§ Order for Second Reading read.
§ Motion made, and Question proposed, "That the Bill be now read a Second time."
§ Mr. PETHICK-LAWRENCE
I beg to move, to leave out the word "now," and at the end of the Question to add the words "upon this day six months."
This Bill, though it comes before us as a private Bill, raises public issues of fundamental national importance. I know that there are large numbers of Members in all parts of the House who desire to take part in this very important discussion, and therefore I propose to set forward our ease against the Bill as briefly as I can. I am happy to think that both those who are promoting this Bill and those who are opposed to it are agreed about one thing. We are agreed in regard to the grave injury that is brought by these diseases on the health and life of the community, and as to the vital necessity of taking steps to eradicate them by every possible means. But we differ from the promoters of the 447 Bill fundamentally as to the method to be adopted. The promoters believe that compulsion is the best means to the end that we both desire. We believe that compulsion will have precisely opposite results to those which they contemplate.
I wish to emphasise this, because the opinion appears to be widely held that our opposition to this Bill is based solely, or mainly, upon our objection to the infringement of individual liberty. For my own part, I desire to say that, grave as is the infringement of individual liberty that this Bill would involve, I would even be willing to tolerate it if I really thought that the enactment of the Bill would operate more speedily to get rid of this disease in the country. But I am convinced, both by the teaching of experience and by the commonsense view of human nature, that the exact reverse would be the case.
The Bill, as put before us, is of a somewhat hybrid character. We have the text as it is printed, but concurrently with the text the promoters have circulated a memorandum in which they propose gratuitously to make very considerable Amendments. I cannot help feeling suspicious of these modifications so gratuitiously offered. I am a little bit in the position thatTimeo Danaos et done ferentes,because my good friends who are promoting the Bill must know quite well that if you are to have compulsion there must be means to carry that compulsion into effect. Therefore, if they remove the overt means by which that compulsion can be brought about, it can only be because they realise that there are latent means by which they can carry out their will in other ways. But in whatever form this Bill is presented, whether in its original form or in the form in which they suggest it should be amended, I find it objectionable.
We are asked to allow the Second Reading to-day in order that the Bill may go upstairs to a Committee and be dealt with there. But it is here and now that the main underlying idea of the Bill has to be settled. If this House is going to dispose of that main underlying idea, it must make the decision here and now. I hope that no one will vote for the Second Reading in the belief that the one 448 main idea can be modified after the Bill has gone to a Committee. What is the defence which the promoters offer for this Bill? They say that it is necessary to provide compulsion in order to catch defaulters. They have large numbers of people coming voluntarily for treatment, but they find that before the treatment has been fully developed and before cure is completely effected, a certain number default, and they say—there is a good deal of specious argument supporting that view—that if only they could introduce the principle of compulsion they could oblige those who come for treatment to continue until the cure is complete. The mistake that they make in that view is this: You cannot isolate the question of default; you cannot graft compulsion on to the voluntary system. You can either have a voluntary system or you can have a compulsory system, but it is impossible to imagine that you can have both.
A vital issue which the House has to realise is the extent to which compulsion will cut off the supply of patients. At the present time all patients are voluntary. They know that they have a right to be treated or not to be treated—to be continually treated as long as they like—and in consequence they know that their wishes will be respected and that everything will be done in order to make it easy for them to go forward. If you carry this Bill you will have two classes of patients, those who come voluntarily and those who are brought compulsorily. Let us take the volunteers first. Can anyone with any knowledge of human nature doubt that under this Bill the volunteers will be considerably reduced in number? Those who come will know that they will have to submit to the treatment, whether they like or not. Perhaps they will have to submit, if they go to a clinic, to such a doctor as is prescribed for them, and, they will have to continue their treatment until what is called a cure is effected. I appeal to the medical men in the House to say whether any two medical men will agree exactly as to when a cure is effected. If that be so, from the patient's point of view we know that there will be an apprehension that this treatment may be continued almost indefinitely. In consequence of that, large numbers of people will hesitate to come.
Further, we all know that in every form of treatment there is a certain element of risk and danger, and it may 449 well be that certain unfortunate events occur in certain cases. If that should get about, the opposition to coming for treatment will be very much greater still. But it is not only that fewer patients will offer themselves voluntarily. A vital question is, at what stage will they offer themselves for treatment? At the present time patients in many cases come in the very early stages of the disease. If that statement be doubted, it can be proved by the fact that of 19,000 volunteers over 4,000, or something like 22 per cent., came and were found not to be subject to the disease at all, which shows that people were so willing to have the treatment applied that they came even when it was quite unnecessary. But if this Bill be carried and people know that when they come they are going to be subject to this long period of treatment and under compulsion right through, they will postpone coming, and postpone it to the time when some of the most important opportunities for dealing with the complaint have gone. Further, during the interval they will very likely consult quacks, because they will hope in that way to escape the full rigours of the complete treatment.
Passing from the volunteers let us come to the conscripts. Will they make up in numbers for the falling off of those who come voluntarily? Who are they going to be? They are not going to be the well-to-do, because the well-to-do will consult their own private practitioners, and as there is no compulsory notification under this Bill their cases will not be notified. It is the poor, and the poor only, who are going to be dealt with. They are going to be informed against to the medical officer of health by a medical practitioner. But where is the medical practitioner going to get his original information? Is it suggested that he is going to get it from anyone who chooses to come and believes that he or she has been infected by the person in question? That surely is too preposterous to be believed. Or is the medical practitioner going to get it, elsewhere, from his own personal observation in hospital or clinic? If he is going to get it in the second way, is it not patent that that is going to have a very deleterious effect upon the coming voluntarily of men and women to be treated in hospitals and clinics? Some of the most valuable work that is being done now in this country, the coming of 450 mothers to pre-natal clinics, will he very gravely injured in consequence. But I think it is very likely that public opinion will be too strong to allow this miscellaneous dragging into the net of all sorts-of men and women in this way, and it is very likely that in the end these provisions would really be confined to prostitutes. If that be so, it would re-open the chapter of failure that many of us thought was closed for good.
Just a few words with regard to the defaulters. The Edinburgh Corporation, in a statement that they have issued, have shown that in the five years from 1922 to 1926 the defaulters fell from 44 per cent. to 29 per cent. of those who were under treatment. This figure includes those who were dead and those, such as seamen, who could not possibly go on with the treatment: so that the actual number of defaulters is very much smaller than the figures shown. It is worth while noting that, even if compulsion be adopted, it by no means follows that all the defaulters will be kept under treatment. In New South Wales, where compulsory treatment has been in existence for some time, they have succeeded in bringing back only 25 per cent. of those who defaulted. Is it seriously suggested that for the sake of 25 per cent. of the defaulters the whole principle of our treatment of these diseases is to he reversed and that we are to try this dangerous experiment?
We are recommended to this Bill on the ground that it will remain in force for under five years, and that then the question can be reconsidered. What are the grounds on which we could reconsider it at that date? Is it suggested that there will be any reliable statistics to help us to come to a conclusion then? It may be thought that if the number of new cases shows a falling off, that will be used as an argument to prove the success of the experiment in eradicating the disease. But that will merely prove that fewer people are coming to be treated. We have definite medical opinion in Australia where this compulsory system has been in force in certain States. I find that a medical conference on venereal disease held in Melbourne in, 1922 passed the following resolution:That in the opinion of this conference there is no evidence to show that the passing of this legislation [i.e., the compulsory V.D. measures] has resulted in any reduc- 451 tion of congenital venereal infections. Judging from the infantile mortality rates under one month, there has hitherto been no such reduction.I have put forward the grounds of my opposition to this Bill. I am strengthened in that opposition by my knowledge that the society in this country which has studied this question in great detail for many years—the Association for Moral and Social Hygiene—is diametrically opposed to the passage of this Bill and believes it to be a thoroughly retrograde step. We have also the support of all the women's societies in the country with a few small exceptions. [Interruption.]Yes, we have the bulk of the women's societies in support of the opposition to this Bill, and you can be quite sure that women are not anxious to have the spread of venereal disease.
Those are my objections. I have not based them on sentimental grounds and I have not even based them upon the fact that some years ago Mrs. Josephine Butler carried out a campaign which was thoroughly successful in the repeal of the Acts of that time, because I know it may be said by my hon. Friends who are supporting this proposal that the two things are different. But in my view they are certainly cognate, and it will he a strange irony if at a time when we are celebrating the centenary of that great woman, such a retrograde Measure as the one which this House is asked to pass through its Second Reading to-night should be placed upon the Statute Book of this country.
I beg to second the Amendment.
I propose to base the arguments I am about to use entirely upon medical reasons for supporting the rejection of this Bill. I may perhaps claim some special right to speak in that sense, because for 26 years I have been at the head of two hospital departments in London where the treatment of these diseases is part of the work of the clinic which I conduct. I have seen very great changes in that long period. I go back to two great names in the history of syphilis, Hutchinson and Fournier, under both of whom I sat as a pupil. Hutchinson taught that two years was quite a sufficient treatment to guarantee a cure. Fournier at the same period 452 taught that eight years was not more than an adequate period for continuance of treatment. These were rather irreconcilable views. Fournier has been proved to be far more right than Hutchinson and more prolonged treatment is the rule for both these diseases than was the case when I began to practise. The treatment of syphilis especially has been very materially altered by the introduction of two great inventions—a test for syphilis and a certain kind of treatment. Too much force has been attached to both these inventions, as I propose to show, but there is common ground even among medical men, who differ so greatly, that early treatment is of essential importance in both diseases for two reasons: Infectivity is earlier checked and the prospect of ultimate cure is very greatly increased in proportion to the earliness of the treatment.
It is therefore far more important to get a new case than to go on treating an old case, and the Edinburgh Corporation seems to me to have entirely missed the significance of the treatment of syphilis in the importance they attach to the question of defaulters. I think it must be explained what "defaulters" means. It means nothing more than that certain persons leave off treatment before the authorities who look after them think that they are cured. The number of defaulters becomes a matter of a personal equation. The tests which are applied vary in different clinics, and it is almost impossible to compare figures. The figures relating to defaulters attending the same clinics in Edinburgh have been demonstrated as having fallen in a period of five years from 44 per cent. to 29 per cent., so that the main reason that we have been given for this very revolutionary proposal has been by their own statistics shown to be of diminishing importance.
The Trevethin Committee, which reported in 1923, made a certain tentative suggestion that special measures might be necessary to deal with defaulters, but they also said that defaulting was not so serious a menace to public health as the statistics would imply. Not only is the number of defaulters decreasing, but the whole incidence of both diseases is rapidly diminishing in this country. I have that upon the authority of clinics in the city of London. This has been under the voluntary methods which were 453 instituted no longer ago than 1916. The period which has elapsed since then is hardly sufficient to declare that the system has failed, even if it had failed, but I think one can say that the system has been eminently successful.
I want to say that medical opinion is overwhelmingly against compulsory measures, and I give certain statements in support of that contention. The Royal Commission of 1916 was much the most authoritative expression of opinion upon these matters. The experts called by that Commission were the very flower of the profession in our country. Their opinion was overwhelmingly in favour of voluntary, secret, confidential services, and upon that recommendation the clinics were established with an expressed promise to patients that secrecy would be observed. Upon that system, the whole of the success, the very great success, of these clinics has been established. The British Medical Association in 1923 issued a special circular to all its members—something like 30,000. The response to that circular was overwhelmingly against the introduction of compulsory notification of venereal diseases. The compulsory notification of venereal diseases is a much less serious infringement of liberty than compulsory treatment, so that the greater carries the less. In 1923, the Trevethin Committee reported. It consisted largely of eminent doctors. They were not men who knew syphilis or gonorrhœa from personal medical experience and therefore were not a very happy committee, but, as far as their authority goes, they did support the view that compulsory measures were not likely to achieve the purpose which was to secure early treatment.
The Edinburgh Corporation opposes this expression of medical opinion by a statement that the Edinburgh division of the British Medical Association at a meeting they held in Edinburgh voted in favour of the Edinburgh Corporation Bill. I took the trouble to find out how many persons attended that meeting. I was told that there were something like 60. It was not a unanimous vote, but a majority vote. There are 1,500 persons practising medicine in Edinburgh, and 60 out of 1,500 surely cannot be said to voice the opinion of the medical profession in Edinburgh. The Bill will be absolutely unworkable without attention being given to the prospects of co-operation by the 454 medical profession, The vast majority of the medical profession are opposed, and the must be opposed to compulsion, because one of the most important traditions of the medical profession is the sacredness of the professional secret, and if that tradition is threatened, the medical man at once shows his opposition and refuses to have anything to do with the proposal. It is suggested by the medical officer of health of Edinburgh, who is the protagonist of this Bill in Edinburgh, that they are not relying upon the doctors, and that they are going to obtain their information from a crowd of "competent officials attached to public health departments." They will be asked, I presume, to go foraging around inquiring into the venereal history of the neighbourhood. I should not like to be one of those officials visiting a quarter which I know well—the East End of London, where I was medical officer for some years—for I think I should receive more brickbats than information. This is not a medical agitation, but a bureaucratic agitation. It is the corporations and not medical bodies who are seeking this Bill.
