§ 4.23 p.m.
§ Mr. Lees-Smith
The Third Reading of the Consolidated Fund Bill gives us an opportunity of raising some wide administrative questions covering more than one Department.' My hon. Friends wish to take this opportunity to raise the general problem of the nutrition of the people of the country, particularly on account of the recent inquiries and researches into this subject by the medical profession, and we wish to criticise the attitude which a number of Departments, particularly those now represented on the Front Bench 1489 opposite, are taking towards the new science of nutrition which the medical profession has lately adopted.
The first fact that these medical men who are bringing this question of nutrition before the country are impressing on us, is that they believe that our whole sense of perspective on this question is still distorted. They insist that by far the most important element in the health and well-being of the people at large is the actual intake of food—the right quantities and the right proportions by which people should build up their muscles, bones, sinews and blood—and that if this intake is insufficient, or in the wrong proportions, we produce jerry-built bodies. Their view, broadly, is that half the people are sent into the world with jerry-built bodies, and that no amount of tinkering and dosing will give them a sound structure in which to pass the rest of their lives. This fact of the importance of nutrition as against other elements has been rather strikingly revealed by the number of inquiries taking place on the housing estates of the country, particularly those where slum populations have been taken. It was found in an inquiry in 1933, and in others since, that when you take a slum population and put it in a new housing estate, if the rents in that estate are substantially higher than the rents that were paid in the slums, the death rate actually goes up; the fact that less is spent on nutrition wipes out all the advantages of having more air, more sunlight, better houses and more widespread amenities.
The first Department which has come into conflict with this new view of the importance of nutrition is the Board of Education, and it is to that Department that I will first turn my attention. It is the duty of the Board to see that every local authority feeds children wherever malnutrition makes it necessary. The hon. Gentleman opposite said last year that it was the policy of the Board to prevent malnutrition from arising anywhere. The Board of Education has, in the course of its duties, to decide, in the case of every child in the elementary schools, whether it is suffering from malnutrition or not, at three stages in its career. It is done by the method of clinical assessment. This merely means judging the child's nutrition by looking at it; roughly finding how tall it is and how much it weighs, and then judging 1490 by its general appearance. This method is carried out by medical officers of health, nurses, teachers and anybody else who may be interested. The Chief Medical Officer to the Board published a short time ago his annual report on the health of the school child, and there he gave particulars for the year 1937 of the routine medical examination among elementary school children with regard to their nutrition. These are most important figures. By this method it is found that the nutrition of 15 per cent. of the children is excellent, that of 74 per cent. is normal, that of 10 per cent. slightly abnormal and that of 7 per cent.—really only about one in almost 200—is bad. Those are the results of the Board of Education.
The doctors who are responsible for the policy of nutrition say that these results are not only wrong, but that they are fantastically wrong; they are wrong by 100 per cent. They put forward, in order to maintain that position, their alternative method which leads to extraordinarily different results. I am not a doctor, but I have tried to understand this alternative method, which broadly comes to this. They calculate the actual quantity of proteins, vitamins, carbohydrates and minerals, and so on, required by a child at different ages in order that it may have a full and complete standard of nutrition. They then calculate what it actually costs per week to buy the food which will contain the ingredients for this proper standard of nutrition and they come to the conclusion that, if the family is not sufficiently well off to be able to spend that particular sum of money upon the food week after week, you may say with absolute certainty that in 90 per cent. of the cases the children in that family will suffer from malnutrition. They say that the best and by far the safest policy for the Board of Education to pursue would be to feed and to give free milk to all children coming from these families in that state or range of income. Even if, occasionally, they made a mistake and fed some child who had a sufficient standard of nutrition, the money would not be wasted. The only reason might be that the mother of the child would be living on margarine and tea.
The figures of Sir John Orr are elastic, and I am going to quote the figures of the British Medical Association because they represent the opinion not merely of 1491 doctors who are interested in nutrition, but of the average medical profession throughout the country. They are very well-known figures. The British Medical Association say that it requires nearly 6s. per week per child to be spent on food in a family in order that a proper standard of nutrition may be obtained. That is not a surprising figure. The Board of Education spends 5s. 6d. per head per week on the food of the children in the special schools, and that is bulk purchase, and therefore corresponds very well with the 6s. that the British Medical Association lay down for the ordinary family. They found that nearly 30 per cent. of the population of the country spend less than 6s. per head per week on food, and that therefore at least 30 per cent. of the children in the country suffer to a greater or less degree from malnutrition. If you compare these figures with the figures reached by the analytical assessments of the Board of Education,.7 per cent., or less than one in every 100, suffer from bad nutrition and only one-tenth are slightly subnormal. These differences are still more striking if one takes the well-known figure given by Sir John Orr, who, as a result of his investigation, came to the conclusion that, unless a family spent 4s. per head on food, the children of that family would be deficient of every constituent of proper nutrition, and that, therefore, their condition must be thoroughly bad. When you come back to the Board of Education results, only about one in every 100 of the children suffers from bad nutrition, and 10 per cent. of the children are only slightly subnormal.
These discrepancies are most disturbing. The health of countless children going into life depends upon the explanation of how these discrepancies are reached, and I will give the explanation which is very obvious to me. A medical officer of health is told to ascertain and make up his mind whether children passing in front of him are normal or slightly subnormal. What is his standard? It is the standard of the children in the area where he lives and in the midst of which the school is situated. That is to say, his standard is the average for that area, and in these circumstances, if you take the average, it is not surprising that 10 per cent. are below the average and one in 100 very much below the average.
1492 But the investigations of Sir John Orr, Sir Gowland Hopkins, Professor Mottram and all the specialists, and also of the British Medical Association, show that at least one-third of the children are undernourished and that the average child suffers from malnutrition. Therefore, all that the figures which the Board of Education produced lead us to is that they are the figures of the children who are abnormally under-nourished because they take the under-nourished children as the normal in these schools. I made observations on these lines on the Education Estimates last year, and I found that my views were very greatly reinforced by a paper by Dr. Wilkins, Assistant School Medical Officer for Birmingham, who examined this subject in "Public Health" in July of last year. This is what he says:I think there is a great deal of evidence that the term 'normal' is taken by most of us as meaning more or less average. We are unduly influenced by the standard of physique which we habitually see, rather than by what we think it ought to be.I ask the House to remember that the Board of Education shows 74 per cent. of the children abnormal. This is Dr. Wilkin's observation, in a striking passage, on that point from his own experience in doing the work:If we include as abnormal those who are suffering from defects due to poor nutrition in infancy, then, according to my experience in Birmingham, the normal practically disappears.And you get a discrepancy between the 74 per cent. of the Board of Education and the nothing per cent. of this medical officer in Birmingham. I noticed that Dr. Wilkins says that we ought to judge by what nutrition ought to be. That is to say, if you are judging normal nutrition you should take as your standard a child of 14 or 15 years of age who has had a full, complete and adequate nutrition from infancy upwards, and then compare your school population with children in that position. That has been done. One of the best known calculations of Sir John Orr—it has been quoted before in this House, but I will quote it again—has done that. Sir John Orr went to schools in this country attended by children who are being properly nourished in their infancy and whose parents are all comfortably off. He went to Rugby, Winchester, Westminster and Charterhouse and measured the height of boys of 13, 1493 and he found that the average was five feet, two inches. He went to Christ's Hospital, where the boys are not quite so wealthy, and he found the average height of boys of 13 was 4 feet, 11 inches. He then took a great range of elementary schools and saw large numbers of boys, and the average height in those elementary schools was four feet, eight inches. So that by the age of 13 this whole section of our community has lost six inches in average height, with all that that means in lowered vitality, in lessened reistance to disease and in staying power on reaching middle age.
I said "staying power," because this was very much brought home to me when I was at the Post Office. I had a little experience there which made me see what I believe to be the proper perspective of this subject. There was an investigation into the health of the women employés in the Post Office, of whom there are tens of thousands, and in order to make comparisons I had an inquiry made into the health generally of women clerks and typists in other occupations. When I saw the result I was shocked at the immense proportion of women in this kind of work who at about the age of 45 just fell out for no definite reason but because they could not somehow stand the strain of industrial life. They are not disabled in any measurable sense of the word. They would be better off if they were. I believe that there is no class in the community to whom modern society is so merciless as it is to those who are half unfit. They do not get the sympathy of the totally unfit, and yet they are unable to hold their own and win a place in the competitive struggle. I made a lot of inquiries about this matter from the most experienced supervisors in the Post Office, and was told that the reason was that these girls are usually rather clever girls and get on a bit, but that an immense proportion of them came from homes where they had suffered from lack of proper nutrition in their early years. They do not show the signs which the clinical assessments in the schools pick out, but, nevertheless, show results which eventually mean a lower vitality which makes them, at the age of 45 or 50, some 15 or 20 years older than their natural age. That is the general picture.
There have been put forward from this side of the House, and from the benches 1494 opposite as well from time to time, a great number of immediate remedies. I cannot debate them at all, because some of the remedies are administrative and others would need legislation, and the two are inextricably intermingled. I will, therefore, read a category of the immediate remedies which have been put forward certainly from this side of the House. They are these: That the scheme for milk: in schools should be continued throughout the year and that it should be extended to children who are under school age; that the experiment of giving cheap milk in Special Areas should be extended to other parts of the.country where there are comparable economic conditions; that there should be services in factories, especially where girls are employed; that the unemployment scales should be revised and raised to give a family, at any rate, the minimum scales laid down by the British Medical Association, and that the Board of Education should provide milk and meals for all children who come below the British Medical Association's scales. These schemes are not impossibly expensive, yet it is really difficult to exaggerate the immense effect that they would have. I doubt whether there is any direction in which you could spend money from which you would get such quick and excellent results as by money expended on the actual food of the people.
A good example of this comes from the War Office. Some hon. Members have no doubt been down to see the recruits' physical training depot at Camberley, locally known as the "Old Teenies." I go there very often during the Recesses, and the results are really remarkable. You get boys there whose physical condition is not good enough for them to be taken into the Army, and when you see. them they are indeed, physically, a pathetic spectacle. They are kept there from three to six months, but are not fed on expensive food. They get the Army rations, plus 2½d. a day, which is spent mainly on milk and bananas. Yet at the end of three or six months 92 per cent. of those boys are fit to go into the Army, after 18 months they are fit to be drafted out to India, and 18 months after that they will be able to go up to the North-West Frontier and to stand up man to man against the Pathans in that part of the world. That is my reason for saying that if we alter our perspective in this 1495 matter it would lead to revolutionary consequences.
I come back to the controversy which began last year and which is still continuing with the Board of Education as to their method of clinical assessment which determines the nutrition of millions of children. Last year there was a very careful investigation into the present methods of the Board of Education by Mr. Huws Jones on behalf of the Liverpool Education Department, the most careful investigation that has ever been made. A great number of schools were inspected and eight doctors took part. Broadly speaking, what Mr. Huws Jones's investigation showed is that by taking what is called the Tuxford index, that is judging the physical conditions by a formula consisting of height, weight and age, you can get the physical condition almost by turning a machine. Mr. Huws Jones and these other doctors went to the schools and compared their final results with the results given by the Tuxford index, and they came to the conclusion that the Tuxford index gave the more accurate results. He summed up what he had to say in this remark:As a result of this inquiry one may venture to claim that the method of assessing nutrition at present followed by school medical officers on the direction of the Board of Education, is unreliable. The results attained by that method are, to say the least, of doubtful value. The conclusions to which they point are insecurely founded; they may give the impression of effective action without the reality.No condemnation could be more severe than that, and the Board of Education could not possibly ignore the challenge of Mr. Huws Jones's results. They have taken the matter up; there is an examination of Mr. Huws Jones's results in the latest report of the chief medical officer of the Board of Education. They admit them. They sayFrom the purely statistical aspect these conclusions are no doubt justified.…Clinical assessment of nutrition is very fallible.Those responsible in the Board of Education have examined undoubtedly Mr. Huws Jones's paper but they have not examined the conclusions to which he was driven at the end of a long and expert discussion which took place on his paper at the Royal Statistical Society. Mr. Huws Jones was driven from clinical assessment and the Toxford index and 1496 came back in the end to this inevitable result:One may perhaps wonder whether it would not be wise to give up the chase after such a will-o'-the-wisp as the 'state of nutrition' and consider other approaches to the problem. For example, free meals or milk or both might be made available for all school children from families where the per capita income falls below a certain level.At the end of all the discussions we are driven back to the advice which hon. Members behind me, whose educational experience is vast, have given to this House and the country for the last 20 years.
§ 4.55 P.m.
§ Mr. Graham White
I am in entire agreement with the right hon. Member for Keighley (Mr. Lees-Smith) as to the desirability of trying to look at this matter from a new perspective. The inquiries which have been directed to the subject of nutrition not only in this country but through the agency of the League of Nations and the International Labour Office, into the subject of the nutrition of workers, have made available a great fund of information and I feel that we are now able to pass from the realm of investigation and discussion into the field of action. What that action should be, its size and scope, is a matter which can be determined by Parliament at any time. I remember reading a valuable document on the policy of nutrition in which it was pointed out that if the problem is to be solved it might be solved immediately, because there is nothing in our knowledge of the problem to suggest that it will be more easily solved in two years' time, in ten years' or in 50 years' time. While there are at the present time many difficulties in the way of vast scale operations in the field of nutrition there are nevertheless fields in which it is necessary that this problem should be attacked.
My mind goes back to an important discussion in this House in June of last year, when the right hon. Member for Sparkbrook (Mr. Amery) made a powerful plea for the institution of family allowances, which he said would deal with the problem at the most vital point. Without question, it is the children and the families with the largest number of children who are called upon to bear the incidence of malnutrition in its most severe and devastating form. There is no question about that. The right hon.
1497 Member for Keighley has referred to an investigation in Liverpool. There was another investigation into the Merseyside conditions, and it was found that something like 25 per cent. of the children were suffering from malnutrition. A similar investigation was undertaken in Bristol, and showed that one child in every five, in the year 1937, a year of relative prosperity, was living in a home in which it was impossible for it to have a fair start in life. If we are looking for an immediate point of attack on this great problem it is undoubtedly in the direction of bringing relief to the children who are suffering most.
I do not wish to minimise what has been done already. The figures which have been produced as to the number of children getting free milk and school meals and for other selected portions of the population, show that a great deal of progressive work is still going on, but we must remember that at best this is a negative policy as it deals with selected people and groups of the population, and is always liable to interruption by school holidays and the like. We must have a policy which will ultimately create a condition in which malnutrition will be substantially impossible. That is the object at which we should all aim. Although there have been many inquiries into this subject I think there are possibly two things on which further inquiry would be valuable. One is an investigation embracing a census of production, because many of our efforts have undoubtedly been frittered away by ineffective or extravagant means of distribution which have kept prices at a level beyond the reach of many people.
It would be most illuminating if we could have an inquiry into the possible costs of the result of malnutrition. By that I mean a medical survey of the illnesses, diseases, and physical disabilities which are directly traceable to poverty and malnutrition. If such a calculation could be made, for what it is worth, it would focus the attention of the whole nation and perhaps enable us more quickly than anything else to look at the matter from a new perspective. In that direction we might well have inquiries made. I should like to see an attempt made not always to relate this problem to the minimum British Medical Association or any other minimum scale. I should like to see somebody make it its 1498 business to draw up what are considered proper scales of consumption—I mean not only for food but with regard to houses and clothes—reasonable and proper standards. Those are the standards, and not a minimum standard, to which we should direct out continuous efforts. That seems a better method of approach.
I should like to come back to one of my own cranks, if that is the way to describe them, and that is to appeal for the removal from the field of nutrition, as indeed from every other field of activity in the social services, of some of the administrative difficulties which stand in the way of the effective carrying out of the purposes of Parliament. It is a very important matter indeed that there should be a clear definition of the statutory functions of local education committees and the operations of the Unemployment Assistance Board. We had an inquiry on the Merseyside and we found that one in five of the members of the Board was in touch either with an education committee or with some other agency which had statutory functions to perform running concurrently with those of the Board. If there is a job to be done in giving effective assistance to the poor and helping those who are below the poverty line, the worst way in which you can do it is to let two authorities have concurrent powers and duties in the performance of the task.
If my hon. Friend will give attention to that matter he will be taking a step forward in seeing that the intentions of Parliament are effectively carried out. I know one district where there are 12 or 15 different authorities acting through the Education Department and other Departments, all charged with the duty of providing—and they do provide—meals for children, milk for children and expectant mothers, and other services of that kind. It hardly seems credible that it should be so, but I think that if there are 12 or 15 different authorities there are probably 15 different methods by which that help is given. I only need to state that to show what a cumbersome and an unfortunate method that is of dealing with this problem. Do not let us have too many cooks. Whatever else we do, it is at least possible for us to see that what we are doing is carried out in the most efficient and effective way.
I am tempted to refer to the major dilemma created by the fact that in the 1499 case of a very large number of applications for allowances, in probably 50 per cent. where there are more than three children in the family, the allowances approach very closely to the wages that they would normally earn if they were in employment. In the case of larger families there is a definite wages stop, which means that, although the Board is charged with the duty of giving assistance in meeting the needs, with the exception of the medical needs, of these families, there is a considerable number for which it is quite impossible for it to do that. That is a dilemma which can only be resolved by Parliament. As long as we have that dilemma it is impossible to avoid serious malnutrition in a large number of homes. There is a matter which Parliament might well decide to investigate and deal with. Lord Rushcliffe has asked for an investigation into the matter, and Sir William Beveridge, the chairman of the Statutory Committee under the Unemployment Insurance Acts, has associated himself with the request, and yet nothing is done. Perhaps it would more properly come under the Ministry of Labour, and I should be grateful if my hon. Friend would draw the attention of his colleague to this aspect of this very important matter in connection with nutrition.
In any house where the average wage is 10s. or less per head it is safe to assume that the children are suffering, and those who make these calculations with regard to food scales are apt to overlook the fact that the question of receipts per head does not apply only to food. Especially in the case of larger families it applies to everything that goes on in the house, such as the number of rooms and the amount of clothes. One unfortunate man said to me, "You have no idea how quickly the bed-clothes wear out when you have four children in the bed." The wastage of crockery and everything of that kind is multiplied to an enormous extent in these houses. We are living in serious times and we have many grave preoccupations, but this matter is a fundamental problem in these days when there is very great abundance in the world.
§ 5.10 p.m.
I agree with the last speaker that this is a fundamental problem and I suppose that no country ought to be more interested in it than this because, like all highly civilised countries, 1500 we have a low birth rate, and it is to our interest to preserve every child that is born. We are not like large Oriental countries which can afford to lose thousands of children. We cannot afford to lose any and we cannot afford to let any child grow up mal-nurtured.
Do not be ridiculous. I do not want to be interrupted to-day. I do not mind on any other day, but this is one of the subjects on which I feel most deeply and keenly. I have given most of my Parliamentary life to the subject of children. First and foremost I am interested in the children of our own country. I wish we could get up as much excitement about them as about children in some other countries. I do not understand how people can get so excited about children they have never seen when there are thousands in their own country who are mal-nurtured. So do not get me started on that. We have about 610,000 children born each year. Of these 25,000 are born dead and 55,687 die before they are 15. This is in spite of our great social efforts. I suppose there is no country in the world that spends more on social services than we do—£504,000,000. It is not the Government that I am getting at, but the country is apathetic. We do not need to rouse the Government so much. We have to rouse the whole country.
I do not believe the country realises that, in spite of the money that we spend on the social services, only half the local authorities have infant welfare centres. That surprises a great many people. Only a half of the children under two years attend a welfare centre, and very few of over two years. We have the problem of how to deal with children between two and five, and how to deal with the 16 per cent. of children who enter elementary schools with some small physical defect. We know that we have so many going to infant welfare centres and so-many to open-air nursery schools, but that leaves us with 1,500,000 who are untouched by anything. They come under no health authority of any sort. Our problem is how to prevent malnutrition among these children. I am certain that a great many people do not understand what malnutrition is. It is not hunger and it is not starvation. It is merely a 1501 lack of proper food, mainly in childhood. It comes partly from ignorance but mainly from poverty. We have to face that fact. [Interruption.] It is due partly to ignorance, but mainly to poverty. We must look at the matter from a scientific point of view and from the point of view of the country, for it is not in the interests of the country that any child should be mal-nurtured. If there is malnutrition, the country has to pay heavily for it later, for mal-nurtured children sooner or later come on to the State.
Milk, eggs, vegetables and fruit are absolutely essential to children. The right hon. Gentleman the Member for Keighley (Mr. Lees-Smith), in opening the Debate, referred to the condition of different types of children in the elementary schools, and drew a comparison between the condition of the children who come from poor homes and those who come from homes that are better off. We have found that the children who go from the nursery schools to the elementary schools are five pounds heavier and half an inch taller than children in the same area who have not had the advantage of proper food. The improvement that can be made in the condition of children as a result of proper nourishment is astounding. We have heard quotations from social surveys, and we must go on making those quotations. These social surveys show that millions of our people are below the poverty line. In Bristol 11 per cent. of the people live below the poverty line, in Merseyside 16 per cent., and in Plymouth, my own constituency, 16 per cent. Sir John Orr—that often-quoted man, although I wish that he was followed more—has said that in this country about 8,000,000 people have a diet that is below the British Medical Association's minimum standard—and that is a low minimum.
