HC Deb 31 July 1916 vol 84 cc2238-44

I desire to direct attention to the answers given by the Secretary of State for the Home Department at the sitting of the House to-day to the questions asked with reference to the issue of the Proclamation restricting the sale of cocaine. I need not say that neither I nor those associated with me take the slightest exception to the restrictions which are proposed to be imposed on the sale of cocaine for improper purposes. On the contrary, we entirely approve of action with that object in view. But we do think that probably, through lack of sufficient consideration, the Proclamation has been so framed that unless the Home Secretary takes special action to prevent it great injustice will be done to unregistered practitioners in this country. It is a mistake to suppose, as the right hon. Gentleman seems to do, that these men are in the main inexperienced and unqualified. For instance, in one organisation, the Incorporated Dental Society, there are some 2,000 members, all of whom have received apprenticeship and training and are thoroughly practical and experienced men. As a matter of fact, the registered dentists, whom the right hon. Gentleman appears to have consulted in this matter, whose views he seems to have asked as to what facilities should be given to them and, apparently, what facilities should be given to those who may be regarded as their trade rivals, cannot adequately supply the dental needs of the community. There are only 5,000 of them altogether. At least 1,000 are out of practice, which leaves less than 4,000 dentists to provide for the dental needs of a community of 45,000,000 people. [An HON. MEMBER: "There is a large number in the Army."] That is so. They are recruited not merely from the ranks of the registered dentists, but also from the ranks of the unregistered dentists. It is extremely hard on those who have answered the call of their country in this time of need that they should find when they come back that the right hon. Gentleman has done what would be achieved neither by action in the Law Courts nor by legislation in the House of Commons, namely, deprived them of the right to administer local anesthetics, which they have enjoyed ever since they were introduced into this country. It is clear that the registered dentists cannot supply the dental needs of the community and that dental work has to be performed by unregistered practitioners. The bulk of the working-class practice is in their hands. In many industrial and outlying agricultural districts they supply the entire dental needs of the community. I do not think there has ever been the slightest suggestion that they have taken any part, direct or indirect, in the supply of cocaine for improper purposes. In no case has any prosecution been directed against any one of their number. I should, indeed, be very much surprised to hear from the right hon. Gentleman that in the case of the thousands of men engaged in this practice has a single one ever been suspected of taking part in any improper practice. As a matter of fact it could not be done, because they use cocaine in such a solution that it could not possibly be done in this improper way. In the solutions which are used I understand that as a rule the proportion of cocaine is from .75 to 1 per cent. It is impossible, except by redistilling such a solution, to use it in an improper way.

These men do not belong to the class of men from whom such criminals are recruited. It is a ludicrous misconception of their position if it is suggested that that is not so. Many of these men are magistrates, town councillors, borough councillors, and district councillors—men who enjoy the esteem of the community in which they live. They have used cocaine ever since its introduction into this country, steadily for something like fifteen years. Literally there have been millions of extractions where, owing to the low charges which they have imposed, patients have been able to secure the benefit of these local anæthetics, when otherwise they would have to endure the torture of unrelieved pain. Now, by the closing down of an iron curtain, comes the barrier of this Royal Proclamation, which shuts them out of the supply of cocaine necessary for the purposes of local anesthetics. The right hon. Gentleman has been entirely misinformed when he says that there are other effective substitutes for cocaine. He in- formed me to-day that they could use novocaine, which was the best and most efficient substitute, and he justified his action with regard to this Proclamation by saying that novocaine could be used. As a matter of fact novocaine is not available at present. It has been restricted ever since the outbreak of the War owing to the action of the Government. The War Office has practically commandeered ail the supplies of novocaine in this country, and I hope, if the right hon. Gentleman finds that that is so, he will either be able to tell us that the War Office no longer requires to commandeer it, and that novococaine will be really available for these men, which will solve the whole difficulty, or, in the alternative, that he will reconsider the position he has taken up.

There is one point which, I think, the right hon. Gentleman ought very seriously to consider. The question of whether this class of practitioner should be allowed to continue the use of cocaine and other anæsthetics was considered by a Committee which was set up by his own Department in 1908. They inquired exhaustively into this very question, and came to the conclusion that the balance of opinion amongst the witnesses was against legislative interference, and they recommended that there should be no restrictions placed upon the use of cocaine as a local anæsthetic by unregistered practitioners. In view of the strong recommendation of that Committee, I submit that this privilege, which has been enjoyed so long by this class of practitioner, ought not to be taken away from them except by legislation, so that this House should have a voice and the whole matter should be adequately discussed, and those men should be heard. At any rate, I submit that the right hon. Gentleman has acted harshly in endangering the livelihood of this class of practitioner, as he has done, interfering with their practice, as he has done, and threatening to bring this inconvenience and pain upon millions of his fellow-countrymen, as he has done, without giving the representatives of these practitioners an opportunity of approaching him and putting their case before him. I suggest, even at this late hour, that at any rate he should not take up an absolutely irreconcilable attitude. As I read the Proclamation there is power left to him within the Proclamation to give general or special permits, and that might be done to all reputable practitioners in dentistry. Surely, if even here and there an occasional disreputable person might use this power if it is left unrestricted, it does not pass the wit of his Department to impose such conditions upon those to whom he gives those general or special permits as that their possibility might be removed. If the right hon. Gentleman cannot announce some concession to-night, which would end the whole matter,' he might agree that these practitioners, who are so deeply affected by this matter should have an opportunity of talking the matter over with him and submitting to him proposals which in their view would adequately safeguard the object which he has in view and at the same time remove the grievance of which they complain.