I propose to give some medical reasons why the Bill would be unworkable. Compulsory treatment of diseases is an entirely new principle with us. It is suggested that, because the specific fevers are subject to compulsory notification, that is an argument for the introduction of this Bill. I would point out that the specific fevers run a very definite well-established, perfectly circumscribed course which inevitably ceases at a given time, which is well recognised. There is no trouble at all about knowing when a case of scarlet fever is and is not infectious, but the same statements do not apply to syphilis and gonorrhœa. There is no comparison possible. The infectivity of syphilis and gonorrhœa is subject to no standard, and I will read a section from the Trevethin Report which emphasises that and which, in itself, is a sufficient argument against this Bill. The Trevethin Report says:There is another grave difficulty in the way of any form of notification reinforced by measures to compel treatment that in the present state of knowledge there is no standard of non-infectivity or cure generally accepted by the medical profession, and until this has been attained it is difficult to see how any system involving notification and compulsory measures of treatment could be applied.455 That is absolutely true of the scientific position of this question at the present moment. There is no agreement upon this question in the medical profession. Reliance to be placed upon both the new test and the new treatment has been greatly over-estimated by lay opinion. We started—I remember it very well—with the idea that we had a perfectly easy scientific test. We started with the idea that we had a method of treatment which would eliminate syphilis. Ehrlich himself announced that his drug was going to sterilise the patient by one dose. Both these theories have gone by the board absolutely. It is a very difficult test to apply. It is a physiological test not a chemical test, and certain laboratories have become famous for their skill or otherwise in performing the test which is extremely difficult to apply.
It is proposed by the Bill that detention and treatment should be compulsory until the patient can obtain a certificate of cure from "any medical officer." Detention has been ostensibly abandoned by the corporation by the relinquishment of Clause 3, but I was told by one of the protagonists for the corporation that they did not attach very much importance to relinquishing that Clause because they thought they could get all they wanted by the application of Section 7 of the Public Health Act by which any infectious disease could be detained until infectivity was over. So detention is still contemplated by the terms of the Bill, detention for periods which vary enormously, detention resting upon a certificate given by any medical practitioner. I am not behind any man in the House in my respect and love for my profession, but I recognise its limitations, and I think it is impossible at present to expect that the general profession throughout the country will be in a position to give certificates of that kind which will be of any value at all. The tests and the treatment for this disease require very wide and highly specialised experience, and teamwork by many experts. A case presenting itself at a hospital is not treated by one man. It is turned over to half a dozen people, who will go into it very carefully before making any report. Is that possible anywhere in general practice? Yet we 456 are to rely upon a certificate given by any medical practitioner.
We are also to rely upon the treatment given by any medical practitioner. Again I say that the modern highly specialised treatment is very dangerous except in highly skilled hands. I have had three deaths from "606" in my personal practice. We a.re going to compel persons by law to submit to treatment which carries those risks! It is an impossible proposition in the present state of medical science. Certificates given under these conditions will be largely valueless. The patient will be assured that he is cured when he is not cured. The practitioner will have a very strong motive for giving a certificate. Common humanity will urge him to give a certificate, when he can, for the patient to avoid the horrible consequences of this Bill in the matter of detention and treatment. He will be like a bad bridge player, who discards from fright and not from judgment: he will give certificates in order to get the patient out of a hole, and those certificates will be valueless and dangerous because the patient will believe he is cured. The defaulter has not that illusion at all. He knows he is not cured, but the patient who is told he is cured is in a different position and a source of great danger, not only to himself but to the public. The second alternative is that the patient shall be kept under treatment for much longer than is necessary. Again a very Revere handicap to the citizen who is, unfortunately, caught in this hideous machine.
It is suggested that the experiment can be restricted to Edinburgh and to five years. The first contention is dropped by the supporters because they say if Edinburgh gets it Glasgow, Aberdeen and a dozen corporations will get it. It cannot be restricted to Edinburgh. It cannot be effectively compulsory if it is so restricted, because nothing is easier than to get out of the area of compulsion and go to an area where the more sensible voluntary system is still in force. A short railway journey to Glasgow takes the patient out of the operation of the Edinburgh Corporation. If the Bill becomes universal we may get a system of compulsion, but we cannot get a system of compulsion unless it is universal. It 457 cannot be confined strictly to Edinburgh, and it cannot be restricted in point of time, because the effect of introducing compulsion would be at once to annihilate the whole voluntary system. After five years of compulsion what patient will think that he can go to Edinburgh and again have confidential treatment.
The voluntary system cannot survive such a shock as this would imply, and it is farcical to suggest that we can return to where we are without any damage done. It is as if a surgeon should suggest cutting off a patient's nose in order to give him a better one, but if the patient said, "Can I get, back my own nose afterwards?" the surgeon would be discreetly silent on the point. That is the position here. You cannot go back to where you were after the experiment. The voluntary system will be finally destroyed, and I ask the House not to take a step which will lead to that terrible disaster. These clinics have been giving the most devoted service for years. A great success has been made of them and we are succeding daily more and more. There is no reason for panic legislation. Let us go on with this highly successful system. It is said the system of finding out defaulters in Edinburgh is very incomplete and there is only one officer to do it. Let us improve our methods of administering the voluntary system but do not let us scrap a going concern for one which is of such very doubtful advantage.
§ Sir PATRICK FORD
I think the best course to pursue is not at this stage of the Debate to be drawn into the detailed allegations of the Mover and Seconder of the opposition to the Bill. I am bound to say their case was moderately stated and the one criticism I would make about the Mover is that he talked a great deal about statistics which he said proved the non-success of compulsory and similar methods in other countries, but he went on to say, for some obscure reason that I could not follow, that if we had an experiment for a certain number of years in Scotland the statistics that would be acquired could not be relied upon. That is a sort of argument that is hardly admissible. Either we think there is something in statistics or we dismiss them altogether.
§ Mr. PETHICK-LAWRENCE
I never quoted statistics as proving that the thing had been a failure in Australia. I 458 said medical opinion in Australia did not consider that any good had resulted from it.
§ Sir P. FORD
I think that opinion was founded upon the statistics they collected. Or was it just a haphazard guess? With regard to the second speaker, I would really suggest that he himself admits there has been a considerable conflict of medical opinion. I would suggest also that in Edinburgh, which has one of the finest schools, and where we have the latest methods and latest information, we feel we are not to be guided by the more antiquated ways of looking at these things. What the hon. Member proves, on his own statement, is that there is a conflict of opinion on a very technical subject, and I do not think the Floor of the House is the place where these things can be satisfactorily cleared up.
Having, I hope without offence, stated my objection to certain implications in the speeches of the Mover and Seconder, and recognising the very temperate way in which they have stated their case, I think I might state what seem to me to be the reasons why we are entitled to ask for a Second Reading of the Bill. Its object has nothing to do with moral or social problems. It is to stamp out disease, and the power of some form of compulsion is sought to deal with what we might call the dead end of cases, which for some years have remained steadily at between 900 and 1,000. The clinic has been run, as is generally admitted, with the greatest of skill and success, and yet we cannot get away from these 900 to 1,000 centres of infection every year which are going about as dangers to the neighbourhood and the country. There is no suggestion on the part of the promoters of the Bill that voluntary work should cease, but we say when you come to a certain type of case, the case that is perhaps not entirely responsible, a case which may be perhaps recklessly vicious, and is entirely recalcitrant, you want to have more power to deal with it.
One objection to the Bill is that it interferes with personal liberty. Honestly I do not think it interferes with personal liberty more than any of the regulations under the Public Health Act, where certain types of disease are notifiable and people have to submit to treat- 459 ment and be segregated until they are cured. Then we are told the evil will be driven underground, that it will be evaded and people will not go to the clinics. The Edinburgh clinic has been run on lines rather different from what have been adopted in most other centres. People are treated in a friendly way, a beneficent way. They tell their experiences to others, and they know they have nothing to fear and everything to gain. The opinion of the medical officer of health and the officers who deal with these cases so successfully ought, I think, to entitle them to some consideration. Their view is that can get on perfectly well, but there are a certain number of cases, the dead end of cases, that remain stubbornly recalcitrant and cannot be brought in without compulsion, and the great work that is being done voluntarily, and which will not suffer by this compulsion being enforced, is to a large extent being undermined by the fact that these cases cannot be dealt with. That is the reason why they have asked for these powers. It seems to me that people who have made a success of this work, and whose success have been acclaimed throughout the medical world, should have a little attention paid to their views in these matters. It is said that it is very easy to escape from the area. Not only as a Parliamentary representative of Edinburgh but as a citizen born and bred in Edinburgh, I say that if they did escape from the area I should be very glad, but what would happen would he that other districts would find that it would be to their advantage to adopt similar measures, and soon there would be no escape for the people who are a running source and menace to the people of this country and they would be dealt with wherever they went.
Do not let people say: "We lead virtuous lives. We never run risks of that kind." Do not imagine that it is only in immorality that that sort of thing may happen. In a very large number of cases it may happen that you can get the infection from a public drinking cup, or you can get it, so doctors will tell you, by the use of a common towel in a railway station lavatory. Those things have been known to happen, and that is a danger which is incurred from people who are in a state of infection. There are 460 numbers of up-to-date doctors who will back me up in saying that there is a danger when these infected people are handling our food. Therefore, do not let us think that because we are virtuous and because we run in the straight and narrow way that we are not threatened by this menace. It is a tremendous menace to the whole of society, and we want to clear up that dead end.
What are the actual powers that are sought in this Bill? Allusion has been made to the Amendment which the promoters are willing to accept if they get a Second Reading of the Bill. For the most part, there is not a great deal of substance in the Amendments, but there is one important Amendment to cut out Clause 3 (3) which is the operative Clause. That Sub-section says:Where it is certified by the Medical Officer of Health that a person is suffering from venereal disease and liable to infect other persons … it shall be lawful for any magistrate or judge of police … on production of such certificate or on being satisfied by medical evidence of the necessity or desirability in the public interest of the removal and detention, to grant warrant to remove such person to a hospital and to detain him therein.That has been deleted, because that is not the proper way to deal with that sort of case in the first instance. I admit, and I think it is right, that the same power still remains to public health authorities as the last recourse. In the Bill it is laid down that persons who refuse treatment or who default from treatment and will not come back for treatment can be dealt with in the first instance by a fine, but there is still Section 54 of the Public Health (Scotland) Act, 1897, which gives power, on a magistrate's warrant, to remove a contumatious case who will not submit, and to have him segregated. Hon. Members talk about compulsion. What is the nature of the compulsion? In the first place, there is no compulsory notification. In the second place, there is no compulsory examination or compulsory treatment in this sense, that no doctor can, by saying: "I have a warrant to do it," forcibly examine any patient, man or woman; and no patient who is taken, even in the last resource, to a hospital, can be forced to take any medicine, to suffer any injections or to have any physical treatment. There is no compulsion at all. What we simply say is, that 461 where it has been established that there are these dangerous cases we are, surely, entitled to segregate them, and if their sense does not teach them to take treatment, they remain segregated and remain out of the way of giving infection to other people. With all due regard to sentiment for these unfortunate people, I would rather that they suffered in this way if they have not the sense to take treatment, than that innocent people should suffer because of our false sentimentality towards them.
I do not like the suggestion that this is one law for the rich and another for the poor. I would rather have seen, along with this proposal, compulsory notification, but I do not think that the opinion of the country is yet ripe for that. How is the information brought? In one Subsection it is stated that the medical officer of health, if he is informed and has proper reasons to believe that there is a patient who ought to be treated, may take steps to serve a notice on him and say: "You must either produce a certificate from a doctor or from a clinic"—I think it would be better if they had to go to the clinic, where the acknowledged expert is—"that you are free or that you are undergoing treatment, you must come to be treated." The information will come to the medical officer in the case of children born with congenital disease from the parents who seek attendance for the child, or it might be brought by a private doctor. If a private doctor had a patient who refused treatment he would be entitled to go and inform the medical officer of health. I am afraid that he might not go, but the man or the woman who is going to employ the doctor will want to get their money's worth and see that he takes the necessary steps for a cure. The difficulty that has been made over that point is grossly exaggerated. The medical officer is not entitled to act on any information except from a doctor, unless he takes reasonable steps to make sure.
If hon. Members suggest that this is going to be an open channel for blackmail, I do not believe it. I do not believe that any responsible medical officer is going to do these things in a lighthearted manner. If the information which is laid proves to be false, not only is there a small fine provided for in the Bill but an action for damages for a 462 very considerable sum will lie. One hon. Member, who is a doctor, did not seem to have as high an opinion of members of the medical service as I have in regard to some of the things which they may be tempted to do. I can assure him that the doctors would not do that sort of thing in Scotland, and I do not think they would do them in England. I think it is a case of exaggeration. In Scotland and I am sure in England, the Court is always very jealous of encroachment on the liberty of the subject, and they would lay the onus of proving that any information was laid in good faith very severely on the person who laid it. The safeguards there are perfectly sufficient. We have to weigh up the advantage in some rather hypotheical cases of doing a possible injury against the necessity for clearing up by compulsion what seems to be a fixed remainder of cases which are a danger to the whole community.
