TUBERCULOSIS

HC Deb 10 November 1943 vol 393 cc1178-223

Motion made, and Question proposed, "That this House do now adjourn."—[Mr. James Stuart.]

Mr. Ammon (Camberwell, North)

I can think of no stronger indiotment of our social and economic system than that after all these years we still have to discuss as a matter of primary importance the incidence of tuberculosis among our people. Looking back as far as one can, this has been a perennial subject in this House, and my mind goes back to the days, a great many years ago, that I spent in the Post Office service, where tuberculosis was then considered a scourge to such an extent that people used to look round their offices and almost be able to tell who was going to die next from it. During the course of years due to improvements in conditions, better office accommodation and instruction how to deal with the complaint and the actions of the staff, who were among the first to combine in order to build sanatoria, the disease has gradually been eliminated from the Service, but we are now in the position, in 1943, that it is possible for the Ministry of Health to say that tuberculosis is still the chief destroyer, except in war, of human life in its prime. I submit that that opens up a very grave condition of affairs, more particularly as there has been a considerable increase in the incidence of tuberculosis from 1938 up to the present time, although there was a slight drop between 1941 and 1942.

The tragedy is all the worse because this position is largely remediable. It would be possible in a properly ordered society to stamp out this tragedy because it arises largely from lack of nutrition, over-fatigue, excessive drinking, poor ventilation and lack of exercise—all things that are in the realm of handling in a properly organised society. Looking at the complaint itself, I suppose it would be fair to say that the soil of it is the body and that the seed are the bacilli. It is necessary, therefore, to make the soil as infertile as possible, that is, to build up bodily resistance. It is true that much can be done by training of conduct and habits to prevent the spread and growth of this disease, but it does require a little more than that, and that is why some of us are very anxious that there should be some definite indication as to post-war planning, with regard both to housing and dealing with our medical services and also seeing that, so far as is possible, the men return from the front to conditions which will not be conducive to the growth of this terrible disease. Still more is this necessary because there is no doubt men will come back in many ways more susceptible to the disease, and that susceptibility will be increased if provisions are not made to deal with the matter as quickly as possible. So the Debate takes on a little more urgency than it has done on previous occasions, because we have to face the very serious facts that exist with regard to the health of our population. Before the war it was a matter of concern that we were an ageing population, that in a few years a very large proportion, if not the majority, of us will be drawing pensions. How far will that be accentuated, following the loss of the best of our young people in the war? It is essential that we should give very earnest attention to grappling with this disease, which is still the most fatal to our race, apart from war. There must be an early searching-out of causes which are likely to develop active T.B., and steps have to be taken soon to do so and to prevent the soil, which is the human body, becoming a means of carrying and disseminating this evil complaint.

From some statistics I saw the other day, I understand that we have made a start with mass radiography, but that the number of sets is inadequate, and there is difficulty in obtaining the necessary skilled staff. In those conditions, I beg the Ministry that there will be no attempt to treat this matter in a spirit of fatalism, but that there will be an earnest effort to deal with it, even if it costs money, inconvenience and a certain amount of risk. In the long run the risk and the expenditure can be no greater than they will be if the disease is allowed to get out of hand. One of the things that can be done in the use of radiography is to take the sets to the factories instead of the managements sending workers to a more or less distant point. The objection will be at once raised that there are two difficulties, one of which is expense and the other the obtaining of the necessary expert staff. So far as the first is concerned, I think there is no reason in present conditions for expense to be allowed for one moment to stand in the way of improving the health of the community, even if it means saving the life of only one man or woman. Everything must be done to bring into service all the latest scientific developments and everything that research can give us, in order to undo all that may have grown up during these years of war. We have cause to be grateful for those who have had the ordering of our food supplies and have kept them on lines where we have had the maximum of nutritional advantage, during times of real difficulty.

The other point follows from what I have said. It is useless to discover early cases and to put the people off work only for them to stop at home waiting for beds. That will not help the situation a bit but will add considerably to the anxiety of the patients and of those who have the care of them and are near and dear to them. From many inquiries I have made I understand that more beds could be occupied at once if there were the necessary nursing and domestic staffs. I speak on this matter with a certain amount of knowledge in regard to a large municipality. One of the things which the Ministries of Health and Labour must do is to see that adequate staff is supplied to deal with this problem as and when it arises.

That brings me to two other points in dealing with this problem as a matter of national urgency, as it undoubtedly is. There is the difficulty of chronic cases which are discovered too late to be cured. Something can be done by care and training in habits that will help to restrict the infection. I hope as time goes on that one will not allow unreasoning sentimentalism to prevent the separation of chronic cases from the rest of the community. In that connection one can strongly commend such enterprises as Papworth, Preston Hall, Spcro and similar workshops, and steps should be taken to increase them. These patients are capable of doing work and, with proper care and conditions, can live a considerable number of years.

I pass to my final point, which concerns allowances. The time has come when we have to draw the line between what we call recoverable cases and cases that will not recover, but allowances should be provided for all. It is a matter of concern to the whole community that the health and economic conditions of these patients should be well preserved, because the complaint is bound up with the health of the community. It is very pathetic to have to tell a man in a sanatorium that he cannot have an allowance because he is not likely to recover, when he is alongside another man who is getting an allowance. It has the inevitable result that the first man is referred to public assistance, which causes depression in the sufferer and has a psychological effect retarding recovery considerably. Expense is a minor consideration. What really matters is proper treatment for the recovery of the patient and building up the health of the community. This can be done, and will give us a return pressed down and running over.

Faced as we are with a certain depletion of the best manhood and womanhood of the nation, arising directly out of the war and the fact that in postwar years we shall have a call to deal, as far as we can, with those who will return giving them such accommodation and conditions as to enable them to put up the biggest possible resistance to the ravages of this or any other complaint, it is essential to bear in mind that these measures are bound up with the whole of our post-war development. It is essential that we should get a clear statement on questions of housing, prospects of employment, medical health and national service. I hope that in the discussion which follows hon. Members will bring home to the Ministry the need of not accepting with complacency the present situation, hoping that somehow, somewhere and somewhen these things will right themselves. They will not right themselves except by a rigorous campaign against the disease. The mere fact of the existence of the disease is the strongest condemnation of our present economic and social system. The complaint is absolutely within the power of the community to remedy, but it is still the greatest potential danger in our midst to human life.

Mr. Clement Davies (Montgomery)

I am glad that the hon. Member has given us an opportunity to discuss this question. It has always seemed to me that the subject divides itself into three parts: prevention, precautions and treatment. With regard to prevention, I am glad that the hon. Member has called attention to some of the factors which are the main causes in the spread of this disease. It is extraordinary that even now our laws are, in the main, passed for the protection of property and not for the protection of persons. The whole strength of the law is brought to bear in any shape or form if the least bit of property is interfered with, but the full strength of the law is not brought to bear when personal suffering occurs which may be due to sheer neglect on the part of some member of die community or, indeed, of the community as a whole.

I was called upon in 1937 to inquire into this subject throughout my country, which unfortunately holds a very bad record in the matter. One of the most startling things is that at the head of the list—that is, the black list of tuberculosis—are three of the counties which one would rave thought would be the healthiest in the land, Anglesey, Carnarvon and Pembroke. Those three counties have not only the sea about them but perfect scenery, hills and so on; nevertheless year after year they show the worst tuberculosis record. One asks, To what is this due? There is this germ from which all of us may suffer but which no one has found, but which is met with everywhere. Why is it that, in some places, it can attack with such fatal effects? Apparently it is due to malnutrition, insufficient food, bad housing, bad conditions in school, bad conditions in factories and in mines, and the hon. Member has quite rightly urged 'that if these are the main factors they are matters which we can tackle. Quite rightly he says, What do we propose to do in our postwar policy to tackle this question?