I say, like the hon. Gentleman that we have no objection at all to the general regulations. We think they are necessary. We think that the Home Secretary has taken a wise step in doing everything in his power to prohibit the improper use of this drug. We are dealing only with people who have for many years been using this drug for the purpose of the mitigation of pain during the operation of dentistry. We are not going tonight into the question of registered or unregistered dentists. That is a matter that may have to be raised in this House at some future time. The point is that these unregistered dentists at this moment are legally allowed to pursue their profession, and if any change is to be made certainly this is not the best moment to do it, especially seeing that there is such a shortage in regard to dentists generally. We believe that the Home Secretary, by regulating the kind of solution that is issued, and the percentage of solution that is issued can avert the danger of having this drug used for any improper purpose, because, in so far as it is used improperly, it is used, as a rule, in the form of powder, and that could be mitigated entirely. From the standpoint of many working people the only chance of having their teeth attended to at all is by their going to these unregistered dentists, where the work is cheaply done. If you stop the supply of cocaine to these unregistered dentists at the present time it means that these people can have no anæsthetic when they go to have dental operations. I hope that from that standpoint the matter will be taken in hand. It may be said that there would be a danger that some of these men are not men of repute. In point of fact there are organisations which bind .together these unregistered dentists, and these organisations themselves turn down anybody whom they do not believe to be above suspicion. Therefore, if the Home Secretary would get into touch with these organisations he would be easily able to check any question where there was suspicion of improper use. I am quite sure that all that he is concerned with is not to judge between this class and that class, but to see that this drug is not put to an improper use.


I am glad that the hon. Gentleman approves of the general purpose of the regulation. I do not think that the hon. Member who began the discussion is correct in saying that the regulation deprives any unregistered dentist of the right to administer local anæsthetics. It deals only with cocaine, and I am advised that among registered practitioners novocaine is used more than cocaine.


They cannot get it.


Novocaine is regarded as a safer and better means of applying a local anæsthetic, and it is anticipated that the effect of this regulation will be to stimulate the production of novocaine. If it is the case that novocaine is really unobtainable at the present time, that is a new fact which has not previously been brought to my notice, and it is a fact that I shall have to take into consideration. I am advised that the right course, if my hon. Friend agrees, is to stimulate the use of novocaine rather than make exceptions in the regulation restricting the use of cocaine. I am informed on very good medical authority that the application of cocaine may be extremely dangerous in the hands of unskilled persons. There have been some fatal and a large number of nonfatal cases.


They are among the registered dentists.


No, unregistered dentists. I have had a number of specific cases mentioned to me within recent years of death and serious poisoning due to unskilled use of cocaine, and it is regarded by many as being more dangerous in its application than ether. A certain number of men who practice dentistry without being registered are also chemists and druggists, and all these men can obtain cocaine for the purpose of their dental business, because they are also chemists and druggists, and, therefore, free from the restrictions.

Others, however, move about from place to place; they cannot be traced. A certain number of them are men of no very elevated character or remarkable skill or training, and it is considered that there would be very great administrative difficulties in trying to organise a scheme if, we allowed the use of cocaine by these individuals, for the very reason that they are not registered. My hon. Friend suggests that many of them belong to organisations. I do not know that it would be practicable to give these organisations an official status and recognise the use of cocaine by all the members of these particular societies. Certainly we cannot allow any person who chooses to call himself an unregistered dentist to obtain a supply of cocaine as though he was a registered person in recognised practice.


Can you issue licences under special conditions?


It would be a very difficult thing, especially now when all officials are greatly overworked, to establish an entirely new class of unregistered dentists, in which every case would have to be inquired into one by one. I have listened to what has been said as to the question whether there are sufficient supplies of novocaine and to that aspect of the question I will certainly address myself.


Will the right hon. Gentleman not consider the question of giving a little time to these men. They might be ruined. At any rate, he might consider the suggestions put before him which would enable the possibility of bad treatment to be prevented entirely.


I will do so. I will first see whether novocaine cannot be obtained quite freely.


Undoubtedly a difficulty would arise if the suggestion which the right hon. Gentleman has made in regard to novocaine could not be carried out. I think he will find, however, that the War Office have practically commandeered the available novocaine, but there will be no difficulty in producing all the novocaine required for this purpose. There is another loophole in the Order, which enables the right hon. Gentleman to prohibit the use of cocaine by anybody who is not an authorised person. An authorised person may be a person, who gets a general or special permission for this purpose, and I hope if there are difficulties in regard to novocaine that they are not insurmountable. In cases where the right hon. Gentleman is satisfied that a genuine practice is carried on, he can give a general or a special permit, but he would not care to regard all unregistered dentists as authorised persons for the receipt of cocaine, for that would make the Order practically of no effect.


There is one point to which I should like to call the attention of the Home Secretary, who made the remark that many of the unregistered dentists were men of not very good character, they went wandering about, and so on. That may be true of a few, but certainly there are some of them who are men of the highest character, and, locally, are very highly regarded. That, of course, makes it a very difficult question, but it would be a very hard thing if these men had to suffer because of the few who wander and are more or less disreputable people.


If these men show that they would be practically ruined by the removal of this anæsthetic from use he will admit that it ought not to be by regulation of the Home Office. That would be against his principles.

Question put, and agreed to.

Adjourned accordingly at Twenty-nine minutes after Eleven o'clock.