I have quoted the view of clinic officials, and the quotations which have been made from the Report of the Royal Commission tend to emphasise the desirability of having the question really thrashed out in a judicial way. I can quote to the House what the Royal Commission said in 1916 in a rather different sense to that which has been quoted by an hon. Member on the other side of the House, although it must be remembered that this is not a party matter at all. It is not even a matter of doctors against the laity; it is not a matter of women as against men, because there are strong cross divisions in all groupings of individuals. When I said a Member on the other side of the House, it only happened that the hon. Member was sitting on the other side of the House. Let me quote from the Report of a Royal Commission in justification of the proposal we are putting forward. The Royal Commission said:No system of notification of venereal disease should he put in force at the present time.We do not propose to do it.The application of compulsion to cases in which there is no sense of responsibility, where no restraint is thought of, and where contagion is in its most active and virulent form, can be defended on strong public grounds.The Royal Commission appeared to think that the time was not ripe for this, and went on to say: 463It is possible that the situation may be modified when these facilities have been in operation for some time, and the question of notification should then be further considered. It is also possible that, when the general public becomes alive to the grave dangers arising from venereal disease, notification in some form will be demanded. The measures which may be required in the future must depend on experience gained after the existing deficiencies have been remedied.I maintain that the facilities are there, and that public opinion in Edinburgh, where it has been operating for some time, is undoubtedly in favour of carrying out some such proposal as the present. The views laid down by the Royal Commission have been fulfilled as far as Edinburgh is concerned, and if you take the Trevethin Report of 1923 they were of the opinion that any system of general compulsory notification of venereal disease would tend to concealment and would prove a backward step. We are not proposing this. They also said:It may well be that in certain areas special measures for the prevention of venereal disease would be justifiable, for example, measures for dealing with defaulters. We think that local health authorities who are able to make … a special case for some such special measure should be allowed, at any rate for some limited period by way of experiment, to carry out the measures they propose.That is what I find in these Reports. The hon. Member opposite found other things. Surely that is an argument for having the whole matter gone into in a more judicial atmosphere than in this House. The whole weight of opinion of local authorities in Scotland is behind this Bill. The Convention of Burghs in 1922 passed a resolution in favour of the compulsory notification of venereal disease, and at their most recent conference held on the 27th January, 1928, in Edinburgh, they passed the following resolution:In the opinion of this conference the present law and machinery are inadequate to secure the proper control and treatment of venereal disease, and that it, is essential that further powers should be conferred on local authorities in the direction of compulsory measures to secure submission to treatment by all persons infected by a venereal disease and continuance under treatment until discharged.The Scottish Board of Health, in 1922, said:The Board are still of the opinion that the first step should he not notification of 464 cases of venereal disease but compulsion on persons knowing or having reason to suspect that they are suffering from these diseases to submit themselves for treatment, and having so submitted themselves, to continue under treatment until discharged by the medical officer in charge of the treatment. The Board have under consideration a draft Bill dealing with this question, that might be promoted when opportunity offers, and in regard to which they propose to invite the observations of the Convention of Royal Boroughs before any overt steps are taken.The Scottish Board of Health did not produce the Bill, and the Edinburgh Corporation and its medical officers, who have led the way in this matter, felt that they could not wait any longer. In the Report of the Board of Health for 1926 this statement appears:It is not surprising, therefore, that alike among local authorities who see so imperfectly utilised the treatment facilities for which they in the first instance are financially responsible, many clinicians should feel their time and skill are largely wasted, and among social workers and others, whose duties bring them into daily contact with children maimed through the uncured disease of their parents, there is a great growing demand for compulsory measures to secure submission to treatment by all persons affected with a venereal disease and continuance under treatment until discharged.We have all these local authorities supporting this Measure. It is all very well to say that there was not a full attendance at the Edinburgh branch of the medical association, but you can be pretty sure that all those who took any interest in the matter were present, and they passed the resolution by a large majority. You have also the Edinburgh branch of the National Council of Women's Societies, the Edinburgh branch of the Women Citizens; the local branch, which includes not only Edinburgh but the south-eastern district as well, of the Scottish Co-operative Women's Guild, who wrote in the strongest terms in its support and said in a letter to me:We implore you to support this Bill in the interests of the women and children.These are working class women, and they see no distinction between the poor man and the rich man. The extraordinary thing is that all these societies have been more or less in touch with the work of the Edinburgh clinic, and they know how beneficent have been its effects. It is only when you get far away from Edinburgh, to places like London and Plymouth, that you find opposition to this Measure. I trust not to unenlightened 465 opinion but to the enlightened opinion of the City of Edinburgh, which has one of the greatest schools of medicine in the world. I trust to that opinion, and I think this House might trust it too. We have also the remarkable phenomenon of the whole Corporation of Edinburgh, with two dissentients on the ground of expense, in favour of the Measure. All the Members for the City of Edinburgh ask you for the Second Reading.
§ Sir P. FORD
All the Tory and Socialist Members ask for a Second Reading, and the Liberal Member who sits for the Port of Leith (Mr. E. Brown) takes an opposite view. I am told that his wife has told him that he must speak against the Bill. My wife has told me to support it. As against the hon. Member for Leith Boroughs, I put the Liberal Lord Provost of Edinburgh and Baillie Allen, who has done a great deal of hard social work for the people of the district. I say this in order to show that there is no party question in it at all. We have Tories—if you like to call us so—and Socialists—if you like to call hon. Members opposite by that name—and also Liberals, who are just as true Liberals as the hon. Member for Leith, unanimously in favour of this Bill. The nearer they are to Edinburgh the more they are in favour of it. In view of that weight of opinion, I suggest that it is hardly fair that the people who have been operating successfully in the fight against this disastrous disease should be refused by the House of Commons, without the details of the matter having been gone into, the powers which they say they need, Technical differences will develop as the Debates go on, but I submit it is the duty of the House to give the Bill a Second Reading in order that it may be sent to the Private Bill Committee where evidence can be led and the matter can be threshed out in a judicial manner.
If hon. Members think that by doing so, the House would be committing itself unconditionally to any principle in the Bill, I would refer them to Erskine May who points out that there is a difference in the case of Private Bills as regards the implication of a Second Reading. I have not the actual note here but I think it will be found that Erskine May points out that Private Bills are based upon local and other con- 466 ditions of which the House cannot be apprised, and, that therefore, it is right that such a Bill should be sent to a more or less judicial committee in order that the preamble of the Bill may be proved. The House is not prejudiced because it sends a Bill up for such an inquiry. It is perfectly free, after all the evidence has been threshed out, either to pass the Bill or not to pass it. But the House will take upon itself a grave responsibility if, in view of the strong feeling in favour of this Bill on the part of those most nearly associated with the Measure, and in view of the conflict of expert opinion it refuses to give it a Second Reading on this occasion. I trust to the good sense and the generosity of the House not to stand in the way of those who are making this fight to eliminate disease, and who have been doing it so successfully.
§ Dr. SALTER
In addition to the objections on principle which have been put forward by those who are opposed to the Bill, I desire to submit a further series of reasons based mainly on practical considerations why the House should reject this Measure. In the first place, I suggest that any law is a bad law if it offers practically unlimited opportunities for evasion and if it is unequal in its incidence on the community. It would he extremely easy for any person who wanted to do so to defeat the whole object and purpose of this Bill. It has already been pointed out that any recalcitrant can evade the operation of the Bill by moving into another district. Such a person can also evade the purpose of the Bill by giving a false name and address. I understand that in New South Wales, where a complete system of compulsion is already in operation, the Director General of Public Health has reported that it has only been possible to bring back to treatment 25 per cent. of the notified defaulters because of the number who gave false names and addresses. Any man or woman could submit to treatment voluntarily but could refuse to give any name or address. I understand it is the purpose of people in Edinburgh who are opposed to this Bill to induce each person who applies to the clinic in future to describe himself or herself as "X" of "X" street and to decline absolutely and emphatically to give any name other 467 than a pseudonym. Unless the promoters propose to introduce a Clause in Committee, making it obligatory on every applicant for treatment to give a correct name and address, the only way to put the Bill into operation will be to establish a new department of the city police and to have a corps of detectives following up every person who goes to the clinic for treatment.
As to the question of compulsory treatment, there are grave objections which up to now have not been answered. I understand that the main argument of the supporters of the Measure is on these lines. They say, "Here is a person who has been incompletely treated, who is not cured, and who is, therefore, infectious and a danger to others. On the ground that he may injure other persons and injure the community, he should be compelled to submit to treatment so that he may be rendered non-infectious." It is said that in the old days syphilis was known as "the great pox." Every sufferer from small-pox is compelled to go into an isolation hospital and receive treatment and it is argued that that if it is so with the small-pox, why not also with "the great pox" which is an even more terrible disease. I submit that that argument is fallacious. The facts are not as suggested by the supporters of the Bill because, in the first place, a man suffering from small-pox is isolated in hospital and is not compelled to receive any treatment at all. If he objects to treatment, whether it be drinking medicine or receiving inoculation, he can refuse to submit to it. He is merely kept in the hospital for a limited period but is not subject to treatment of any kind whatever. The Bill, however, does not propose to isolate people. On the argument which is put forward, it would be logical to say that if small-pox patients are isolated, then "great pox" patients should a fortiori be so isolated, but the supporters of the Bill do not propose anything of the kind. They merely propose that the person affected shall be compulsorily treated.
I wish to direct the attention of the House to that question of treatment. The method of treatment of the disease of syphilis is by the injection of certain highly toxic substances of the arsenobenzol group, popularly known as "606"—salvarsan or one of the later deriva- 468 tives. I believe, speaking as a medical man, that that method of treatment is effective. If I had the misfortune to become infected with one of these diseases in the ordinary course of my professional work, I should be most eager to avail myself of that treatment. But I should do it with my eyes open, knowing that I was accepting a very grave risk. I want the House to understand that death results from this treatment in a considerable number of cases every year in this country. Every few weeks the medical papers report cases of grave accident following the treatment, and a very terrible disease known as acute yellow atrophy of the liver follows not infrequently. Other great damage to health, as well as sudden death, following an injection are also reported from time to time; and I submit that it is an entirely new principle in British law that members of the public are to be compelled to take risks of this description. It is not a principle with which the medical profession as a whole has ever associated itself, and, I believe, does not associate itself at the present time.
Though I accept this modern method of treatment, from my own point of view, as being efficient, there are many doctors of high standing in the profession who do not regard it as any advance at all on the older method. There are a, great number who believe that the older method was just as effective in the long run as the newer method of treatment. Apparently, by the operation of this Bill one particular method of treatment, and that alone, is to be enforced, and if a patient declines that method, and demands treatment by the older method, he is not only to be refused it, but punished for demanding it. Again, I submit that it is an entirely new principle in British law.
§ Lieut.-Colonel FREMANTLE
Will the hon. Gentleman point out where that provision comes in the Bill?
§ Dr. SALTER
Certainly; that is the implication of the Clause dealing with the subject. If it does not mean that, it 469 means nothing at all. It is true that the patient can apply to another medical man to give him treatment, but in the case of the poorer people the patient has practically no option. There is another very serious position which will arise if this Bill becomes law. At the present moment, if a patient voluntarily attends a centre for treatment, and happens to suffer injury, or is killed as a result of the treatment, no liability rests upon the doctor, or upon the institution, clinic, hospital, or authority which is supplying the treatment. The man has gone there of his own free will, the doctor has given the best of his skill and has not been negligent, but the man has unfortunately suffered injury or has died. The position, however, will be quite different under this Bill. Perhaps the Secretary of State for Scotland will be able to tell the House whether the whole position will not be revolutionised by the compulsory enforcement of a particular form of treatment, and whether it will not be the case that, if a man suffers injury or death as the result of treatment compulsorily applied, against his will, that man will not have an action for damages, either against the doctor who gave the treatment, or against the authority or institution of which the doctor was an official. That seems to alter the whole aspect of the position.
Finally, I suggest that this method proposed in the Bill is entirely unnecessary. The Corporation of Edinburgh have published figures in which they themselves show that the percentage of defaulters has been reduced from 44 to 29, but the Medical Committee of this House had the opportunity and advantage of meeting a number of officials of the Edinburgh Corporation in a Committee room upstairs, and they supplied us with another series of figures. We were then told that in 1922 the percentage of defaulters of all cases who presented themselves for treatment was 18; in 1923, 15; in 1924, 12; in 1925 it was 13; in 1926 it was 72; and I am subsequently told that in 1927 it was 11. That would seem to show that the present voluntary method is distinctly effective, in spite of the fact that, as I am told, the Edinburgh Corporation have only one official who acts as a follower—up of these defaulting cases. There you have, even with a relatively inefficient method of following-up the recalcitrants, and a relatively insufficient number of 470 persons doing the work of inducing defaulters to reapply for treatment, a progressive fall in the number of defaulters, a diminishing number of persons who fail to apply for treatment. I submit that, before introducing such drastic proposals as this, further methods on voluntary lines, with more effective medical persuasion and an increased number of followers-up, should be undertaken. If that were done, there is every prospect that the number of recalcitrants, with the exception of an extremely small minority, will be abolished altogether.
This experiment of compulsion has been made in a great many countries in the world, but not in Great Britain and Holland hitherto. The interesting thing is that, as far as the published evidence is available, the number of persons, who have been described in this House to night at defaulters, is smaller in Great Britain and in Holland, the two places where the voluntary system is in operation, than anywhere else. That is a remarkable fact in itself. I am also informed that in Holland the chief director of the Polyclinic at Amsterdam has stated that, with the following-up system, 95 per cent. of syphilitic men and 85 per cent. of women have remained continuously under treatment during the two years that this system has been in operation, and that these figures cannot be surpassed by those published in any country where compulsory treatment has been in force. If Holland can achieve such success as that without any evidence of compulsion, there seems every reason for hoping and believing that in this country, with improved methods, we shall have equal success.
Finally, I would submit that it is a very serious thing that a person, who cannot be proved to be dangerous to other persons, is to be compulsorily treated or punished. Many of those persons who have been for treatment, and failed to continue to attend, are in some cases infectious, but in many cases they are not infectious; there is no evidence that they are, and no evidence whatever can be produced that they are. When there is no proof that people are infectious or dangerous to others, it is an extremely serious thing to say that they shall be punished if they refuse to continue treatment. The Bill does not take any steps to prevent people who are infectious from continuing to infect other 471 people, and a man suffering from venereal disease who is attending one of these clinics regularly may be infectious, may remain infectious for many months and may go on spreading infection amongst the general population. The 13i11 does not propose to deal with that situation; but it proposes to deal with another man who may not be infectious at all, but has simply defaulted in his treatment, has not followed up his treatment for as long as the medical officer thinks he ought to have done. It seems to me that unequal incidence of that sort is a serious thing and ought not to be tolerated.