May I mention to the House now a few matters upon which I have to report? With regard to housing, after the last war opportunity was given to local authorities, but very few opportunities have been taken. They were given power to build. What did I find? There were still thousands of houses in which people lived which were unfit for human habitation, where not only had the women to contend day by day with dampness, earth floors and so on, and where children were born and brought up, where the tuberculosis patient lingered on month after month, and where he died, and where nevertheless families went on living. Houses were pointed out to me which were known as death houses, where healthy families had come in one by one only to be wiped out by this dread disease. I shall never forget one house to which I was told five young men had brought their brides, five young families had been born there, five families had been completely wiped out, and still that house existed. That is to be found everywhere. Surely we can tackle that and tackle it nationally with greater power being exercised than has been exercised by the Ministry. I found, unfortunately, that so many local authorities had failed in their duty. Why? Because the penny rate loomed larger in their minds than the health of the people, and no steps had been taken by the Ministry of Health to correct that. Take my own county. A penny rate produces for the whole county only £630. There are eleven councils, including six so-called urban councils, although the biggest town is under 5,000, and four rural councils. Far away the wealthiest is a rural district council with 19 parishes. Thanks to the fact that the Liverpool Corporation pay such a handsome part of the rate, their penny rate amounts to £290 out of that £630. What has been the result? They have built between the two wars fewer than one dozen houses for the 19 parishes. Not a word of protest from the Ministry. I want them to take in the future a much more active rôle. Then there are the conditions in the factories, the mines, and the quarries. I only wish that Members could realise the conditions under which slate is quarried in the Blaenau Ffestiniog district, where there is so little air where the man is working down in the bowels of the rock that there is not sufficient to keep a candle alight standing upright; it has to be laid on its side, and you cannot see the man when he is two yards away because of the dust. Again, those are conditions which we can rectify. Some steps have been taken since I reported on that in 1938.

In the case of schools, again I blame the central authorities. In 1927 a report was called for by the Board of Education with regard to the schools in Wales, and I think—I am now speaking from memory on matters which were brought before me five or six years ago—that there were something like 187 schools blacklisted by the Board of Education as being an actual danger to the health of the little children attending. If the parents knew that and kept their children at home, they were liable to be brought up before the magistrates and prosecuted for not sending their children to a school which the Board knew was a danger to the health of the children. I come along ten years later and find the same condition of things, practically unchanged. Letters have passed between the Board of Education and the local education authorities with three months elapsing between a letter and a reply. These have been the usual things: I desire to draw your attention to such and such a school … and I am in receipt of your letter and will lay it before my authority when it meets. and meanwhile the children were still going to a school which in the knowledge of the authorities was a danger to their health. Those are conditions which we can and must see that they cease to exist at the earliest possible moment.

Then, on the question of feeding, it is another terrible thought that it required a war for us to appreciate the necessity for feeding schoolchildren at midday. Some of us were campaigning for that long before the war and were not being listened to. The cost again loomed in their minds, the penny rate once more, the removal of responsibility from the shoulders of the parents. In the meantime the child was suffering. What is the cost? I remember so well being present at a march past of these little children. There is a wonderful movement in Wales which in my opinion is far finer than the Boy Scout and Girl Guide movements. We know it as the "Urdd Gobaith Cymru," where the little mites are brought together, and every year they assemble in what I suppose Boy Scouts would call a jamboree, but it is a far finer intellectual movement which we have for our children. On the occasion to which I am referring the retiring President was the right hon. Member for Carnarvon Boroughs (Mr. Lloyd George). The incoming President was myself. We were standing together watching these children go by, and I have never forgotten his turning to me as the sturdy little children came on, carrying their flags and marching like an army. He said, "Country children." I replied, "No, sir, the Rhondda." He said, "Impossible." I replied, "Yes, sir, warm meals midday." Another little lot came up looking weak and puny. I said, "Country children, sir." He said, "Why?" I replied, "No food from early morning breakfast until they get back after walking across the fields."

As well as feeding for the children there should be clinics. I think there should not only be a kitchen and a place where the children have their meals together, but there ought to be attached to each school a little clinic. Another great advantage the war has taught us is the necessity for these little clinics attached to every factory. Already they are to be found here, there and everywhere. Why not have one in the schools? Little children fall and meet with accidents. The mere fact that they have to attend such a clinic will itself assist them in after life.

All these are on the preventive side. Now for the precautionary side. I am very glad there is a movement for mass radiology. What we want, of course, is to find the patients at the early stages. Unfortunately what so often happens is that they do not come into the hands of the doctor until it is almost too late. I therefore want every effort made to see that there is made available in every district a method of examination so that they can be tested. You have also to bear in mind that you have to proceed very carefully. There is a shyness; people are afraid of the verdict. Therefore they should be encouraged to go and should be told, "Do not worry about the verdict. If by chance you have got it, do not worry; there are tens of thousands who have it slightly, and they can still go on. Go in, find out what is the matter, and we can cure you."

Finally, there is then the curative side. There is nothing quite so heartbreaking as the case where the patient has now been told, "You are suffering from this dread disease of tuberculosis. The best treatment that can be given to you cannot be given at home, and we are making arrangements for you to go to a sanatorium." Well, it is a big wrench, but at last the patient consents to go, and then when he has summoned up his will to go and his family are prepared that he should go there comes the news, "There is no bed ready for you, and you will have to wait." He has been told that the cure is there, but not at home, but that he cannot be taken because there are not sufficient beds. There is a waiting list in Wales, and there has been a waiting list year after year after year. Sometimes it gets a little less, sometimes it increases. There ought to be always vacant beds ready to take in the patient at any time. That means more sanatoria, more beds, more staff. I am glad the hon. Lady nods her head in regard to this matter.

How are you going to get more staff? May I beg the Ministry of Health to make the conditions more attractive for the staff? I should imagine that there is a world of difference between the nurse in a general hospital where the patient is there for a short while, where her best attention is required for a little while, where she sees an improvement and she then attends to someone else, and a nurse who day after day is in attendance on these poor people, sometimes seeing them instead of improving going slowly down. What are the conditions under which she works? I hope there has been an improvement since I saw them in 1937 and 1938. In no single instance did I find real attraction in the way of accommodation for the nurses, what I might call perfect surroundings. In so many institutions they were provided with dormitories for six, or eight, or ten. I know the female sex well enough to know that there are moments when a woman likes to be alone by herself in a place where she can throw herself on her bed and sob for ten minutes, go to sleep and then be all right again. She cannot do that if there are six or eight people looking on. That can be improved, but there are other things which are thoroughly bad. One wants better treatment for the staff, better accommodation for them, and a more attractive life. How many instances do we know of men leaving the sanatorium because their families were getting less money than they would if these men were at home? A little improvement in this position was announced a few weeks ago, but not enough. We have to say to the man, "Here is an opportunity for you to become a healthy member of the community. We will take care of you in this sanatorium. While you are there we will also take care that you do not have any mental worry, by keeping your family as well as we can. Come, health is in front of you! there is a new life for you." That I should like to see the policy of His Majesty's Government.

Sir Henry Morris-Jones (Denbigh)

We are indebted to the hon. Member for North Camberwell (Mr. Ammon) for raising this subject. We have been much moved by the speech of my hon. and learned Friend the Member for Montgomery (Mr. C. Davies). We in Wales are very greatly indebted to him for a valuable report which he published, after a careful inquiry, some years ago. I have never embarked, and I do not intend to embark, upon a technical discussion of any subject in this House. This is not the place for it. But I might mention that there is a very great difference between tuberculosis now and what it was when I knew it in general practice 30 years ago.

It was then the terror of families. Now it has become an ailment which is within reasonable measure of being eliminated. But I agree with the hon. Member for North Camberwell that it is a blot upon this great country that we have not done more to eliminate this dread scourge. We ought to concentrate upon the main problem of housing. My right hon. Friend the Minister of Health is doing what he can, under very great difficulties. It is the custom in these days to look upon Russia as being par excellence everything that is good. I must say that when I read the news service which we get from Russia I cannot look at the figures there without admiration. Already in this war they have built 176,000 houses in the destroyed areas of Stalingrad and elsewhere. That is an example which we might follow. Materials should be given priority over anything, after the immediate war necessities of the moment.

