable assistance in connection with another Irish Bill which had just left a Grand Committee, and he hoped the authorities who selected persons to serve on Grand Committees would note that he was a fit and proper person to serve in connection with the Bill now before the House.
§ MR. SUMMERBELL
wished to appeal to the Government to be as fair as possible in dealing with a matter of this kind. In this Bill machinery was going to be set up with the object of preventing the spread of tuberculosis in Iceland, and no one would say that the object was not a good one. It was from Ireland we obtained a large number of our soldiers, and he hoped the House would take note of the fact that the Government were discharging from the Army every year about 400 men who were suffering from consumption. They were seat away to their homes as unfitted to continue in the Army, and according to the evidence on the subject they carried with them the liability to spread this dread disease among other people in various parts of the country. He contended, in view of that fact, that before they asked municipalities to be at the cost of setting up machinery in order to grapple with the disease, the Government ought to do their duty by guarding against the spread of disease by soldiers who were discharged from the Army. The War Office authorities had been appealed to on the subject, but they had declined to spend the few thousand pounds that would be required in order to effect that object. He took advantage of the present opportunity to appeal to them again to do their duty and see to it that they were not the principal people to spread the disease in various parts of the country. 986 At a cost of a few thousand pounds the War Office authorities might establish an institution for the treatment of these soldiers, and so prevent their going away, with the result, perhaps of communicating the disease to other persons. He had served on a Select Committee in regard to this matter, and he was strongly of opinion that before the Government brought forward a Bill of this kind they should agree to the small expenditure that would be needed to put an end to the risk now caused by the annual discharges from the Army of consumptive soldiers.
§ LORD BALCARRES (Lancashire, Chorley)
was sure that every Member of the House must sympathise with the desire of the Chief Secretary as embodied in the Bill, but he confessed that he had read the proposals of the Bill with a certain amount of doubt. He thought Members of the House ought to realise that tuberculosis was not a defined disease like scarlet fever or small-pox, but that two or three medical men often made different diagnosis in the same case. He himself—and probably every other Member of the House was in the same position—knew of individual patients who were stated by one doctor to be suffering from tubercular disease, while another doctor, equally well qualified, denied it. Tuberculosis was not a defined disease, and the Government admitted as much in the first three lines of the Bill, because it was provided that the Local Government Board should make an order prescribing the circumstances in which a person suffering from tuberculosis "of any form, or at any stage" should be notifiable. They did not think it necessary to state that forms of small-pox had to be defined by the local authority. It was a matter that could be determined, and it caused no criticism among medical men. That was not the case with tuberculosis, and the clause was drawn so widely that any person suffering from any form of consumption, or at any stage of the disease, had to be notified. The far-reaching character of the proposal might be gathered when he informed the House that he was told that three out of ten normally healthy persons were suffering from one form or another of tuberculous weakness. He did not 987 know whether the Government seriously intended that regulations of so severe a character should be issued. The matter was one of great importance, and such a Bill as this ought not to be rushed through after midnight, but should go to a Grand Committee for full consideration. The Bill said that the Board might from time to time prescribe forms and stages of the disease, but the House did not know in whom the right was to be vested. The position was rendered very difficult by the fact that there existed the great and substantial disagreement among doctors on the subject to which he had alluded. The hon. Member for Dublin had said that they were running a great risk of causing hardships. His own view was that they were running the risk of, so to speak, scheduling these people as suffering from a really serious disease and doing them more harm than they could possibly hope to do them good. They incorporated five or six different sections of other Acts in the Bill, and altogether it was about as complicated a case of legislation by reference as they could have. These six sections gave the local authorities the rights they now possessed in cases of small-pox. The Bill also authorised the local authorities to establish hospitals, and there was a point in regard to which he felt himself at issue with the Bill. The county councils