§ Sir BASIL PETO
Would the hon. Member support a Bill for segregating people who are suffering from venereal disease until they are certified cured?
§ Dr. SALTER
I would not support such a Bill, because I believe that, like this Bill, it would be ineffectual sand would make the position worse. As was said by the hon. Member who moved the rejection of this Bill, I believe this Measure would simply drive the disease underground. Many persons who would now be inclined to attend a clinic will hesitate very seriously before they present themselves if they know that they are to be treated as potential criminals for failing to keep up their attendances. Therefore, I believe this Bill is going to increase the amount of venereal disease, or, at any rate, there is a risk that it may increase it; there is no evidence that it is likely to diminish it; and therefore I hope that the House will reject it. The provisions of the Bill can be easily evaded. Any provision of this sort is quite useless unless it is universal. If the Measure is to apply to a limited area, it will be hopelessly inadequate. I submit to the House that if compulsion of this sort is to be attempted it must be universal, and before any such drastic provision is introduced into British law the most 472 exhaustive overhauling of the case in its national aspect should be undertaken by a Royal Commission.
§ 9 p.m.
§ Dr. DRUMMOND SHIELS
I am rather surprised that a better case against this Bill has not so far been made out. The Mover of the rejection spoke of the defence of the Edinburgh Corporation. It is not Edinburgh Corporation which is on its defence, but those who are opposing this Bill. [Interruption.] The Bill is designed to fill a gap in the operation of the Infectious Diseases Acts, under which we have had compulsory powers since 1889. The reasons why these particular diseases have not been brought under those Acts are various. Up to comparatively recent years their seriousness was not understood, and their responsibility for the disastrous after-effects which they produce was not realised. Then, again, the specific causes were not known, and there was no certainty of a cure. For these reasons, venereal diseases have not come under the Infectious Diseases Acts. There is, however, high medical and legal authority for believing that they could come under the operation of those Acts, and certain parts of this Bill are identical with the provisions of the Infectious Diseases Acts. It has been pointed out that these diseases differ from the ordinary infectious diseases in that ordinary infectious diseases run a definite course and, if the patient recovers, the disease is cured and infectivity is stopped, whereas, with venereal disease, except in a few cases, no institutional treatment is required; the treatment may be prolonged to as much as two years, and the patient is able during the course of treatment to carry on his ordinary employment. Therefore, it is necessary to modify somewhat the procedure of the Infectious Diseases Acts, and that is the reason why this Bill is introduced. It is rather a curious thing to find so many hon. Members demanding preferential treatment for those suffering from venereal diseases while perfectly willing to continue to deny to the victims of other contagious diseases the liberty and freedom of which they are at present deprived, often at very great inconvenience to themselves. As has been pointed out, the Royal Commission visualised a time when compulsory 473 methods might be necessary. It was quite impossible for the Royal Commission to recommend compulsory methods in 1916. There were no treatment centres, and comparatively few doctors were familiar with the modern technique; but the Royal Commission very definitely envisaged a time when compulsion might be applied. The Trevethin Committee—of which I am not going to speak, as we have present a distinguished member of it who will, I hope, be able to speak later—also very definitely outlined something like the experiment which is proposed in this Bill.
I do not think it is necessary to waste any time in speaking about the liberty of the subject. There has been no liberty for the subject to spread disease in Scotland since 1889. At that time a cry was raised, very similar to the cry which has gone up in connection with this Bill, about interference with liberty, and so on. That cry has long since died out and if we were to pay heed to that cry to-day we should need to destroy a very large amount of our public health legislation. Nowadays, compulsory measures in connection with ordinary contagious diseases are carried out without any difficulty and with no real compulsion whatsoever. There is only one serious argument against this Bill, and that is that it will hamper voluntary treatment and drive the disease underground. That is a serious and a sensible argument, and one which we have to meet. What surprises me is that the people who are most certain and most dogmatic on this question are people who are either only theorists or people who have had no personal association with the treatment of these diseases. We find that the venereal diseases officers and medical officers of health and members of public health committees take another view.
§ Dr. SHIELS
I am entitled to state my own opinion, and I have good evidence for what I have said. I am not aware that any venereal diseases officer or any medical officer of health in Scotland has suggested that the introduction of the proposals contained in this Bill 474 would do any harm to the operation of the voluntary system. That system will continue. The Mover of the rejection of this Bill suggested that the two things were not compatible. We believe, however, that the voluntary system can go on perfectly well and can be supplemented by the compulsory parts of this Bill, as they will only be used for a small number of people. I might, in passing, speak about the criticisms relating to the terrible risk to the patient which the hon. Member for the London University (Dr. Little) and the hon. Member for Bermondsey (Dr. Salter) have referred to. May I point, out that what those two hon. Members referred to was the condition of things ten years ago, and that these statements are not true to-day. As a matter of fact, there has been only one death following injection in Edinburgh since 1917. The other conditions might arise, and certainly in the early years of this treatment, they did arise, but the cases are now few and far between.
§ Dr. SALTER
It has been stated in the medical Press recently that over 30 cases of death under these circumstances have occurred.
§ Dr. SHIELS
I am speaking of experience in Scotland, and I know that what I have stated is the state of affairs there and, doubtless, it is the same else-were. Sometimes we hear of people suddenly dying when they are having teeth drawn or in hospitals while undergoing an operation, but we are not going on that account to say that people should not have teeth drawn or that operations should not take place. The treatment has now become so safe that a public authority is perfectly justified in using the methods proposed in this Bill. After all, hon. Members who are medical men know perfectly well that if there is potential danger in this treatment, there is an absolute certainty of grave danger awaiting these people if they are not treated.
The opponents of this Bill have very generously admitted the success of the Edinburgh centre, and have agreed that Edinburgh has probably the smallest percentage of defaulters of any part of the country. I am sorry to appear to be boosting Edinburgh so much, because like other Edinburgh men, I am naturally modest, and it, hurts me very much to do it; but I speak solely in the interests of 475 truth. Everything in Edinburgh has been done to make the system a success. A statement was made that in Edinburgh there was only one almoner. This almoner is a woman, and she is only sent to cases of women. It is considered by the Edinburgh authorities that the pledge of secrecy and confidentiality cannot easily be carried out if a man was sent under the circumstances in which most of these men are placed. They have to be seen at home, and it is entirely in the interests of the success of the voluntary system that the procedure in regard to visitation has been taken. Considerable success has been achieved, and yet it is the fact that, with all the admitted efficiency of the Edinburgh Centres, there still remain 800 to 1,000 cases a year of defaulters, many of them in an infective condition. Besides these cases, there are also an uncertain number who do not come for treatment at all.
Does the hon. Member mean to say that the only cases which are followed up are women?
Then the only people who are followed are the women. I think that is a most important point.
§ Dr. SHIELS
The Noble Lady must accept my statement that every effort is made to follow up the cases of the men by a confidential letter, and, if necessary, by calls in suitable circumstances. I was pointing out that there is a much greater difficulty in the case of visiting the men than in the case of the women, but the Noble Lady can be assured that those who understand this matter are satisfied that Edinburgh has done full justice to the voluntary system. In spite of that, we have many people who are careless as to the danger to themselves and the danger to other people and they refuse to accept treatment. These people form a very effective bar to the ultimate success of the treatment of venereal diseases in Scotland. What is the ultimate object of all this treatment of venereal diseases? Are the old methods to go on perpetually and are we to go on indefinitely with a system which is very like pouring water into a sieve? Last year we spent over £20,000 on the treatment of this disease in Edin- 476 burgh. The estimates of the Board of Health for the treatment of this disease in Scotland show that £62,000 will be required next year. That is only three-fourths of the amount, because the local authorities have to make a contribution which raises the total to over £87,000. It is an interesting fact that this is £4,000 more than last year, which does not suggest that the purely voluntary system has been successful in reducing venereal disease in Scotland. In the whole of Britain we are spending over £300,000 in dealing with this disease, and we are doing that to provide free treatment and skilled specialists with a view to stamping out the disease—we are doing it as a part of preventive medicine.
Doctors are sometimes criticised in this House, and I am not going to say that they do not sometimes deserve it, but I think it will be admitted at any rate that doctors have before them the aim of preventing disease, in the treatment of which they earn their living. The doctor's ideal is preventive medicine, and he is looking forward to a time when he will not be curing disease, but, instead, will be keeping people well; and I can assure the House that, although it might be thought that it was a matter of indifference to the clinic doctor, he finds it a very depressing thing to discover that much of his treatment is of little effect because of the carelessness and indifference of a certain section of the population.
The expense that I have mentioned is not all. Our general hospitals, our Poor Law hospitals, our asylums, our prisons, are very largely filled with the end-products of this disease, though these in many cases are recorded under the names of different conditions. You may have a development of valvular disease of the heart, seriously incapacitating and painful to witness; you have arterial and nervous diseases, often paralysing in their effects. Insanity and blindness also may follow the neglect of these conditions. The expert of the Ministry of Health on this subject, at the recent Imperial Conference at Wembley, estimated that the treatment of venereal disease at the present time saved £50,000 a year in asylum expenses, and, if treatment can do that on only one aspect of the end-results of this disease, what would entire prevention achieve, 477 even in economy? We believe that compulsion and early treatment of these residual cases would result in the prevention of many of those later developments, and that would release a large number of very much needed beds in our ordinary hospitals.
"But," say our opponents, "you have done very well. Why are you not satisfied I Why not carry on? You have brought down the figures very well; why should not you continue the system?" Because the promoters of this Bill are satisfied that there is a residue, after everything has been done, which cannot be touched by the voluntary system at all. It is said that the disease will be driven underground, and that people will go to quacks. I have spoken of the keenness of the medical officers of health and of the venereal disease officers to get rid of this disease altogether, and I say that when they, with their special knowledge, say that these compulsory measures will not have that effect, their opinion is entitled to very great respect. It is said that the moral stigma in connection with this disease frightens people away, and that it will prevent them from attending. I do not claim to be an expert in this subject, but I have had the advantage of working for a considerable time in this department in Edinburgh and also of keeping in touch with the department since that time; and my experience, and it is confirmed by all clinical officers, is that the great bulk of these people are keen to get well, they are eager to get better; 90 out of every 100 give no trouble at all, and under the new provisions these people will not be affected by the knowledge that compulsion may be used on others of a different mentality.
The people who default, and whom we are trying to get at, are not affected by moral consideration or by the voluntary nature of the voluntary nature of the system; they are not frightened away because of any moral stigma, or because of the effect of public opinion. They do not come to the clinics either because they are weak minded, or frivolous, or utterly careless and irresponsible. My opinion is that, if there is any effect on the voluntary attendance, it will be a good effect. At the present time one of the disadvantages in the treatment of venereal disease is that the public do not 478 sufficiently realise the seriousness of it, and the fact that there are no compulsory powers in connection with it, while there are compulsory powers in connection with a great many other diseases, impresses on the public mind the idea that venereal diseases are not such a serious matter. There is no doubt that compulsory powers would awaken the public mind to their seriousness, and would, I am quite sure, intensify and increase the attendance of the purely voluntary comers at these clinics. With regard to treatment by quacks, it is quite well known that since 1917 it has been illegal and a serious offence for any unqualified person to treat venereal disease. Therefore, I submit that this fear of interference with the voluntary system has no basis in fact or experience to support it, and there is, at the worst, so slight a danger as not to stand in the way of this important experiment being carried out, especially at the hands of those who have carried out the voluntary system so conscientiously and so successfully.
I have been rather surprised at the action of some of the women's associations, and I would say in this connection that those women's associations in Edinburgh which have opposed this Bill are small associations, whereas those which have supported it have been large associations, although they may not have been quite so vocal. I have been surprised at the unscrupulous use which has been made of the memory, which we all revere, of Josephine Butler, and the comparison of this Bill with the Contagious Diseases Acts of the middle of the last century. Those Acts applied only to naval and military towns. They were directed only against prostitutes, and were carried out by the naval and military authorities. To say that this Bill, promoted and to be worked by the democratically elected Town Council of Edinburgh, is analogous to those Measures, is an insult to the citizens of Edinburgh, and also to the intelligence of the Members of this House. As a matter of fact, in these modern days, prostitutes do not form a large percentage of the patients. If they become infected, they are only too eager, for obvious reasons, to get cured, and there would seldom be any necessity for compulsion in their case.
479 The thing that surprises me is to find some women's societies against this Bill, when this disease means so very much to women. When we have cases of men who are infected by this disease, married men who have got infection outside, who refuse to be treated, and who yet demand the right to have marital intercourse and infect their wives, in spite of the wives' protestations, I ask, is that equal citizenship? We had in Edinburgh recently nine cases of married men, and the doctor pointed out, after hearing their history, that it was almost certain that all their wives would be infected; and he asked permission to see the wives and to get them treated. Six of the men gave permission, but the other three refused permission, and, under the present arrangements, there was no authority and no power to do anything for those three women. Is that equal citizenship? I am certain that many of these well-meaning women who are against this Bill, if they really saw the cases and understood the circumstances, would be turned round into most ardent supporters of the Bill.
§ Dr. SHIELS
Yes, but the women are not aware that they are infected. I think it is very desirable that the House should realise the sort of material we are dealing with, and the cases which have justified the proposals in the Bill. I do not want to take up the time of the House unnecessarily, but I think a few cases will be worth giving. Here is a case of a male patient, single, treated for three weeks for syphilis and defaulted. Married one year later, infected his wife, who had two miscarriages and subsequently two children who survived, but were found to be infected with syphilis. In addition other members of the same household, aged 12 and 14, were innocently infected with syphilis on the lips. Four years later this man had an abscess of the brain and paralysis due to syphilis. Power to compel this individual, in the first instance, to complete his treatment would have prevented the infection of his wife, the miscarriages, the inherited syphilis in his two surviving children, the acquired syphilis in two children in the same household, and his own death.