Neither of the two hon. Gentlemen touched on what is probably one of the chief causes. I think that the black-out has aggravated tuberculosis. People in this country for the next three months will be sitting in rooms, in factories, in hotels, in clubs, in all the buildings of these islands, from five o'clock in the afternoon until eight o'clock in the morning, without any fresh air penetrating to them. I have seen a system by which ventilation is achieved in spite of the black-out, but in the greater proportion of buildings in this country there is no ventilation of any kind during the black-out. This is not the time to discuss whether we could have a reconsideration of the whole question of the black-out, but I think that the authorities should ameliorate it at the earliest possible moment when they consider themselves in a position to do so. I would endorse what my hon. and learned Friend said about the conditions of staffs in hospitals and sanatoria. The nursing service in this country has as high a standard as any nursing service in the world in regard to ability and devotion, but the conditions of nurses and other hospital staffs are not as good as those in many other countries. In New Zealand they have excellent amenities, both physical and mental.

Dr. Edith Summerskill (Fulham, West)

New Zealand has a Labour Government.

Sir H. Morris-Jones

In Sweden and Norway the system of State supervision and care of hospitals and nursing far exceeds that in this country. The conditions of service, the salaries and pensions and the amenities provided are far better than is the case here. I appeal to my right hon. Friend the Minister of Health and to those associated with him to put this matter in the first category of social improvement. In that way the staff position will be improved. I am confident that in a few years tuberculosis in this country will have become one of the diseases of the past, like smallpox and the other epidemics which used to haunt us in the old time.

Dr. Edith Summerskill (Fulham, West)

It is very regrettable that an important Debate which concerns thousands of suffering people in this country should have been initiated at such short notice. A number of Members are very interested in this matter. My hon. Friend the Member for South Tottenham (Mr. Messer) is chairman of a large hospital, and the hon. Member for Stone (Sir J. Lamb) is chairman of a hospital. I know that both were very anxious to take part in such a Debate as this. It was a great surprise when I came to the House to-day to hear that this Debate was to be held at such short notice. Even those of us who are very familiar with the subject, who spend our lives in great part tending sick people, would have liked notice. I should have liked to bring certain documents to the House. I have been unable even to obtain a list of the new allowances. I want to register my protest against the Debate being conducted in this way.

Mr. Speaker

I hope the hon. Lady is not suggesting that I was wrong in selecting the subject.

Dr. Summerskill

No, Sir, I am not for one moment criticising you. But unless one makes a protest Debates are initiated in this haphazard fashion. We are always being told that Parliamentary time is very limited. There are many things which I should like to raise, and I hope to have the opportunity of doing so on the Adjournment next Session. I am surprised that when Parliamentary time is so limited we do not use it to the best advantage. Had we had notice, these benches would have been better tenanted.

I was very glad to hear the hon. Member for Denbigh (Sir H. Morris Jones), a professional colleague of mine, illustrate his remarks by referring to progress in the Soviet Union and in New Zealand. I endorse everything he has said. The other Members who have spoken have dealt with the general aspect of tuberculosis. I want to address myself simply to the new scheme of allowances. The Ministry of Health, out of its experience, knows that a tubercular patient is reluctant to have treatment in a sanatorium, because he knows that during his stay there he will be losing his wages, and his family will be suffering. There is always a desire to leave the sanatorium before the patient is cured, and before it is advisable for him to return home. The Ministry felt, quite rightly, that a scheme of allowances should be introduced to subsidise the workman entering into a sanatorium, and to free him from anxiety. I feel that that reform should have been introduced many years ago. It is deplorable that so many patients should return home to infect their families, who in turn have to be found accommodation in sanatoria. This scheme was introduced, but to our surprise and horror—horror is not an over-statement—we discovered that these allowances were to be given only to those patients who were considered curable and that those patients who were suffering from chronic tuberculosis, whom the experts thought were hopeless, were to be denied these allowances.

I cannot understand how the Minister of Health, who makes on many occasions such noble professions in his desire to help the suffering, should have been persuaded to allow such inhuman and callous treatment to be meted out to a section of the community who are deserving of the greatest pity and sympathy. I want to remind the House what this means. If a patient is told that he is not to receive an allowance, he interprets the withholding of the allowance as a pronouncement of the death sentence. I have a number of letters on this subject, and the Minister of Health must have been deluged with letters, judging by the number I have received as a result of putting down certain Questions in this House, but one that I read last night was poignant. It was written by the parents of a boy of 22, who informed me that they had been told that this youth was not to receive the allowance, and they were withholding that information from the patient because they could not bear to see the despair of this boy of 22 if he knew that his case was hopeless and incurable. I want Members of the House to realise what a dark future must yawn in front of these patients when they are told that they are not to have an allowance. As a doctor, I find it very difficult to understand the approach of these officials who must have drawn up this scheme. It is absolutely contrary to the principles and practice of the medical profession. What would be the effect if we adopted the same principle in our hospitals and told our almoners in the hospitals that they must separate the curables from the incurables as that tragic procession of out-patients comes into the hospitals? Suppose they were to be examined, and the almoner was to tell them, "We cannot manage or afford treatment here. The hospital is too poor to finance you, because you are regarded as incurable, chronic, hopeless. Would you mind leaving by that door?" To other patients they would say, "The doctors say there is a chance for you. We think we can find enough money for you. You can go through that door and have an operation and a bed in this hospital, because there is hope for you." If we applied the principle which is expressed in this scheme to our hospitals, that would be exactly the treatment we would mete out to our patients to-day. How would the world regard us? They would regard us as savages and as barbarians if we treated our sick and helpless in this way. It is opposed to all that is fine and noble in the treatment of the sick and needy.

I have often heard the Minister of Health quoting the Scriptures. I wonder whether he has ever heard of the parable of the good Samaritan? How can he justify the passing by of the sick and helpless, leaving them to die? I wonder also whether he has ever seen, what so many of us who are in the medical profession have seen, the life led by the sufferer from tuberculosis who is not in hospital. I have been in those little back rooms in London where a, working mother has been told that her grown-up child needs fresh air, plenty of food and a room to itself. I have been in those little back rooms, with the windows wide open and with as little furniture as necessary, stripped of all but the bare necessities. I have myself stood there shivering and have talked to the poor, pathetic patient in bed, lying there in misery. These patients are often deprived of visitors, because unfortunately, the sufferer from tuberculosis in our midst is often regarded by the healthy as untouchable. There are these individuals lying in little back rooms—and I say little back rooms because generally the family have to give up a small room because they cannot spare a large one—throughout the country. Now, these people, who are without companionship, without visitors and without the normal creature comforts which we enjoy, have been given a companion by the Minister of Health—black despair. I call upon the Government to reconsider this inhuman Regulation which treats the patients so savagely.

I want to say a few words about the amounts of the allowances. Everybody here knows—and it is not denied—that these allowances are inadequate. I sat in this House last week and heard it said that most of the allowances approximated to the public assistance rates, and my hon. Friend the Member for South Tottenham (Mr. Messer), who is chairman of a hospital committee, said that in many areas the allowances were less than the public assistance rates. When I raised this matter before, the Minister reminded me that there were such things as discretionary allowances. Most of us are familiar with the working of the discretionary allowances. It means nothing to the sufferers. They want to know how much they will get if they go into a sanatorium. It is no good saying that there may be a kind of means test and that they may be given a certain amount. They want to know what their financial position is likely to be, otherwise they will not be able to make the arrangements necessary for a long stay, not one of a few weeks but of six months, a year or two years in a sanatorium.

I was discussing this a fortnight ago with a specialist who is in charge of a chest clinic in the East of London and he told me that in his opinion, looking at the matter objectively, this scheme would have no appreciable effect and would not reduce the incidence of tuberculosis in this country. I only want to mention one allowance which I consider so inadequate and ludicrous that it is difficult to believe that the Government could have given the particular section of the community that will be given this allowance any consideration at all. I refer to the housewives' allowance. According to the scheme, if a housewife develops tuberculosis, the husband is to be given 10s, a week during her absence in the sanatorium. Every Member in this House knows how difficult if is to get domestic help of any kind. Could any hon. Member find a woman to go into a working class house to do all the cooking, scrubbing, mending and to care for the children for 10s. a week? It is impossible for that to be done, and if I am told that there is to be given a supplementary allowance I can only say that, in order to find proper domestic help in these days for a household where it is necessary for the woman to care for the whole of the household, it will be necessary to give a larger and more generous allowance. Otherwise, what will happen? The housewife, of course, will refuse to go away. She will stay on. She may infect her children, and if she is at last persuaded to go away, she will be worried and anxious all the time she is in the sanatorium, wondering whether her children are being properly cared for.