Malnutrition can never be tackled unless we can get rid of public apathy on the subject. I have quoted Sir John Orr; we hear him quoted in this House, but we do not hear enough about him outside. I do not think people have the slightest idea how much of the disease in this country could be prevented. I am more hopeful on this score now than I have ever been before, because we have a Minister of Health who understands children. It was he who introduced the milk-in-schools scheme. He really knows about the subject. We have a Parliamentary Secretary to the Board of Education who is deeply 1502 interested in the question. If these two Ministers, instead of defending what has gone on—although there is a very good, defence that they can make, because everybody knows that the social services are expanding and are splendid—would say to the House that something drastic has to be done, it would soon be done The Medical Research Council, in their last report, said something which is quite true:The cure of disease is always dramatic. There is nothing dramatic about the disappearance (that is, the prevention) of disease.There is a great deal of feeling on the: subject of cancer and certainly cancer is-a very tragic disease, but it is not half as-tragic as malnutrition, because it affects relatively so few people; yet the country has been roused on the subject of cancer, and a regular campaign has been started. It is a very different campaign that we want to have started. The Ministry of Health have been pretty vigorous, but not nearly vigorous enough. Certainly, the present Minister of Health realises the importance of milk, which is absolutely essential to children.
Far too little milk is drunk. Anybody who has looked into the matter knows that there are many reasons why more milk is not drunk. We must get over the prejudice against milk. One of the real difficulties is that children begin by never tasting milk; they are given tea, and once they have been given tea, many do not like milk. We have found that to be so in the open-air nursery schools. And we have to face the fact that once a child is started off on milk, that child does not want tea. Although there are 3,000,000 children drinking milk in the schools, the consumption of milk in schools is not increasing in the way that it ought to do. The children should be made to drink milk soon enough, so that they will not want anything more stimulating. The Hanna Dairy Research Institute carried out an investigation covering 13,000 children. About 52 percent. of the children did not drink milk at all; 84 per cent. took tea twice a day, and 50 percent. took tea three times a day. On the average, tea was taken nearly four times as frequently as milk. That is a very serious position, and the only way in which it can be remedied is by having an educational programme and by making milk available to every child.
§ Mr. Williams
On a point of Order, Mr. Deputy-Speaker. The Noble Lady was giving an account of an experiment and she did not give the results. I merely asked, quite courteously, what the result was. She then asked me to stick to my last, which she described as being drink and not milk; but I have no connection whatever, either directly or indirectly, with the sale or production of alcoholic liquor. May I suggest that the Noble Lady be asked to apologise?
§ Mr. Deputy-Speaker (Sir Dennis Herbert)
I think the incident might be allowed to pass. I do not think that either the hon. Member or his friends would consider that he was seriously insulted by the Noble Lady's remark.
§ Mr. Williams
Further to my point of Order. The Noble Lady has a practice of making offensive remarks to hon. Members which would not be tolerated from other hon. Members, and on that ground, I ask for your protection.
The figures which I have quoted are very alarming, especially when one considers that a number of those children have really not tasted milk. I want to ask the Government whether they will try an experiment with the "Oslo breakfast." It might be arranged by one of the local authorities—for instance, one of the Welsh local authorities, in an area where conditions, as we heard in the Debate yesterday, are so tragic. The experiment known as the "Oslo breakfast" has been a tremendous success in Norway. The Oslo breakfast has many advantages. It is given before the school work starts, and as it is a cold breakfast it needs no canteen or kitchen, and so is cheap. It is composed of a glass of milk, bread, margarine or butter, cheese, and some fruit. An experiment was made between children having this breakfast and others having a midday meal. The latter was not nearly 1504 so good in its effect on the children. It would be worth while for the Ministry of Health to get a local authority, for instance, in one of the Welsh areas where malnutrition is very bad, to try such an experiment. I am certain that the best way of meeting the problem of malnutrition is to do something dramatic.
Then, I want to ask my right hon. Friend whether he cannot increase the expenditure on the milk-in-schools scheme. At the present time, it costs about £500,000 a year, and covers about 3,000,000 children; that is to say, only about one-half of the elementary schoolchildren. If double the number of children took the milk, or if each child were given double the quantity, it would cost the Government only another £500,000. This would help the farmers, because it would mean that they would have to keep thousands more cows. It is a policy which ought to appeal not only to the Parliamentary Secretary to the Board of Education, but to the Minister of Agriculture. I ask the Government seriously to consider this suggestion. It is of no use telling me that there is not the money for this, because we are spending a great deal of money, although I claim that it is not being spent to the best advantage either of the children or the farmers. For instance, this year the wheat subsidy will be about £8,000,000, and the sugar beet subsidy £5,000,000. If a bit were taken from the wheat subsidy, and a bit from the sugar beet subsidy, and devoted to increasing the consumption of milk, it would directly benefit the children and the farmers, for the farmers would have to produce more milk. Another important thing is that safer milk is essential if people are to drink more milk. The ideal thing would be to have safe raw milk, but probably we shall not be able to get that in our lifetime. We have to make up our minds also to have pasteurised milk.
The risk of bovine tuberculosis is almost eradicated by pasteurisation. In Toronto, where pasteurisation has been compulsory since 1915, there is not a single case of bovine tuberculosis to be found, in spite of the fact that 25 per cent. of the raw milk contains tubercle bacilli. In the United States of America, in 500 towns, 99 per 1505 cent. of the milk was pasteurised, or from tubercle-free herds. In London, about 90 percent. of the milk is pasteurised, and milk-borne diseases have been almost abolished in London. We are bound to have pasteurised milk. There has been a great deal of opposition to the pasteurisation of milk, but pasteurised milk has been proved to be equally nourishing. It is essential that we should get rid of the fear about drinking milk, and the only way of doing that in our lifetime is to have the unsafe milk pasteurised. It has been tried in the United States of America with great success, and I hope the same thing will be done here. It is said that children should be given bread and sugar, but when people say that, they do not realise that those are energy foods and are not as healthy as milk. Children do not need energy foods as much as health protective foods. I see no way of giving these health foods to the children unless we have an entirely new policy.
There are 8,000,000 people living in conditions of poverty, and although it is not so important to get rid of the malnutrition of adults, it is essential that we should tackle the question among children. I wonder whether people realise what this malnutrition costs the country in sickness. Some maternal mortality is due to malnutrition. Rickets is increasing in this country, although it is a disease that could be prevented. In the open-air nursery schools we can guarantee that children who are in the most rickety condition at two years of age will be completely cured as a result of proper food and fresh air. Three years ago I knew of a case of a child who came to an open-air nursery school, suffering very badly from rickets. The doctor wanted the child to be taken to an orthopaedic hospital and to have an operation, but we begged the mother to allow the child to come to the nursery school for one year; and within a year and a half, that child was completely cured. Malnutrition has appalling and devastating effects, and a great deal of the sickness in the country is due to it. Sir George Newman, who was one of the greatest medical officers of health in the world, said that if we neglect the children between the ages of two and five, it is a seed plot which we shall neglect to our own cost.
I know that we cannot expect the Government to do what is necessary all at 1506 once but they should have a policy and we have offered them a policy. If they spent £2,000,000 a year for 10 years we could have open-air nursery schools—proper schools, both elementary and secondary, providing continued education. I do beg of the Government to consider that question. We have a policy worked out and we offer that policy to the Government. A 10 years' policy costing £2,000,000 a year would be very little to undertake, considering what we are spending already on wheat and sugar subsidies. It would be very little for a nation which spends as much as we do on other forms of drink than milk. It is rather terrible to think that as a nation we spend three times as much on intoxicating drink as on education, five times as much as on old-age pensions, three and a-half times as much as on bread, and nearly three times as much as on milk. The average expenditure on drink per head of the population is £512s. 9d. and we spend £119s. per head on milk. As to what we spend on gambling—my goodness. [Laughter.] It is very alarming, now that we are in such a serious position, and I think that as a nation we ought to wake up to the facts. The national expenditure on gambling to-day is £400,000,000, or an average of about £10 for each man, woman and child in the country.
How anybody can look at these facts and not be moved by such an appalling expenditure on things that do not matter, while at the same time we neglect our children who are the citizens of the future, I cannot understand. I am not a revolutionary, but I feel that whatever party we belong to we should look at this subject from a point of view entirely unprejudiced by party, and we ought to be behind the Government in trying to rouse the country to a sense of the seriousness of the position. It is no good saying that we can clear up the whole question of poverty. I doubt whether it will ever be cleared up in our day or indeed in any other day. Man being as he is, there will probably always be some who are better off than others. But we can clear up this question of malnutrition and I plead with the Government to get ahead with measures for dealing with it. I ask them not to look at what has been done or has been left undone elsewhere, but to get on with experiments such as the "Oslo breakfast" to double the quantity 1507 of milk supplied to the children, to go ahead progressively with the provision of school milk and school meals and have a nutrition policy for the children. Let them open up nursery schools, and even if they cannot do it all at once, a great deal can be done now. Let us try to make sure that every child, no matter where that child is born or what that child's parents are, shall be given proper nutrition. Let us make sure that no child is allowed to go through life a weakling because of preventible neglect and recognise that it is the duty of every human being who calls himself a Christian to see that the children are safeguarded.
§ Mr. H. G. Williams
On a point of Order. In the course of the Noble Lady's speech she made a remark which was very offensive to me personally and without warrant. I raised the matter at the time, but I understand that you, Mr. Deputy-Speaker, did not catch the nature of the Noble Lady's observations. I had asked her a perfectly legitimate question and her observation was to the effect that I should stick to my last—drink. That, clearly, is a most offensive observation which I think the Noble Lady ought to withdraw and, again, I ask for your protection, Mr. Deputy-Speaker.
§ Mr. Deputy-Speaker
I heard the Noble Lady saying to the hon. Member that he should stick to his last, but I did not hear the word "drink." She may have said it, but her remark did not strike me as a very serious accusation and I do not imagine that the Noble Lady meant anything seriously against the hon. Member's character or suggested that he was specially concerned with the drink trade. If that is so, I think we might very well let the matter pass.
The hon. Member came in and he was obviously not in the least interested in the subject, but he tried to be offensive. I said, "Stick to your last—drink." I did not mean to be offensive to him. I was only annoyed at him. If he wants to make me withdraw, I will withdraw for your sake, Mr. Deputy-Speaker, and for the hon. Member's sake too.
§ Mr. Williams
An apology ought to be an apology. If the Noble Lady does not desire to apologise handsomely, I would rather she did not apologise at all.
§ 5.37 p.m.
§ Mr. Ritson
After the controversy between two hon. Members of the same party, I think we may be allowed to continue the discussion on the subject of mulnutrition. I was struck by the remarks of my right hon. Friend who opened the Debate and who tried to get down to the basis of malnutrition by going into facts and figures of the Tuxford index and the results of various investigations. I was reminded of the fact that in Woolworths you can put a penny in the slot and a fairy will come out and tell your fortune. I think sometimes that in dealing with the care of the children we are inclined to begin our assessment from a mechanical standpoint instead of from the human standpoint. I agree with a great deal of what has been said by the Noble Lady who spoke last. I think there is no man or woman who will not admit that milk has the highest food value, and that the trouble in this country is that we cannot instil that fact into the parents. I live in a suburban area of Sunderland and when I pass by in the morning, the houses of people who earn salaries or wages of from £250 to £300 a year, I am struck by the fact that the milk bottles at the door are hardly bigger than egg cups—yet each of these represents the supply of milk for a whole family.
When I was comparatively poor I always felt that my first duty was to get as much milk into the house as I could. I assure the Noble Lady that my children started with milk. Their mother believed in milk and they got plenty of it—fresh and not pasteurised. That is where I disagree with the Noble Lady. I do not believe in half-boiled milk. I believe that by boiling it you kill the very soul of the milk. You kill the milk before you get to the germs. Give me tuberculin-tested milk in the raw state from a healthy cow and I am certain that children will get more value and more vigour out of it than out of the stuff which has been half boiled because that process is supposed to kill the germs. In dealing with this question of malnutrition we have to get down to food values and I would rather have my children educated in food values than in mathematics, because there is no use trying to put learning into a weakened and unhealthy body.
1509 My hon. Friend the Member for Spennymoor (Mr. Batey) will bear me out when I say that there are many thousands of children in Durham who are suffering from lack of the proper food. We heard about Wales yesterday, but we are in a very bad state in our county, and the conditions in the towns in Durham call for attention. The Noble Lady has been in Sunderland in connection with some branch of child welfare activity, and although she did not pay a very handsome compliment to the beauties of Sunderland, I suppose her presence there was a compliment to us and that she supplied the beauty. I am sure the Noble Lady is not the sort to take umbrage at references to herself, and while I disagree with her as to one part of her remarks, I agree with her on the importance of knowing food values, because of my own experience. Hon. Members may say that I am a very poor example, but they may be interested to know that at one period I was assured by many eminent medical men that I had not long to live. I adopted a sensible diet, and however miserable-looking I may be now, the important fact is that I have been almost 15 years longer here than anybody ever anticipated.
I have a great regard for the opinion of medical men, but there are other things to be taken into consideration, and I would like the Noble Lady and also our education authorities to take this into consideration. Nobody knows better the kind of food which the child ought to get than the mother. An important factor is that different types of children require different types of food. I have experience as the father of a family and I know that some article of food which would upset Mary, might be of great value to Jane. I know men, some of the strongest men I have ever met, who could eat almost anything except eggs, but if you offered them eggs they would turn green. What applies to the adults applies also to the children, and if diet has been of such benefit to an old horse like me, surely it would be of much greater benefit to young children. But it is the mother who knows best the type of food which is suited to each member of the family. We may call in the experts, but there is no greater expert in food values, when you give her the money with which to buy the food, than the mother.
1510 I have no sympathy with people who try to make capital out of some personal horror in which they have shared, but I must recall some of my own experiences in my earlier days. We lived in a house in which we had two bedrooms, no back door, no sanitation outside, and no through draught. What saved us when we were living under such conditions was the food that we had. It was because the mother knew the value of certain foods to certain members of the family that we were brought up at least in reasonable expectation of a fairly long life. We have been told to-day that the Medical Association say that six shillings ahead is only a bare minimum on which to provide food. If that is the case, what of the Durham miner to-day earning 7s. a day on five days a week with a family of five or six? I do not know where he comes in. We are all proud of the Union Jack as a symbol and we claim to be the proudest and strongest people in the world. When the next war comes—and we are all praying that it will never come—and our men have to go abroad again to defend their nation, I believe you will find there are more C3 men in this country than there were even in 1914. I agree with the Noble Lady that some children do not like milk, but once a child begins to get an appetite for milk, for pure milk, it is not only beneficial to itself, but it is beneficial also to the great industry of farming. Where the Noble Lady and I fall out is with regard to the difference between the semi-boiled, soft stuff that she favours and the real, raw material that the cow produces. If God had intended us to have pasteurised milk, He would have heated the cows at birth and kept them hot, but He did not.
Apart from milk, we need fresh air, and I do hope we are not going to neglect that matter, because no man can breed an animal, let alone a human being, even if it is fed on the best things, if there is not good air for it to breathe. When I was working in the pit I could get food to go down the pit with, but I could not get the oxygen to keep me running while I was in the pit, and the same argument applies to fresh air for the children in the schools. May I say a word here to the Parliamentary Secretary to the Board of Education? I hope he will get us some better schools, because it is of little use parents doing their best, with windows 1511 open at night, to give their children all the oxygen they can, and all the fresh air and walks they can, if then they have to send those children to miserable schools such as I have seen in Durham. I remember that in 1918 the vicar would not allow me to go and speak in the school on politics for fear that I should upset it, but it would really have been a good job if I had blown the place to pieces. It stank. It was the most miserably damp place I ever saw, and it could give neither spiritual urge nor educational urge to any child in it.
However healthy a child's home may be, and however well fed the child may be, sitting in a damp rotten school more than counteracts everything that that child's parents try to do for it in the way of health. It is essential that the children should be sent to the right kind of school, especially if they come from slum areas. In some of the schools that are now being erected in Durham they have playgrounds, and flowers, and plants, and trees, and beauty, and beautiful passages, well aired, with the sun nearly all round them. I went to a school that the sun never entered at all. It could not, but it can in these newer schools that are being erected, and I want to press on the Minister of Education that he should give children the opportunity, when they go to school, not only to breathe the best air, but to have the sunlight and cheerfulness. If he does that, I will give him a guarantee that his record of examinations will improve immensely. It is possible to improve the child, it is possible to kill malnutrition, and we must not forget the mother who is going to bear the child. We must not let her wait until the child is of school age before she has good milk to drink.
I will give an example of what can be done. I was on the Sunderland Town Council for many years, and while I take no credit for this, what happened was that immediately after the War there were lots of huts left on the seashore, and someone had a great idea and suggested that we might make a holiday camp there for the slum children. After a big fight, and after the reactionaries had had their say, we carried it and arranged to have the children there in turns for a fortnight out of the schools. We gave them good food, and in the summer time they went straight out of the huts into the sea for 1512 a bathe. Many of them had never had a bath before. There was comradeship there, and they were under the charge of teachers, and those children in 14 days put on 3 lbs. in weight, on the average. If that could be done in a fortnight, what could not be done if we laid ourselves out to do it in a real common sense way?
I wish we could give more opportunities to the child when he is out of school to get the fresh air that he ought to have. I am on a committee now that is dealing with a Bill to provide better access to mountains. I want the children to have access to everything there is, as far as the opportunity can be given them. I had some children to take out into the sun on one occasion through the kindness of a gentleman of good will. They had never seen the country before. We took them on to the Pennine Range, and there were some bilberries there. They had never seen bilberries growing wild before, and we could not get them away from them. They were out on the hills gathering the bilberries, and in three weeks they came back, T.B. cases as they were, renewed with hope and strength and vigour.
I hope we shall not take too narrow a view of the matter when we talk about nutrition, but that we shall include in our proposals access to all places where children can get the air, the strength, and the vigour that they need, and that we need as a nation. Let us begin with the children and give them spiritual urge, and insight, and moral force, that will more than pay for anything we lose in the way of the expense. I ask the Minister of Health, whose record in Scotland, I believe, was high, to look into this matter. I disagree that it was he who started the milk campaign. I think it was my right hon. Friend the Member for West Stirling (Mr. Johnston), but I am sure he is big enough to admit that he is prepared to share the honours in trying to develop his own country in this particular respect. I wish we could get on this question the spirit that we get on a Scottish night in this House. Scottish Members never differ on anything when it is a question of getting something out of England, and I wish we could get that spirit here on this question to-night. I do hope the Minister will give us the support that we want.
§ 5.54 p.m.
§ Mrs. Tate
The figures which we have of the number of children who enter our 1513 schools with some physical defect must give rise to very serious concern throughout the country, and I think it is a question which should be studied from every angle. We all know the tremendous amount of work that has been done by the Noble Lady the Member for the Sutton Division (Viscountess Astor) towards the encouragement of nursery schools, and I hope that the growth of these schools will continue all over the country. We are spending and losing a tremendous amount of money on ill-health, and I feel that the time has come to save that money and to spend more on constructive measures to prevent illness. The other day we granted sums in this House for the treatment of cancer. I feel that had we granted long ago sums for the building-up of good health and for the prevention of disease, we should have been doing our country a greater service. We have our children medically inspected in school, but I wonder whether it would not be better now to institute a service for all children to be medically inspected once a year. I wish that we could also have some clearing house where the knowledge gained in welfare centres as to the diseases from which children mostly suffer could be correlated and effective measures taken to prevent them. It is at the present time considered quite a normal thing for measles and other infectious diseases to run through a school almost annually, and I do not think sufficient measures are taken to prevent children attending school when they show the first signs of cold or of disease. Now that we are taking children by bus to our central schools, particularly in the country areas, I think there is a certain increase in the spread of infection and that that is a matter which should be inquired into.
Wonderful as are the measures which are taken to give the children milk, I do not consider that they are adequate. We are hearing to-day a great deal about the desirability of holiday camps. I should like to see it made possible for every child in the country to have at least a fortnight every year in a holiday camp. I believe that that would be one of the most effective means of teaching the children to like healthy food. The Noble Lady has said that a great many children dislike milk, and that is quite true, but let us not hide from ourselves the fact that in certain areas the housing conditions are so bad, with regard to the 1514 possibility of the storage of food, that it is almost impossible to keep fresh milk, and the children are fed on tinned milk because of that difficulty of storing fresh milk. To-day, when we hope to see many more of our children kept at school for an extra year, the time has come to give better instruction, particularly to girls, not only in domestic subjects, but in the dietetic values of food. I very much regret—and I wish the Minister of Health would give me his attention for a moment.
§ Mrs. Tate
It is regrettable that in this country equal attention is given to the teaching of cookery and the teaching of laundry. They are very often taught in the same room, and very often the same amount of time is given to the teaching of the two subjects, whereas they are not of equal value. I think that the cookery appliances which are used in the schools are very often not such as to give the children the full opportunity for benefiting from the knowledge gained when they have to cook in their own homes.
The Noble Lady has stressed the importance, in the interests of health, of the pasteurisation of milk. I am very anxious to see more milk drunk by our children, but I do not want any of it pasteurised. I know that the Noble Lady and the hon. Member for St. Albans (Sir F. Fremantle) advocate the pasteurisation of milk because of their tremendous anxiety concerning the incidence and the suffering caused by bovine tuberculosis. I hope we shall not begin to combat that scourge at the wrong end by pasteurising milk. Milk is a vital food and contains vitamins and hormones. No one knows how many of these are destroyed by pasteurising the milk. We want milk free from germs produced by herds which are free from disease, and we are less likely to achieve that if we think we can do away with all the germs by simply boiling the milk.