480 Here is another case: Female, aged 36, seen at hospital and delivered of a stillborn child due to syphilis. Advised to attend for treatment and repeatedly implored to do so and bring her family. Two years later reported with child, aged 5, suffering from loss of sight due to syphilis. Mother at that time seven and a half months pregnant; child subsequently born suffered from syphilis. Mother now states she wishes she had been compelled in the first instance to attend for treatment. The eldest child's sight would undoubtedly have been saved and both saved from suffering from syphilis. Another case is that of a child, six days old, brought to hospital suffering from ophthalmia neonatorum, which leads to blindness. Father and mother found to be infected. Both refused to continue treatment, although both told they had syphilis and gonorrhœa. Child died. Eighteen months later the same mother reported to hospital with another child, suffering from syphilis, which also died. Father and mother have consistently refused to be treated and are both of child-producing age. The second child could certainly have been saved if father and mother had been treated.
It seems to me, also, that these women societies might very seriously consider the case of the children. It is the cases of innocent children which have moved very many of us in the matter. In the Edinburgh centre there are between 200 and 300 children attending, and to me they are one of the most pathetic sights I know. They have a Christmas party where they all assemble, and it is very tragic to see children who should have been born healthy who have been condemned to suffer the stigma of this disease. Is that to go on?
I would like to say one word about this matter of class distinction. This Bill does not abolish class distinctions. That is not its purpose, but it does not create any new ones, and, in my opinion, the poorer section of the community will benefit most from the Bill, because the poor people suffer more from most diseases than the rich. When you have bad housing, overcrowding, poverty, ignorance of hygiene and lack of facilities for its exercise, you inevitably have an increase of contagious diseases and venereal diseases are no exception to the rule. As a matter of fact, all types of people attend these clinics and people 481 of all social grades. There have never been any class distinctions, and there will not be in the future.
Another argument I would like to meet is the question of the treatment in other countries which has been brought forward by our opponents. It must be remembered that compulsory methods in Europe have only been against prostitutes and have no reference to the system suggested in this Bill. In Germany, however, which has always been a progressive country in public health, a few weeks ago a system was introduced there on very similar lines to this Bill. If we take our Dominions, we find that in Canada in some towns, in Toronto for instance, there is a similar system working. In Toronto less than 2 per cent. of prosecutions are required to make their system effective. Then Australia has been a good deal mentioned. I have some knowledge of Australia and of the condition of things there. I had the privilege of looking into this question in all the States of Australia and of a special interview with the director of Federal medical services in Melbourne in regard to this matter. They are perfectly satisfied with the system there. They have had two Royal Commissions, and they consider the compulsory powers are of very great value. Comparison of defaulting figures is not very useful in view of the scattered nature of the country and the difficulty in many areas of securing treatment. It is however a significant thing that there has never been any demand for doing away with the system. The Royal Commissions have reported that the system has not been a failure and that where the administration has been effectively carried out it has been successful. There is one quotation I should like to read from the Commissioner of Health for Western Australia. He says:V.D. clinics are well attended, and literally hundreds of patients have been returned for treatment chiefly by persuasion, who without the Act with its compulsory powers would have remained partially treated and so sources of infection. … Such prosecutions as there have been have been almost entirely against, men. Very few women have been brought up, and such as have been have had plenty of warning and have been knowing and deliberate offenders. …I think it will be conceded by all fair-minded people that the Act is certainly doing good, and it is a well-known fact that 482 although there is a Vigilance Committee in this State, which has asked anyone who considers himself or herself wronged by the administration of the Act to report themselves and their cases will be inquired into, no such case has been brought forward since the Act came into operation in 1916.There is one last point, as to the criticism that this is a local Act and not a general Act. I understand that this is said to be the reason for the opposition of the Government to this Measure. The Board of Health has more than once in its Report spoken of the necessity for compulsory measures. The English Ministry of Health, however, has always seemed to have had a curious prejudice against any legislation on this subject. They opposed the Bill of the hon. Baronet the Member for Barnstaple (Sir B. Peto) for carrying out another of the recommendations of the Trevethin Committee and they also put in Reports against the Bradford Bill and the Liverpool Bill, and now they have opposed this Bill. The right hon. Gentleman the Secretary of State for Scotland is, I understand, very gallantly drawing the fire of the enemy to-night and appearing as the villain of the piece, but this time we will not accept him in that role. It seems strange that a united Scotland, with all its local authorities behind this Bill, should be prevented by an English Ministry of Health from making an important experiment and a try out in public health in connection with this important disease. Some people might even suggest it as an argument for Home Rule for Scotland. There is nothing in the private Bill argument at all, because it is perfectly well known that very much of our general public health registration has been built up by local experiment. Even the Act of 1889, the Infectious Diseases Act, was in operation in Edinburgh for 10 years before it was made a general Act. The same is the case in connection with the compulsory notification of tuberculosis, which was in existence in many towns before it became a general Act. This Bill is supported, as has been pointed out, by the vast, majority of the citizens of Edinburgh, by the democratically elected town council, and by every Member of Parliament for Edinburgh, except the hon. Member for Leith (Mr. E. Brown), who very courageously opposes the Bill. I would point out, however, in extenuation, that he is an Englishman and has 483 only recently come amongst us, and I have no doubt that when he has been a little longer with us he will have developed the progressive spirit of the other Edinburgh Members on this subject. In conclusion, may I say that I believe that those who oppose this Bill are undertaking a very grave responsibility, and I hope that the Members of this House will show themselves enlightened seekers after public health and at least permit Edinburgh to prove its case upstairs by giving a Second Reading to this Bill.
§ The SECRETARY of STATE for SCOTLAND (Sir John Gilmour)
The hon. Member for East Edinburgh (Dr. Shiels) has made a direct reference to myself as the Minister responsible for health in Scotland, and I am not in the least afraid of standing fire on this or any other occasion. But I approach this subject with a measure of responsibility, since I am the Minister responsible for the Department of Health in Scotland. I approach it also without the technical knowledge revealed in the speeches of a number of doctors who are hon. Members of this House, and I approach it with a feeling that it is a problem which deserves the closest consideration of all the citizens of the country and of the Members of this House. I regret that I shall have to advise the House, quite plainly and quite emphatically, to reject this Measure. I do so after very careful consideration with my advisers, and, while reference has been made to letters and communications made by the Board of Health at certain times on this problem, and to the possibility or the necessity arising of using compulsion in dealing with this matter, I would remind hon. Members and those who are supporting this Bill that any such communications were made prior to and not after the issue of the most recently considered reports upon this problem.
We have heard arguments used on both sides, in support of and against this Measure, and I think the House will agree that one thing is clear, and that is that this is a scourge which affects the health of our community, and that it is essential to make as great progress towards the elimination of that scourge as it is possible to do; but I wish to submit to the House that in this problem, 484 as indeed in many others, the measure of progress, at any rate among our people, must always be in proportion to and not in advance of the volume of public opinion which can support it.
§ Mr. SCRYMGEOUR
Is the right hon. Gentleman aware that in No. 144 of the Recommendations of the Royal Commission the Board of Health was especially recommended to leave it to the larger local authorities to deal with this question by themselves?
§ Sir J. GILMOUR
I am not conversant with the actual point to which the hon. Member refers. I am not saying that one does not have a great deal of confidence in the ability and skill and foresight of many of our great local authorities, and I want to say at once that I recognise, as indeed my Board of Health recognises, the skill with which the Edinburgh Corporation, and many others throughout Scotland, have endeavoured to deal with this problem. But I come back to this, that while one quite realises the intense anxiety of those who are responsible for dealing with this disease to make more rapid progress, and while one realises, in cases such as hon. Members have quoted of infection of children deliberately done, the aroused indignation, and the rightly aroused indignation, of those who have to deal with this problem, that does not remove this difficulty, and I ask the House to consider for themselves: Is it quite certain that if you did have compulsion, you would any more readily deal with these very cases than now? Having read the Report of the Trevethin Committee, I find that they say, for instance:It has been suggested by some that in order to secure unbroken attendance of patients at clinics, a modified form of notification supported by appropriate compulsory measures should be applied to those who have once attended the clinics. … but in our view such a system would be more likely at the present time to deter than encourage attendance, and it seems difficult to justify the imposition of a penalty on those who have come for treatment while leaving untouched those who have made no effort to seek treatment.I submit that that is a condition which this Bill would propose to carry out, and it is on those grounds that I am compelled to say to the House that I do not think that they would be wise to proceed.
§ Sir B. PETO
On what grounds does the right hon. Gentleman say that this Bill deals only with those attending clinics and leaves out all those who do not attend clinics?
§ Sir J. GILMOUR
As it seems to me, unless you have compulsory notification in conjunction with it, obviously that must be the result. I am told that there is unanimity in Scotland upon this subject, but let me point out to Members of this House that, while Edinburgh comes making certain proposals, as she does to-night, upon certain lines, the great Corporation of Glasgow is coming and making proposals upon different lines. Therefore, there is no uniform opinion yet among those who are most closely concerned with the method of dealing with this problem.
§ Sir J. GILMOUR
I am sorry. I do not propose to take up the time of the House at great length, but I would say to the House, in all seriousness, that under the voluntary system admittedly we have made great progress. I do not feel convinced, nor do my advisers, that the possibilities of education and of voluntary teaching and, if you like, the pressure of public opinion, have been fully exhausted. In these circumstances, I suggest that the House would have to think very carefully indeed before making an experiment which is admittedly one with very far-reaching consequences, and one which, whatever we may say and claim, if it were made in this or that area, is bound to have its effect on areas far outside that in which it is made; an experiment which, if it fail or partially fail, is bound to have reactions which many of us cannot foresee. In these circumstances, while I regret having to express an opinion which is contrary to the aspirations, hopes and the genuine anxieties of a great corporation working, as I know and believe, for the betterment of the health of the people, I am bound to ask the House to reject this Measure.
§ Lieut.-Colonel FREMANTLE
I hope I may be allowed a few minutes to express a view that will assimilate itself to the view of some of my profession while bitterly opposed to that of others who have spoken this evening. We happen to have been affording the House to-day one of those delightful opportunities of seeing the medical profession divided, and we are divided all the more because of our honesty and genuineness of determination to tackle evil questions. But there are certain definite grounds that we have in common. In the first place, we have in common a realisation of the intense seriousness of the position that we are trying to treat. I do not think it is sufficiently known by the public how serious is the position. I shall not enlarge upon it, but I would remind the House, and through the House possibly the public, of the conclusion of the Royal Commission in 1916, that no fewer than one person in ten of the whole population of our large cities was infected with syphilis. That is one of the great killing diseases. More so, gonorrhœa is equally prevalent or more prevalent, and that is one of the great crippling diseases. I hope that a great deal of the feeling that has been aroused about the Bill will at any rate be excused when people realise what we are up against.
There is one note of criticism which is rather irrelevant, even as raised by my right hon. Friend the Secretary of State. It is suggested that the number of defaulters is being reduced by the voluntary system. It is true that the number of defaulters has been reduced, and I hope it will still continue to be reduced. But leave aside the statistics. I ask any impartial man or woman of the world whether, knowing what men and women are, knowing the conditions under which at least a certain enormous proportion of the population is infected, do they imagine that any system of voluntary treatment is going to clear the slate or secure the treatment of those who are recalcitrant? Of course not. There must be always a large proportion who will refuse treatment under any conditions. That must be common ground. I am sure that it is common ground among medical men, even among those who have spoken against this Bill. I cannot imagine the Noble Lady, the Member for Sutton (Viscountess Astor), who is against the Bill, refusing assent to that proposition, There 487 is a large residue of people who will refuse treatment unless it is known sooner or later that it will become compulsory. The Government in the pronouncement that we have just heard, and those who are opposed to the Bill, are quite content that nothing should be done for these people.
§ Lieut.-Colonel FREMANTLE
These people will refuse voluntary treatment. They are careless. They will go once or twice for treatment and then break off. They cannot be got at by voluntary measures. I could enlarge on that point by cases right and left. You can do a very large amount of work by voluntary measures. The medical profession and everyone who has to deal with public health are unanimous that the main basis of the treatment of the disease, and still more the measures of prevention, must be a voluntary system. There is no question of trying to get over that. That is why all statistics from other countries are incomparable—because we intend to keep the voluntary system under this Bill. The question is, can you clear up the dregs and the recalcitrants at the bottom?
I must bring the House back to the actual system as I have seen it working in Edinburgh. There has been a surprising advance made by the voluntary system in the course of only 10 years. Whereas 10 years ago it was almost taboo to mention these subjects, and it was difficult to get anyone to appear anywhere for treatment of this disease, now you see the cases coming up and pouring in, sitting side by side in the general clinic and anxious to continue their treatment. Why? Because they know its effect. Why? Because they know that confidence will be respected, that the secrecy is as absolute as it can be made. It cannot be absolute secrecy, because they are sitting side by side in the waiting hall of the public clinic. They give their names and addresses, and this has to be done in order that their treatment may be continued and that a record may be produced if they lapse for a time and then come back. That record is absolutely confidential and there is one medical officer who is responsible for keeping the record under lock and key. What happens? The medical officer knows that certain people 488 continue treatment and others refuse it. At present the ones who refuse, after a short space of time infect people right and left. It is often found that the wives and children who come in are all infected. The doctor knows that the man is continuing to spread the infection, and at the present time he can do nothing to compel that man to continue his treatment. The man's wife can do nothing, although she is being infected, to prevent more infected children being bred. The Secretary of State says, "We do nothing in that case." The Edinburgh Corporation say, "We want to deal with that case." That is the ease for the Bill.