I do ask the Minister to reconsider these scales. I want more adequate allowances, and also the allowance to be given to every tubercular patient irrespective of the stage of the disease in order to give these unfortunate people a chance to regain their health and strength.

Colonel Sir A. Lambert Ward (Kingston-upon-Hull, North-West)

It was not originally my intention to intervene in this Debate, and I would not have done so had it not been for the emphasis which practically all previous speakers have made, that the incidence of this terrible disease is entirely due to bad economic and social conditions, malnutrition, bad housing and the like. They may be right, but if so, how do they account for the cases which occur in houses where the conditions are ideal and where the meaning of the word "malnutrition" is not even known because conditions are ideal in every respect? During the course of my life five cases have come intimately to my notice each of which terminated fatally and in not one of these cases did poverty enter in the slightest degree. The housing in each case was luxurious and food in unlimited quantities was at disposal. At the same time, the patients died. It may be said that is ancient history. It is not. In one case it happened quite recently. In the house where the patient lived the conditions were ideal, food was always forthcoming in unlimited quantities and the patient always used to exercise in the open-air, but the result was the same. If, as previous speakers have said, this is entirely due to poverty, how do they account for cases like that?

We are also told by the medical profession in this House that if this disease is taken in time it can always be cured. I can only conclude that they mean that traatment should start before it can be detected by the ordinary medical practitioner or even by the specialist. In the cases that I have in mind not only were the ordinary medical practitioners called in, but specialists of the most expensive kind were called in during the comparatively early stages of the disease. There is one hope, in my opinion. One hears a good deal of talk in these days about mass radiology, and I understand that the Ministry of Health has completed arrangements for the manufacture of a certain number of sets of the necessary apparatus. I believe that up to a few weeks ago 17 of these sets had been issued, but what are 17 among a population of 42,000,000 or 43,000,000 people? When I made application for a set to be issued to the City which I represent—the City of Hull—I was told that there were not sufficient and that the 17 sets which were ready were to be issued to other places. Surely it is time that every city of any size had facilities for mass radiology. I believe that it is only by such means that one can hope to tackle this disease in the stages which are sufficiently early to allow a recovery to be made. I am not an authority on this subject, and it is not my intention to speak for much longer, but I beg the Ministry of Health to do more than they are apparently doing at the present time with regard to the provision of sets of this apparatus. From the experience one has had up to the present time and the hopelessness of expecting an ordinary medical practitioner to diagnose this disease in time for it to be cured, an appreciable improvement can be made in the treatment of this terrible disease only by the issue of further sets of apparatus.

Mr. McNeil (Greenock)

It is not my purpose to join with the opening thesis of the hon. and gallant Member for North-West Hull (Sir A. Lambert Ward). I think it is beyond dispute nowadays that this disease varies in its incidence directly with poverty. My hon. Friend the Member for North Camberwell (Mr. Ammon) and my hon. and learned Friend the Member for Montgomery (Mr. C. Davies) did a service to the House when they repeated what cannot be too often said, that death can be bought off, at any rate so far as this disease is concerned. I am quite certain that if the public of this country had firmly fixed in their minds the figures provided by experts, they would not allow any Government to remain in power which did not address itself to the basic problem of the prevention and cure of this disease. The Ministry of Health should say to the Treasury, "This is our business. We will tell you what the cost is afterwards, because we know that whatever it is in pounds, shillings and pence it will be far less than the cost in misery and squalor not only now but in future years."

I want particularly to refer to what my hon. Friend the Member for West Fulham (Dr. Summerskill) said., namely, the extraordinary restriction on this scheme of maintenance and treatment allowances. I want to say to the Government spokesman who will reply to the Debate that the Ministry of Health and the Department of Health for Scotland that they have deliberately gone out of their way to mislead the public on this issue. The Department of Health for Scotland have issued what they call a model leaflet which they suggest should, in turn, be issued to the public. The first paragraph of this leaflet says: In order to help men and women who need treatment for pulmonary tuberculosis but for whom treatment will mean an interruption of earnings and other income, the Government make special allowances. As my hon. Friend the Member for West Fulham has pointed out, this, to say the least, is a gross inaccuracy. In the circular which the Department of Health sent out to local authorities they tell a rather different story. My hon. Friend said the allowances were not made available to people who were incurable. The picture is much worse than that. Here is an extract from paragraph 27 of the official circular in which the local authorities are warned: … it is clear that the purpose of the allowance (as described above) cannot be met where treatment cannot do more than alleviate a chronic condition. That seems to me to say that not only is the incurable person to be pushed aside but that the person whose condition might be alleviated by treatment is also excluded from the scheme. Moreover, as my hon. Friend quite clearly showed, a burden is thrown upon the local authority and upon the medical officer of the local authority, which is not only unprofessionable and intolerable but, I suggest, is not an administrative possibility. The medical officer is to say that certain people shall qualify and others shall not. The second group of patients are not given details of this circular. They are just told that they do not qualify. If relatives or even the patient presses for a reason why they do not qualify the doctor is left with this most unprofessional task of saying, "You do not qualify because in my opinion I cannot return you to work within a definable period." One of the greatest medical officers in this country, a man whose reputation is of the highest, said to me that he was being asked for the first time in 40 years of public life to hand out death certificates to some of his patients. That is inhuman and it is a harsh administrative principle for which I cannot find any parallel except in that of the Poor Law in the 16th century.

My hon. Friend quite properly said that the Minister of Health enjoys a reputation as a good man of the church. My right hon. Friend the Member for Stirling and Falkirk (Mr. Westwood), who is now on the Government Front Bench, enjoys an equally good reputation outside and inside our party. It is not peculiarly germane to our discussion, but I should like to ask either of them to justify this attitude in terms of the Christian doctrine. They may say that it is not their job so to justify it but to justify it as an administrative scheme. When I questioned the right hon. Gentleman previously on the subject he sought to escape by saying that he had acted upon the findings of the Medical Research Committee, which was set up to inquire into this matter last autumn. But that is not sufficient; it is never sufficient to throw an authority across the Table of this House. That is no escape or defence. If a Minister intends to cite an authority to this House, then he must explain why the authority should be accepted. In this case examination of the authority will not provide an escape. As my hon. Friend the Member for North Camberwell pointed out, this same report provided for the treatment and employment of chronic pulmonary tuberculosis cases which are now excluded from the scheme. One other possible reply is that the primary purpose of the scheme is to restrict the spread of infection. I should be inclined to agree that that would be an excellent basis. But my right hon. Friend cannot believe that that is happening under this scheme.

Life my hon. Friend the Member for West Fulham, I have had many letters. I do not mean to quote them all to the House, but here is one from a patient in a sanatorium. I will not reveal the names but I do not mind letting my right hon. Friend see the letter. The patient says: Just before I was discharged another patient left of his own accord although he was obviously far from well. I asked his reason and was informed that he had been told he was a chronic case and was not eligible for maintenance grant. Until then he had held out some hope of recovering sufficiently to be able to resume more or less normal life but when told he was incurable he immediately said, "Then I shall die at home. That is sad enough, but let us look at the administrative importance of the question. The letter goes on: He arranged to leave the sanatorium a day or two later despite the fact that he has a family of eight youngsters among whom he will now be in an excellent position to disseminate the germs of tuberculosis … My hon. Friend the Member for Hamilton (Mr. Fraser) told me that in his Division a man had said to him, "I am not going to be left to die and rot in an institution, uncared for." He probably inferred—although he had no right to do so—that if the State were not prepared to make to him and to an acute case in the next bed similar allowances, he would not be prepared to have the full professional service made available to the other acute case. That man also went home. In my own Division yesterday an officer told me of a boy of 16 whom the medical officer was unable to include within the scheme and who had to be considered as a chronic case. Of course, the boy's mother took him home. I am not arguing on sentimental grounds; I am arguing that if the aim of this scheme is to prevent the spread of this infection it will fail by excluding the chronic pulmonary cases. The chronic type of case goes home and goes to work. My right hon. Friend, who is an authority on this Committee's report, knows that. They go to work where, of course, they infect their fellow workmen.