Certain experiments have been carried out lately on rats to try and prove that pasteurised milk has no ultimate effect on, for instance, the breeding capacity of rats. These experiments are in the main of no value whatever, for the reason that pasteurised or unpasteurised milk cannot be given to 1515 a rat until it is four weeks old. Rats are fed on their mother's milk for four weeks for obvious reasons. Therefore, in their childhood they are having unpasteurised milk which entirely nullifies the value of any experiment upon them from a scientific point of view. Certain experiments have been carried out on calves, but no experiment which is carried out on any animal as to the value of pasteurised or unpasteurised milk is scientific if the pasteurised milk was bought from a commercial plant, because no one can prove whether such milk was or was not genuinely pasteurised. No experiment is of any value unless the milk is pasteurised where experiment is made, and no experiment with regard to the value of pasteurised or unpasteurised milk is of the smallest value unless the health of the animal experimented upon is investigated from every possible angle and not simply as to whether or no it is able to reproduce its species. It is not always the healthiest human being who is the most prolific. The animal's resistance to disease, too, should be tested. No satisfactory experiments on these lines have been carried out. We should try to rid our herds of disease by some constructive method. It is tragic that this country has not followed the example of Northern Ireland and attempted to make the Spahlinger vaccine available to the community. It could wipe out this disease in animals, and if it were used tuberculosis could very soon be wiped out of the world altogether.
I urge that a larger number of children should be medically inspected at an earlier age; that the knowledge gained should be centralised and used for the good of the whole community; that a larger number of children should be given an annual holiday in those camps which we have probably got to form for air-raid precautions, if for no other reason; and that cooking and dietetic values should be better taught in our schools. It may be said that every one could understand good cooking if they only had the money to spend on food, but English women are in the main exceedingly ignorant concerning cookery—[HON. MEMBERS: "Absolute nonsense!"] It is no good saying it is absolute nonsense. We have many national virtues, but we have many national failings, and a real knowledge of cookery and the best methods of utilising every portion of our joints and 1516 of our own food products is not one of the virtues of this country. [Interruption.] It is no good the hon. Member trying to get class conscious. There is bad cooking in almost 80 per cent. of every class of home in this country, and there is a great deal of ignorance, not only on how to cook food, but how to serve it when cooked. We are all here to-day wishing to improve the health of our country, and a real knowledge of cookery and dietetics would sensibly assist us on our way.
I want to urge on the Parliamentary Secretary to the Board of Education the importance of speeding up the improvement of our school buildings. For instance, in a school in my constituency, in the village of Pensford, there have been repeated applications to the county council for the installation of electric lighting. The electric cable is only 50 feet away, but the children are working by the light of oil lamps. The Minister will find on investigation that the proportion of children attending that school who are obliged to wear glasses is very high. That sort of thing should not be allowed to continue. It is a false economy if excused on the score of cost. The expense of installing electricity is surely nothing compared with the expense of allowing the children to grow up with some permanent disability of eyesight. I hope my hon. Friend will have that looked into at an early date.
§ 6.7 p.m.
§ Dr. Haden Guest
I want to direct attention for a moment away from the child population to the general adult population, because it is well known that something like 10 per cent. of the population of this country are living in bad conditions which include bad nutrition. Their housing is bad, their food conditions are bad, and their working conditions, especially their hours of work, are bad. It is, of course, out of the family of those people that we get the worse examples of bad child nutrition and a large proportion of tuberculosis and other illnesses. The hon. Member for South Croydon (Mr. H. G. Williams), who intervened earlier in the Debate, will perhaps be interested to know that the total cost of illness in this country, medical and surgical costs, is something like £300,000,000, of which at least one-half is to be attributed to some form or other 1517 of malnutrition. It is well worth while trying to avoid this extraordinary wastage of life force. It recently came to my attention that in another country with which we are much concerned in foreign politics at the present time, they are not neglecting the nutrition of the lowest 10 per cent. of the population. I understand that in Germany considerable attention is being given from a realistic, and perhaps even a militaristic point of view, to the nutrition of the lowest 10 per cent. of the population. My authority for that statement is Sir John Orr, whose name has frequently been quoted in the Debate, who recently paid a visit to Germany and gave me that information when he came back.
I want to devote the remainder of what I have to say to the question of children, and especially school children and their nutrition, because I was for many years one of the consulting school medical officers of the London County Council, and I did a large amount of work in connection with the feeding experiments before the Great War in London. Indeed,. I carried out the first experiment. I would say, in agreement with what has been said by various speakers, that the idea that you can set up an absolute standard, a clinical standard, of nutrition, is a pure illusion. You cannot do it. It was the habit when I was one of the school medical staff for all of us from different parts of London to meet together in a conference at County Hall under the chairmanship of our chief. We there compared the criteria which we were applying in all matters of school medical inspections in regard to teeth, enlarged tonsils, anaemia,, and so forth. It was always found that our criteria were different because all of us were working in particular areas and therefore we accepted the conditions in our particular area as the criteria and the norm. It is impossible to avoid that unless you have an objective criterion, that is to say, for instance, a colour range of blood, and you test the colour of the blood of each child by comparing it with such a colour scheme. Only in such an objective way could you make definite comparisons. That particular operation, however, would be impossible.
We cannot make, in the conditions of ordinary medical inspection of children, all the elaborate inquiries which would be 1518 necessary to set up a definite standard. The only way to set up a standard is to have a reasonable common-sense standard. I suggest we should abandon once and for all the idea of attempting to estimate the precise point at which a child becomes under-nourished, but to set out as a matter of course to see that every child gets adequate nutrition. We want to have an optimum condition of nutrition and not a minimum condition. It has been pointed out that if we wait, as certain education authorities do, until signs of definite malnutrition show themselves, the child gets into a condition from which it will take some time to recover. It has got into a condition of illness and we ought not to allow that to happen. References have been made to the standards of the amount of money that ought to be spent on food, and my right hon. Friend on the Front Bench referred in particular to the British Medical Association standard. That standard has often been misunderstood. It arose because the Ministry of Health produced a standard of what they thought was necessary to spend on food to give a minimum standard of nutrition. The British Medical Association, representing the medical profession in the country, did not agree—[Interruption.] Do I understand that the hon. Member for South Croydon does not agree that the British Medical Association represents the medical profession?
The register of the British Medical Association for National Service purposes contains 95 percent. of the medical profession. I do hot know whether the hon. Gentleman wants a higher percentage than that. I was saying, when the hon. Gentleman gave one of his characteristic interruptions, that the Ministry of Health standard was intended to be a standard of the bare minimum on which it was possible for people to live. It is a very low standard. It is not the standard which the British Medical Association regard as desirable. It is the barest minimum on which existence can be maintained and it depends on prices, which vary from time to time. It is not a desirable, but is a minimum standard. The standard of Sir John Orr is a different one altogether. He estimated the amount of income 1519 which a family would require to have per head, paying a normal proportion for rent and so on, out of which they would be able to get an adequate amount of food—a quite different state of things.
I suggest that the only useful way to look at the problem of the nutrition of the children of the nation as a whole is for each of us to look at that problem precisely as we should look at the problem of the feeding and nutrition of children in our own families, and that we should see to it that they get a diet which is really completely satisfactory. Many hon. Members have said that everyone agrees as to the value of good nutrition for children. The hon. Member for Frome (Mrs. Tate) said that. I was glad to hear it from her, but I can assure her that it was not always the case. Not so many years ago it was thought that children of the working class required much less food than the children of the middle and the upper classes. I see that the hon. Lady expresses dissent.
I am glad that it was not within the hon. Lady's experience, but the idea that the children of the working class require less food than the children of other classes was very prevalent indeed in London. As a member of a committee conducting a food experiment in London I recall a lady who, when I presented the actual schedule of the food to be given to children, said "Oh, this is much too much, Dr. Guest." I asked, "But why? It is the food I should give to my own children. "She said," Oh, but our children"—she was kind enough to include me in her class—"require so much more than their children." That was literally said and was understood by a woman of position, a woman of importance, a woman doing a lot of very useful work, and it did represent a point of view which, I am afraid, is not quite extinct even at the present time.
The real difficulty about the nutrition of children is that we will insist on looking at it from the standpoint of what is the minimum of food on which they can make progress. We know quite well that 25 percent. of the nation's children live in homes where the income is under 10s. per head and where, consequently, the diet is, on 1520 the authority of Sir John Orr — and with him agree the other authorities who are advisers of the Government—deficient in every constituent. It is simply ridiculous that we should allow 25 per cent. of the children of the nation to be growing up under those conditions. There is no excuse for it at all. It is very bad economy. It is extraordinarily wasteful, because it costs us immense sums of money in hospitals, it costs us immense sums in loss of working capacity, and immense sums in the actual shortening of life. What we ought to consider is how to provide the amount of food required for the child population. Let me put it from that point of view. I will read an extract from a document:If the nation is going to deal with milk it must think of the 6,000,000 school children and the 3,500,000 children of pre-school age and pregnant and nursing mothers. According to the recommendations of the Committee on Nutrition set up by the Government, the consumption of milk by children should be 1½pints and by mothers 2 pints a day. To enable us to consume this amount of milk we would need to increase the dairy herds of this country by 33⅓percent. and have all the milk consumed as liquid milk. Under the present scheme the price of liquid milk has been raised, but the liquid milk subsidises manufactured milk, with the result that milk for luxuries such as the making of chocolates which are sold at 4s. per pound can be bought for 9d. a gallon and liquid milk cannot be sold for less than 2s. a gallon, and the price is rising.Since that letter was written the price has very considerably gone up. I read that, and did not express that view in my own words, because it happens that it is an extract from a letter to me written by, perhaps, the greatest authority on milk in this country, namely, Sir John Orr, and the point about it is this: If we make up our minds to supply the necessary amount of milk to give children proper nutrition we shall need, in order to do that, another enormous number of dairy cattle, an increase, probably, up to 33⅓ percent., which will mean that we shall put the fanning industry on to its feet once again.
No, Sir. The hon. Member can make his own speech afterwards. I do not propose to give way. It is quite possible to do that, it is quite reasonable to do that, and it would result in an immense increase of physical vigour for the nation as a whole and an immense improvement in the farming industry, and 1521 it is a thing which can be done. It would certainly need a subsidy, need a considerable amount of money. The amount which I have myself estimated might be required in the first instance would be something in the nature of £20,000,000 a year, but if by spending £20,000,000 a year we could save, in the incidence of tuberculosis and other illnesses, something like £100,000,000, as we should easily do, it would be a bargain very well worth making, and we should have a population whose physical condition was very much improved.
There is, however, another point. It seems to me that it is time we gave up boggling about which children shall have milk in schools and which children shall not, and which children shall have meals and which children shall not have meals. It is a waste of time, and it often involves expensive apparatus, to make the inquiries, and it prevents the children having food. I do not propose to quote a large number of figures, but all over the country, practically speaking, there are very large numbers of children who, because of their nutrition, ought to have milk and do not get it by reason of existing administration conditions. I would suggest, especially in view of some of the revelations which came up yesterday in the Debate on tuberculosis in Wales, that we ought to see that every rural school provides a half-pint of milk for every child and provides a solid meal for that child in the middle of the day. It might be paid for by those who could afford it, but they should not be asked to pay for it unless they came over the income limit of 10s. per head in the family. I believe it would pay the country handsomely in cash, and pay very much more otherwise, if every elementary school provided a mid-day meal free for all the children. Those from families whose incomes were over the 10s. per head limit should be asked to pay afterwards, but there should be no difference whatsoever between one class of children and another. But I do not want to put my point in any more detail. I think I have made the point fairly clear.
I would ask the Minister one question with regard to the expenditure upon milk in schools. During the Debate upon the Milk (Extension and Amendment) Bill on 4th July last year, the Minister of Agriculture said: 1522In the meantime the Bill proposes that for those purposes"—that is the milk-in-schools scheme—the limit of the total Exchequer grant available should be increased to £750,000, that is to say,£250,000 more than the £5,00,000 which in past years has been made available and this will allow for the payment of grants for the maternity and child welfare milk schemes as well as for the various extensions of the milk-in-schools scheme which are contemplated."— [OFFICIAL REPORT, 4th July, 1938; col. 117, Vol. 338.]I have received to-day a communication which has seriously perturbed me, because on very good authority I am informed that none of that extra £250,000 has been spent, and in view of the very serious conditions of malnutrition among children in the country as a whole I want to know from the Minister whether it is a fact that any money has been spent which is additional to the £500,000, and how much, because if it is a fact, as I am informed upon good authority, that that money has not been spent, I think the Government will be hard put to it to justify their position in view of the condition of malnutrition in this country.
§ 6.25 p.m.
§ Mr. H. G. Williams
I am not quite clear why the hon. Member for North Islington (Dr. Guest) was so terribly indignant when I sought to ask him quite a simple question, and declared almost with violence that he would not give way. Everybody seems to think that everything said by somebody called Sir John Orr, who, I think, comes from Aberdeen, is necessarily the only thing to be said on this subject. The hon. Member, as a doctor, was quoting from the gentleman from Aberdeen how many school-children there were, and as the number of school-children has a quite specific bearing on the point he was making, his calculation as to the number of additional milch cows, and it seemed to me that his figure was an over-statement, I thought there would be no harm in slipping in the question at that moment, but he was so very indignant that I was deprived of asking him when he was in his full flight of calculation. If he looks at this year's Estimates of the Board of Education, which can be obtained from the Vote Office—
§ Mr. Williams
—and then studies them, he will find there has been a very large fall in the school population. He will 1523 find the estimate of the number of children in average attendance, and, later in the book, will find an estimate of the number of children in the secondary schools, and if he will add those figures together, making a certain allowance for the fact that they represent average attendance figures, and add a bit for Scotland, he will get a total which, I think, he will find is substantially less than 6,000,000, probably about 5,600,000. Therefore, the number of cows would have to be modified. If he had been less indignant at the time he might have been saved what, I think, was a certain error in arithmetic.
One good thing he did say was that there was no clinical standard of nutrition. I am glad he said that. I think there is more nonsense talked about nutrition by the experts than almost any other subject. When I was Member of Parliament for Reading I represented the place where, I believe, they discovered vitamins—however one chooses to pronounce it. Nobody has ever seen those pretty things, but they are said to have marvellous effects. I think they have now got to the letter "E" in describing them, and vitamin "E" is supposed to be the most interesting of the lot. Most learned things are said about them, and anybody now inventing a patent food makes reference to its vitamin value and produces certificates. Whether it is all true goodness alone knows, but I have always been inclined to disbelieve those people who lay the law down and I do not believe all that Sir John Orr says. I think it was Lord Stamp who made the calculation, which no one has challenged, that, broadly speaking, the purchasing power of working-class incomes to-day is about four times as great as it was at the time of the Battle of Waterloo. It is a very remarkable change. The right hon. Member for Bow and Bromley (Mr. Lansbury), who has been a long time in this world, and still looks well, can recollect even better than I can the perfectly amazing changes within his lifetime and my own. The statisticians can give us some indication of the progress that has been made, and we need not argue about it, but people did not all die of malnutrition round about 1815, when the average income of their families, as tested by purchasing power, was about a quarter of what the average is now. That is a fact about which we do not want any 1524 doctor to tell us. How did those people survive when their incomes were so tiny, according to modern standards? They were able to bring up larger families than people do to-day. True, there was a heavy toll of mortality; nevertheless, a great many of them survived.
That rather leads me to believe that what is wrong is not necessarily the amount of money available for food, but the way in which we use it. Hon. Members opposite say that poverty is responsible for a large percentage of the trouble, but I do not believe that is true. If it were, this country would not have any population in it. The population would have died 150 years ago. The Noble Lady—I am sorry that she has gone out, because there were certain remarks in her speech on which I should like to comment—seems to believe that if people only had the right food and ran about a lot in the fresh air they would never get rickets. I wish that were true, but it is not true. A substantial number of people on whom every care is lavished, and where there is no shortage of the wherewithal to buy all the things that are deemed necessary, do, nevertheless, develop rickets. Later in the Debate my hon. Friend the Member for St. Albans (Sir F. Fremantle), who is an expert in these matters, will no doubt be able to furnish some information on this point. I am thinking of a case of certain people; every modern thought was applied to their feeding, but they developed rickets. The cure was treatment with artificial sunlight; a series of doses of that is very often far more effective than all these attempts at cure by nutrition. Then we have the experts saying: "You want so much of this and so much of that." They all seem to measure food values in calories, but, after all, that is not a measure of food value, but a measure of energy. Yet we find that of two children fed alike and living in the same house one prospers under the diet and the other does not. I am, therefore, not in the least impressed when people bring me elaborate scales and say: "This will produce the result and the other will not," because my day-to-day experience proves to me that many of those assertions are unfounded. We want a good deal more information, and we should not be too much impressed by the experts.
1525 Let us take two simple cases of disease in which there has been a vast improvement. It is very interesting to get the Registrar-General's report on births, deaths and marriages and to look at the summary tables in which he furnishes statistics over a long period of years. If hon. Members examine the statistics of infantile mortality they will be very surprised. They will find that round about 1846, when these statistics were first collected on a proper basis, and up to the year 1900, there was no improvement. Infantile mortality rose, if anything, and in 1900 reached almost its highest level of 156 deaths per 1,000 births under the age of one year. That was a terrible toll. The year 1900 saw the beginning of an improvement which became rather rapid about 10 years later. Those who have studied the figures quarter by quarter—this argument all has a bearing on food, and although it may appear I am getting away from the subject, I am not—find that the third quarter of the year was always a period of tragedy. Every summer enormous number of children died from infantile diarrhoea, due to food being affected in some way by the climate conditions.
In the year 1911, if my memory serves me aright, we had the first hot year in which the customary epidemic of infantile diarrhoea did not occur, and it has never occurred since. I have asked a great many medical men why that is so, but I have had no substantial and satisfactory explanation. I believe that the most probable explanation is that the coming of the motor car has been almost entirely responsible, because it has resulted in the elimination of horse dung from the streets. Horse dung was a breeding ground for flies which in turn infected the food, and its disappearance was a most important factor. To-day the road is a comparatively antiseptic place. Products from the running of a car act as disinfectants upon the road, and therefore, instead of flies walking in dirt, in a clinical sense, they walk on roads which are relatively antiseptic. There has never been any investigation of the cause of that vast improvement in the incidence of infantile diarrhoea, which dropped from 156 to something under 60 per 1,000 births. It is good to find out why things have improved; if you can find the cause of an improvement in one direction you may 1526 be able to bring about improvement in another.
Some reference was made by the Noble Lady to maternal mortality. This is a subject to which the Prime Minister attaches the utmost importance. I well remember his great speech in February—I think it was 1928—when he introduced the Local Government Bill. He referred to the importance of increased grants in the hope that the terrible toll of maternal mortality might be reduced. He recounted the fact that he had been a victim of it. I think his own mother died when he was born. By a curious chance, or because of it, a tremendous change has come over the situation. It may be the result of better feeding and treatment, but I doubt it, because the big fall in the general causes of maternal mortality has been in septicaemia—which is only dirt writ large in the medical sense. It has dropped by half in the last 10 years. An amazing change has come about. Is that a result of pre-natal attention, of special food given to the mothers, or of the more exact care given at the time of birth, regarding the birth of a child as an operation which ought to be accompanied by all the precautions which are taken when an ordinary operation happens in a nursing home? I do not know the reason. Let us find out the causes of our progress. Here we have two very remarkable cases, both of which may be attributed to better nutrition or to other causes. I would like us to investigate the causes of virtue and not be always studying the causes of vice.
The Noble Lady was telling us a story, and she was asked a simple question which provoked a good deal of wrath on her part. She was telling of some dairy that conducted an experiment in relation to 13,000 children. I never got to the end of the experiment, but it appeared to show that some children drank tea twice, some three times and some four times a day. What the result was I did not learn. I think a great deal too much tea is drunk. As a small boy I used to spend a lot of time in North Wales, where some of my relatives were, and there tea was an accursed drug. They would put the tea into the pot the first thing in the morning and fill the pot up periodically with more hot water, and the tea was never cleared out. What they got inside them towards the end of the day I do not know. I am in favour of proper nutri- 1527 tion and sensible feeding, but we cannot shove it down people's throats. As a boy I intensely disliked eggs and milk, but now I like them both, and perhaps I might drink more milk than I do. I find it very refreshing and interesting. There are many people who dislike certain kinds of food, and therefore I do not think you can do much good by setting up rigid standards and trying to force everybody into the same habits. There is the old phrase that a little bit of what you like does you a lot of good, and I think there is a good deal in it.
A curious thing about milk is that animals do not instinctively drink it. I remember the story of the man who had a tame lion and asked his friend to pet it, saying, "It is all right, it was brought up on milk." The friend declined, saying: "So was I, but I eat meat now. "If you watch animals, you find it is the rarest possible thing that the adult animal drinks milk. You may find a badly brought up calf still sucking, but it is usually somebody else's mother. The only animal I know that lives on milk is the cat, and it has been led into that habit, good or bad, by human beings. One of the strangest things is this dislike which human beings have for particular foodstuffs. I am one of the people who have an abomination for tomatoes, although I believe they are a most healthy food. I find that my children revel in them, but it is no use their dictating to me that I must eat tomatoes and my dictating to them about the things which they dislike. We have to take account, to a much greater extent than we do, of the chemistry of the human body, which is a very mysterious thing, and of which we are now very greatly in ignorance. In some mysterious way human beings differ from each other, but why that should be is almost inexplicable. I am satisfied that we want a great deal more investigation and information about these things than we have yet had.
I would make an appeal that we should try to find out what has been the causes of some of the very remarkable advances that have taken place. I have mentioned infantile mortality and the dramatic fall in maternal mortality from septicaemia. I would also draw attention to the amazing results in respect of tuberculosis, and even in this case the reasons are not apparent. There is a lack of uniformity 1528 from district to district which is very striking. Some causes are suggested which are more apparent than real, when you consider the smaller birth-rate, the higher average age of the population and the proportion of the population which is exposed to the disease, and which is probably less than it was 50 years ago. The proportion of the population exposed to cancer is, on the other hand, higher than it was. One factor appears to have gone up more than the other. Nevertheless great progress has been made in certain directions, and I believe there should be more inquiry into the causes of the progress that has been made, so that the lessons we might learn could be applied in other directions.
§ 6.43 p.m.