I want to say something as to the objection that secrecy is to be broken. What will actually happen is this: the medical officer for the most part has information through the cases or their friends and relations that come for treatment. He is not going to spoil his system by breaking the secrecy. What does he do? He writes privately to the man concerned. He does that now. In many cases he is unable to get the man concerned to come for treatment. But there are a certain number of cases which will not come under this system. He writes to them a letter and says, "Please come for treatment." If they do not come, he is then enabled by this Bill to say, "You must forward to me a certificate that you are being treated." It is not compulsory for him to come to the clinic even if he is a poor man. There are poor men's doctors to whom he can go, and he can get a certificate from them.
§ Lieut.-Colonel FREMANTLE
It is quite true, as the hon. Gentleman the Member for West Bermondsey (Dr. Salter) said, that treatment given by the poor men's doctors very often is not the best treatment.
§ Lieut.-Colonel FREMANTLE
The hon. Gentleman said that the treatment given by the private practitioners very often would not be the best treatment.
§ Dr. SALTER
I am afraid the hon. and gallant Gentleman is confusing my speech with that of somebody else. I did not make any suggestion of that sort at all.
§ Lieut.-Colonel FREMANTLE
Very well, we will leave that. This Bill is not intended to be comprehensive, but is a Bill simply to get a certain move forward. It will give a certain move forward. What is the effect on those people who know that they ought to go for treatment when they receive a letter from the medical officer? There is the menace of compulsion behind it.
§ Dr. SALTER
May I ask the hon. and gallant Gentleman if he will answer the question which I put in my speech, namely, what is going to happen if the applicants for treatment universally refuse, or in large measure refuse, to give either their names or addresses, as they are entitled to do?
§ Lieut.-Colonel FREMANTLE
If that did happen they would not be treated. They would be the worse, and it would be a universal failure. But that will not happen. The success of this Bill depends on administration and personal contact, and it is because these medical officers who deal with this subject know how to get at the people by wise means that it will be a success. The measure of compulsion is only kept in the background. It is actually the same in dealing with infectious diseases at the present time. Practically no one refuses to be taken to an isolation hospital, but there is the power of compulsion behind.
The hon. and gallant Gentleman said "these medical officers." Suppose you gave this power to other medical officers, would it not be a pretty strong lever in the hands of any medical officers?
§ Lieut.-Colonel FREMANTLE
I think it is perfectly true that this experiment is asked for by one corporation and by one set of medical officers, and it is because we believe that they have met with great success in this treatment and can be trusted that I support this Bill as an experiment. I quite agree that other proposals with regard to other authorities would equally have to be considered on the merits of the particular localities. I will simply conclude by saying that the Trevethin Committee, of which I happen to be the only member in this House, in making their report made the very definite reservations which have already been referred to this evening. We have 490 to recognise that these reservations in the Trevethin Report are very serious and must affect our judgment. Notwithstanding the points which the Secretary of State quoted, notwithstanding the fact that they were at that time opposed to compulsory notification, notwithstanding what we have heard by way of information, it may well be that in certain areas certain measures would be justifiable in dealing especially with defaulters. In this way the report says, they may ultimately be able, by a body of experience of great value, to determine future policy. Anybody who has been through this problem as we went through it on the Trevethin Committee will realise how intensely serious is the proportion of recalcitrants and defaulters. Nobody can say that a corporation such as the Corporation of Edinburgh, who are fully conversant with the difficulties and dangers, and who are responsible to the people at the next election for what they do, are not the ideal body for making one of these experiments on which alone we can build up a system of general administration.
§ 10.0 p.m.
§ Mr. E. BROWN
As my name has been referred to twice in this Debate, I desire to say a word or two, not on the general question, but upon the facts with regard to Edinburgh as I see them. It is perfectly true that I have the misfortune of only having been in Leith for a year, but time, I hope, will remedy that as the years go on. When the hon. Member for East Edinburgh (Dr. Shiels) tried to raise the issue that I was an Englishman opposing the Bill he forgot that among the four other Members for Edinburgh who are supporting the Bill there is also one Englishman, so that that issue does not arise. I deny entirely from my observation during the municipal elections of last November and since I was asked to put my name to the original Bill, which, unfortunately, I had to refuse, that there is a unanimous public opinion in Edinburgh in favour of this Measure at all. I deny further, that any single Member for Edinburgh has the right in this House to speak for his own constituency on this point. I have no right to say that the electors of Leith are either for or against this Measure. The hon. Member for North Edinburgh (Sir P. Ford) has no right to say that the electors of North 491 Edinburgh are for or against this Measure. My reason for saying that is, that this issue has never been put to the electors in Edinburgh. Neither at a General Election, nor at a by-election in Leith, nor at the municipal elections last November was one single reference made in the public Press—and I think I read every column—to this problem. Therefore, although the Corporation are entitled to vote as they wish and to bear the penalty of getting the reward afterwards if their action is approved or disapproved by the electors, they have no right to say that the citizens of Edinburgh demand this Bill. The hon. Member for East Edinburgh has no right whatever to stand up in this House and say that he speaks for a united Edinburgh or a united Scotland.
The course of this Debate will have shown the Members of this House the kind of public opinion that has been aroused in Edinburgh in favour of this Bill. There has been no discussion of the merits of the Bill by the supporters of the Bill. The whole of the argument has been based on defaulters. This Bill does not merely deal with defaulters. It is not a Bill with which Edinburgh alone is concerned. It is a Bill which raises the whole issue as between the defaulters behind voluntaryism, honesty, faith and moral forces, and legal and medical compulsion. That is the issue which is raised in this Bill. It is obvious that the Edinburgh Corportation realised that there is very great opposition to the Bill in Edinburgh, because before the Second Reading of the Bill has been taken they have already proposed to cut out two of the most drastic of the original proposals.
Let me remind the House what the original proposals were. The first was, that if a medical officer of health has reason to suspect that a person suffers from this disease the person may be notified to attend for treatment. "Any person," not the defaulters, not the persons now attending the clinic, but any person the medical officer has reason to suspect. Secondly, in Clause 3, they ask for powers of arrest, powers of detention, not merely for defaulters but for others, and powers of examination of parents whose children may be found to be suffering from the disease. The issue 492 —I say it without fear of contradiction—has never been discussed in public in Edinburgh by those who support the Bill. When the original decision was taken to proceed with this Bill there was no public report of the debate in Edinburgh. When the second decision was taken after it had been announced that the Government were opposing the Bill there was a public report of the debate but not a report on the merits of the Bill. The, examination of the Bill was made in private, and there was no public report. Almost the whole of the public report that I saw dealt with the issue raised by the supposed intervention of the English Ministry of Health, and the thing was discussed, not on the merits of the Bill but on the question of Home Rule or otherwise for Scotland. This is not a Bill that ought to be proceeded with by the Private Bill Committee. The right hon. Gentleman the Member for Central Edinburgh (Mr. W. Graham), realising that there is much to be said both ways and that there is a great division of opinion in Edinburgh about the Bill, will not attempt to justify its merits—[HON. MEMBERS: "Speak up."] I have not spoken in Edinburgh about it, because I hoped until the last minute, when the Government said they were against it, the Corporation would withdraw it, but I propose, and my wife also proposes, to speak against the Bill in Edinburgh, and we will do it in Leith too, and we will go to some of the private places where they have been and put the other side of the case.
When the hon. Member for East Edinburgh talks about public opinion he means private opinion, and private meetings not publicly reported where he and his friends have gone to say what they like about the case for the treatment of the disease, for cleaning the city, and for the care of children, ideals that are common to all of us. There is in Edinburgh a great body of public opinion, not merely fanatical public opinion, not merely theoretical, but of practical people against the Bill. I will read one letter from my correspondence. It is from the Edinburgh Home for mothers and infants, and I am sure the hon. Member for East Edinburgh will not call the lady who superintends that home and has to deal with one dead end of the problem a theorist: 493Dear Sir,As a voter in your constituency and one whose work draws me into close contact with the problem, I write to say it was with great satisfaction that I learned to-day that you are opposed to the Edinburgh Corporation Bill for compulsory powers for the treatment of venereal disease. From my experience I feel strongly that compulsory treatment is not the best way of dealing with this disease, and that it is most important that the success of the voluntary scheme should not be endangered.The right hon. Gentleman the Member for Central Edinburgh will doubtless say, "Let the House send this to a Committee, and then let us deal with it in private." This is the last kind of Measure that ought to go to a Private Bill Committee. This is a Private Bill and it will not go to a Standing Committee, where Members of the House are both counsel and judges. The Edinburgh Corporation has behind it the whole of the ratepayers' money with which to ask for skilled counsel to support the Bill. It can call upon the pockets of those in Edinburgh who are for the Bill and those who are against it equally to contribute to fight the case in a Private Bill Committee. We who feel as strongly against the Bill as they do for it have no such pocket to go to. The voluntary organisations that are against Bill will have, if there is a long legal fight in Committee, to finance it out of their private funds. That is a very pertinent reason why the Bill should not go to a private Committee. I should have liked to say a word about the wider issue, but I am here regretfully, because this is one of the worst of all conflicts, a conflict of idealists. Those against the Bill and those for it both desire the elimination of this dreadful disease. I am profoundly convinced that those in Edinburgh who think this Bill on a compulsory basis will eradicate the disease are mistaken, and I am bound, therefore, with regret to go into the Lobby against the Bill.
§ Sir SAMUEL CHAPMAN
Doctors differ, men are puzzled, and women are divided on this question. As one of the Members for Edinburgh I, too, am puzzled, and, although my name is on the hack of the Bill, I stand as sponsor but not at present as a supporter.
§ Sir S. CHAPMAN
I am the Member for South Edinburgh, and I shall be the Member for South Edinburgh when the hon Member is not the Member for Dumbarton Burghs. I was going to say, while I am not a supporter of the Bill, I want to see it sent to a Select Committee. How can we in 3½ hours conic to a definite conclusion on this Bill when we have so much wonderful contradictory advice? We have had some of the most wonderful medical evidence submitted to us on both sides. I want that evidence sifted upstairs in a formal, legal manner. I know the other side of the question quite well, because I made it my duty to go amongst these very ladies who are opposed to the Bill, and for 2½ hours I heard the most wonderful case put up against it. Then I asked the medical officer of health to meet these very ladies. I kept my mouth shut—an example which a good many Members might imitate when they make long speeches in a Debate of this kind. I heard the medical officer of health put up an equally wonderful case, and I came away thoroughly puzzled and determined to take the action I am taking to-night. Let the Bill go to a Select Committee. Let us get evidence from every quarter, and then we shall possibly be able to ascertain the truth.
§ Mr. STEWART
I speak as one who is connected as a layman with this question. I have been a member of the Lunacy Board. It is quite possible that on occasions I do not know where I am, but to-night I do know where I stand on this question. I claim as a layman to have some knowledge of this trouble. As a layman on public authorities, I have been connected with this disease from 1901 until the present time. I know what it means. I have seen its ravages amongst the children, and I have seen its effects in our asylums as the cause of general paralysis. I know exactly what this disease means. If to-night the House agrees to make this Bill compulsory, for that is what it means, you are going to defeat the object of everyone who is concerned about the elimination of this disease. It is claimed by the promoters of the Bill that this is a voluntary system, that it is going to he voluntary, yet right through the speeches there has been the element of 495 compulsion. If a person has a child and that child is suffering from ophthalmia neonatorum, and the case is notified, the parents are to be examined and compelled to attend for treatment.
If I thought that compulsion would do what the protagonists of this Bill claim, I would support it with all the powers I have within me, but it is because I do not believe that the result will be as they claim, that I oppose it. In the case of a man who is suffering from the disease and a woman is the cause of the disease, and the woman is named, she will be compelled, under this Bill, to undergo medical examination. If a woman is examined and she makes a complaint against a man, then he has to undergo an examination. According to statements that are made, there is an ever-increasing number of people who are going voluntarily to the clinics and who are not proven on examination as suffering from the disease. The voluntary system is gradually making its way. It is gradually gaining the confidence of the people by these means, by fostering the voluntary system, by making the people understand that they have something to gain, that the sympathy of the community is not against the people who suffer from this disease, that they are not to be ostracised, but that they are victims of something from which we wish to save them. To have a clinic on those lines would do much more good in the elimination of the disease than any method of compulsion that may be undertaken.
Those people who are in Edinburgh to-day may leave it and go elsewhere, and, that is another means of defeating the objects of the Bill. You may go to Queensferry but you come to Edinburgh to be treated. After several treatments, if the doctor will not give you a clean bill of fare you cease to come to the clinic in Edinburgh, still residing in Queensferry, and they have no power to follow you there, although you may come into Edinburgh to spread the disease. If we want to deal with this disease on compulsory methods, the only sane method is to make a general Bill, if the community and the country decide in favour of it, and then we may do some good, although I have my doubts as to any compulsory system, If I believed that 496 compulsion would work, I would vote for it to-night and speak for it wherever I had the power, but because I believe that in the voluntary system we can manage much better, I hope the House will reject the Bill.
This is a question which concerns every citizen in the country. It is not only a question for Edinburgh, it goes much beyond the confines of that city. I, like other hon. Members, know exactly that compulsion feeling which you get when you find a person suffering from these diseases and you have no power to detain them. I know that longing for the power of compulsion. I remember during the War a young girl coming to me afflicted with this appalling disease. There was no means of detaining her. She was able to go out on to the streets again. If you look at a few cases like that, and cases of men who ruin their wives and children, there is something which rises up within you in the nature of a longing desire to get at the particular individual. But this is a question of a particular disease. You cannot compare it with any other disease. It is a moral disease. Our winds go back to Josephine Butler and our own Contagious Diseases Acts. In dealing with this disease man has always thought that if you could confine the individual, if you could use compulsion, you would do away with it. We have found that it does not. There was a flaw in the Contagious Diseases Acts, and instead of doing away with disease they only increased it.