I would also like to say, not so strongly although I think I am on fairly firm ground, that the Government make a similar mistake when they exclude the non-pulmonary cases. I have a letter from an authority on non-pulmonary tubercular diseases who says: The reply I should make is that if the non-pulmonary case in the non-productive group does not get early enough treatment he stands a fair chance of becoming a pulmonary case. I had one example thrust on my attention concerning a bus driver, suffering from a hip condition, who was ruled outside the scheme. His general condition deteriorated until he is now, unfortunately, within the scheme. Whether he will remain within the scheme and not develop as a chronic case is at this stage a matter of medical guesswork. One other defence may be made, that this scheme is an experiment. I should think that the experiment has had by now a fair chance of being examined. It has been running for eight months, which the House may be surprised to learn. One of my right hon. Friend's greatest difficulties, with which I very much sympathise, is of course the limitation of the number of beds available, but hope that is not going to be used as an excuse—it is not a reason—for this restriction of the scheme because, even if it is true that we cannot find beds for these chronic cases, I am arguing—though I do not need to because it is axiomatic—that it would be much better to provide funds to permit these chronic cases to stay at home. They will not be non-infective there. They may infect the children. But still they will be in contact with a lesser potential area for infection than if they are forced out to work by not being provided with adequate funds. The hon. Lady dealt with the inadequacy of the scales. Let me corroborate what she said. For certain categories in Glasgow the public assistance scales are higher than those which the Government have laid down. I hope that my hon. Friend the Member for Gorbals (Mr. Buchanan) may deal with this aspect of the scheme be- cause on scales and insurance there is no greater authority on this side of the House. I am distressed and a bit disturbed about this scheme, and I may be thought to be prejudiced, so let me read part of a letter from that most sober journal, "The Scotsman," in which the writer discusses the scheme and says: This extract may be interpreted as meaning that it is unjustifiable to spend money on people whose disease is incurable. Viewed in this light, the scheme appears as a piece of cold blooded expediency designed not for the relief of mental or bodily sickness but purely as a measure towards alleviating the man power shortage. As such it is a disgrace to a so-called Christian country. There is a loophole within the scheme for local authorities which I hope they will use. Paragraph 26 of the circular says: If the authority are in doubt as to the application of this memorandum to individual cases in respect of which applications are received, the Department will be ready to advise and give a statement of the facts, but it is not contemplated that such reference should often be necessary. I do not like the last phrase. I have tried to get figures from the Minister of Health and have so far failed. But I have some figures from the Scottish Office. They disclose that, out of every three cases making application, one has been refused. If the Department does not contemplate that local authorities will often have to refer cases to them, that is not a contemplation based on facts. It is a hope. I hope on the other hand that every local authority in the country, and every medical officer who is truly a medical officer will say, "It is no part of my job, it is not my duty, it is not a task for which I have ever been trained to be a finance clerk for the Treasury. My job, is to heal people and, if anyone wants to decide that this man or that woman is inside or outside the scheme, let them decide." I hope local authorities will make the scheme unworkable by referring every tuberculous applicant to the Ministry of Health for decision.

Mr. Cocks (Broxtowe)

I should like to say a word or two in support of my hon. Friend's appeal to the Government to remove from this scheme the limitation that these special allowances shall only be given to sufferers from tuberculosis who can be healed sufficiently to go back to work. I am very sorry, in view of the importance of the matter, that the Minister of Health is not here himself. I do not know why he is not. With all respect to the Under-Secretary of State, he is really not an adequate substitute on this matter for the Boanerges of the platform, the pulpit and Parliament. My hon. Friend the Member for West Fulham (Dr. Summerskill) asked how it was that the Minister of Health could justify the fact that he ignored the parable of the good Samaritan and saw sick people and passed by on the other side. It is very simple to give an answer. He can say, "I am not a Samaritan, I am only a Siinonite—in other words, a mere camp follower of the Tory Party." As he is not here, why is there no representative of his Ministry? What about his, I am sure efficient but rather more obscure, Parliamentary Secretary? She was here only a few moments ago. Why have we not any representative of this great office present? I do not know whether it is an indication of the reconstruction of the Government which is now taking place and which has long been due.

I have here a circular issued by the Public Health Department of the Nottinghamshire County Council. It says:— In order to help men and women who need treatment for pulmonary tuberculosis, but for whom treatment will mean an interruption of earnings or other income, the Government makes special allowances. The object of the allowances is to enable necessary treatment to be undertaken without feeling anxiety about the support of a family or the upkeep of a home. Judging from that, it is not merely whether the case can be cured or not. It is only to meet cases of interruption of earnings. I have a case in my constituency of a girl of 18. For two years she has been ill with pulmonary tuberculosis. She was in a sanatorium for nine months and was discharged in December, 1942. The doctor said he could do no more for her. She is and will always be unfit for work. She was taken ill when 16, so she has not enough stamps on her card to qualify for unemployment benefit, and she gets nothing under the scheme, although she will never again be fit to earn money. I have a letter from a distinguished doctor, the county medical officer for Nottinghamshire. He says: I have now personally looked into the record of this case carefully and regret to say that under the terms of memorandum 266D, the patient is ineligible to receive the allowance. She is in such a stage of the disease that treatment cannot do more than alleviate the chronic condition. She is therefore not eligible under the scheme. He goes on: This limitation in the terms of the Memorandum of course excludes a considerable proportion of tuberculous persons benefiting under the arrangement and imposes upon the officers concerned with its administration a duty which from a purely humanitarian point of view is very distasteful. I think the Ministry should remove this limitation. The general impression is that these allowances are provided only if people can be patched up and made fit to work again. In other words, the scheme is based upon earning ability and profit-making rather than humanity. The Government are winning a great war through the sacrifices of millions of people, and a scheme like this is unworthy of such a Government and should be altered in the way my hon. Friend has suggested.

Mr. Sloan (South Ayrshire)

These recurring Debates on tuberculosis do not often lead us very much further. I am old enough to remember that when consumption was diagnosed it was generally considered as a death sentence, and its victims were allowed to cough their lives away. They were offered very little hope indeed and were looked upon almost as suffering from some type of leprosy. We have certainly travelled some distance since then, although the attempts to get a grip of the disease and have it eradicated are not very widespread. It is alarming to know that it is still on the increase. Many reasons are given for this, but I think it requires no new investigation and no experimental or research work to understand what is the cause. I remember during the last war, when the right hon. Gentleman the Member for Carnarvon Boroughs (Mr. Lloyd George) was outlining the new world that was to come, he said that the causes of T.B. were very simple. They were bad housing, especially dampness, bad sanitation, under-feeding and over-work. I do not think the decade which has passed since then has fundamentally altered the causes of T.B. They are still there. I do not know why we should wonder at the fact that there has been an increase, or at least no diminution in this disease when we remember the 20 years of poverty and malnutrition that we have experienced in the interval. If malnutrition, under-nourishment, bad feeding were the causes of the disease then, these have been accentuated since, because there has been no general improvment, at any rate up to the time of the outbreak of war.

As far as Scotland is concerned, the position of housing remains practically unaltered. It is true we have built a number of houses, but it is also true that the position is not very much improved. I believe that there is more overcrowding in Scotland to-day than there was at the commencement of the building, because for every house that we have built, we have demolished one and the position as regards overcrowding is better only to the extent that the people are living in houses of a better type. But the overcrowding remains and we have villages in Scotland, especially in the mining districts, where there is no water supply, where an open stinking drain is the only form of sanitation, and where the open "midden" is an eyesore. We find those disgraceful conditions prevailing 20 years after the time when we were promised "homes fit for heroes." How we are to eliminate this dreadful scourge without tackling the root cause, is one of the things which it is most difficult to understand.

The question of hospital accommodation has been widely discussed in this Debate, and I suggest that to proceed on the lines of the tuberculosis hospitals is the wrong way to set about dealing with this problem. Even to-day, with all the education that we have had in regard to this disease, people are very reluctant to go into what is termed a sanatorium. We have tried in some cases to change the name from "sanatorium" to "chest hospital" but that does not materially alter the position, because people are enlightened enough nowadays to know that when the chest is in danger, it is a question of the lungs. Our attempts, so far to provide hospital accommodation have been of a most inadequate description. Generally the hospitals are built in the most outlandish places, are most incommodious and are difficult for the relatives of the patients to visit.