§ Mr. Ridley
The hon. Member for South Croydon (Mr. H. G. Williams) is in such a mood of modest inquiry this afternoon as to be hardly recognisable. I am sure that hon. Members have never heard him confess so many times in one speech his absence of information about so many things. I suppose he had an objective and a purpose in his speech. I suppose there was a point at which he was driving, but I confess that I am entirely mystified by it and have not succeeded in discovering it. He, apparently, was trying to persuade the rest of the House—he would do so with more difficulty than he would persuade himself—that the present position is relatively more satisfactory than we think it is, and that all that is needed is a great deal more scientific inquiry and not more food. This afternoon we are discussing a very serious question, to which the House ought to give more frequent attention. It appears to be too little conscious of the gravity of the subject. The hon. Member professes not to be able to discover any reason for the very welcome fall in the incidence of certain major diseases in the last 30 or 40 years. His experience is a great deal longer than mine, and he must know that one of the major reasons has been—I hesitate to say this, but to state my case accurately I must say it—the building up in the last 30 or 35 years of a great social service system in the teeth of the fiercest opposition from his political friends. May I relate a personal experience? I went to the Library a year or so ago to read the Debates in connection with the Necessitous Feeding Act of 1906. I am sorry that the 1529 right hon. Gentleman the Member for North Cornwall (Sir F. Acland) is not here at the moment, because he was a member of the Committee. That Measure was designed to feed, at the expense of a ½d. rate, the necessitous child; and the child had to be an almost starving child to come within that definition. The opposition to it was led by Sir Frederick Banbury, who said that this modest Bill would lead to a terrific production of children, that it would lead to improvident marriages on the part of young persons of 19 and 20, and that it was a deliberate incitement to the working classes to spend their money on drink. That class view still persists over a very wide area, especially in local administration.
In my view, this question can be simplified. Malnutrition is entirely a matter of money. I remember my hon. Friend the Member for Hemsworth (Mr. G. Griffiths), in an interruption during a speech of the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) some time ago, putting the whole philosophy of an economic text-book into one phrase: "If you will give us the money to buy them, we will buy all the eggs your hens can lay." That is all the truth that we need to search for in considering this grave question of malnutrition. In these Debates about malnutrition, school feeding, unemployment, and so on, I am not influenced by statistics. I think there is a too ready disposition to be converted by statistics. It may be a matter of some satisfaction to the House as a whole, and to the Minister of Labour in particular, that the unemployment figures in a given week have fallen from 2,000,000 to 1,900,000, but it is small satisfaction to the man who has not found a job, who has been searching for a job for 10 years, to know that someone else has got one.
We must face the simple inescapable fact, over which this House has a direct control and for which it has a direct responsibility, that we are condemning at this moment, by the inadequacy of unemployment benefit and unemployment assistance, 6,000,000 people to live a substandard life, a life in which they are constantly denied a sufficient satisfaction of all their material needs. It seems to me that, in the case of the unemployed man, we do this in the most diabolical fashion. We say to him, "For the first 1530 six months, for yourself, your wife and your child, there will be 29s. a week. We know that you cannot live on it, that you cannot buy enough food, that your sheets and saucepans will wear out and you will not be able to replace them; but that is the best we can do." After six months we say to him "You have come to the end of your statutory benefit. We know that your home is there, and that for six months you have been out of work, and you might suppose that in those circumstances we should improve your conditions. Not at all. You have a nasty packet coming to you; you have the means test. You will have less money; you will be able to buy less food; you will have an even smaller opportunity of satisfying your physical requirements." It cannot be doubted that 6,000,000 people are being condemned by the authority of this House to live under these sub-normal conditions, and we add the extra pain and suffering and anxiety that are inevitably imposed by the means test.
I see no temptation to sentimentalise about this matter when I go to my own constituency, and there are many constituencies in an even worse position than my own. I am conscious of a grave food shortage in far too many homes, and I am ashamed of the comfort of my own home life. We are condemning millions of fine men and women to a life that denies them the opportunity of ever believing that it will contain for them any happiness again. Even though I may be accused of cheap rhetoric, I cannot help saying that this Government can borrow, and regard itself as observing all the laws of financial rectitude, £1,000,000,000 or thereabouts in order to build up defensive armaments, while seven or eight years ago it could destroy a Labour administration because it desired to borrow what in these terms was a microscopic amount in order to provide food in the homes of the unemployed. By their neglect of this problem, and by the imposition of grave malnutrition, the Government are laying up for themselves a very grave problem, particularly among the children.
There is on the Statute Book to-day a wide range of permissive powers which local authorities can employ if they desire to do so, and need not employ if they do not desire to do so. In my view there is a real need for what I would call a major survey over the whole field 1531 of these social services and permissive powers, in order that the House may discover how far they are being used where they are needed, and to what extent they are being completely or relatively neglected despite the needs that exist. They relate to ante-natal care, medical services, midwifery, nursing services, home visits by home visitors, infant welfare centres, and day nurseries. Can the House be satisfied that the needs which these permissive powers were designed to meet are really being met; and, if it cannot be satisfied, what steps can it take in order that it may be afforded some better degree of satisfaction? Take the case of nursery schools. They are not primarily educational establishments; they are health establishments. I detect sometimes, even on the part of my own friends, a very unfortunate tendency to regard them as class institutions, as very desirable for the children of working-class men and women. They should not be so regarded. We have at the moment 111 of them containing about 8,000 children. If one thinks of these figures in terms of the magnitude of the problem, it is obvious that we are taking only hesitant steps in this very important direction.
Last year I alleged, and I allege again, that there are class standards in the matter of health. There is an elementary standard for the children in elementary schools. I loathe the term "elementary education," though it is still employed by the Board. It means the smallest possible amount of education which is just sufficient to make the children of working-class men and women educated enough to serve as humbly as possible the people above them. [HON. MEMBERS: "No."] At any rate, that is what it used to mean, and the word is still employed in terms of education. My own view is that there is an elementary standard in the matter of health just as there is an elementary standard in the matter of education. I am, to use an expression which the right hon. Member for Epping (Mr. Churchill) once used, fortified in my argument by Dr. Crowley, who was formerly senior medical officer of the Board of Education. In a very interesting article in the "Highway," he says:The returns for the year 1937 show that, of 1,696,527 children examined at the prescribed age groups, 15 per cent. were returned as 'excellent,' 73 percent. as 'normal,' 1532 10.6 percent. as 'slightly subnormal' and 0.6 per cent. as 'bad.' In the case of all such returns it should be remembered that the standard of the examiner is probably influenced by the stratum of society to which the children examined generally belong. In particular must a warning be given as to the use of the word 'normal.' Observation and experiment have shown that many children classified as 'normal' are capable of reaching under healthier surroundings generally, and especially under improved conditions of feeding, a higher plane of physical well-being.''The point is made, not by me, but by Dr. Crowley, who speaks with almost unrivalled experience, that there is a class view of health as between elementary schools and Eton or Harrow. I invite the Parliamentary Secretary to the Board of Education and other Members of the House to look at an extremely interesting book, which I believe I mentioned to him last year, entitled "National Fitness," in which a number of school medical officers expressed their opinion about the existing system of nutritional survey. One of them says:Normal nutrition implies a fair average for the child population of the elementary schools of the area; it does not imply that the child so classified reaches any ideal standard of fitness.It is abundantly clear that the statistics which are now put out as a result of the annual nutritional survey are worthless in any comparative sense, for they merely determine whether in the view of the examining officer the child under examination is normal according to the average health of the school in which the child is being educated. I think that reference has already been made, but I do not apologise for repeating it, to the very well-known Brecon experiment. The school medical officer was disturbed to find that his estimate of the nutritional standard of children did not agree with those of other people, so he took 50 boys and 50 girls and had them examined by the school medical officers of Carmarthen and Glamorgan as well as by himself. He found that sub-standard cases were 20 percent. in Breconshire. The Carmarthen doctor, who came from a relatively good county, said there were 37 percent. of sub-standard cases, and the Glamorgan doctor, who was used to a very low standard of life, said there were 13 percent. There was therefore an unconscious comparison made with their own standards. There should be a first-class scientific investigation into this matter, and I cannot be satisfied that the Board 1533 are intent on discovering whether annual statistics may be produced which will be worth while because they will be comparative and relative in a reliable sense.
I want to say a word about solid food in schools. I asked the Parliamentary Secretary to the Board of Education to supply information about the number of boroughs and county boroughs and county councils which make use of their powers in regard to the provision of solid meals in schools, and he informed me that 83 per cent. of county boroughs use their powers and 73 percent. of the county councils do not use their powers. I hesitate to say it again, but I think I must, that there are political indications in this. The county boroughs are largely controlled by people who want to feed hungry children, and the county councils in the main are controlled by people who obviously do not. Let me take my own constituency, a mining constituency entirely controlled for all those purposes by the county council, for we have no higher local authority than an urban district council. In my own constituency there cannot be more than 69 children having free solid meals, and no Member of this House could possibly walk through one of these mining constituencies without recognising immediately the need for those solid meals. This is a very important matter indeed, for the simple reason that hunger is the frustration of education. It is impossible adequately to educate the inadequately fed child. I ask the Parliamentary Secretary whether he thinks the permissive powers are being used as widely and energetically as they should be, whether the Board has taken steps to induce the authorities to use their powers, whether finally these permissive powers will not break down before the urgency and the magnitude of the problem, and whether it is in the mind of the Parliamentary Secretary and of the Board as a whole that even wider and more authoritative powers may be required in order to make certain that every child who needs a meal gets it, and that the purpose of education is not frustrated? I am fortified by Dr. Crowley, who says:What we need to-day is a fresh conception, on the grounds both of health and education, of the place of the mid-day meal at school for all children as a part of the normal school curriculum.
§ 7.6 p.m.
§ Mr. Elliot
The Debate has run on two very important lines which are, however, perhaps not so closely connected as one might think. It has covered the question of nutrition as it more particularly affects the child, and the speeches have also ranged over the general problems of nutrition and health affecting the community as a whole. It would be impossible for me to go at length into either of these problems—the conditions of time do not allow it. Also, as the Parliamentary Secretary to the Board of Education is to speak later in the Debate, and will deal more particularly with the educational aspect of these matters I shall, if I may, leave those aspects to him. But I think it is true that there is a danger that we may feel that remedies can be found by ad hoc measures in the schools, leaving out altogether the fact that unless the homes, and indeed the circumstances, of the wage-earners themselves are adequate and decent, merely ad hoc remedies in the schools will not suffice.
The hon. Member for East Birkenhead (Mr. White) pointed out that he himself had frequently brought to the notice of the House the possibility of family allowances. It is clear, I think, that what has been discussed by a good many Members this afternoon is almost a system of family allowances in kind, and I am not sure that that particular remedy would solve the problems with which we are now dealing. In this Debate on the Consolidated Fund Bill we are reviewing the very big question of how these enormous sums which we are voting are being expended, and whether indeed we are getting full value for them, and whether progress can be made in the direction which we all desire—that of building a fit and happy nation. We are precluded on this occasion from discussing remedies involving legislation, so some ambitious remedies, such as the £20,000,000 subsidy for milk brought forward by the hon. Member for North Islington (Dr. Guest) or some of the other remedies which have been recommended I cannot go into on this occasion. The hon. Member for the Clay Cross division (Mr. Ridley) indicated very considerable dissatisfaction with the method of clinical assessment of school children, and that was re-echoed by a good many speakers. As I say, the Parliamentary Secretary will deal with some of these subjects at greater length. 1535 but neither he nor I regard that assessment as a satisfactory or absolute test. We only say that if that test were dropped out of the school reports altogether, hon. Members opposite would be the first to clamour for some sort of report from the doctors as to what the condition was of the children they had examined. I think that some sort of assessment by the medical officers would be demanded in all parts of the House if we happened to omit it from our reports.
I want to deal for a short time more particularly with the problem before us—the sums we are voting—and to consider whether we are in fact making progress, because I think that none of us can say that we have arrived at the ideal. None of us would claim that the conditions to-day are ideal. We want to know whether we are progressing towards a better state of affairs in the health of the nation. I think the Government can claim credit for having introduced the subject of nutrition to our national Debates. I think it will not be denied by anybody in any part of the House that one of the great factors in making the nation more conscious of the problems arising out of nutrition was the setting up of the Market Supply Committee by the Agricultural Marketing Act, 1933, for it was in fact from an examination of the problem of feeding the nation carried out by one of the civil servants in the employ of the Market Supply Committee that the statistics were compiled which were subsequently the basis of the book which has been so frequently quoted in these discussions. We are certainly not stopping there, for these investigations are being pursued, and we shall in due course be able to report to the House what the results have been.
But I think it is also true to say that we have not stopped at investigation. We have taken action—we have taken a very great deal of action—on the newer knowledge of nutrition, and I hope to be able to show to the House that that action has had, and is having, the effect of marked improvement on the health of the nation. It is worth while to stress again what was stressed by the Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor) and other speakers—that milk is a primary food which nothing whatever can replace. We 1536 have a good deal of sympathy with the hon. Member for Durham City (Mr. Ritson), who said that he preferred milk from a T.T. herd to milk which had been subjected to any form of heating process. The difficulty, as he knows, is that of achieving a sufficient supply of milk from T.T. herds because that will take a long time, and we are anxious to adopt every possible method of making milk safe for drinking during the period which must elapse before we can achieve the ideal of perfectly clean milch cows none of which are infected with tuberculosis.
I will not go into the question of pasteurisation. That is too much a subject for controversy. It is well known that a proposal in that direction brought forward by the Government in this House did not meet with acceptance and we have had to re-examine the question. But I do not think anybody will deny that milk sufficiently clean and safe to satisfy the medical profession is one of the most important factors in the extended use of milk. We must make every effort to see that a supply of such milk is available for the people of this country. We already consume in this country a very large quantity of dairy products. The hon. Member for North Islington truly said that our present consumption could be raised to the great advantage of our people. Yet it is not generally recognised that the consumption of all dairy products—if one turns butter and cheese into their liquid milk equivalent—increased in the United Kingdom between the quinquennium 1925–29 and the quinquennium 1930–34 from 73 gallons per head per annum to 89 gallons per head, and in that latter period the consumption in the United Kingdom of dairy products per head—I do not say of liquid milk—exceeded the consumption not merely in Italy, in Germany, in Belgium, and in France, but even in the United States. Now it is perfectly true that there is a certain fallacy in these figures, because one cannot take butter as simply the equivalent of liquid milk. Many of the minerals and other valuable substances in liquid milk are not present in butter. Yet none of us will deny that butter is a most valuable food and ranks very high among the protective foods.
The consumption of milk by children has also gone up, and the consumption
1537 of milk by patients in institutions. The hon. Lady suggested that I would no doubt quote the extent to which the liquid milk consumption has gone up. It is not my desire to weary the House by statistics, but I should like to say that the consumption of liquid milk in England and Wales increased between 1936–37 and 1937–38 by 35,000,000 gallons. The consumption of liquid milk under the milk-in-schools scheme has gone up in recent years by something like 6,000,000 gallons. That shows, I think, the value of propaganda. I do not need to speak of the steps that have been taken towards the purifying of the milk supply. The number of Attested Herds has risen rapidly. We have instituted a State veterinary service, which is carrying out routine examination of milk herds in all counties, whereas previously it existed only in some, and these examinations are being carried out by whole-time veterinary officers instead of part-time veterinary officers. We consume great quantities of milk and dairy products, we are constantly raising the standard of the liquid milk supplies of this country, and we are increasing the staff by which we keep up the pressure upon both the farmer and the local authorities to ensure that the premises in which milk is produced and the herds from which it is produced are constantly supervised.
§ Mr. Elliot
The premises where it is consumed come under the housing legislation of this country. We have now built 4,000,000 houses, and we are starting on the fifth million. I think those houses—the premises where milk is consumed—bear comparison with any in the world.
No one would deny that in the lower-income classes, malnutrition does arise from inability to afford adequate supplies of the protective foods. We must not forget, however, that that is not the only factor. Yesterday, we discussed the report of the committee which examined this matter in relation to the Anti-Tuberculosis Service in Wales. That committee reported thatthe consensus of opinion of the witnesses was that poverty was by no means the chief factor in malnutrition in Wales and that wrong choice of foods, ignorance and carelessness were much more responsible.1538 The committee also drew attention to the changed habits of the population as regards food. I do not want to stress that but the hon. Member for Clay Cross made a very strong point that if sufficient money were given to the housewives of the country they would buy the correct food. If they can do entirely without instruction on this matter they are the only class that can. I think all of us benefit from instruction, and that no class of the community can dispense with it.
§ Mr. Ridley
What I said was that an insufficiency of money denies people the power to buy either the right or the wrong things.
§ Mr. Elliot
None of us will deny that. I laid considerable stress on that. But there are other factors as well, and it is for us to take them into account. An insufficient supply of money means that it is not possible to buy an adequate supply of food, but progress is also being made in that direction. We have to-day 12,000,000 persons employed in this country at a higher level of wages than they have had at any time since the War. The cost of living has fallen by three points in the past year, and retail prices of food by five points.
Mr. West wood
Has the cost of milk, which is admitted to be one of the most essential foods, fallen during that year?
§ Mr. Elliot
I do not say that the cost of milk has fallen, but the retail cost of all foods, including milk, is five points lower than it was last year. I agree with the hon. Member for Clay Cross that an adequate supply of cash to buy food at a reasonable price is a fundamental requirement in relation to the problem of nutrition.
§ Mr. Elliot
The effect of rents was mentioned by several hon. Members who spoke of the work of Dr. M' Gonigle. I have here a report on a study of the conditions of 69 working-class families in Newcastle-on-Tyne. It is worth remembering that what has been said about the effects of moving from slum areas to new 1539 housing estates is not borne out by subsequent investigation. The investigator at Newcastle-on-Tyne went so far as to say that rents were 21 per cent. higher for the new houses than for the old houses, but that rent "did not appear to be closely related to intake of food." I have taken that matter into account. I am watching it carefully. I feel that the inroads of such expenses on the amount available for food are important, but I say that nobody in the House will quarrel with the thesis that a higher level of wages and a lower, or stationary, level of food prices is a fundamental requirement, and that, in so far as we have achieved that, we have improved the living conditions of the people of this land.
I was asked by the hon. Member for Clay Cross whether we should not have an inquiry into the question of how far the health services were being taken advantage of, whether the permissive Acts of Parliament were being used by the local authorities—and, of course, whether the services were being used by the people who come under the local authorities. The attendance of children under five at infant welfare centres has gone up from 7,000,000 in 1931 to nearly 9,500,000 in 1937. The attendances by women at the ante-natal clinics has gone up in the same period from 728,000 to nearly 1,500,000; and the number of women attending them has gone up from 204,000 to 337,000. These are not merely inspections; the people attending these centres are getting assistance in regard to nutrition, such as the House desires that they should have. Out of 412 authorities in England and Wales, 407 are supplying milk free or at less than cost price to expectant mothers, 409 to nursing mothers, and 407 to children under five. We put out a circular on 1st April, 1937, drawing the attention of the authorities to the first report of my advisory committee on nutrition, and more particularly to the importance of milk for pregnant and nursing mothers and young children and asking them to review their arrangements. Since that time the final results show that 77 authorities, covering a population of 6,500,000. have increased the quantity of milk supplied per day or per week under their arrangements; 155 authorities, covering a population of 13,000,000, have extended the period during which it is supplied; and 62 authorities, covering a population 1540 of 7,500,000, have adopted a more liberal income scale. I think that shows that, at any rate, the Acts are being worked in the sense in which the House intended them to be worked.
§ Mr. Ridley
The right hon. Gentleman has not said anything about the barren areas. What authorities, for instance, are not providing ante-natal clinics?
§ Mr. Elliot
It is true I have not done that, because I am anxious not to make inroads unduly on the time of the House. The hon. Member will see that improved conditions have been obtained in a great many instances, and, although there may still be barren fields, we can point to increased intakes of cultivation into this barren land.
The advantages of the milk scheme have spread also into the factories. Milk in factories and mines schemes now cover 2,139,000 persons, and in the one month of November, 1938, over 730,000 gallons of liquid milk were estimated to have been consumed in the factories under these arrangements. If it is true that these increasing administrative advantages are being given, if it is true that the wage level is able to purchase more food than previously, the improvement ought to be showing itself in what one might call the statistics of stamina, that is, the statistics showing to what extent diseases of malnutrition have been repelled from our population. I would take four of these, which I think all would agree upon as being useful statistics for this point. They are infantile mortality, maternal mortality from all causes, maternal mortality from puerperal sepsis, and tuberculosis. I will not go back a long distance; let us take quite a recent period. The infantile mortality rate in 1927 was 70 per thousand births; to-day it is 58; the maternal mortality rate from all causes was 4.11 in 1927; to-day it is 3.26. The maternal mortality rate from puerperal sepsis was 1.57 in 1927 and 0.98 to-day; and the mortality rate from all forms of tuberculosis was 79 in 1927 and is 56 to-day. I think these figures do show that these measures are having a result, and that the standard of nutrition of our people has improved.
All the statistics tell the same tale. I agree that statistics themselves are not conclusive, but they are pointers and indications upon which we have to work in this House. Young women are peculiarly 1541 susceptible to tuberculosis. I note that the figures of tuberculosis and of the notification of tuberculosis among women aged 15–25 have also fallen. Notifications which were well over 7,000 in 1931, were under 6,000 in 1937. I am, therefore, entitled to say that the indications point to a conclusion that an improvement in the nutrition of our people is taking place. The heights and weights of school children continue the same tale. In Leeds, comparing 1927 with 1937, the boys are over an inch taller and they are 3½lbs. heavier, and in Huddersfield over 1 inch taller and over 5 lbs. heavier. All these things show the result of the steps for which this House has passed legislation and is voting money and for which the local authorities are engaging upon these administrative schemes.