I wish every hon. Member would read the life of Josephine Butler and realise what she has done towards dealing with this horrible and dreadful disease. She advocated voluntary free treatment in 1864; and after having tried every other kind of system it is now realised that only under a voluntary system have you any chance of getting at the men and women who are the victims of this disease. Like the last speaker, I should be in favour of compulsion if I thought that it would eradicate the disease, but you cannot do it in this way. It is a moral disease, and there is only one way in which you can protect the children; that is by a single moral standard. We have to consider the best method of dealing with this disease, whether it should be voluntary or compulsory. It is a 497 disease of which the victim is ashamed. It is not like measles, or any other such complaint. The people who are its victims, and those who are interested in the problem know that the real essence of the problem is to get the treatment as soon as possible. By this Bill you are going to risk a system of treatment that has only been tried for 10 years, but which is obviously succeeding. You are going to risk all this success in order to get a small number of defaulters. That is what it really conies to. The voluntary system, which is now at work, is to be risked. In Australia, the defaulters, under the compulsory system there have never been below 75 per cent.; whereas the defaulters in Edinburgh are 29 per cent. That should meet the criticism with regard to the defaulters.
This Bill has been changed. When it was first brought in it was much stronger. There is a type of thought which really believes in compulsion. There are two entirely different types of thought in regard to this subject. What we are up against here is what has been done in Bradford and what they wanted to do in Liverpool. That is what is wanted now in Edinburgh. One of the arguments used in favour of the Bill is the argument about the children. I want the House to remember that in Bradford where they have what is being asked for by Edinburgh, the number of babies affected with gonorrhœeal blindness and ophthalmia has increased from 6.4 per thousand births to 9.1 per thousand births. The chief medical officer of Edinburgh suggests that this increase has been due to lack of care on the part of doctors and midwives, and the conclusion therefore is that since notification in Bradford the midwives have been more careless. As a matter of fact, exactly what everybody dreaded has happened. The people are not coining forward. It is quite true that statistically the number coming forward is greater in Bradford as it is greater everywhere all over England, but the increase of the disease among the children has been greater in Bradford since compulsory treatment.
§ Lieut.-Colonel GADIE
I do not understand these figures. I have a telegram from the medical officer of Bradford in favour of this Bill.
I agree. The medical officer is in favour of it, but I 498 am saying that in Bradford the percentage of babies affected with gonorrhœal blindness and ophthalmia has increased from 6.4 per thousand births to 9.1 per thousand.
Since compulsory notification. When the hon. Member for Barnstaple (Sir B. Peto) was asked whether he wanted people compulsorily locked up he would not say so, but I know that, sub-consciously and at the back of his mind he feels that if you could lock up the people suffering from this disease you would get rid of it. I regret to say that you would have to lock up a very large number of the population. That is not practicable, and this Bill is not practicable in itself. I regret that the whole House did not hear the speech made by the Secretary of State for Scotland. As he pointed out, this Bill is neither compulsory nor voluntary. It falls between the two. It is a backward step. It is said that some women are in favour of the Bill, but I submit if they are, they do not really understand it. When the subject has been threshed out and when it is properly understood you will find that no Bill which has ever come before the House of Commons has created more disturbance in the country than this is likely to create. I am not speaking, however, from the women's point of view. I am speaking from the point of view of the effective treatment of the disease. It seems to me that we should risk our voluntary system which has succeeded so well if we go back to the compulsory method. There are many points which I desire to make, but having waited some five hours to speak I have promised Lot to take much time. [HON. MEMBERS: "Three hours!"] One of the opponents of the Bill referred to the progressive state of Germany, but I would point out that Germany has only lately given up licensed houses.
It is England which has led the way on this moral question. It is really a moral issue and that is why some of us feel so strongly about it. An hon. Member said—and I thought it a very important point—that it was only the women in Edinburgh who were followed up. That is what some of us dread. We feel that, if this Bill is passed, it will fan more heavily on the women than on the men, but even if by falling heavier on 499 the women than on the men this disease will be cleared, it will be reasonable; but it is because we do not think that it will do anything but drive the disease under cover, and make people afraid to come forward, that we feel that it is a retrograde step. As long as there is a double standard of morals, there are bound to be more evils in the country.
It is a tragic thing that both Committees, in reporting on this disease, have said that drink was one of the causes of it. I feel very strongly about it. I do not want only to look at the results of the disease, but to go to the root of it. This is a question which it is hard to discuss, even in private, but I rejoice that the time has come when we women can get up in the House of Commons and, along with the men, discuss it in a dispassionate way. All of us have but one idea, and that is to eradicate it. It is a great tribute to the House of Commons that we have got that far in this country. Though we may differ in our methods of treatment, we all agree that our desire is to get rid of it. I hope and pray that the House will not allow this Bill to go any further, because it is a retrograde step, and if it once gets through, other authorities will want the same powers, and we shall lose the voluntary system, with men and women coming forward of their own free will. I would say one word about medical authorities, and it is that they cannot guarantee to give any real cure. The right hon. Member for Central Edinburgh (Mr. W. Graham) is going to speak, and I would like to know what the Council propose to do. When a case is notified, how are they going to treat it? How are they going to confine it? How are they going to be sure that when a person has treatment he is not still spreading the disease?
§ Mr. WILLIAM GRAHAM
In the time that I propose to occupy the House, I shall not develop the note on which the Noble Lady has just concluded her speech. The House has had an important Debate upon a subject of great gravity in the public health administration of this country. The Edinburgh Corporation, in preparing this Bill, recognise that something much wider than a purely local issue is involved, and the town council would 500 never have taken this step unless, at the end of 10 years of stiff and intensive experience of this problem, they were satisfied that the case for the Second Reading of the Bill could be established. Let us turn our minds to-night, in a preliminary way, to the national aspect of this question. If it were stated purely in terms of business, this is one of the services of local authorities to which the National Exchequer is making a particularly high contribution. The ordinary rate of contribution is 50 per cent. In this case, the State gives 75 per cent. of the approved outlay on these schemes. I say nothing at this stage of all the human and moral issues which are undoubtedly involved. But, taking it on that basis for the moment, it is perfectly clear to all of us that the taxpayers as a whole have a vital interest in seeing that this work is reasonably complete, that it covers the whole field, and that we are not continuing under the existing system some inherent weakness of importance which is undermining a great deal of the work in which we are engaged. That is the broad national or State feature on the purely financial side.
In that atmosphere, let us come to the attitude of the Scottish local authorities. For the most part, these schemes have been in force for 10 years north of the Tweed. During that time, everything possible has been done to build up the voluntary system, and with complete success. But during recent years these local authorities have drawn attention to a side of the danger which is illustrated by this Edinburgh Bill, and they have been passing resolutions in the most representative assemblies, like the Convention of Royal Burghs, urging that some form of compulsion is necessary, and that greater powers should be conferred on them in order to overtake the weakness to which I have referred. Side by side with that the Scottish Board of Health, in Reports from 1922, and on one or two other occasions, have alluded to the possibility of the consideration of some form of compulsion, and have recognised that, in all the circumstances, it is not surprising that local authorities should take this step. Therefore, first of all, we have a kind of State environment, and then we have the attitude of the local authorities in Scotland; and in that way we come to the expression of public opinion 501 in Edinburgh itself. It is quite true that the city, in its Parliamentary representation, is divided in the proportions of five to one.
§ Mr. GRAHAM
All that I am arguing to-night is that the Edinburgh of old, which is the only Edinburgh that matters, is in favour of this. So far from the subject not having been discussed, it has been debated from time to time before all kinds of bodies, and it is not true to suggest that at the last meeting of the corporation the great bulk of the discussion turned on the attitude, or the supposed attitude, of the English Ministry of Health.
§ Mr. BROWN
Will the right hon. Gentleman pardon me? [HON. MEMBERS: "Order!"] I had only 10 minutes. I did not suggest that in my speech. I was referring to the "published Report," which is a very different thing. I went out of my way to say that the major discussion on the Bill took place in private.
§ Mr. GRAHAM
That is quite true; but the point of the hon. Member's speech was that, in fact, at that critical meeting of the corporation, there was no real analysis of the merits of the Bill.
§ Mr. GRAHAM
In point of fact a long statement was made by the Town Clerk of Edinburgh on the whole merits of the Bill; and to their attitude we must add the substantial majority opinion of the Edinburgh branch of the British Medical Association, the opinion of the Edinburgh Women Citizens' Association, the support of the co-operative guilds, and of a large number of other bodies in the city. Therefore, I will not detain the House longer than is necessary to say that this question has been very widely canvassed, and that it comes forward to-night with a great body of support from the people of Edinburgh.
§ Mr. GRAHAM
I fear I cannot give way. I have very little time left and I want to summarise the situation. The Corporation of Edinburgh were practically unanimous in support of this Measure. I find that only two members dissented, and they dissented on grounds other than the strict merits of the Bill. Consequently, I 502 ask the House to believe that this Measure comes forward as a considered proposition.
Let us turn more particularly to the merits of the Bill itself. We must recognise that it introduces a measure of compulsion, but we dispute the idea that the measure of compulsion introduced is going to override or undermine the voluntary system which has been worked with undeniable success in the City of Edinburgh. During the past 10 years we have been dealing with what is admittedly a great and an important medical centre. The facilities for the investigation of this and other diseases lie to the hands of the Edinburgh Corporation and other public bodies in the capital of Scotland. Under the scheme to which practically universal tribute has been paid, we make it a cardinal part of our case that we have done everything in our power with the voluntary system, and we ask the House to notice a residue over which unfortunately at the moment we have no real control. That voluntary system has been pursued to the utmost limit, but there still remains a list of defaulters which when analysed over the past five years runs into between 850, 900 and 1,000 people who gave up treatment at various stages. They have passed back into the community, and we have no real power to compel them to take continued treatment. Consequently, they are a grave danger to themselves, and, above all, to innocent people.
We have been asked: "Why do you not pursue your voluntary method under which you have been admittedly very successful?" The simple reason is that we have taken all the steps we can take, and we have put all possible pressure upon these people who have discontinued their treatment. The lady almoner has visited a large number of eases, and the Corporation is satisfied that we have now reached the point at which this defaulting class is, so to speak, steady or fixed, and all that we are doing, and all that we are trying to do in existing conditions apparently makes no real impression upon that part of the problem. A very great deal has been said to-night about the merits of the voluntary and the compulsory principle, but, after all, the House of Commons, which usually takes a perfectly fair and dispassionate view of these problems, must recognise that in a case of this 503 kind, and in connection with a disease of this gravity, a very large public interest is involved.
The House will at once recognise that, in certain diseases which many people do not regard as anything like so urgent or dangerous as this disease, compulsion has, in fact, been carried to an extreme point. That has been done with the intention to protect the community. But the suggestion is that in the case of this particular disease there is a moral element, or, rather, an element of vice, which makes it very important that it should be treated on somewhat different lines. I think that an argument of that description can be altogether exaggerated, and for my part I would devote far more attention and far more consideration to the grave danger of this class of people to themselves and to the people around them, and I would of set purpose, in a matter of that kind, make more of the strict public interest. There is not the least doubt that a grave danger is present in the position as we find it in Edinburgh and other communities under existing conditions, and if we are able to say to-night that, having done everything in our power under the voluntary system, and having reached the conclusion that there is an apparently static condition affecting 1,000 people year by year who are going back into the community, I submit that we have established our case, at least for investigation by a Select Committee.
The Government to-night found themselves in part on certain public documents relating to venereal disease; but the Government themselves, in the statement of the Secretary of State for Scotland, give the case away. The Royal Commission on Venereal Diseases undoubtedly relied on purely voluntary measures, and it also said that notification at that stage was not desirable; but in the pages of the Report of that Royal Commission there are indications of a quite definite recognition that conditions might arise, as a result of experience in this sphere, in which some different plan might be urgently required; and to that we are entitled to add to-night the recommendation of the Trevethin Committee. I do not make more than a passing reference to it, because hon. Members have already quoted it in full; but that Committee, 504 while maintaining in substance the central principle of the Report of the Royal Commission on Venereal Diseases, indicated that you might have a state of affairs in which this compulsory method, or some such method, was desirable in appropriate centres. Our case in Edinburgh is simply that, so far from running counter to the broad purpose of the Royal Commission's Report and of the Trevethin Committee's Report, we have embarked upon a step which those two documents, read together in regard to that part of the problem, concede that some day might be strictly required.
It may be suggested that, if we take a step of that kind, we are undermining our voluntary scheme in Edinburgh; iii other words, that the two systems cannot exist side by side. It is our idea in Edinburgh that we can quite easily make this part of the scheme ancillary to the broad voluntary method that we intend to pursue, and I altogether dispute the argument that we are going to kill the voluntary method by what we propose. In point of fact, it may he argued with very great force that we might in some ways strengthen the voluntary method by the presence of powers of this description, and it is remarkable that within recent weeks, when the discussion of this whole question has been before the public, and when in fact a Debate on these very compulsory powers has taken place, there has been an increase, within limits, in the number of people who are corning for treatment and advice. I do not think that in the community as a whole there is any real anxiety on this point, and I am perfectly satisfied that in any event it is our duty in the House of Commons to give a Select Committee of our colleagues the chance of investigating whether the Corporation of Edinburgh, on all the facts, can establish its case on this point. The voluntary method will remain, and we propose to try to complete the structure of our work, so to speak, by such powers as will enable us to deal with defaulters and one or two other classes, and so prevent the main part of our work from being undermined.