Then we have started out on the lines that these people must be segregated. I think we must recognise that as entirely wrong. Hospital accommodation for tuberculosis patients should be part of our general hospital scheme. Accommodation for the treatment of the disease should be part of the general hospital set up in any district. There is just as much reluctance on the part of parents or other relatives, to send members of their families to sanatoria as there would be to sending them to mental institutions simply because of the difficulties that have grown up in this respect. In Ayrshire we are attempting to deal with that problem by making the tuberculosis hospital part of the general hospital scheme. It is no wonder that people die in so-called sanatoria because if you go into them and look at them, it must strike you that there is nothing left for a person to do but to die—in such a place. Something ought to be done to brighten the lives of the patients and give them an incentive to live, but if they are shown a ten-year-old cinema picture now and again, we imagine we are providing adequately for the entertainment of these unfortunate people. I do suggest that in considering the question of hospital accommodation we should aim not at separating those who are under treatment for tuberculosis but at making such treatment part of the general hospital scheme.

The difficulty still remains of diagnosing this disease. From my experience and having spoken to doctors in these institutions I would say that the patients are generally far too late in arrival at the institution for treatment; that the disease has taken such a hold that the cure is more difficult than it might otherwise have been, and that, in many instances, the patient is beyond recovery. I should like to know what is the difficulty about instituting a system of mass radiography. The disease ought to be traced earlier; and surely there ought not to be any difficulty in providing the necessary apparatus for this purpose. I have seen patients who have been treated for almost every disease under the sun, who have been in various institutions for treatment and have been sent hither and thither until they completely collapsed. Then, when they were X-rayed, it has been found that they were being treated all the time for the wrong disease. Surely we have travelled sufficiently far to be able to find a way of preventing that sort of thing. The quicker the disease is diagnosed, the more easily it can be treated and the better the prospect of a cure.

When you speak to medical authorities on the matter they say, "If we could get them in time, we could eradicate tuberculosis in a generation in this country." If so, why all this difficulty about securing the equipment necessary for this elementary process? I hope something drastic will be done on this question of mass radiography. Doctors tell me that when a case of tuberculosis is diagnosed, it is imperative that every member of that family should be tested. The discovery of one case is evidence that the infection is in the family somewhere. It does not grow of its own accord and when tuberculosis is detected in a family, every member of that family ought to come under observation, to ascertain whether there is a carrier among them. If we merely lift out the one person who has collapsed from the disease, and take that person away for treatment, and leave the family as it is, we are not doing what we ought to do to eradicate the disease. I wonder whether powers of compulsion could be used to bring every member of a suspected family under observation and investigation. If we are to get to the root of this problem and not merely to tinker with it it is along those lines that something must be done.

I have many objections to the scheme of payments which has been outlined. It is an inadequate scheme and is only playing with the question. We have now added to our investigators, a new official known as the "T.B. Investigator" who wanders round the districts. Why should all this be necessary? We are introducing a scheme for the benefit of sufferers from this disease. Why cannot we do it without all this investigation. If the doctors certify that a person is suffering from tuberculosis, we then require special proof that the person will recover sufficiently to be able to resume work. How is it to be known whether a patient will ever recover or not? Who is to say to a man or a woman in these circumstances "No, we cannot assist you because you are doomed to die. We will never be able to put you on your feet again; you will never recover and therefore you cannot receive the benefit of this scheme." I think that is the most shocking part of this proposal and one that ought to be removed from it altogether.

There are many other aspects of this question, but I am sure hon. Members of this House who pay particular attention to it, realise that if we are to eradicate this disease, we must first house our people properly. In my own county we need 10,000 houses before we can say that our people are living without fear of contact with tuberculosis. We must remove the rotten insanitary conditions under which so many, of our people live. We must make sure that after this war we shall not have another 20 years of malnutrition and poverty as we had after the last. All your medical authorities can do will be insufficient, unless the standard of nutrition is maintained among the people and the question of dietary will need to receive a great deal more consideration than it has had up to the present. There is no denying the improvement that is taking place among our schoolchildren where they are being provided with meals at school. In most areas parents are perfectly willing to pay for these school meals, and the feeding of our children should become part and parcel of our educational system. It should be as necessary for them to have their meals in school as it is to have their mathematics. Where the children have been fed and where they have taken advantage of the milk that has been supplied there is an undoubted improvement in their health, and one that will be lasting if we are able to continue it and able to improve upon our very meagre attempts at the present time. I hope, therefore, that the question of these allowances will receive a great deal more consideration from the Department, that some of the anomalies will be removed, and that people will not be made to feel that there is some taint connected with them when they are asked about it. It is our bounden duty to do the best we can to eradicate from our midst the scourge of T.B.

Mr. Buchanan (Glasgow, Gorbals)

I understand there is a desire to proceed to another subject of some importance. I have no wish to intervene too long in this Debate, but I do want to raise one or two points. I want to emphasise the points that other speakers have made. My first point is one which has been raised by at least three other speakers, the making against the medical profession one of the most unfair charges I have ever known. When this scheme was announced, the Secretary for Scotland almost captured my enthusiasm for the measure. I thought that for once Parliament had got something. I lived in a fool's paradise for two or three weeks. The object of the scheme is set out in the Memorandum. One of the difficulties that local authorities and the medical profession found in grappling with this scourge was that people were faced with a terrible financial position when they went to receive treatment. The financial handicap was so great that people would not be treated. When this Paper was issued it was thought that an effort had been made to grapple with the financial hardship arising from treatment.

My first point is the terrible responsibility resting on the medical profession. I confess that when I first considered the scheme I thought it embraced T.B. as a whole. I, like many others, know very little about the science of medicine, and one has got to be guided by those who do know something about it. From my contact with the medical profession I find that there are a good many quite honest differences of opinion among it. A great number of medical men take the view that after a certain age T.B. is practically incurable—that men and women who reach a certain age cannot be properly cured at all. The symptoms can, perhaps, be modified, but there is practically no cure, and that is why local authorities, the medical profession and everybody concerned with the disease try to contact the victims of it at the earliest possible stage. What does this scheme mean? It means that unless a medical officer of health says that a person can be cured, that person does not get an allowance. The medical officer must certify that in his opinion the person concerned is likely to respond to treatment. Failing that, there is no allowance for the sufferer.

The refusal of the allowance to a victim of this disease is the worst thing that can be done. In the past the refusal of unemployment benefit had the same effect. It was not the actual refusal of the money alone that was the worst; it was the fact of the refusal that practically sent the refused person to hell, and that is much the same position here. If there was no scheme, a person would not apply, and he would not be refused. Now that there is this scheme, he applies, thinking he comes under it, and the medical officer of health says, "No allowance for you." In effect, he is -saying to that person, "No allowance; absolutely incurable." That is the effect of this scheme, and I think it is a shocking thing. I think we ought to take the view that if a person is prepared to try and try and try, no matter how incurable his condition may seem to be, the State ought to assist him in every possible way and not condemn him. I know of a capable man who applied for this allowance but was refused on the grounds we have heard. His case had gone too far. It is a terrible thing to contemplate that man being told that, and that sort of treatment cannot be defended.

The other point I wish to make is on the scale of allowances. What is the scale? The allowance for a man and a wife is 39s. That for a child under 10 years is 5s., between 10 and 14 years the allowance is 6s. 6d. and, I think, between 14 and 16 it is 8s. Therefore, in the case of a man and his wife with two children, one child, say, at 5s. and one at 6s. 6d., the total allowance would be 50s. 6d. This was heralded as something great. Actually, this scale is worse than the Glasgow Poor Law scale, because a man is told that as he is insured under National Health Insurance the £1 which he receives under health insurance has to be deducted from the total allowance. Under the Poor Law Acts the first 10s. 6d. of health insurance is excluded.

We had a great Debate here about ex-Service men. What is the position there? If an ex-Service man receives his pension for T.B., the whole of his pension is taken into account. If he gets a pension for a smashed leg or a smashed arm, then £1 of his pension is excluded. Could hon. Members imagine a more cruel device? It means that if an ex-Service man suffering from T.B. and an ex-Service man suffering from a smashed arm or leg both go into hospital, the wife and family of one of them get £1 a week more than the wife and family of the other ex-Service man. Is there any defence for that?