I hope that the House will acquit me of any discourtesy if I do not go further into the arguments which have been raised during the Debate to-night. There has been a request from many parts of the House that a further campaign on nutrition should be carried out, and I think we would all agree that a further campaign on nutrition should be carried out. The facts which I have very briefly reviewed to the House showed that a campaign is in progress. The position in this country shows that we can very greatly improve the conditions under which we are living to-day, and that we can perhaps bring ourselves to a condition, in which no nation has ever been in the history of the world, when every child, and eventually every adult, will be consuming the optimum diet, which means that it cannot be improved either in quantity or quality. It is an ideal which no nation has ever set itself before, and certainly no nation has come within hailing distance of such an achievement. We have not achieved anything like that ourselves so far, but we have made sensible progress by reason of the Acts passed by this House and by reason of such sums of money as I am asking the House to vote to-night, on the Consolidated Fund Bill.
Is the right hon. Gentleman in a position to answer the question I put to him about the amount of money to be spent on maternity and school schemes which he mentioned in the Debate on the Milk (Extension of Powers) Bill on 4th July last year, which, he said, was £750,000, or £250,000 more than had been 1542 available up to that time? Has that extra £250,000 been spent?
§ Mr. Elliot
I have not had time to go into the point raised by the hon. Member, but I think that what the Minister of Agriculture had in mind at the time was the extension of special cheap milk schemes, and I do not think that it has been possible to extend these cheap milk schemes, because they were seriously hampered by the failure of the general milk policy of the Government, as contained in the Milk Bill, to commend itself to the House, and the difficulties of arriving at agreements with distributors, which formed one of the big problems in the extension of cheap milk schemes. The difficulty of the discussion of these problems was greatly accentuated. I do not think that it has been possible to extend these schemes, and to that extent, at any rate, that money would not have been expended. But I would not like the hon. Member to take that answer as definite, because the matter is one for the Minister of Agriculture and I have not had the opportunity of consulting him because he has not been on this bench this afternoon.
§ 7.35 P.m.
§ Mr. Pearson
The right hon. Gentleman has looked at the question of nutrition from the point of view of comparing the past with the present, and showing the improvements that have taken place with regard to the height and weight of school children. That is all very well, but hon. Members on this side of the House can see another aspect of the problem in regard to the submerged tenth of the population. The House will agree that nutrition is of fundamental importance, but at the same time there are a large number of people who have such small incomes that they cannot be expected to obtain a proper degree of nourishment which would keep them up to the standard of nutrition. An unemployed man, with wife and child, if on statutory benefit, receives an income of 29s. per week. If you take a proportion out of that amount for rent, and payment is made for other necessities, what is there left for food? The sum of 3s. is allowed for the child. There are cottage homes run by public assistance committees, and in my county it is calculated that the cost of feeding the children in the cottage homes alone is 6s. per head per week. That is apart from overhead charges, being for 1543 food alone. The food is bought in wholesale fashion by means of central contracts, and therefore purchased at a much lower rate than the smaller amounts of food that the people purchase in the shops. Therefore, how on earth can the unemployed population maintain their children on the small amounts they receive?
That is the way we look at it. The amount of income coming into those homes cannot be adequate, either from a medical standard or from any other standard, to keep them in a sound state of nutrition. The Minister has referred to food habits and to the question of women not being able to cook with the skill that he would like to see. We on this side of the House believe that the Minister over-emphasised the ignorance in regard to cookery. When we consider the inadequate income which goes into many households to enable the necessary foodstuffs to be obtained for cooking, I really do not understand why the Minister emphasised that point so much. We do not deny that instruction in cookery is good and necessary, but we deny that our people cannot cook if they are given the wherewithal with which to purchase the materials necessary for the cooking of meals.
I want to refer to another aspect of the problem, particularly in relation to the schools. I listened for a good time yesterday to a very interesting Debate upon the very shocking and distressing report of the Committee of Inquiry into the Anti-Tuberculosis Service in Wales. The Parliamentary Secretary to the Board of Education took part in that Debate, and, with a certain amount of pride, quoted figures showing that his Department were year by year increasing their Estimates for school feeding. I want to recall to his memory the fact that in regard to secondary school feeding in Glamorgan, as the outcome of the economy regulations of 1931, there is a smaller amount of money available for that purpose than previously. That may startle the hon. Member, but it is the fact. As a result of those regulations the Education Committee had to find a certain amount of money, and they were asked to find it by increasing the school fees, and also by decreasing the amount of maintenance allowances out of which we were spending 1544 money for school feeding. Since that time we have made a representation to the Board for that sum of money to be increased.
§ The Parliamentary Secretary to the Board of Education (Mr. Kenneth Lindsay)
Does the hon. Member refer to the amount of money available for maintenance allowances in secondary schools?
§ Mr. Pearson
Yes, and the decreased amount that is available for school feeding. In the secondary schools particularly we are providing facilities for dining rooms and so on, but we have the startling position in Glamorgan that, although these facilities are being developed, there is less money to spend on free meals for the children. We are giving milk meals in the elementary schools, and we would very much like to give solid meals in addition to liquid meals. What is the problem there? It is not the lack of desire on the part of the education authorities at all but of finances in order to deal with this problem. I will quote from the report of the county accountant of my own county, and it is a similar report to that which would be made by accountants in other necessitous areas. He says:When the Committee reflect on these Estimates"—it was when we considered the annual Estimates —it will be apparent to them that the continuance of any legislation, well-intentioned and necessary as it may be, is creating a burden for the county that the larger portion of the community cannot reasonably be expected to bear. The product of a penny rate, good as it may appear, is not certain evidence of increased prosperity and is subject to the vicissitudes that befall an area where employment is uncertain or spasmodic. For instance, since the product of a penny rate was indicated, it has been reported that large collieries that have been working regularly for some years are to be closed. Much of the burden and maintenance of the resulting unemployment becomes a State expenditure, the county fund has to bear the expenditure that is consequential to the loss of employment.When we were considering those estimates it was obvious that much as we desired to do more in the way of giving increased milk meals and solid food meals, we were up against the terrible problem of where the money was to come from. The Board of Education contributes 50 per cent., but all these little extras which the county has to bear makes the total liability impossible for us to carry.
1545 As far as the Government are concerned we are seeking the will and the competence to make a larger contribution to help us with this heavy liability. If there had been the will and the determination on the part of the present Government they would have found the means of increasing the percentage grant for this purpose, especially for the black areas, the Special Areas, beyond the 50 per cent. What is to stop the Government making a grant of 75 per cent., or of weighting it according to the needs of the area? Here we are with our eyes open watching the nutritional standards of the people being depressed to the degree they are, although we should have the means of providing these children in the first instance with sufficient school meals.
There is another suggestion I should like to make, and that is that a higher contribution should be made in regard to equipment. At present the Board of Education makes a contribution of 50 per cent. for equipment, buildings and other things which are necessary to provide proper facilities. Does not the hon. Member realise the heavy burden which this means on local authorities? That is the obstacle we are up against, and unless the Government are prepared to do something more they are not showing real seriousness in grappling with the problem. At the present moment we have a medical basis for deciding the amount of nourishment. I will admit at once that it is perhaps a liberal standard, and I know that the Board have urged that this liberal standard should be met. But cannot we go further than that, and saythat in the first place it should be an economic income level rather than a medical level? Is it necessary to examine the child whose father has been unemployed for seven, 10 or 11 years? Surely not. That child, apart altogether from a medical examination, should be given the benefit of a really good solid school meal in addition to the milk meal in order that the nation shall have the assurance that the children are being well and properly looked after.
This brings me to the cost which this would mean. It would mean an added number of children being given meals and an added cost to the local authority. There again I urge that there should be a higher grant to enable local authorities to meet this cost. I should like to see the approach to this problem widened very 1546 much. The nation asks for it and is prepared to pay for it. The nation asks for a bold nutritional policy. We read in the newspapers of surplus catches of fish, and it is nothing but a crime for that fish to be used as manure or thrown back into the sea because it cannot reach the people who need the food. It is the same in regard to agricultural products. We have marketing boards which seem to follow a policy of restriction rather than a policy of expansion which would bring plenty to the doors of people who really require it. I am sure of this, that as nutrition is a fundamental matter for the welfare of the State, food values are all-important.
I do not make the mistake of looking upon nutrition as being a very narrow thing. I know that the children of the rich can be mal-nourished. In my own area a doctor's child was examined without the medical officer knowing whose child it was, and he scheduled the child as being mal-nourished. But the point is that if we guarantee larger incomes going into the homes, we shall go a long way to guaranteeing that the children generally will grow up with well nourished bodies. In the question of the nourishment of school children there comes also the question of footwear. If children are well nourished and their footwear, during the winter particularly, is poor and shoddy, the good which is done by the giving of good meals is undone by the shoddy footwear they have to wear. I should like to make an appeal that something should be done in this respect in order that we may have a full approach to the question of nutrition.
§ 7.53 P.m.
§ Mr. Sexton
This Debate is very important indeed, as it is connected with the twin subjects of nutrition and education. They are very intimately related. Nutrition means that which supplies whatever promotes growth and development or keeps in good health, while the true comprehensive definition of education is first to develop physically, and, secondly, to develop mentally. In the years gone by this country, and indeed the whole world, kept these two subjects of nutrition and education separate and apart, and it is only in recent years that the real definitions have been realised and acted upon. For a long time attention was exclusively given in education to the mind, and that in spite of the fact that teachers had 1547 pointed out over and over again that physical needs must be attended to first. They knew from practical experience that the dictum of Rabelais thatHungry bellies have no earswas true. I myself as a teacher had the unfortunate experience of trying to educate boys and girls with hungry bellies, and well I know that they had no ears, no interest in things of the mind as long as the gnawings of hunger were penetrating their bowels. Attention, therefore, has more and more become concerned with the question of nutrition, the nourishment of the body which promotes the growth and development to which I have alluded. So highly did Cicero prize health that he ascribed health-giving as a God-like attribute:In nothing do men more nearly approach the Gods than in giving health to men.The welfare of the health of children is of paramount importance to the nation. The League of Nations, in its interim report on the problem of nutrition, emphasises this fact when it says:Viewing the nutrition question as a whole, the greatest emphasis deserves to be laid on one particular aspect—namely, the nutrition of children. The national interest which attaches to securing an adequate dietry for young children springs from the fact, now fully recognised, that only by adequate nutrition in the earliest years of life can the health and the full development of the future citizens be attained.It emphasises also the relationship between nutrition and education. It says:Malnutrition, especially in children, affects not only the physical health but the mental development.Local authorities and the Government are now tackling this problem, local authorities in the schools by giving milk meals, and in some cases, although far too few, solid meals, but the full measure of what is needed raises financial questions. It has been said in the Debate that in the homes with low incomes and in areas already very highly rated, with large numbers of unemployed, much more money is needed in order to solve the question. The International Labour Office, in its survey of the question of nutrition, says:The question of income is at the root of the workers nutrition problem. … The average diet in the lower income groups is inadequate for good health. The inference is that among such groups especially there is both mal-nourishment and under nourish- 1548 ment. … Defective nutrition is in the great majority of cases a consequence of inadequate family resources.The problem, therefore, is one of poverty, whether it is the penury of the individual home or the penury of the local authority such as one in a Special Area. The seventeenth century dramatist George Farquhar, in one of his plays, says:There is no scandal like rags, nor any crime so shameful as poverty.The crime is that of society which allows poverty to exist, and the shame belongs to the victims compelled to share that poverty. Poverty in plenty is truly a scandal; poverty amid the prodigality as exists to-day is dastardly criminal. The question of nutrition is affected so much by lack of income that to allow the present woeful conditions to exist is as much a restriction on freedom as is physical restraint. It has been said that:Stone walls do not a prison make, Nor iron bars a cage.But the stone cold denial of human needs makes a very potent prison, and the iron bars of poverty fashion a very complete cage. I have emphasised this side because the educational aspect is so dependent upon it. At home and at school full nourishment must be assured. As regards the educational side, that can only be attained by increased grants for the poorer local authorities. As far as the individual is concerned, increased wages, higher unemployment assistance allowances and higher public assistance grants are all essential. Some people will ask, Would it be worth the original cost? The interim report of the International Labour Office says:From the national standpoint the cost of the investment so made in the health of the children will be more than compensated by the improved vigour and physique of the adult population.Some will ask, Is there any real need? In reply I would say, Read such a document as we debated yesterday on tuberculosis in Wales. Read the quotations from highly qualified medical men recorded in a book recently published on Poverty and Population. I will give two, both from the county from which I come, Durham, and both well known to medical men. First, Dr. O'Hara, at the annual meeting in 1933 of the Durham County Society for the Prevention and Cure of Consumption, said: 1549Most of our children are suffering not so much from tuberculosis as from starvation. Seventy-five per cent. of the cases admitted to the society's sanatorium are traceable to undernourishment.I believe, from a very recent conversation that I have had with this gentleman, that the position to-day is no better. The second quotation is from Dr. Falconer, medical officer for Durham, in his 1933 report:One is forced to the conclusion that want and impoverishment following in the train of long continued unemployment and low wages are amongst the largest exhaustive factors for such a high phthisis rate.The local education committee in Durham confirms what I am saying. The "Northern Echo," on 10th February, referred to the matter under the heading, "Acute Problem of Underfed Children in Durham." A letter that I have from the Director of Education dated 14th February, 1939, uses these words:The position is at present that the committee has decided that, as there are signs generally of deterioration, it will be necessary to supplement the milk meals now given with solid meals to such children as are certified by the school medical officer as being in need of the treatment. The provisional figure for this year, as we do not expect to cover a great deal of the county, is put down at £60,000 but the minimum figure when the scheme is operated will be in the region of £120,000 per annum.Not only do we want meals in the schools, but we want decent schools for our children to learn in. I know it will be said that the local authorities are responsible for the schools. I taught in a school which has been classed as C for over 30 years and is still there classed as C, with long inhuman desks which were in it over 50 years ago, and are still being used by the pupils who sit there. Not far from where I live there is a secondary school, fairly modern, but the increase in the number of pupils makes it so congested that teaching has to go on in the corridors and all sorts of out-of-the-way places. Twice the number of children are attending that it is officially registered as having accommodation for. We want these things remedied. It is no good saying the education committee ought to remedy them. The education committee is not in a financial position to do so, or it would have done it long ago. You have to come to the aid of our people by increasing the grants in these necessitous areas. By doing so, you would improve the nutrition as well as the education, and remove the rude inelegance of poverty. 1550 If we believe with Diogenes that the foundation of every State is the education of its youth, we must insist that more should be done by the Government to carry out its true function, which, as stated by Burke, in his Reflections on the French Revolution:Government is a contrivance of human wisdom to provide for human wants. Men have a right that these should be provided by this wisdom.These human wants are the very ingredients of human freedom. When liberty is gone life grows insipid and has lost its relish. Let the Government come to the rescue of the bairns born in poverty, and seemingly born to poverty. Set a little child in the midst, in this House and none of its needs would be neglected. To each of us would come the personal responsibility. Who could resist the appeal? But when we come to legislation we become impersonal, and therefore very often impervious to the real needs of the bairns. Time and time again the Government have tried to defend their neglect. It may be said, as Burke said of the Government of his day:They defend their errors as if they were defending their inheritance.Far nobler would it be if the National Government would ensure the heritage due to every child in the land and then defend it. We are spending large sums on national defence. Here is a problem of national defence, to defend the heritage which ought to be the right of every child born in the land. For the individuals in the country—in the Special Areas—we need bigger incomes, and for the local authorities in those areas we need more Government aid. We believe that higher Government grants according to the financial conditions of those areas would help very largely to solve the problem.
§ 8.9 p.m.
§ Sir Francis Fremantle
The hon. Member, like several others who have spoken, represents a body of men to whom I owe a very great deal, as the school teachers of the country have taken such an intense interest in this subject since the inspection of school children first of all brought to light the need and the possibilities of looking after the health of the school children by a small Measure introduced into the House of Lords by a bishop in 1907. The school teachers 1551 took this matter up, beginning with the medical officers of health, who were appointed school medical officers. From 1908 up till 1914 I had the privilege of starting the work as school medical officer in Hertfordshire, and I owe more than I can say to the two gentlemen who were appointed as representatives of the teachers on the local education authority. Together we worked out a scheme and a system which has been developed very much since then.
One of the first things we sought to do was to lay down the lines of medical inspection in order that we might have the facts on which to work. We drew up a card of about 30 items, one of which was nutrition. From the first I laid down that the only standard you could have was the standard of the examiner as being, good, very good, bad, very bad and, between them, normal. That is quite useful from the point of view of the particular examiner year after year, and probably the most accurate and the most scientific standard that you can have, but when you compare those figures with similar figures by other examiners and, still more, examiners of other counties, and sum them up and compare them with the figures for other countries, you are in a hopeless tangle, and those figures are no use for that purpose. The question is whether you can get a single standard which will be applicable generally. I maintain that you cannot. The speeches that we have heard show that that is the opinion of other thoughtful people. The standard must differ according to the circumstances and the conditions of the people all round.
That brings me to a further point in the philosophy of this matter which has to be considered. There is a danger of trying to reduce everything to a scientific standard which you can sum up in pounds, or inches, or milligrammes, decimal points, and so on. The danger is of estimating a man as a machine. There is a large part of man, and therefore of the child, which cannot be so measured, and that is, above all, the spirit, the living, activating, spirit of the child, which has more than everything else to do with the health of the child. We all know that certain children lack that spirit, who do not know how to make the best of themselves and who are always out of sorts. There are other children, 1552 in the same school and in the same circumstances, who are always full of the joy of life. Nutrition is not merely a question of the food that you put in. It is a question of the whole circumstances of the child's life.
Undoubtedly, the greatest of those circumstances is poverty. It has been shown again and again that poverty has a tremendous effect on both adults and children. The excellent and useful reports that have been made by Dr. M' Gonigle have aroused tremendous interest in my own profession and among members of public health departments, and they have helped us clearly to recognise the effects of poverty. Dr. M' Gonigle has shown that, much to his own surprise, the children of families that were moved out on to the new council estates outside Stockton were, after a time, in a worse condition and showed considerable deterioration as compared with the children who had been left in the slums. The reason for that was that the parents had to pay an extra 6s. a week rent for the new houses, and although, from the housing point of view, they got value for their money, it meant that they had 6s. a week less to spend on food for the family, first, the food of the mother, secondly, the food of the children, and thirdly, the food of the man.
There is no question that one could get an enormous improvement in health if there was a great increase in the family income, coupled with wisdom in using that increase. Both are needed. Naturally, ignorance makes it very difficult for people to use wisely a fresh access of income. The effects of poverty have been shown in another connection by a very remarkable experiment, which is receiving considerable attention, by a body of people, stimulated largely by Lady Rhys Williams, in the Rhondda Valley. I can quote only the main lines of what happened. They were trying in every possible way to reduce maternal mortality by improving the maternal mortality services, the midwifery services, the medical services, hospital accommodation, equipment, and so on; and yet the local authority could not bring about any marked reduction in maternal mortality. When, however, there was an improvement in nourishment on a very definite scale, it led to a most remarkable reduction in maternal mortality.
1553 Therefore, the question is whether the Government should, as has been suggested, pour out money in order to achieve what seems to be such an obvious solution of the difficulty all the way through. The amount required would be incomparably small as compared with the amount spent on the Defence Services, and it seems that there would bean obvious return for the money spent. I am inclined to think that there would not be a return if the great increase were to happen straight away. Life is too complicated. We are not machines. We consist of an entity which has to grow up as a whole in its surroundings. As has been said, lack of nutrition is a part of the general surroundings, as are heredity, the bringing up of the child within the family, the conditions of the home, the fact that the child may never see the countryside, and the conditions of school life. We have to improve conditions as a whole. A great deal depends upon improving the general conditions and parental authority in home life. One or two hon. Members have mentioned the part played by home life in the development of the child. Often it is not realised that one of the factors in the lack of nutrition is the restlessness of the day and the night, and the lack of sleep which children get. This may be due to many things. It may be due to lice infestation in the bed of the child—a factor which it is difficult to prevent, but which nevertheless is preventible. It may be due to the noise in the street, or to adults, older brothers and sisters, coming in carelessly, up to midnight, when the child ought to have had three or four hours of sleep. In many cases it is due to the children being allowed to go out, with or without their parents or older brothers and sisters, until any hour up to 10 or 11 o'clock at night, in the streets or in cinemas, when they ought to be in bed Instead of getting 10 hours' sleep, perhaps they get only five or six hours.
§ Sir F. Fremantle
That is another of the tortures of civilisation, and the bad effects of that have to be eliminated. Another point that must be remembered is the variation between different individuals. The idea of referring to a standard, as though it were possible to get a single 1554 standard that would apply to all children, is unphysiological, unscientific, unnatural and unreal. Children are different from one another, as we in this House are, even though we may be of the same age and calibre in other ways.
There is another point to which I wish to refer. I am not making a comprehensive speech, but several hon. Members who have spoken have stimulated my ardour to speak on different points. The hon. Lady the Member from Frome (Mrs. Tate) spoke about cookery. It must be recognised that, as a nation, we have not got the art of cookery as, for instance, the French have. Those of us who have travelled or lived overseas know that different nationalities differ in this respect. The French housewife naturally spends a great deal of thought and time and taste in preparing a meal out of almost nothing. Whereas English house-wives may be taught to cook, they do not do it as a result of a natural inclination on their part. Of course, there are tastes; of various kinds, but I maintain that the essence of good nutrition is good cookery. Good cookery comes from good taste, and we have not got the taste for good cookery. That is a fact. Our tastes are much cruder. We like good chops or good rice pudding, but we have not the finer arts and tastes possessed by French people of all classes. It is surprising what good cookery is to be found among the peasant women of France. They have a natural understanding of what good cookery is. If this art can be taught here, and I imagine that it can, just like other arts, by proper instruction, then it ought to be done. But I think that those who are seeking to improve instruction in the schools are apt to treat cookery far too much as if it were chemistry, as if it were a matter of getting so many ingredients, so many ounces of this and so many grammes of that and sticking them together and mixing them together so as to make a cake or a pudding, or whatever it may be. That is not the way in which to get improved cooking. You have to teach cookery as an art.