The right hon. Gentleman the Secretary of State for Scotland used another argument. He suggested that there might be a case for compulsory notification, or, 505 at all events, for a Bill on general lines, and I gathered from his speech that much of his fears turned on the repercussion of the adoption of this principle in Edinburgh on other local authorities in different parts of the land. At the moment there is no prospect of any general legislation. It is quite true that the corporation of Glasgow almost immediately will promote a Bill which aims at compulsory notification. The Government to-night gave no indication of their attitude to a Measure of that kind. If we are driven to recognise that general compulsory or comprehensive legislation may still be a comparatively long way off, and if there is still to he a plea for more experience in the localities, we are to be content with continuing in our own city and, for all we know, other cities are to be content to continue, a method which contains this central weakness and loss, and which must weaken the efficiency of our work. Hon. Members behind have reminded the House that in the treatment of certain infectious diseases Edinburgh was, in fact, in 1879, 10 years ahead of the general legislation which followed in 1889. There is not the least doubt, that on any kind of scientific basis, especially in regard to a disease of this character, you should have freedom of experiment, and that a great corporation with these great facilities should be allowed a chance of even exceptional methods, especially when that corporation undertakes during the Committee stage of the Measure to insert the most complete safeguards, subject to the central principle of the proposal being maintained.
These are, broadly and generally, the arguments which have influenced us in Edinburgh. I suggest that the House would incur a very grave responsibility if it denied access to a Select Committee for the proper investigation of this scheme. Coming for a moment to the Parliamentary or House of Commons point of view, what, strictly speaking, is the attitude which the Government adopt? The Government simply say that on the advice of these Departments they do not think the Bill should have a Second Reading. I wish to remind hon. Members that the Whips are not put on, and that, in point of fact,, there is to-night a free vote of the House of Commons; and that, in any case, there 506 is the complete safeguard in the later stages of this Measure on the Floor of the House, if by any chance the Committee proceedings are regarded as unsatisfactory or undesirable.
What is the attitude of the House of Commons, generally speaking, on the Second Reading of a private Bill? It was very well defined by the right hon. Gentleman the Minister of Transport on the Second Reading of the Railway Bills in this House. He said that, generally speaking, the House of Commons did not refuse a Second Reading to a Bill unless its proposals were manifestly contrary to the public interest. I hardly think it can be seriously suggested that an experiment and investigation of this kind by a great local centre like the city of Edinburgh can be described as hostile or contrary to the public interest. But in any case all the facts bearing on that point are precisely the material which a Select Committee of this House should analyse and into which they should go in the very greatest detail. I submit that on all these facts, and keeping in view this consideration, that the disease with which we are dealing is one of grave national importance, the corporation has made its case for the Second Reading of the Bill, and the House reserves perfect freedom to take any action it pleases at the later stages of the measure.
§ Sir P. FORD rose in his place, and claimed to move, "That the Question he now put"; but Mr. SPEAKER withheld his assent, and declined then to put that Question.
§ Mr. SCRYMGEOUR
I should like to put in a word as from the Dundee Corporation and a short statement from Dr. Burgess, medical officer of that city, who says:Our experience is such as to suggest that further powers are necessary. I find that during the last four years an average of only 36 per cent. of the patients who ceased to attend our centres did so because they were certified cured, and of the remaining 64 per cent. a very small proportion were transfered to other centres.The doctor favours some compulsory measures, making it a legal duty on the medical practitioner to notify the disease. Dr. Burgess also holds that before costly measures are introduced facilities for free treatment of all infected persons must be available to every person. Facilities 507 must not only be of the nature of clinics for out-patients, but also of wards for in-patients. He concludes:Personally, I hope the Edinburgh Bill will reach the Statute Book. I am sure the experience gained would be of very great value to everyone and would make it possible to frame more effective general legislation at a later date.
§ Doctor Averill, in charge of the treatment centre, also contends that all practitioners, and not venereal disease officers only, should have to notify cases.
§ Question put, "That the word 'now' stand part of the Question."
§ The House divided: Ayes, 93; Noes, 156.509
|Division No. 84.]||AYES.||[10.58 p.m.|
|Adamson, W. M. (Staff., Cannock)||Grundy, T. W.||Potts, John S.|
|Albery, Irving James||Hall, G. H. (Merthyr Tydvil)||Preston, William|
|Alexander, Sir Wm. (Glasgow, Cent'l)||Hayday, Arthur||Price, Major C. W. M.|
|Batey, Joseph||Hilton, Cecil||Raine, Sir Walter|
|Beamish, Rear-Admiral T. P. H.||Hirst, G. H.||Ritson, J|
|Bellairs, Commander Carlyon||Hore-Belisha, Leslie||Samuel, Samuel (W'dsworth, Putney)|
|Bromley, J.||Hurd, Percy A.||Sandeman, N. Stewart|
|Broun-Lindsay, Major H.||Jenkins, W. (Glamorgan, Neath)||Sanderson, Sir Frank|
|Burman, J. B.||John, William (Rhondda, West)||Sandon, Lord|
|Chapman, Sir S.||Johnston, Thomas (Dundee)||Savery, S. S.|
|Charleton, H. C.||Jones, Morg[...] (Caerphilly)||Scrymgeour, E.|
|Cluse, W. S.||Kennedy,||Sexton, James|
|Connolly, M.||Lawson, [...] James||Shinwell, E.|
|Cove, W. G.||Lindley, F. W.||Simms, Dr. John M. (Co. Down)|
|Cowan, Sir Wm. Henry (Islington, N.)||Lowth, T.||Sprot, Sir Alexander|
|Crookshank, Col. C. de W. (Berwick)||Lucas-Tooth, Sir Hugh Vere||Sullivan, J.|
|Culverwell, C. T. (Bristol, West)||MacIntyre, I.||Thorn, Lt.-Col. J. G. (Dumbarton)|
|Dalton, Hugh||Macnaghten, Hon. Sir Malcolm||Tinker, John Joseph|
|Day, Harry||Macquisten, F. A.||Tinne, J. A.|
|Dunnico, H.||Makins, Brigadier-General E.||Varley, Frank B.|
|Edmondson, Major A. J.||Mason, Colonel Glyn K.||Waddington, R.|
|Edwards, C. (Monmouth, Bedwellty)||Murnin, H.||Wallhead, Richard C.|
|Foster, Sir Harry S.||Nail, Colonel Sir Joseph||Watson, W. M. (Dunfermline)|
|Gadie, Lieut.-Col. Anthony||Neville, Sir Reginald J.||Watts-Morgan, Lt.-Col. D. (Rhondda)|
|Garro-Jones, Captain G. M.||Nicholson, O. (Westminster)||Welsh, J. C.|
|Gibbins, Joseph||Palin, John Henry||Whiteley, W.|
|Gower, Sir Robert||Parkinson, John Allen (Wigan)||Wilson, R. J. (Jarrow)|
|Graham, Rt. Hon. Wm. (Edin., Cent.)||Pennefather, Sir John||Windsor, Walter|
|Grattan-Doyle, Sir N.||Peto, Sir Basil E. (Devon, Barnstaple)||Young, Robert (Lancaster, Newton)|
|Greenall, T.||Peto, G. (Somerset, Frome)|
|Greene, W. P. Crawford||Philipson, Mabel||TELLERS FOR THE AYES.-|
|Grotrian, H. Brent||Pilcher, G.||Dr. Drummond Shiels and Sir Patrick Ford.|
|Alexander, A. V. (Sheffield, Hillsbro')||Cochrane, Commander Hon. A. D.||Harney, E. A.|
|Allen, J. Sandeman (L'pool, W.Derby)||Cope, Major William||Harrison, G. J. C.|
|Ammon, Charles George||Crawfurd, H. E.||Hartington, Marquess of|
|Ashley, Lt.-Col. Rt. Hon. Wilfrid W.||Crooke, J. Smedley (Deritend)||Henderson, T. (Glasgow)|
|Astbury, Lieut.-Commander F. W.||Crookshank, Cpt. H. (Lindsey, Gainsbro)||Henderson, Lieut.-Col. Sir Vivian|
|Astor, Maj. Hn. John J. (Kent, Dover)||Cunliffe, Sir Herbert||Hennessy, Major Sir G. R. J.|
|Astor, Viscountess||Davies, Maj. Geo. F. (Somerset, Yeovil)||Herbert, Dennis (Hertford, Watford)|
|Atholl, Duchess of||Davies, Rhys John (Westhoughton)||Hills, Major John Waller|
|Atkinson, C.||Davies, Dr. Vernon||Hohler, Sir Gerald Fitzroy|
|Baker, Walter||Dawson, Sir Philip||Hopkinson, Sir A. (Eng. Universities)|
|Balfour, George (Hampstead)||Duncan, C.||Hudson, J. H. (Huddersfield)|
|Barclay-Harvey, C. M.||Elliot, Major Walter E.||Hume, Sir G. H.|
|Barker, G. (Monmouth, Abertillery)||Erskine, Lord (Somerset, Weston-s.-M.)||Jones, T. I. Mardy (Pontypridd)|
|Barr, J.||Fermoy, Lord||Kelly, W. T.|
|Beckett, John (Gateshead)||Fielden, E. B.||Kenworthy, Lt.-Com. Hon. Joseph M.|
|Benn, Sir A. S. (Plymouth, Drake)||Forrest, W.||Kindersley, Major G. M.|
|Bethel, A.||Fraser, Captain Ian||King, Commodore Henry Douglas|
|Bondfield, Margaret||Frece, Sir Walter de||Kirkwood, D.|
|Bourne, Captain Robert Croft||Gardner, J. P.||Lamb, J. O.|
|Bowerman, Rt. Hon. Charles W.||Gillett, George M.||Lansbury, George|
|Bowyer, Captain G. E. W.||Gilmour, Lt.-Col. Rt. Hon. Sir John||Lawrence, Susan|
|Briant, Frank||Gosling, Harry||Luce, Maj.-Gen. Sir Richard Harman|
|Broad, F. A.||Graham, D. M. (Lanark, Hamilton)||Lumley, L. R.|
|Brocklebank, C. E. R||Greaves-Lord, Sir Walter||Lunn, William|
|Brown, Col. D. C. (N'th'l'd., Hexham)||Greenwood, A. (Nelson and Colne)||Macdonald, Sir Murdoch (Inverness)|
|Brown, Ernest (Leith)||Gretton, Colonel Rt. Hon. John||Maclean, Nell (Glasgow, Govan)|
|Buchanan, G.||Griffith, F. Kingsley||Margesson, Capt. D.|
|Campbell, E. T.||Groves, T.||Maxton, James|
|Cape, Thomas||Hall, Lieut.-Col. Sir F. (Dulwich)||Merriman, Sir F. Boyd|
|Cautley, Sir Henry S.||Hall, F. (York., W.R., Normanton)||Montague, Frederick|
|Chamberlain, Rt. Hon. N. (Ladywood)||Hamilton, Sir R. (Orkney & Shetland)||Morrison, R. C. (Tottenham, N.)|
|Clayton, G. C.||Hammersley, S. S.||Murchison, Sir Kenneth|
|Naylor, T. E.||Shaw, R. G. (Yorks, W.R., Sowerby)||Wallace, Captain D. E.|
|Newman, Sir R. H. S. D. L. (Exeter)||Shepherd, Arthur Lewis||Ward, Lt.-Col. A. L.(Kingston-on-Hull)|
|Nicholson, Col. Rt. Hn. W. G. (Ptrsf'ld.)||Simon, Rt. Hon Sir John||Warrender, Sir Victor|
|Nuttall, Ellis||Skelton, A. N.||Wedgwood, Rt. Hon. Josiah|
|Owen, Major G.||Smith, Rennie (Penistone)||Wellock, Wilfred|
|Paling, W.||Smith-Carington, Neville W.||Wells, S. R.|
|Penny, Frederick George||Snell, Harry||Westwood, J.|
|Perkins, Colonel E. K.||Snowden, Rt. Hon. Philip||Wilkinson, Ellen C.|
|Ponsonby, Arthur||Spender-Clay, Colonel H.||Williams, A. M. (Cornwall, Northern)|
|Richardson, Sir P. W. (Sur'y, Ch'ts'y)||Stanley, Lieut.-Colonel Rt. Hon. G. F.||Williams, Com. C. (Devon, Torquay)|
|Richardson, R. (Houghton-le-Spring)||Stanley, Lord (Fylde)||Williams, Herbert G. (Reading)|
|Riley, Ben||Stanley, Hon. O. F. G. (Westm'eland)||Williams, T. (York, Don Valley)|
|Roberts, Rt. Hon. F. O.(W. Bromwich)||Stephen, Campbell||Wilson, C. H. (Sheffield, Attercliffe)|
|Roberts, E. H. G. (Flint)||Stewart, J (St. Rollox)||Wilson, R. R. (Stafford, Lichfield)|
|Ropner, Major L.||Sugden, Sir Wilfrid||Withers, John James|
|Ruggles-Brise, Lieut.-Colonel E. A.||Sutton, J. E.||Womersley, W. J.|
|Runciman, Hilda (Cornwall, St. Ives)||Thomson, F. C. (Aberdeen, S.)||Wright, W.|
|Saklatvala, Shapurji||Thurtle, Ernest|
|Salmon, Major I.||Tomlinson, R. P.||TELLERS FOR THE NOES.—|
|Salter, Dr. Alfred||Vaughan-Morgan, Col. K. P.||Mr. Pethick-Lawrence and Dr.|
|Samuel, A. M. (Surrey, Farnham)||Viant, S. P.||Li[...] e.|
Main Question, as amended, put, and agreed to.
§ Words added.
§ Second Reading put off for six months.