in Ireland were authorised to spend a penny in the, and in certain cases twopence, in establishing hospitals and dispensaries. They were entitled to borrow money for that purpose and in suitable cases two or three had the right to combine for the purpose of establishing a joint hospital. Did the hon. Members who were acquainted with existing hospitals for tubercular disease seriously think that the average county council in Ireland was going to raise money to create an adequately equipped hospital to deal with that particular disease? They would not do it, and he did not think they could afford to do it on a rate of 2d. in the £. The provisions for recouping them were illusory, because in nine cases out of ten it would be impossible for the persons who were treated to repay the local authority the cost of their treatment, which he reminded the House was 988 extremely expensive. He thought that the Bill was based rather upon a misapprehension that tubercular illness was of purely a local character, and he could not bring himself to believe that a county council with an area of low rateable value was the proper authority to deal with illness which was certainly national in its character. They could not trace the source of the illness to any particular locality and he thought the matter ought to be dealt with in a far more comprehensive way than was proposed. It was almost ridiculous to suggest that a county council should appoint a bacteriologist to look into tubercular cases. It was a class of bacteriology which required a longer and more expensive bacteriological training than any other. The whole idea was impossible when associated with county councils. If on such exiguous funds skilled bacteriologists were to be appointed very little money would be left for other work, and the county councils could not keep men sufficiently trained to deal with the very difficult and intricate problems which. would have to be encountered. The Bill ought to receive more complete consideration than it could receive in the House, and should, if possible, be sent to a Grand Committee.
§ THE CHIEF SECRETARY FOR IRELAND (Mr. BIRRELL,) Bristol, N.
I quite admit this is a Bill which deserves full consideration. It has already received great consideration in Ireland. The Bill has been printed in all the Irish newspapers. Its principles have been affirmed by all the medical societies in Ireland. The Royal College of Surgeons, the Royal College of Physicians, the British Medical Association, the Royal Academy of Medicine in Ireland, and the Irish National Association have all gone most carefully into it and considered its provisions, so that although undoubtedly there are points and matters to be considered in Committee, the subject, so far as Ireland is concerned, has already received very careful attention. It is not surprising that Ireland should feel a deep interest in the subject, for the ravages of this disease there have reached a positively appalling figure. The death rate from tuberculosis in England is 1.6 per 1,000; in Ireland it is 2.7 per 989 1,000. In fact one-sixth of the entire death rate in Ireland is due to tuberculosis. Twelve thousand people die annually from it. Now it is certainly known on the highest scientific authority that this disease, if treated properly, in its early stages is a preventible disease. It has also been clearly established that it is spread by very simple and now ascertained methods. Having regard to the fact that this terrible disease is steadily increasing in Ireland, it is not to be wondered at that the Irish people should be alive, and peculiarly alive, to its horrors. Owing to the untiring labours of Lady Aberdeen the subject has attracted an amount of attention in Ireland which would surprise people here. The Tuberculosis Exhibition, a somewhat gruesome thing, has visited nearly seventy places in different parts of Ireland, and has attracted and profoundly interested thousands of people. Lectures have been delivered, over three hundred, by scientific men from all parts, and these have been closely attended and eagerly followed. There have been also, what perhaps is even more interesting, some 900 demonstrations and popular talks with the people upon the subject of how this disease is spread by contagion, what particular acts should be avoided, and what care and what precautions should be taken. The medical men and the local authorities have participated in these efforts in a most remarkable manner. The clergy of all denominations have joined in; and really the matter has assumed something like a national campaign against the disease which, as I have said, is preventible, and the ravages of which can be, if not wholly removed, at all events largely destroyed. That is the state of the case. The noble Lord a little misapprehends the object of the first clause. I quite agree that it is one of the, horrors of this disease that it is a domesticated one, and that poor consumptives have long been regarded by affectionate families as? doomed but harmless people, who might 990 be allowed to remain in their houses, and were to be treated as if they were on the same footing as cripples or persons of inferior