§ Mr. Tomlinson
Will the hon. Gentleman explain how a cake can be made without doing what he has just described?
§ Sir F. Fremantle
A picture cannot be made without actually putting the brush into the oils and applying the oils to the canvas, but that process in itself does not 1555 make the picture. There is the question of art and of taste. There is the something else which makes the difference between a good picture and a bad picture, and there is the something else which makes the difference between good cooking and bad cooking. But these are minor points. It has been suggested by the hon. Member for Clay Cross (Mr. Ridley) that we want a big survey to discover the defects in our social services so that we may devise means to deal with them. We want nothing of the sort. I do not believe in a big survey of that kind. There is a general steady survey going on all the time. There are skilled medical officers who are bound to make reports weekly, monthly and annually. If these are not up to the mark, let us bring them up to the mark, but let us recognise that this survey is going on constantly. It is a great advantage that we should have these reports and that we should have Debates like this one in which these matters can be raised in the House. We have the admirable and invaluable reports of the Chief Medical Officer of the Ministry of Health and the Board of Education which place these questions before us in the proper perspective every year. I do not think we want a further survey, because the facts are already known as well as they can be known. What we want, obviously, is to improve the condition of the people and to spread knowledge and wisdom and understanding as to the proper use of the good things of this earth.
I do not believe that this subject can be dealt with in the way suggested by some of the previous speakers. It has been said that six shillingsworth per week is required for the nourishment of each child. Let us not forget that the Battle of Waterloo and the Battle of Trafalgar were fought in days when this country had a population of 9,000,000 and families of 10 or 12 were the rule. How were they brought up? Supposing that six of the children of a family of those days survived, they would require 36s. a week in order to be properly nourished according to modern standards. But wages then in the country were round about 12s. or 14s. a week. I know that there is a difference in the value of money to-day, but there is no question about this—that the men who fought in those days, the men who were responsible for breeding our industrial population which has swollen 1556 our total population from 9,000,000 to 45,000,000, were not so much undernourished that they were not able to work and to fight and to migrate.
That is one of the standing puzzles and mysteries to us medical men. The fact is that although people are undoubtedly better off by being well-nourished, at the same time much of the world's work is done, and much of the best of the world's work by people who are not completely or ideally nourished, and who are only partly provided with the good things of this world. Some of the greatest inventors have done their work when they have hardly been able to afford a quarter of what we call adequate nourishment nowadays. We must not consider it essential or possible for us to get to the millennium in nourishment or in anything else, but let us definitely work towards it. I think that this Debate to-day and the Debate of yesterday will help us to realise the importance of working, on both sides of the House and in all parties in the community, towards that end which we all desire, and to help the process of improvement which is going on so steadily and so hopefully in this country at the present time.
§ 8.32 p.m.
§ Mr. George Griffiths
I have listened with amazement to the speech of the hon. Member for St. Albans (Sir F. Fremantle). It was very much like the curate's egg, but there was more bad than good in it, and I think when he reads it to-morrow morning he will not feel proud of some of the statements which he has made. I feel inclined to say about him what was said in this House 50 years ago about another hon. Member, namely that when he got up he did not know what he was going to say, when he was speaking he did not know what he was saying, and when he sat down he did not know what he had said. I am sorry that the hon. Lady the Member for Frome (Mrs. Tate) is no longer in her place, but I am not going to sit down in this House quietly and hear people belittling the British housewife. It is always the workingman's wife who is accused of not knowing how to do things properly. I promise the hon. Lady that the statement which she made in this House tonight will go right across her division when the General Election comes. That statement was that 80 percent. of the 1557 women of this country do not know how to cook.
The hon. Member for St. Albans apparently agreed with that statement. He said that the most important work is done by people who are not fully fed. Well, I say shame on the country which depends on underfed people to do its best work. I had not intended to go down that street, but I feel very keenly some of the observations which have been made. In my division there has been a conference of miners' wives, at which it was pointed out that since 1926 many of them have not had more than 30s. a week in the case of some pits, and that the men have not worked more than three days a week for the last 12 years. Before 1926 the miners' wives knew how to cook and they know how to cook to-day. The thing is that they have not the funds with which to buy the food. The hon. Member for Frome talked about housewives not knowing how to cook. In the 1926 miners' lockout we had a lady from London—she said she was a lady—and she came to lecture my women on how to cook cod-fish head, and one of the women said to her, "Who is having the fish if we cook the cod's head?" Give a woman a bit of raw fish, and she can cook it and put it on the table so that anybody can eat it. Give her a bit of parsley sauce, and she will manage it all right. I have had some of it. I have lived with my own folk, and occasionally I have a meal with them there.
I am sorry the Minister of Health has gone out, because I want to speak about some people who are very seldom mentioned in this House, and I feel that it devolves upon me to put their case to the Minister of Health. I refer to the case of some 250,000 people in this country who are suffering from diabetes. Since I have been in this House I have repeatedly asked the Minister of Health—the present Minister and the Minister previous to him—if he will look into the case of the working man's wife or child who is a diabetic and is not enabled to have insulin free. Hon. Members may say, "What has that to do with malnutrition?" It has a lot to do with it. I like to talk about the people among whom I live, and not so much out of the book. I have in my division some people who are suffering from diabetes, and the one thing that will help to keep them alive is insulin. I have 1558 a pal who is not on these benches to-night, but he generally sits behind me, who is dead against vaccination. I am vaccinated twice a day, and I know the benefit of insulin. I have taken it for 15 years, and it brings joy into my life; and I am not going to let anybody cheat me out of the fact that I know it does me good.
Previous to coming into this House I got my insulin free, but now I earn—I think myself that I earn—more than £250 a year, which takes me out of the class of a paid workman contributor into that of a voluntary contributor, and I have to pay for my insulin. I am not grumbling about that. What I want the Minister of Health to do is to look at the report for last year of his chief medical officer of health, and he will see that diabetes is the only complaint—I do not call it a disease—which has increased per million lives. Tuberculosis has gone down, and other infectious diseases also have gone down, but this has increased. Last year I was working out a sum. Some 5,000 people suffering from diabetes died, and a lot of them died because they could not get insulin. Why could they not get it? It was because they were dependants of State-insured persons, and only a State-insured person can get insulin free. That came about when the late John Wheatley was Minister of Health. He sent out an instruction in 1924 that State-insured persons should have insulin free. Previous to that working-class people with diabetes were dying like flies. Immediately they knew they had diabetes, they gave up heart and said, "I am branded the same as Cain, and I cannot live very long." This great medical discovery brought new life, new inspiration, to such people, and Mr. Wheatley made the statement that if insulin would prolong the life of people who could buy it, he would grant insulin free to State-insured persons.
I honour the memory of John Wheatley, because if he had not been there, this chap would have been on the other side of a coffin lid years ago. That is true, and what insulin has done for myself, I want it to do free for others who are smitten with diabetes and whose husbands are State-insured persons. I have a case in mind, not far from my own home, in my own division, of the wife of one of the men at the pit where I worked previous to coming here. He works 1559 three days a week, and because he has a certain income his wife cannot get insulin free from the public assistance committee. It is costing that man anything from 12s. 6d. to 17s. per week in insulin for his wife. There is only his wife—they have no children—and because this man has a certain income, she cannot get insulin free. She has to have a special diet, and he has to suffer in his own stomach because they cannot get the nourishment needed. I think it is a scandalous thing, and I. am glad to see that the Parliamentary Secretary to the Board of Education is taking notes of what I am saying. I hope he will not make them in shorthand, but in long-hand, so that he can understand them.
I think there can be an experiment here from the standpoint of State insurance. I know that it is said that the time is not ripe to have a State medical service, but surely the time is ripe to see that where any dependant of a State-insured person is suffering from diabetes, that dependant shall have insulin free. I am not for the moment asking that it shall be free for those who are not State insured. I would like everybody to have it free, because if a man or a woman suffers from venereal disease and goes into a hospital, he or she can at once get treatment free. That is a dirty, filthy disease, and the man may have brought it on himself. That does not matter. They say to him, "You come in and you shall have free treatment." If we can give free treatment for that disease, surely to heaven we can give free treatment for diabetes. That is the point that I want to put across, and if we cannot give it to everybody, let us start by giving it to the wife, the son, or the daughter of a State-insured person.
The hon. Member for St. Albans has been giving us a few figures. I agree with some things that he said, and while he was speaking I said to myself, "He is making a better speech from our point of view than I ever heard him make." But then he started to queer his pitch. He evidently began to think, "These folk will think I am a Labour man and I must turn for the Government a bit." When he reads in the morning what he has said he will find that in some of the things he was very wide of the mark. The Minister was speaking about what had been done.
1560 I am impressed, however, not so much with what has been done, but with what ought to be done. We talk about prosperity. I have some figures of the result of prosperity in the West Riding concerning persons who come under public assistance. In 1931, when the National Government came into power—when I talk in the country I call them the Grand National Government—there were in the West Riding of Yorkshire 32,991 persons on public assistance at a weekly cost of £8,478. In 1938 there were 44,000 at a weekly cost of £15,931—almost double the amount, and these people were practically all on starvation level.
I may be asked what I mean by starvation level. At one time in the West Riding we were giving these people too much and the inspectors came down on us and surcharged us. Before I came to the House I was surcharged £180. When I got the letter, my wife said, "What's that, George?" I said, "It's a surcharge for £180."She said," What's tha' been doing?" I said, "I don't think I've been doing anything wrong, but we've been giving too much money to the poor people." I was told that unless the money was paid I would have to go to the King's temperance hotel. I said that that would be all right for me because I had a complaint which was such that when I got to that hotel they would have to feed me on my diet. We met these inspectors and they said, "You can only relieve distress." We said, "Will you tell us what is the standard of distress?" They said, "Oh, that is not our business; we have only got to tell you that you have been giving too much." We said, "We are assessing what the standard is and we are giving to these people what we think they ought to have." Then we met another inspector who was higher up than the others. We met him at Doncaster and were for four hours in a closed room with him. At the end of it all, he said, "You will have to pay £2 10s." This is not theory, or something I have read in a book; it is something I have experienced. I put this matter in front of my miner's branch. The Secretary was with me and he was in the tub as well. They said, "You are not going to pay it. You have been looking after our interests and we will pay it out of a fund of our own." That is how I got out of having to go to gaol.
1561 The hon. Member for South Croydon (Mr. H. G. Williams) has been twisting some figures to-night. I do not know a chap who can twist figures like the hon. Member. Sir John Orr states, and nobody has been able to refute it, that there are 4,500,000 people living on not more than 4s. a week. What is 4s. a week for food? Let me work it out in my own elementary school way. Four shillings is 48 pence. If you give these people only three meals a day for seven days a week, that makes 21 meals; 21 into 48 does not go two and a-half times, so that they are spending less than 2½d. on each meal. Another 9,000,000 have less than 6s. per week. That means that there are 13,500,000 people in this country living on less than 3¾d. per meal. Then some folks on the other side say, "You are better off than 20 years ago." They also tell us that our women do not know how to cook. I suppose that is why a woman comes from London to tell us how to cook cod's heads. Fancy telling them how to cook with only 2½d. per meal. If some of these people who say our women cannot cook had to do it, they would not be able to buy the coal on it, let alone the food.
I want to ask the Parliamentary Secretary to the Board of Education to look into the points I have raised.. I am sorry the Minister of Health is out so long. I thought that he would have been back long ago, but I think he must be having herring for his dinner to-night. I hope that notice will be taken of my plea for those 250,000 people suffering from diabetes, some of whom are not having insulin because they cannot afford to buy it. The Parliamentary Secretary to the Ministry of Health told me 12 months or so ago that they could get it free. I asked him, "Since when?" He said, "Always." He wrote to me a day or so afterwards saying that he was sorry that he had made a mistake. I am pleading, as one who knows from practical experience the value of this great discovery, that these people shall have their insulin free, so that none of them shall go down to their graves earlier than they otherwise would do owing to the Government being mingy.
§ 8.52 p.m.
§ Captain Elliston
Previous speakers have given us a fairly complete picture of 1562 the defective nutrition found in all classes of the population and I will confine myself as far as possible to a few special considerations. The investigations conducted by the Board of Education and by school medical officers in all parts of the country show that the actual amount of malnutrition among school children is relatively small, but there is a general failure to attain that optimum of nutrition which means complete physical fitness and the maximum resistance to disease. I feel that the critics of the nutrition policy of this country have painted a darker picture than they need have done, because they should surely be encouraged by the advance we have achieved in this respect during recent years. The provision of meals for necessitous school children is increasing year by year, and the supply of milk in schools is improving.
As hon. Members have said, nutrition is not merely a matter of food. With children in particular it means wholesome home surroundings, hygienic schools, sound physical training, earlier hours and adequate sleep. There are conflicting factors, such as the noise of traffic and of wireless in the home, and disturbance due to various members of the family coming home and going to bed at different times. There is also the tendency to relax discipline in the family, which sometimes makes parents hesitate to send children to bed when they ought to go. These considerations show how difficult it is to legislate for the benefit of everybody. Daylight saving has been a great benefit, but it is a fact to which teachers bear witness that the longer hours of daylight have not been an unmixed blessing to the children. It is a commonplace that it is not only the amount of food that counts and that far more important is the quality of the food. We have seen in the last few days in the Report of the Welsh Anti-Tuberculosis Committee that there have been great changes in the food habits of the people, which are not beneficial to the community. I will take the risk of referring to this matter again. Unfortunately I did not hear what was said while the hon. Member for Frome (Mrs. Tate)—
§ Mr. G. Griffiths
The hon. Member for Frome (Mrs. Tate) said that 80 per cent. of the women of this country did not know how to cook.
§ Captain Elliston
I represent a constituency where the housewives are famed for their cooking. They are very remarkable women, and if anybody wants to know what a Lancashire hot-pot is, let them come to Blackburn, where the women can work wonders in their kitchens. But the fact remains that the habits of the people are changing. We have only to look in the shop windows to see the temptations there are to overworked housewives to make use of the fruits of the earth which are brought to this country from all parts of the world for their convenience and enjoyment. The shop windows are full of tinned goods, usually of high quality, and in areas especially where women work in the mills and elsewhere it must be a temptation to them to use the tin-opener instead of undertaking the laborious work of preparing a meal. It was stated in the Welsh report, after a careful examination of evidence, that the nourishing porridge of other days, the soups and stews which used to be in the stock-pot, are disappearing, and that this prepared food, which comes from all over the Empire, saves the need for the cooking and is very acceptable to the family. Although that food is usually of good quality it is expensive food, and when people have to look at every penny, as the hon. Member for Hemsworth (Mr. G. Griffiths) says, it is an unfortunate thing that tinned food is in such general demand. The great problem we have to solve is how to secure abundant supplies of the protective foods—meat, dairy produce, fruit and vegetables—at prices which people can afford to pay. That is the problem if we are to deal effectively with malnutrition.
That brings me to a matter which I specially desire to emphasise to-night, namely, the fundamental importance of milk as a factor in the nutrition of the people. We are faced with the fact that milk, the most complete of all foods, is regarded as a serious source of potential danger, not only by the medical profession but by large sections of our population. The Welsh report which we debated this week says some very severe things about the responsibility of local councils for neglecting to enforce the safety of milk supplies, but Parliament itself is not free from blame in this matter. There is an overwhelming consensus of scientific and medical opinion that in the present condition of our dairy 1564 herds, and with the present standards of dairy sanitation, the only milk that it is safe to drink is pasteurised milk. Nevertheless when the borough of Poole and a great city like Glasgow come to Parliament seeking power to enforce requirements to make milk safe for their people, they are persuaded to withdraw on the promise of a national Bill. But when a national Bill is produced and it becomes known to Members of this House—to Members on both sides—they make it perfectly plain that any Clause requiring the safeguarding of milk will be rejected. To my mind it is no good our condemning the little district councils for neglecting their duty in regard to milk when we as a Parliament fail to do what is essential for the safety of the people.
Regarding pasteurisation, I would quote this from the Welsh report in connection with milk for school-children:We are of opinion that the children should be supplied with only one quality of milk, and that the best. It is wrong that children should run the risk of being infected with the bovine tubercle, and thereby possibly of being crippled for life, merely because the authority, which is entrusted by the parents with the care of their children, is indifferent or careless about the quality of the milk supplied.It goes on:We feel that an authority which is content to supply undesignated milk, and thereby allows the children to run the risk of being infected by bovine tubercle, when it can procure clean, pure milk, free from tubercle, can only be described as callous.Again it says:In view of the medical and educational evidence given before us, we do urge upon school teachers not only the desirability but the necessity of using all possible means to inculcate the habit of milk drinking amongst children; but of course it is useless for us to put forward this suggestion to the teachers unless the authorities make a supply of pure, uninfected milk available in the schools.Then again, the report says:If, in the interests of the farmers and the public, efforts are to be made to encourage a greater consumption of milk … every step possible should be taken to ensure that the milk supplied is free from the danger of conveying disease to the consumers, especially such a serious disease as tuberculosis.Another passage refers to the employment of infected persons in the work of dairy farming. The Commissioners say that medical officers of health ought to take steps at once, no matter how indifferent the authority may be, to enforce the regulations, and they add: 1565Until he is satisfied that the infected person has been removed from the handling of milk which is to be used for consumption, the sale of milk from the farm or depot at which such person is employed should be forbidden. This may be drastic, but the health of others is at stake, and should not be endangered, however hard it may be upon the individual.''I call particular attention to the word "drastic" in that report. To me it seems amazing that it should be regarded as drastic to require the exclusion of infected persons from farms that supply us and our children with milk.
This Welsh report, which we were considering earlier in the week, was mainly concerned with tuberculosis, but what of the other infections contained in milk? In 1936 there was a typhoid epidemic at Bournemouth in which 1,000 people were infected, and there were 50 deaths. The medical officer of health for Poole when he compiled his report on that epidemic, said that had the children been supplied with the raw milk that was responsible for the epidemic instead of the pasteurised milk provided in the schoolsthe result would have beggared description.Those are the words of a man who is usually very restrained in his expression, but it conveys some idea of the risk that was involved for Bournemouth and neighbouring towns. In Doncaster, during the same year, there were 100 cases of scarlet fever, and 229 cases of sore throat, from raw milk supplied to 330 families in which there were 218 school children. Of those 218, 53 developed scarlet fever and 37 developed sore throat. Fortunately for Doncaster, the milk provided in the schools was pasteurised, but the raw milk supplied to those few households had a devastating effect on the health of the children. In the same year, at Wilton, there was an outbreak of gastro-errteritis in schools. In the first school of 89 children which took raw milk 79 were infected, and in the second school of 33 children who took the milk 32 were infected. I could go on almost indefinitely multiplying cases of milk-borne infection. There have been outbreaks in this country, Canada, and the United States which establish to the satisfaction of all reasonable people that in present circumstances of dairy work at home and abroad there is no milk safe except pasteurised. The failure of Parliament to give the public protection in this matter seems most amazing, when we consider 1566 that we are well into the twentieth century.
I submit therefore that one of the first essentials is the provision of safe milk, if we hope to secure better nutrition of the people and increase the prosperity of dairy farmers. When agriculturalists can satisfy the medical profession and the thinking people of this country that milk is safe, they will be amazed at the enormous advance in the consumption of that wonderful food, and they will wonder in the years to come why on earth they resisted this reasonable requirement.
§ 9.11 p.m.
§ Mr. Tomlinson
One of the advantages of being called late in a Debate of this kind is that one is compelled to say something original, inasmuch as all that one intended to say has been said by other speakers. I am, however, in the fortunate position of having been given many things I would like to say by the speeches that have been made by hon. Members opposite. In opening his speech, the Minister of Health suggested that because the course of the Debate had taken the direction of pointing out the necessity for dealing in the main with school children, his duty as Minister of Health was to show the necessity for improvements being made in the home. I do not think that any hon. Member will question the Minister's desire to improve conditions in the home in order that children, who we wish should be well fed, may enjoy the additional advantages that will result, but when the Minister suggested that the only justification for the clinical report, to which reference had been made, was that there must be a test and it could therefore be justified on those grounds, it seemed to me that we were in grave danger. It seems to me that a test which is used simply because we want a test and not because it is the best test that can be devised, or because it suits the purpose of clouding the issue, is, on the part of the Minister of Health, something that needs a good deal of understanding and justification.
I suggest that the discussion which has taken place with regard to normality, particularly in dealing with school children, reveals a state of affairs which ought to be inquired into and on which some definite action ought to be taken. My hon. Friend the Member for Clay Cross (Mr. Ridley) showed quite clearly, by the extracts he made from speeches delivered 1567 in this House 12 months ago during a similar Debate, that there is no standard, and that normality in one district is abnormality in another. He showed also, from the standpoint of attempting to devise a standard, that each medical officer or school medical officer was left pretty much to his own devices. Although standardised forms are sent out by the Board of Education to every school medical officer to fill in, what happened to the percentage was determined entirely by where the officer set that standard of normality. The hon. and gallant Member for Blackburn (Captain Elliston) dealt with the position in such a way as to show that everything in the garden was lovely.
I was interested also by the speech of the hon. Member for St. Albans (Sir F. Fremantle), who, however, caused me some little consternation. He referred to the Battle of Waterloo. I have been told on several occasions that the Battle of Waterloo was won on the playing fields of Eton, and I am sure that the nutrition standard of those who were playing on the fields of Eton at that time was well above the standard, which was referred to by my hon. Friend, of the people who actually won the battle of Waterloo, as he indicated, on almost empty stomachs. During the 12 months that I have had the privilege of being a Member of this House we have discussed many questions. I have seen the House seething with excitement when we were discussing questions which in the final analysis will depend for their settlement on the question which we are now discussing to empty benches. Whether the battle of Waterloo was won on the playing fields of Eton or not, the armies of the future are going to require well-nourished individuals for their maintenance, and nutrition is going to play an important part.