Take the case of the man with a wife and two children who gets the allowance of 50s. 6d. less £1 health insurance, which brings his total income to 30s. 6d., and who has been earning, say, £4 or £5 a week. Where is the financial inducement for that man to be properly treated? When this scheme was introduced I thought it a step forward. As a matter of interest, some of the assistance boards treat the people better. When a man of, say, 65 marries a younger woman of, say, 55, he becomes chargeable to the assistance board, but she may be receiving National Health Insurance, and in that case their total allowance exceeds the 39s. payable under this particular scheme. The scheme is not attractive, and I trust that the Secretary for Scotland and the Minister of Health will apply their abilities and their minds to seeing that those people who deserve not merely our sympathy but our help get it, and that they will at least make some endeavour to rescue them from the terrible disease from which they suffer.

Lieut.-Colonel H. Guest (Plymouth, Drake)

I do not wish to intervene in this Debate except to say that I am associated with one of the London hospitals in connection with the T.B. problem, and I think we all welcome the scheme of radiographical stations throughout the country for the early detection of T.B. I think that if T.B. can be detected in the early stages it can be very largely cured. I am associated with some voluntary hospitals connected with the T.B. problem, and I should be grateful to the Minister of Health if he would reveal to us how we are going to associate ourselves, in view of the municipal hospitals, State hospitals, and hospitals maintained by the rates, with those with whom we shall have to work in co-operation. Voluntary hospitals do very good service with this T.B. problem, largely because they are able to carry out research and go in for the very high-class form of surgery which is called for. The greatest trouble that we have, as a research hospital, is to know where to send patients when they have undergone the necessary surgical treatment. If you catch T.B. early enough and treat it properly it can be dealt with, but even with scientific dealing you must have some place where patients can go afterwards to have real remedial care. It is in that connection more than in any other that we in the chest hospitals find the difficulty about recuperative treatment.

I should appreciate it very much if the Ministry of Health could tell us in no uncertain language how the voluntary hospitals which serve such a useful purpose can be best associated with the great State effort which is being made to treat tuberculosis as a whole. Both sides have a function to fulfil. The State can do a lot in the way of general treatment, and the specialist hospitals can do a great deal indeed in scientific development of treat- ment, but until we know how we are to be related, from the voluntary hospitals to the State hospitals, it is impossible to make any satisfactory progress. Tuberculosis is the great scourge with which this country has to deal and we need to draw in all the efforts of medical skill and science and of voluntary and State help. It is up to the Ministry of Health to guide us how we can best guide the nation to get through this serious and increasing trouble of tuberculosis. I know that the trouble is largely due to housing and nutritional conditions. During the last four years we have had a larger access of T.B. than in the years preceding. The problem can be dealt with and I think that the Government are taking the right line with these radiological centres. If it is possible to detect T.B. before it becomes acute it can be dealt with on broad general lines by voluntary and State effort, and I think that a great step will be made thereby.

Mr. Gallacher (Fife, West)

Two years ago or so I was making an inquiry into the incidence of T.B., and as a result of that inquiry I wrote a letter to the Secretary of State for Scotland in which I put forward certain proposals in connection with housing, central cooking and dieting, and one or two other points that I considered essential for combating this disease. I hope that that letter will be dug out and reconsidered in the light of the discussion which has taken place to-day. Many of the points which have been brought out are of the utmost importance if we are to make a serious effort to tackle this terrible disease. I want first of all to draw attention to a matter which should be considered by every sufferer in the country, and it is that tuberculosis is not something that should be hidden or be ashamed of. There is a terrible feeling everywhere that T.B. is a sort of secret crime and that people must not let anyone know that there is anybody in the family suffering from it. One member of a family after another will hide it and never admit its existence to anybody. That is one of the difficulties.

One or two speakers mentioned the necessity of finding out whether there is a carrier of tuberculosis in a family from which cases have come. It should be the duty of the doctor to find an opportunity of examining other members of such families. I have been visiting some of the institutions recently where I have seen many difficult cases. I was speaking to a case where three members of a family had been through a sanatorium. Then another was brought in, the mother, and it was discovered that she was the carrier in that family. Anyone is liable to the disease if his system is weakened by over-exertion or chills. It should not be thought that T.B. is something peculiar to a family, and people should not hesitate to make its existence known. Mass radiology will be very valuable, but it is not enough. I was talking to a patient the other day who had been called up for the Army. A member of his family had been affected by T.B., so he reported it and asked for an X-ray. He got it, and he was passed A.1. His chest and lungs were as near perfect as could be. A year later he was in a sanatorium. T.B. does not of necessity start in the lungs, but can be in other organs. If a patient is examined by someone who understands the disease, it can be detected. Therefore mass radiology may give very good results in people who nevertheless have T.B. elsewhere in their system.

Children who are affected should be taken away from bad surroundings immediately. There should be a special ward set aside in hospitals for the care of children suffering from T.B. Another important thing is that some interest is provided for patients. I was at the Glen Lomond place, where patients have all kinds of interests provided for them. I liked the method of accommodation, small rooms which were very useful in the treatment, and were very different from the general hospitals with their large wards where all the patients succeed to a great extent in depressing each other. The patients were interested not only in light labour but in making things. They had built themselves a very fine bowling green. Patients can be encouraged to organise entertainments. Musical instruments might be supplied and opportunities given for the development of the theatrical art.

Above everything else I would ask the Department to use their influence with the Board of Trade to get an allocation of 16 millimetre projectors for some of these institutions which are far from any social centre. The Secretary of State for Scotland can say that they get along very well for three months with some patients, and when they have just become of use they leave, because they are far away from any centre. There is not much chance of social life for patients or nurses. I know that these projectors are of great value to the Forces but I suggest that an allocation should be made so that once a week some entertainment could be given, not only to the patients but to the attendants. I hope that everything will be done to make the scheme a success and that many of the suggestions that have been made to-day will be accepted, because they would strengthen the scheme and make it cover a much bigger range than it will cover in its present state.

Mr. Mathers (Linlithgow)

In the raising of this matter to-day and in the discussion, I think Scotland has taken more than her share, certainly more than the Goschen quota which is usually allowed to us. It is all to the good that this matter has been raised in the way it has, and I am certain that we do not need to appeal to the Secretary of State for Scotland or to the Under-Secretary of State to be sympathetic to the point of view that we have been putting forward. I am certain that we have that sympathy in advance. In pressing this matter to-day my colleagues have plied the Ministry of Health and the Department of Health for Scotland with reasons why they should demand an improvement in the scheme that has been in operation for a short time.

I know there is keen interest among hon. Members to hear the reply on behalf of the Government, so I will limit myself to one or two points. I shall allow others to speak for me, which I shall do principally by quoting letters from constituents of mine who are suffering from this disease. Out of the number of letters which I have received on this matter I have chosen two from nurses who contracted this disease in the course of their nursing service and are now declared ineligible for any allowance because they are not considered to come within the scope of the scheme for remedial treatment which would enable them to get back to work. There is something serious in the fact that nurses can contract a disease of this kind in their service and be made entirely incapable for work. Yet apparently there is no compensation for them at all and no possibility of their sharing in the scheme.