understanding, until they met their inevitable death—usually between the ages of twenty-five and thirty-five. Now we are all agreed, I am sure, that you have to deal with the utmost tenderness with cases of that kind, and that it is impossible, however terrible the disease may be, to let doctors loose upon these homes and remove these people forcibly as it were, and stamp them as infected. That is the reason why, I believe, the first clause is worded in such a manner as to leave it to the Local Government Board, who have skilled doctors as part of their establishment, to determine the circumstances in which notification is to take place, to secure privacy, and generally to deal with this difficult matter in a spirit of the utmost care and in a tentative and most judicious way. The clause is so put down, rather with reference to public opinion than to health considerations. We cannot go ahead of public opinion, and the clause is framed and appears in its present shape so as to prevent our travelling too fast. With regard to hospitals, there are counties in Ireland, certainly, which are not in a position to establish, and which would never dream of establishing, hospitals on a scale large enough, but they could act in association with others, and even if it is only a small hospital that is established it is of great value, from the educational point of view, among the teachable population as showing how the thing can be dealt with in the cases of persons in an advanced stage. Then there are the sanatoria, which should be inexpensive indeed, the more inexpensive the better, because after a time they become so infected that they are better destroyed. The ravages of this disease affect us all, and most of us, I dare say, have friends who have derived enormous benefit from the treatment they have received in sanatoria in healthy spots in the country. 991 I should agree that if you had to deal in this aspect with the whole population it would be beyond the means of certain, counties, but that is not what is intended. The idea is to set the thing going in such a way as to show by hospitals for extreme cases, and by sanatoria in the best parts of Ireland for those who can be treated curatively, and in the hope of restoring them to society, how much can be done to check the inroads of this disease. There is also the dispensary system, which is enormously interesting and important, and which will enable us to treat people who are in their own homes skillfully, and with all the arts of medicine, so that the chance of the disease spreading by contagion to other members of the family may be reduced. The Irish people want these things, and the Irish people within reasonable limits will be prepared, I doubt not, to rate themselves for them. I point out again that the subject has been already considered by competent persons and has received the support of all authorities and of the people to a most remarkable extent. Everyone is prepared to join in the campaign, from the simplest and the humblest of the population, and to have the local authorities invested with the means of organising and maintaining of a complete campaign against tuberculosis, which carries off so many thousands in Ireland. I agree there are many points of detail which require consideration, and if the House will give the Bill a Second Reading it will be desirable, I think, to allow it to be considered in Grand Committee. I do not think that at this period of the session it would be very easy to deal with it on the floor of the House. The course of sending the Bill to Grand Committee may possibly delay the passage of the Bill at this period of the session, but we should, I hope, take it up again in the autumn.
§ MR. J. MACVEAGH
May I ask whether the effect of the statement just made is that if the Bill were com- 992 mitted to Committee of the Whole House the right hon. Gentleman could not get it before the recess?
§ MR. BIRRELL
That would depend, of course, upon the number of the Amendments, and I am rather disposed to think it would be very difficult at these hours of the night. If it goes to Grand Committee we could not get it till the autumn session.
§ Replying to MR. NANNETTI—
§ MR. BIRRELL
said that it might be the best course to move that the matter be proceeded with in Committee of the Whole House. They could then see the number and character of the Amendments. Some of these might be dealt with by friendly intercourse without debate, and they might see what could be done in that way. He would, therefore, propose to move that the Committee stage be taken in Committee of the Whole House.
§ MR. FORSTER (Kent, Sevenoaks)
regretted the right hon. Gentleman had not adhered to his original decision to proceed with the matter by means of Grand Committee. He now proposed to take the measure in Committee of the Whole House. In that case, he (Mr. Forster) hoped Members would be given time to put down Amendments, because there were undoubtedly points which would have to be carefully considered.
§ Whereupon Mr. SPEAKER, pursuant to the Order of the House of 10th July, adjourned the House without Question put.
§ Adjourned at twenty-eight minutes after Twelve o'clock.