I was interested in what the hon. Member for Blackburn said about the habits of the workpeople. He argued that the women of Blackburn found tinned salmon attractive. One of the arts of the shopkeeper is to make the things that are put into the shop windows attractive, but does not the hon. Member realise that the reason why workers buy tinned salmon is that they are not in a position to buy fresh? I can assure him that they do know the value of fresh salmon when they can get it. They do not buy tinned sal- 1568 mon because they do not like fresh salmon, and, when they cultivate the taste for fresh, they leave the tinned for someone else. As to the question of cooking, I resent what the hon. Member for St. Albans said about the British housewife in comparison with the French working woman. I am all for the Entente Cordiale, but I think it can be carried a bit too far. I have been given to understand that they cook many things in France that we should not like to ask our wives to cook. It may be due to lack of education. Toads and frogs may be very nice; I have no objection to them; but we have not been educated up to the standard at which it has been found necessary to cultivate that sort of culinary taste, which, the hon. Member for St. Albans seems to think, puts them in a different and a better category than we occuy. I am not prepared to accept that.
I have been glad that several hon. Members, at any rate, have got away from the quoting of statistics all the time with a view to proving various things. Statistics, in my judgment, can be very useful, and I am not suggesting that they ought not to be used, but I do suggest that wrong conclusions can be drawn from them, and that sometimes figures can be used instead of action being taken. One can quote a figure which runs into millions relating to school children. The number of milk meals and the number of solid meals provided is 2,498,000, a figure which, when it is quoted, seems startling; but when you are dealing with a school population, and realise that that figure covers six days a week in some cases the whole year round for something like 5,000,000 children, the figure is misleading from the point of view of what is being done.
Some figures were quoted, however, which interested me—I think they were quoted twice from different parts of the House—with regard to the heights and weights of individuals in different circumstances. The figures were quoted for children in elementary schools and children in other types of schools, for children in one area and children in another area, showing how in some cases these children were lacking in inches. But you do not need statistics to prove that; all that you need is a Division in this House. When I first came to this House, I was startled when I found myself in the Division Lobby among quite a number 1569 of hon. Members opposite. When I met them in the Lobby I felt like a pigmy in the Valley of Giants. I looked up at them, and was very glad that political issues in this country are not decided as they sometimes are in the French Chamber, because I should have had difficulty in reaching them. I asked myself how it was that these people—very nice people—were so much taller and so much bigger than, in the main, the average Member who comes from a working-class home. You have the explanation in the statistics that have been given. They remind me of a story which perhaps I may be allowed to tell to the House, and which in my opinion illustrates this point very well. It is the story of two boys who went in one Sunday to dinner, where the mother could cook. She took the only joint of meat they could afford, and put out the dinner on the table, and the younger of the two boys said to his mother, "Mother, our John's got more meat on his plate than I have. "The mother, quite naturally, replied, "Well, our John's a bigger boy than you." "Yes," said the boy," but if our John always has more meat on his plate than I do, he always will be a bigger boy." Is not that true?
I have been reading—I wish all Members of the House would read it—the Spens Report. One of the most interesting chapters in the Spens Report deals with the development of children between the ages of 11 and 16. It tells us about the formation of bone, the length of bone, and the reason for growth, and how that growth longitudinally to which I have been referring takes place, in the main, between the ages of 11 and 16. I asked myself, after reading that in the report, whether it was an explanation of the difference between my stature and the stature of some hon. Members who adorn the benches opposite. I am not begrudging them their height; I am glorying in it; but I get the explanation in this report. It tells us of the things that will make bone, and of what should and should not be done by children between the ages of 11 and 16. I was working in a cotton mill then, carrying heavier weights than I ought to have been carrying—the very thing that the medical men who gave evidence before this Committee said again and again ought not to be clone. You can go through the towns in Lancashire—Blackburn, Rochdale and so 1570 On—and notice the people there. How is it that they are stunted? Why are they bow-legged? It is simply because, at the ages when, as the report tells us, bone should have been forming, it was being disjointed and thrown out of shape by doing things which ought not to be done at those ages.
To return to the question of nutrition, I do not speak as an expert; I speak simply from experience, derived in the main from observation, and as a layman. I know it is fashionable to talk about proteins and calories, though I admit I do not know what they mean. I know the need that there is for a careful selection of diet, but I am still strongly of the opinion held by many of my hon. Friends on this side, that in the majority of cases of malnutrition or subnormal nutrition the main lack is a lack of purchasing power. It is not a lack of knowledge of what to buy. The root cause is absence of the wherewithal to buy it. I can imagine circumstances in which a knowledge of proteins and calories and the requirements of a scientific diet could be a grave disadvantage to a mother. The mother has a difficult task now. We give her 30s. a week and she has a family to keep. Teach her all that you want to teach about calories and the balanced diet, and as it is an utter impossibility to feed her children up to that standard her worries are ten times worse.
I wish hon. Members on the other side would study the economics of food. I am strongly of opinion that economics determine to a large extent not only the food we eat but the kind of food we eat. I wonder whether there was a rush in the dining room to-day because of the important event that took place this morning. I had two friends in to lunch, and it is a good job I was not on unemployment pay this week. The Kitchen Committee would be questioning my economics. I have often wondered why oatmeal porridge was so popular in Scotland. It can only be explained on the basis of economics. The Scotswoman could only satisfy her bairn by providing the food that was cheap enough and filling enough. She did not consider its calorific value or the proteins it contained, but what she could get that would fill the children, alleviate the pangs of hunger, and at the same time help them to grow. It was that which made oatmeal porridge popular.
1571 I am convinced that bread was the staple diet of the working class for the same reason. It was the only thing our mothers could give us—bread with dripping or margarine. I wonder why it was that when the Noble Lady the Member for Plymouth (Lady Astor) was speaking about the great food value of milk she forgot to mention that butter was made from milk and that in not one of the illustrations she gave did she use margarine. I hope that was a slip, because I think that the workers of this country are entitled to butter on account of the fats it contains. But why has bread always been the basis of the worker's meals? When he goes out to work he takes bread with him; it is the principal item of his diet. Since I became better off and had the privilege of sitting down to dinner with those who were, not my betters but more privileged than I had been in days past, I can never finish the meal. I never get to the end of the last course. Why? For the simple reason that I had always been taught that it was a crime to eat fish or meat without bread. In a working-class home the meat or the fish were luxuries, eaten in order that you could get down the bread which was the basis of the meal. In short, the basis of your nutrition is, and always has been, an economic basis.
In spite of all the speeches made to-day I think one important factor has been forgotten. Nutrition must begin before the child is born. In the development of the ante-natal clinic and in the provision of the nurture of the mother when carrying the child is determined to a large extent the chance which that child will have in after life. It is there that the beginning should be made in seeing that the mother is adequately supplied with food. I know we are taking a good deal more care than we used to, and medical officers to-day are concerned particularly about dental treatment for expectant mothers. I am glad of it, because I realise the need for that care. I knew a man who pledged his false teeth. When I asked him why, he said he was on the means test and he had nothing for them to do. It is essential that the expectant mother should be properly cared for. Milk is not enough. We ought to see that she is well and truly nourished when she is doing what I consider to be one of the 1572 most important tasks that any individual is called upon to perform in this nation.
I would have liked to follow the Noble Lady the Member for the Sutton Division of Plymouth in her advocacy of nursery schools. I believe that in the nursery schools there will be an opportunity of developing the knowledge that has been spoken of to-night. I believe that you should begin your training early enough, and that is why I want to close the gap between two and five years of age by the provision of nursery schools. In the nursery school not only are the children given adequate food of the right kind, but they have other things which enter into the question of nutrition—sleep and adequate play. And another very important factor, applying not only to children but to grown-ups, is the care which is taken at meal time. One of the tragedies of working-class life is that we have always been compelled more or less to bolt our food. There has never been adequate meal-time for the workers. I am quite sure that if we had more time to spend over meals, particularly the meals in the workshops, it would be advantageous.
That is why I believe in the training of the nursery schools, where the children are taught to help each other, where they develop a technique with regard to meals which will be of real value in after life. That can be carried on after the nursery schools, as it is in some places, and become a feature of the meals served in elementary and secondary schools. In the district represented by my hon. Friend the Member for Nelson and Colne (Mr. Silverman), experiments have been made in the school feeding centre, and some attractiveness has been brought into their provision and laying of the meal, with the children themselves acting as the little fathers and mothers of the community, and with the provision of tablecloths and flowers and the encouragement of conversation during meals, rather than the disciplinary attitude that only one thing must be done at one time. It seems to me that improvement along those lines could be made.
In spite of all the figures quoted and what has been said about the milk-in-schools scheme, the fact that only 49 per cent. of the children are receiving it is a condemnation. If it is good for the 49 per cent., it ought to be available for the other 51 per cent. I plead for the 1573 sweeping away of the cost of this milk to the children altogether. That would be an investment the nation could well afford. It would pay for itself over and over again. The report says that milk is one of the principal factors in the building up of that bone about which I have spoken. If it is so essential, I cannot understand how we are satisfied to allow it to be made into collar studs, when it could be turned into bone in our children. I realise the value of collar studs, but I think we should have them made of something other than milk. We could solve two or three problems by utilising the milk for the purpose for which it is best suited, the building up of a good, healthy, well-nourished people. If half the attention that is being paid to other questions were paid to nutrition, and if we were to examine the balance sheet of the values which come to us through the money spent in seeking health and happiness we should get a return for our money not only in health, but in that true wealth, a happy and contented young life.
§ 9.39 p.m.
Lieut.-Colonel Sir William Allen
Perhaps I shall be forgiven by the House if I say, in the first instance, that I am speaking under a cloud, owing to the sudden passing of the chairman of our little Ulster party in the House of Commons. I am certain the sympathy of the House will go out to Lady Reid in her sad bereavement.
We have had very interesting Debates, both yesterday and to-day, on the health of the people of this country. I listened with particular interest to the opening statement of the hon. Member opposite yesterday, in his indictment of the conditions in Wales. The picture there is not entirely gloomy, although it certainly is very bad. Last Saturday week I attended a football match in Belfast, with 30,000 or 40,000 people looking on. It was the annual contest between the young men of Ireland and the young men of Wales. Whatever maybe wrong in regard to nutrition in Wales or the condition of the people there, the young men of Wales gave a very good account of themselves, and beat the Irishmen to a standstill. So everything is not gloomy in Wales.
What we have been trying to impress on ourselves, and on the nation generally, 1574 is really that the men and women of the future are the boys and girls of to-day. If we are to have a healthy nation in the future, we must see to the health of the boys and girls of to-day. Yesterday, there was a long and very serious, and very proper, Debate on tuberculosis. A good many of the sanatoria are filled with young men and women suffering from that terrible disease. I do not think it would be wrong to say that they contracted that disease from malnutrition in their youthful days, or the conditions under which they lived. For the past two or three years the Corporation of Belfast have been looking in vain for a place on which to erect a great sanatorium for tuberculosis. I wish the people who are looking for such sites would think for a moment how they could better the position of the people by spending the money in providing them with proper housing accommodation. We have had poor people dying in their own homes of what we call consumption—or what somebody yesterday called "the decline." The homes were broken up, beds were sold, other poor people got hold of the beds and installed them in their homes, and after a few years they, too, died of tuberculosis. That is going on still. If the money were spent in the burning of those beds and the provision of proper housing accommodation, we should need no sanatoria at all.
I am glad to say that in Northern Ireland we have taken the question of providing schools very seriously. When our Government was first formed our school accommodation was in a very sad condition. There were certainly a number of fairly good schools, but on the whole the accommodation was poor, ventilation was bad and sanitation could not have been worse. But, to the credit of the Government of Northern Ireland, the first thing they tackled seriously was the accommodation of the school children of our Province. Anyone who has been in Northern Ireland during the last 10 years will have seen the magnificent schools that have been erected. They are airy, with large accommodation and plenty of playgrounds, and they are in every way thoroughly up to date from a sanitary point of view. That is proceeding. The result, naturally, is that we are, we believe, rearing a population of more healthy young men and women than ever has been reared in Northern Ireland before. We begin by, to some extent at 1575 all events, the provision of nursery schools. They are attended by children over two and under the compulsory school age who are living in districts where the housing and general economic conditions are seriously below the average, and whose home surroundings, in consequence, leave much to be desired. The primary object of these nursery schools is not instruction in the general sense of the term; it is rather to provide healthy external conditions for the children, to train them in wholesome personal habits and to develop their minds and senses by suitable occupation and prepare them for the public elementary schools in favourable dispositions of mind and body. I am reading from the educational report of the Ministry of Northern Ireland. Provided we have a sufficient number of these schools, I am satisfied, and I am sure the House will agree, that we are proceeding in the right direction to attain the groundwork and the foundation of the health of the children. That is only in its infancy. I have already mentioned the fact that we have had a large increase in our schools accommodation. As the House may be aware, we have our regional county committees who look after the education in the particular counties. I read again from the report, which states:In most of the regional schools a sufficiently long break is given in the middle of the day to afford the children an opportunity of going home for the mid-day meal, but judging by the speedy return to the school premises of many of the pupils the meal must be a light one. Arrangements continue to be made for meals for the children at mid-day, particularly where it is possible to have a light meal.These conditions are going on all the time, and I am glad to say that the improvement in the health of the children is manifest. I take this opportunity to voice my feelings with regard to what we are doing in Northern Ireland, and it is greatly to the credit of the Government of Northern Ireland that such a condition obtains to-day. Year after year we increase the number of our schools, and provide healthy and good accommodation, and I have no doubt that in the end the result will be very satisfactory.
§ 9.49 p.m.
§ Mr. Westwood
Those of us who have listened to this Debate from the beginning will whole-heartedly subscribe to the 1576 first statement that was made by the hon. and gallant Member for Armagh (Sir W. Allen), namely, that the Debate has been very interesting and of great use, and no doubt will be helpful in dealing with this great problem of nutrition and the health of the people of this country. I am in agreement with many of the things that have been said by hon. Members opposite, but two definite statements were made by hon. Members opposite with which I must at once join issue. The Noble Lady the Member for the Sutton Division of Plymouth (Viscountess Astor)—I am sorry she is not in her place—made a suggestion which may be entirely misunderstood unless it is dealt with from this side of the House. Special reference was made to the expenditure on milk and the expenditure on intoxicating liquor, and to the fact that three times the amount was spent on drink—to quote the words used by the Noble Lady—as compared with the amount spent on milk. Unless we deal with facts as they are, it is possible for people outside as well as Members of this House to get the impression that that meant three times the quantity of intoxicating liquor was drunk compared with the quantity of milk. That is sheer rubbish. There is no tax on milk, but there is a very high tax on intoxicating liquor. I have no doubt that when the Noble Lady has guests, although she herself may be, like myself, a life-long abstainer, and offers them a bottle of champagne her contribution to that expenditure of three times more on intoxicating liquor than on milk will be 42 times as much as the working man's expenditure on a glass of beer.
I do not want to be misunderstood, and I do not want anyone to run away with the idea that I am advocating expenditure on intoxicating liquor. I do not know the taste of intoxicating liquor. I have never spent a penny piece on it. One thing I do know from bitter working-class experience is that, although I am a lifelong abstainer, when working in the mine earning what was considered then to be good wages of 6s. per day, an average of five days a week, I had 30s. per week on which to keep a wife and family, and had no money left, nor had my wife the means to buy the milk that was necessary to give us the sustenance which would have enabled us to enjoy the benefits of true nutrition. It is false to suggest, either on the part of the Noble 1577 Lady or anyone else, that if the working classes ceased to spend all they do spend on intoxicating liquor they would have sufficient with which to buy the milk necessary to give them the well-balanced diet for which we have been asking on both sides of the House to-day.
The second statement on which I want to join issue was one made by the hon. and gallant Member for Blackburn (Captain Elliston), the hon. Member for St. Albans (Sir F. Fremantle) and the hon. Member for Frome (Mrs. Tate) in which all three suggested that the working-class mothers of this country are not good cooks. I would be the last individual to make the claim that we have reached perfection in the culinary art, just as we have not yet reached perfection in the art of oratory even in this House. There will always be room for improvement, but I resent the suggestion that working-class women do not know how to cook the food that they are able to buy. It ill becomes those who have never known the horror, anxiety, and mental stress of having to wait for Friday's pay before they could buy Friday's tea, and who have had to make a tasty meal out of potatoes and dripping with no meat, and who on many occasions have had to make a tasty meal out of potatoes without fish, but merely with the assistance of parsley sauce. It ill becomes those who have never known that problem to suggest that working-class women are not good cooks. I suggest in all seriousness that it is not a problem of cooking as far as our discussion to-day is concerned, but of getting the materials to cook. Provide the materials, and then there will be no mistake about it; we will get the better cooked meals that are necessary as far as the working class are concerned.
I do not propose to enter into the merits of pasteurised or unpasteurised milk which led to a little scene earlier in the Debate because here again the problem for the working-class women is not the question of deciding whether it is preferable to have pasteurised or tuberculin-tested milk.
In the first place, tuberculin-tested milk is dearer than pasteurised milk and, therefore, the working-class housewife cannot afford to buy it. The problem for her is not whether the milk is pasteurised or tuberculin-tested but how, with the low wages coming into the home, 1578 she is to get milk at all. The Minister of Health made a reference to a scheme dealing with milk for those who are working in factories, and I hope it may be possible for the Parliamentary Secretary to give us some outline of this proposal, where it will apply and the conditions under which it will apply. The Minister of Health made the admission that there are actually black spots in England where no proper provision is made under the maternity and child welfare Acts. The right hon. Gentleman was at one time Minister of Health for Scotland, and I want to suggest that he should do the same for England as he did for Scotland. When we were discussing the child welfare and maternity Act, 1926, a suggestion was made that a map of Scotland should be prepared giving the areas in red where the child welfare and maternity schemes were being administered and where they had been prepared, and in black those areas which had not prepared any schemes.
I suggest that the same thing should be done for England. It would then be easy for those who are dealing with these problems and for the Department itself to see at a glance where local authorities were doing their duty and where they were neglecting their duty. I still have my map at home. It was very useful from an administrative point of view and also assisted me when I was pleading for improvement so far as child welfare and maternity schemes in Scotland were concerned. I hope my suggestion will be conveyed to the Minister of Health. It is more than possible when we are discussing the problem of food and nutrition that we may get into the great danger referred to by a great expert on dietary, Professor Urquhart, the Chairman of the Departmental Committee which inquired into and reported on the health services for Scotland. Dealing with that danger he said:There is a great danger that people may develop a pathological interest in food; that it may become too food conscious, due to the superfluity of ill-advised chit chat concerning the virtues or the evils of this or that particular article of diet.He went on to suggest a guide for determining what or what was not good food to consume. He defined it in this way:Eat all kind nature doth bestow;It will amalgamate below,If the mind says it shall be so.But if you once begin to doubtThe gastric juice will find it out.1579 That seems to be fairly good sound common sense and advice from an expert. There have been many references to the many reports which have been issued dealing with the problem of the nutrition and food of the people. I want to make a brief reference to one, the report which was issued in March, 1937, of the committee set up in June, 1935, to advise on nutrition. They stated:There is a deficiency of milk in the diet of large sections of the population. It is prorbable"—I do not know why they should have any doubts on this matter. If they had had a little more practical experience of working-class conditions they would not have had any doubts—that insufficient fruit and vegetables are eaten.I know from working class experience that insufficient fruit is eaten by the working classes because they have not the means to purchase the things which are desirable and advisable from a health point of view. In the first part of their report this committee emphasised the unique value of milk in securing a balanced dietary, and incidentally they reported that the average amount of liquid milk consumed in Scotland was only.479 of a pint per day, whereas to give the balanced dietary which the Committee considered to be necessary, there ought to be at least a minimum consumption—I want hon. Members to note this—of seven-eighths of a pint per day.
An unofficial committee is also carrying out an inquiry into dietary and clinical work in 1,000 families in Scotland, under the chairmanship of an expert who has been often referred to, Sir John Orr. This committee is carrying through a survey on behalf of the Carnegie Trust. The survey is to take two years for the purpose of gathering information regarding the amount and the quantities of food bought by families throughout the country. I would suggest that I could write a part of their report at once. Bitter experience would enable me to write it perhaps far more efficiently than Sir John Orr, despite his great ability. Our knowledge of working class conditions convinces us that even without these scientific surveys, which I admit without hesitation are valuable, there is ill-nourishment and under- 1580 nourishment of our population simply because they have not the means, because of low wages, to buy the foodstuffs which they require for good health. The prevention of sickness and disease both caused by malnourishment and ill-nourishment and under-nourishment to be nationally effective must begin with the expectant mother. This question has been repeated and emphasised, and the policy of the pervention of sickness and disease must continue over the impressionable years of early child life.
It will be admitted that a large volume of disability and the disposition to disease can be traced definitely to what I would describe as nutritional disorder, caused in some cases by under-nourishment, because we have had an illustration where the child of a medical man was discovered by a medical officer of health to be ill-nourished. Ill-nourishment and bad nutrition, or malnutrition may mean different things. In the great mass of cases it is not ill-nourishment but malnutrition, caused definitely by under-nourishment owing to the inability of the working classes to purchase the foods required. The committee on which I sat for several years inquiring into the health services of Scotland had most valuable advice and information placed before them by Sir John Orr. This is what he said in the written evidence that he submitted for our consideration:Improvement in nutrition would prevent a large proportion of the disease affecting the present race. The results of experiments suggest that the universal adoption of an adequate dietary would reduce disease by more than half. With regard to the amount of money spent on medical and social services, it is probably no exaggeration to say that £1 devoted to securing better nutrition of expectant mothers and children would yield greater results from the point of view of the quality of the race than £10 spent in treating disease. Foodstuffs are being produced with increasing efficiency. Foodstuffs which have a special health value can be produced in abundance. This has proceeded so far that there is in many cases, as in the case of milk for instance, a glut, and provision is being made to regulate the supply coming on the market. It is suggested that, if improvement in distribution could be attained, it would be possible to effect great savings in medical and social services with at the same time an improvement in the general health of the community.I think that statement ought to carry conviction to those who have given careful consideration to the problem of nutrition. A vast amount of debility, sus- 1581 ceptibility to infection and inability to put up a successful fight against infection once it is contracted is also directly due to the want of the essential factors and quantities in diet. This fact has been proved conclusively by research which has been carried out by Dr. Telfer, ably assisted by the medical officer of health for Glasgow, Dr. MacGregor. The present state of affairs is mainly attributable to the low wages and the inadequate purchasing power of the workers, the inadequate allowances to the unemployed, the lack of development of the social services, and the miserable pensions paid to the aged people in our midst. I think these statements are fully justified, and they are also substantiated and proved by statements made by Sir Frederick Gow-land Hopkin, Professor of Bio-chemistry at Cambridge, who claims that the problem of nutrition is an economic problem. He goes on to state:The problem involved in securing right nutrition for all classes of the nation is essentially an economic problem. If it is to be solved, there must be no class without spending power adequate for the purchase of all essential foodstuffs, even the more costly, in sufficient amount. This must be recognised in all honest attempts to fix adequate wage rates, and the taxpayer must face the financial problem in the case of the unemployed. When, however, its importance becomes fully realised by all, the difficulties will be faced, especially when it is understood that the necessary expenditure cannot fail to be a highly profitable investment. This is no sophism. The profit would by no means arise from a saving in the public health services alone. The greater return would be in the increase of national efficiency.What is the main problem, and on whom does this tragedy of under-nourishment and ill-nourishment and lack of nutrition most heavily fall? First of all, it is mainly a poverty problem, and it is on the mothers and the children that the sharpest edge of poverty falls. Where you have large areas with a high percentage of unemployment, they suffer the very worst effects from their long continued unemployment and from their greatly intensified poverty. Under our wages system no provision is made for the needs of the dependent family. I only received the same wage, working in the mine, when I got married as I received when we had a family of six. It required a bigger amount coming in to give the same average per head to purchase the foodstuffs that were required. We could not get additional foodstuffs nor the quality of 1582 foodstuffs. My experience was that of tens of thousands of the working class. We had to struggle on. We could not buy more food. We could get milk only in our tea, instetad of tea in our milk. We could not even get the same strength of tea when the family got larger. All we could do was to save up and buy a bigger teapot. We had the same amount of tea with more water in it. We did not get more meat and vegetables. We saved up to buy a bigger kail pot, and all that happened was that there was more water in it. That is not good enough. There is plenty to go into the kail pot if we are wise enough to arrange for its distribution scientifically and wisely, and an adequate supply for every one.
Every additional child reduces more and more the margin available for food, so that the mothers often starve themselves. That is the reason I resent bitterly the suggestion that has been made that the mothers in the class to which I belong do not know how to cook. If they do not know how to cook, they know how to make sacrifices on behalf of their children. Time and again the mother tells her children that she has had a meal, when it is not true; she starves herself in order to provide a last bite for the children. I am not going to argue that there is abject starvation in this country, because I know the difference between the word "starvation" and the word "malnutrition." The womenfolk of our class are willing to make sacrifices in order to provide a little more for the children they love so well. It is always the womenfolk and the children who are in greatest danger of under-nourishment, with all its consequences in the way of weakness in resisting disease, disease itself, and the long-drawn-out tragedy of ill-health, for, as has been rightly stated by Sir Robert McCarrison, malnutrition is not so much a state of ill-health as it is of many states of ill-health; and the infections and diseases that may attack the body in consequence of lower vitality and lower resistance to these diseases, through insufficient and improper food, are almost too numerous to mention. The multitude of diseases that follow from malnutrition and undernourishment is known to almost every hon. Member.
I do not want to confuse the word "malnutrition" with the word "starvation." In the Debate, to-day the word 1583 "starvation" has been used a few times. Starvation means an inadequate intake of food, leading to loss of weight and to death from a shortage of food. Malnutrition, or under-nourishment, has a much wider meaning than starvation. It means the presence in the body of physical defects, lower general health, lower resistance to infection and disease, which could have been prevented by adequate supplies of the right kind of food, of which there are adequate supplies available. There is plenty of milk and there are plenty of good foodstuffs, and, what is even more important, there is a depressed agricultural industry willing to expand and to produce still more of those things which are necessary to solve the problem of malnutrition and under-nourishment. We allow people to suffer, rather than face the problems of distribution and increased purchasing power for the people who are the victims of malnutrition. The first consideration of the housewife belonging to the working class is the weekly overhead expenses, such as rent, fuel, light, insurance and so on; and when she has defrayed these expenses, she has, in tens of thousands of cases, an inadequate amount left for the purpose of purchasing the foodstuffs required.
Sir John Orr has shown that a considerable proportion of the population—between 4,000,000 and 5,000,000 of our people—are unable to spend more than 4s. per head per week on food, while approximately 9,000,000 of our people are limited to an expenditure of 6s. per head per week. On such an amount it is impossible to have a properly fed or well-nourished population, and one of the tragedies associated with that first figure is that one-quarter of that number are children. I have taken part in the "Fitter Britain" campaign. I have tried to do my little bit as a member of the National Advisory Council and on the public platform to make our people health-conscious; to make them realise the value of true nutrition and of being healthy and consequently having a better chance of happiness. May I suggest, however, that the "Fitter Britain" campaign becomes a mockery if the children are denied the food which they need for better health. I would suggest a nutrition and agricultural policy to hon. Members opposite. We are to discuss a 1584 Scottish Marriage Bill next Thursday. Let there be a marriage between agriculture with its powers of production, and the people with their unsatisfied needs of consumption. That would be a case of real holy matrimony, from which there never could arise a cause for divorce.
If in our time children continue to grow up stunted in body or dulled in mind through want of proper food, it will be because we as a nation—though the responsibility meantime belongs to the Government—have deliberately neglected the opportunities which science has thrust upon us. The application of science to agriculture has brought within our reach for the first time in history a potential food supply adequate for the whole community. Achievements in the science of nutrition have effected a revolutionary improvement in the public health by making good the deficiencies commonly found in the diets of mothers and children and of the general community, particularly those in the lower income levels. We could rear a generation stronger, more alert, less liable to disease and more fitted for work and enjoyment than any previous generation. In so far as those who sit opposite, with their powers of administration and their opportunities to achieve the ideal which I have inadequately tried to outline, fail to improve the child life of the nation, I would remind them that judgment has already been passed upon them by the greatest Judge of all:Whosoever shall offend one of these little ones, it is better for him that a millstone were hanged about his neck, and he were cast into the sea.
§ I0.25 P.m.
§ Mr. Lindsay
In spite of the somewhat sparse attendance, we have had a most informative Debate. To-day and yesterday we have heard many speeches rich in hard experience, delivered with a racy wit from Yorkshire, Lancashire, and Durham, and yesterday from Wales, but all packed with common sense, and I am quite prepared to say that to me it has been an education to listen, and not least to the speech just delivered by the hon. Member for Stirling and Falkirk (Mr. Westwood). I am very happy also to have had the opportunity of working in partnership with my right hon. Friend the Minister of Health and his great Department. I think we are a little apt to look at these matters in a departmental 1585 manner, and, particularly when we are considering nutrition, I believe it is most necessary to keep in close touch with each other. In fact, I do not believe that many of these problems can be attacked except on a broad front, bringing up, as several hon. Members have suggested, reinforcements from the Ministry of Agriculture, possibly the Home Office, and certainly the Ministry of Labour.
§ Mr. Lindsay
Yes, and the Treasury. This is particularly true where environment and teaching have such an important part to play as they have had in these two Debates. As the hon. Member for Birkenhead, East (Mr. White) said, there are very genuine problems relating to the administration of the Unemployment Assistance Board and the different income scales of local education authorities, a point which I very much appreciate, and similarly to questions dealing with the footwear of children, which, as some hon. Members know, in Scotland is dealt with by local education authorities. The hon. Member for Keighley (Mr. Lees-Smith), who apologised that he had to go away, raised, I suppose, the key question, so far as my Department is concerned, in this Debate, and I want to say a word or two about the questions both of the clinical assessment and of the provision of meals and milk. He asked whether free meals could be given solely on the income basis for about a third of the children. It is clear to me that if local education authorities were given the power to feed on this basis, there would be no assurance that they would do it, because they do not exercise their existing powers now. That was a point made by the hon. Members for Pontypridd (Mr. Pearson) and Clay Cross (Mr. Ridley), and I think one or other of them suggested that it might become a statutory power. If it did, the cost would be—this is for free meals for a third of the children —about £7,000,000 a year if given on school days, and about £10,000,000 a year if holidays also were included.
There is another figure. The hon. Member for Farnworth (Mr. Tomlinson) asked me about milk, and I thought I would just give him the figure there. He said, "Why not sweep away all these 1586 charges and costs?" I cannot go into questions of legislation to-night, but I thought he would like to know that the figure would be about £6,000,000, of which about £4,000,000 would fall on the Exchequer and £2,000,000 on the local authorities, but it would involve the abandonment of a principle which—I am not saying that it is right or wrong—at present exists. That is the principle that the local education authorities are responsible for feeding children who are unable to benefit by the education provided. Hon. Members will remember that there is a long history behind this. Seventy years ago we passed an Act making education compulsory. Only at the beginning of this century we discovered that a number of children were ineducable; they were not fit to take in the education given them. A whole series of Acts was passed before the War for school meals and the rest, to try and bring physical fitness into the schools. Owing to the school medical service, one may say that the life of the school child has been revolutionised.
The local education authorities are not responsible for poor relief. They are not responsible for feeding as such, but only for feeding children who are unable to benefit from the education. Under the present system meals are provided by the local education authorities as supplementary nourishment for children who on physical grounds cannot take full advantage of the education provided. If free meals were given by local education authorities to all children below a certain income scale, as has been advocated by various bodies—the Children's Minimum Council for instance—the Unemployment Assistance Board would be bound to take it into account, and therefore the families would not be any better off. I do not want to load the House with statistics, but I must in fairness give three figures.
§ Mr. Ridley
I recognise that the most recent circular of the Board is a good circular, for it says to local authorities, "You may feed a child on the slightest pretext," but assuming permissive powers, the fear of my hon. Friends, justified by experience, is that local authorities take too low an interpretation of the instructions of the Board.
§ Mr. Lindsay
I will come to that point in a moment. I just want to put these figures across to the House.
§ Mr. G. Griffiths
The hon. Gentleman will have to put them across to this side because there is nobody on the other side.
§ Mr. Lindsay
I will assume that the House is full. Ten years ago there were 82,000 children receiving free meals or milk. Last year there were 151,000 receiving free meals and 560,000 receiving free milk. I come to the second point about the number of authorities that are doing it. Ten years ago there were 132 authorities exercising any powers at all; to-day there are 270. That is double. There are 315 altogether, and 270 out of the 315 are exercising powers for the provision of milk or meals. Ten years ago the expenditure of local authorities on this service was £182,000. The figure in the Estimates which I am going to introduce this year is £1,050,000, nearly six times as much. I will quote from what we say in the Circular in order to make the position clear to my hon. Friend the Member for Clay Cross and my hon. Friend the Member for Farnworth:The Board are concerned to secure that school-children who are unable, by reason of lack of food, to take full advantage of the education provided should receive such supplementary nourishment as may be appropriate in each case, the meals being free where the parent is unable to pay, and for this purpose in their view provision may properly be made for any child who shows any symptoms, whether educational or physical, however slight.That shows that the hon. Member for North Islington (Dr. Guest) was a little out of date in what he said on that point. We pointed out that there were difficulties in implementing this policy. What were the difficulties? They were too severe income scales, the nature of the food provided, the service of the meals and the condition of the premises, and I very much agree with the hon. Member for Farnworth in what he said when he pointed to the experiments which were being carried out in the serving of these meals—I think he quoted Nelson.
Since 1937 I have myself personally visited 30 counties in this country to impress upon them the need for going full steam ahead with meals and milk; but that is only part. The most effective method is the nutrition survey. The Board have in recent months been surveying the position in many parts of the country and have already addressed survey letters to nearly 90 authorities. I wish hon. Members would realise how 1588 much work that has meant. I have here a packet of such surveys. They give a detailed analysis showing precisely what is happening under each authority, and it brings very closely to the minds of those who are administering affairs the position in their own counties. In other cases the matter has been discussed with officials of the local education authorities. As a result of such a discussion recently Durham county is now for the first time to introduce free meals in that distressed area, and I am very glad to know it. Here is a list of the places where as a result of our survey progress has already been made—I think the good authorities may well be shown up. Five authorities have begun or are about to begin the provision of free meals—Bedfordshire, Derbyshire, Durham, and Aberdare and—experimentally—Carmarthenshire. Twelve authorities have introduced more lenient income scales—Birmingham, Lindsey—the other Lindsey, in Lincolnshire—Birkenhead, West Bromwich, Chepping Wycombe, East Retford, Leyton, Mossley, Hebburn, Carmarthenshire and Barry. There are three new authorities beginning provision of free milk—Bedfordshire, Bacup and Coseley.
Ten authorities have agreed to undertake periodic surveys. I attach great importance to this, because surveys at intervals of six months really mean that they are keeping up to scratch. In spite of all that one can say about clinical assessments—and that method is probably as good as any other—there is no perfect method. Doctors agree about that, and in our own report they say:Life is dynamic. Its functions can be estimated only by repeated observations to detect secular changes. We can no more evaluate the health of an individual by a single examination than we can tell the rate at which a vehicle can travel from an instantaneous photograph.It is better to have a look at the whole child in the flesh and then to estimate its general well-being. The 10 authorities which have agreed to undertake periodic surveys are Barnsley, West Hartlepool, Bacup, Finchley, Hartlepool, Jarrow—Jarrow is a striking example for, since the Board's representation the number of children receiving free dinners has increased from 170 to nearly 1,000—Lytham-St. Annes, Wallsend, Hebburn and Mountain Ash. Last week also I announced new arrangements for providing milk to sick children at home. That 1589 shows what has happened. Though many of us may not be entirely satisfied it shows that there is pretty definite progress being made on this nutrition survey work.
§ Mr. Westwood
Can the hon. Gentleman say whether anything comparable is being done by the Scottish education authorities?
§ Mr. Lindsay
I should be very happy to say so, but I will convey the hon. Member's question to my right hon. Friend the Secretary of State for Scotland. I could not speak for Scottish affairs to-night. I would make one further point about income scales. I believe there is an idea on the benches opposite that the automatic feeding of all children whose parents fall within a certain income figure is the right solution. In the Board of Education we do not believe in that, and every-day experience proves the contrary. It is not only an undesirable method but also a most unsatisfactory one, for it overlooks and neglects a large number of children who are in need of nourishment.
I must say that this was rather news to me when I first discovered it from the officers of the Board. I will give one or two examples of the way in which feeding on an economic basis works out. In Cardiff, a survey was recently undertaken by one of the Board's medical officers of the children in a large school, where 67 children were discovered whom be held to be definitely of subnormal nutrition. Of these only five were receiving free meals or milk. Similarly, in Abertillery, where the income scale was the sole method of selection, our doctor examined 1,158 children. He found that259 were definitely undernourished and that of these, 89, or 34 per cent., were receiving free meals. This, he said, was because the basis of selection for free meals was an economic one, and that very often missed the point. Unless the parents apply for a place for their children on the feeding list, they are overlooked and no satisfactory measures are taken. I could quote other examples from Ebbw Vale and Monmouthshire.
I want to say a word about school canteens. Hon. Members have mentioned several times to-day that in addition to the provision of milk they would like to see further provision of solid meals. Hon 1590 Members will know that there are two kinds of meal, that in the big urban feeding centres and the meal in the rural elementary school in the countryside. The figure to-day is 45,000 children receiving dinners on payment in the new senior schools. I have had many a dinner of that kind and I can certainly testify to the quality and indeed to the quantity. The meal can be brought down to a cost of 3d. a head. In some canteens it is being brought down to 2½d., but there is no reason why it should not generally be 3d. a head, which brings it within the possibilities of the people, as in East Suffolk. For years those meals have been going on in East Suffolk, and hundreds of children of agricultural labourers have had them. There has been payment by the children. The parents are only too glad. I would remind hon. Members that all the expenses of service, fuel, equipment, cost of the cooking and all the rest of it ranks for a 50 per cent. grant. A few weeks ago I believe it was thought to be only 20 per cent., but it is 50 per cent., which makes the whole thing much more possible. Quite apart from the value of the meal. There are many oilier considerations. For instance, very often the vegetables are grown in the school garden.
§ Mr. Lindsay
I do not know whether it comes within the provisions of the School Medical Service, but it comes under special services and it ranks for 50 per cent. grant. Another point is that the mere common act of sitting down with a number of other children for these meals helps to build up a corporate life in these modern schools. The hon. Member for Farnworth made a small error when he said that 49 percent. of the children of the country were drinking milk; it is actually 53.8 per cent.
§ Mr. Lindsay
Anyhow, the figure is now 53.8 percent. and that makes a difference of 200,000 children. The hon. Member and many other Members have referred to cooking and to the housewife, and I was interested in what he said about porridge and about bread and milk. I must say that I have a great deal of 1591 sympathy with hon. Members opposite. When I was speaking last night, I referred to the breaking down of the old home lore, about which I know something which was not learned from books. We have now an elaborate course in the elementary schools for cooking. I said then that my ancestors, who knew how to cook, including my own mother, never learned it in school, but now there has been a change. I would never say, however, and I think it is not an easy thing for anyone to say, that the working women of this country do not know how to cook. I have been in too many miners' homes, and in the War days had too many apple pies in Wensleydale, Swaledale and other parts of Yorkshire, not to know that there is a great deal of good cooking; but there is a problem here. I have found it when I have been going about the country and asking hundreds of children what they had in the morning before coming to school. The answer most often has is "Bread and tea." There is no doubt that, over large areas of the country, bread and tea is the familiar meal at the beginning of the day, and I am afraid it is very often the familiar meal at the end of the day. That is why I am glad to see something served in between that is a little more nourishing in the way of school meals.
With regard to secondary education, I only want to say that I should like to see far more hot meals provided for secondary school children, and for this reason In the secondary schools you have many children who have previously been in elementary schools, and, by reason of the sacrifices that have to be made by their parents, there is still a problem there. I cannot say off-hand that the overhead expenses rank for the 50 per cent. grant; that is a question which I would like to look into.
The hon. Member for Stirling and Falkirk raised several points. With regard to factories, this milk is ordinary milk, provided at not less than the normal rate. It goes to 7,000 factories all over the country, and I think time is given off as a break for that milk to be drunk in the morning. I will convey to my right hon. Friend the other questions that the hon. Member raised, such as the black-spotting of certain local authorities and so forth. For the rest, most of his speech, 1592 and of other speeches, was devoted to questions of very general application, such as low wages, pensions, the needs of dependants, family allowances and so on. Obviously, I cannot be expected to go into these questions to-night.
The hon. Member for Pontypridd made a very interesting speech, in which he raised one question at any rate that I would like to look at—all these questions are very difficult—as to whether, if there could be no increase of grant for meals in schools, there could be any increase of grant for overheads. That is a real problem with hard-pressed local education authorities trying to provide milk and meals on the present scale. I appreciate it. There are also, as was pointed out by the hon. Member for Clay Cross, many authorities in the country which might well put these provisions into operation. We try our best with local authorities by making speeches to them, by making representations, and I must confess that at times my patience gets rather thin.
As for the teaching of cookery, I do not think that it is being conducted to-day in quite the terms that the hon. Member for Frome (Mrs. Tate) used. I would like her to see a modern school with a four years' course in cookery. It is a revelation. I do not say it is universal, but it will be when our reorganisation is completed. The hon. Member for Hems worth (Mr. G. Griffiths) asked about the question of diabetes. I can only report obviously, because this is not within my knowledge. As I understand it the point is that any local authority can obtain sanction from the Ministry of Health to supply insulin free of charge to poor people suffering from diabetes. The only qualification is the definition of the word "poor," and that apparently rests with the local authority.
When we have finished with our statistics and proved our points, the stark fact remains that there are far too many of our child population who are unable to obtain those protective foods which make such a difference to a healthy life; and if great progress has been made—and I think I have proved that very real progress has been made—standards have also improved. I must say I have been reflecting all through these two evenings about what in. the world happened 25 years ago. It does not make me com- 1593 placent at all, but I just wondered; and the only answer I can give is that standards have definitely improved.
We are living in what is called a democratic age, and we must face up to this problem. The dictatorships are taking a great deal of trouble about feeding. Sometimes they are controlling essential foodstuffs. It has been shown from our surveys that, though we can all vote freely in this country, and speak and worship freely, we have not yet attained what I think is the most important thing in a democracy—equality of physical opportunity. Well, we have started on the race, but I do think that until we have got to that point there is something still missing. And my last word is that the life of the schools is the most helpful factor in providing that opportunity; for into the school to-day come not only the 1594 teachers and the taught, there comes the doctor, there comes the dentist, there comes the nurse, and above all there come the parents themselves, and that combination is helping to provide what I think is the brightest sign of the future, a more healthy child population.
§ Question, "That the Bill be now read the Third time," put, and agreed to.
§ Bill read the Third time, and passed.
§ The remaining Orders were read, and postponed.