The first letter I want to quote sets out the experience that the nurse had and the position in which she is now placed, and I wish to quote to the House her summarising of the position after she had been refused an allowance by the medical officer. She says: So it boils down to this: Either I must stop having the food my condition urgently requires and get into so weak a state that I won't be able to take any precaution to prevent others taking it—[the disease, she means]—or I eat the food which my mother and brother should be having and if (which would be very probable) they should contract the disease the Government will immediately pay them an allowance to prevent T.B. from spreading. It does not sound sense and is it human? I think there we have the position very succinctly summed up and put in a way which must appeal very powerfully to those who have charge of this scheme and who must realise what the position is. I forwarded it as I do the letters I get in connection with this matter to the Secretary of State for Scotland, and nothing could be more kindly than the type of letter I receive in reply when these cases have to be refused because they do not come precisely within the scope of this scheme. Yet even in sending these kindly worded letters to these people, telling them they are not to have the allowance because of the limitations placed on him, I shrink from doing so. Yet there is no alternative to my making the position known. It is obvious that the patients themselves have not, up to the time of my sending them the reply of the Secretary of State for Scotland, fully realised the position in which they are placed, because that same correspondent, that same nurse from whose letter I quoted, after receiving the reply I was able to send her from the Secretary of State, said: Had the medical officer been honest with me, I would have saved you the trouble of taking up my case. There is something despairing about that which I am sure is recognised by anyone who has to deal with a case of that kind. Here is another nurse in exactly the same kind of position who has been denied the opportunity of having this scheme extended to her. I will not go into her history. I simply want to show how the reaction of the refusal of the allowance can be different in one case as compared with another. This correspondent says: I am deeply grateful to you for the help you have given me in this matter concerning T.B. I shall look forward to the day when some of my wishes come true. It is because I have the disease myself that I understand so well the sufferings, mental and physical, of those like afflicted and whom I want to help so much. I will try to be patient because I know that huge Government schemes take time to get properly going. Thank you again. That is her reaction, and I suggest that this is the kind of thing at which this Debate should aim, not to appeal for sympathy, but to inspire those who are in charge of these affairs with the absolute necessity of being more strenuous in their efforts to serve these people and more demanding upon the Treasury, because it is not simply a case of pleading that there is not the accommodation in the different sanatoria throughout the country in order to treat these people. I believe it is necessary to provide money in the homes like those in the first case which I quoted, to provide the money in order that we may be absolutely certain that they are properly fed, that they have a sufficiency of proper nourishment, which, even if it cannot remedy their condition, will certainly alleviate it and have a tendency to prevent the disease from spreading further. My feeling when listening to this Debate to-day is that the Government should be aware that there is a strong feeling in this House that more is required in connection with this matter and that if it be that the remedial measures cannot be properly applied, in any case let us have the means of alleviating the effects of the disease, even if that only means providing more money to meet the case of those who are denied the opportunity of sanatorium treatment and must stay at home.

The Joint Under-Secretary of State for Scotland (Mr. Westwood)

The hon. Member for North Camberwell (Mr. Ammon), who opened this Debate, set a very high standard, which has been maintained right to the last speaker in dealing with a subject which, I think, can more keenly interest the Members of this House than almost any other subject, the subject of a disease which has for generations been exercising the minds of those who are keenly interested in our health services, a disease which, in the words of the hon. Member for North Camberwell, is the greatest destroyer of life. While there may have been some criticisms of the scheme that was brought into operation by the Government, and of which it has been suggested that it does not do all that ought to be done and that it is rather hard on some of those who do not get a 100 per cent. grant from the State payable through the local authority, nevertheless there will go out to the country as a result of this Debate something which I think will be very useful. There are far too many people who have, in their minds even yet, despite all the preaching, all the talking and all the pamphlets dealing with this problem, that this is an incurable disease. One thing as a result of this Debate which I am perfectly sure will be a message of hope to thousands of those suffering from this insidious disease will be the realisation that, if caught in its early stages, if treated properly, getting the advantages which ought to be and can be provided within the limits at our disposal, the medical knowledge that is available and the medical science that can be provided, they can be cured. There is that hope so far as those hundreds, thousands of people are concerned who contract this disease or even may be liable to contract the disease, because I believe it is possible to discover now whether a person is liable to contract the disease and possibly save him even from contracting it. Then in the other cases where it is contracted, by remedial measures, by action taken in its early stages, the people concerned can be restored to health and strength again.

I entirely agree with what has been said by many Member—I think the suggestion has been contained in every speech—that if we are to eradicate this disease from our midst, because at the moment we are only dealing with remedial measures, I think I will go the length of saying that we can never eradicate it from our midst unless we have good housing for our people, unless we have an adequate supply of proper food and unless we have in any social system of the future security from want. These are the three points which were specially made in the opening speech of this Debate by the hon. Member for North Camberwell, which have been followed by almost if not quite every speaker who has taken part in the Debate.

Mr. Kirkwood (Dumbarton Burghs)

This is a workers' complaint; where are the Government?

Mr. Westwood

I am speaking for the Government. I hope I shall make just as good a job of it as those who have already taken part in this Debate. I will try to keep to as high a level as has been maintained. Special reference has been made to mass radiography and to its inadequacy. We have got to start some time. We have started now, even in the midst of war. It is perfectly true so far as the scheme is concerned, which I will deal with later, that it is a war measure, but I am one of those who sincerely hope that when the bells of peace ring out that will not mean the end of this measure. I want to see it continue. It is quite possible that we may discover, as a result of experience, that there are improvements that can be effected so far as the scheme is concerned, but the mass radiography is a start. Thirty sets are to be provided. Of these, three sets are to be provided in Scotland. That means training staff and getting accommodation, and consequently that cannot be done just at once. The three radiography sets in Scotland will be placed in Glasgow, in Edinburgh, and in the county of Lanark. It is quite possible that we may be able to develop that later, but we are in the midst of war, and there is difficulty in getting these sets, but even in the midst of war we have been trying to do something for the purpose of dealing in the early stages with this particular disease.

Another point raised by several Members in dealing with the general problem of tuberculosis was the shortage of staffs. That happens to be a very distressing fact, a shortage of domestic staffs, a shortage of trained nurses. That is a reality we have to face up to; it is there. Some methods are being tried out with a view to encouraging young, women to enter the nursing profession. I shall not argue at the moment whether they are adequate or not. I am merely pointing out that there are inducements being held out and prospects offered with a view to attracting into the service those who can give their assistance in dealing with these particular problems. I am inclined to think that if we are to meet the requirements of nurses we will require an adequate domestic staff, because you cannot provide the amenities for the nurses unless you have an adequate domestic staff. Therefore the work on which we are engaged just now, even in directing domestics to take service or get work in our hospitals and to recruit in connection with that service, I for one am perfectly sure will help us in dealing with this particular problem.

The hon. and learned Member for Montgomery (Mr. C. Davies) said there were three outstanding things we had to keep in mind in dealing with this problem: prevention, precaution and treatment. I am rather pleased that he made special reference to the need for developing the feeding of schoolchildren. It is a thing I have argued for ever since I have been in public life. I believe that if it is possible to get in our schools as part of the school curriculum the provision of a well balanced mid-day meal free, and I am working towards it—I remember the Debate on the Scottish Bill very well—we will have gone a long way to improving the health of our children. We can now see the progress being made. We can see the equipment being provided. In my own county of Fife, once we provide the equipment, with the scheme which they now have, we shall have the finest feeding service in Scotland. We shall be able to build up a healthy childhood, which will grow into healthy youth and be able to resist the attacks of tuberculosis. I was very pleased to hear that reference—not the only one which has been made in the Debate—to the need for developing the school feeding service, in the interests of better health.

I come to the scheme which was discussed by the hon. Members for West Fulham (Dr. Summerskill), Greenock (Mr. McNeil), Gorbals (Mr. Buchanan), and others. This is the scheme which has been announced and which is now in operation in Scotland and in England. I put Scotland first, because I am a Scots Minister; no doubt, if an English Minister had been making this speech, he would have put England first.

Mr. Cocks

Why is not an English Minister doing it?

Mr. Westwood

Because I think on this occasion a Scots Minister can do it just as well as anyone else. [Interruption.] It often happens that Scots Members do not help a Scots Minister when he is doing his best. The tuberculosis scheme arises from recommendations made by the Committee on Tuberculosis in War-Time, which was appointed by the Medical Research Council, at the Government's request, in the autumn of 1941. The Committee were asked to advise on possible preventive measures, because there was a serious increase in the incidence of tuberculosis. That that increase was alarming is shown by the fact that the figures for 1942 showed an increase in pulmonary tuberculosis of 31 per cent. in notifications and 18 per cent. in deaths over the figures for 1938, the last complete peace-time year. To cope with the rise in the incidence of the disease the Committee recommended, among other things, the controlled use of mass radiography.

Sir A. Lambert Ward

What are the figures for non-pulmonary tuberculosis?

Mr. Westwood

The corresponding figures are three per cent. and 12 per cent. I have already given the number of mass radiography sets that are to be made available.

Mr. McNeil

Two years after.

Mr. Westwood

You cannot do everything at once. Yet have to get the sets. It is not a crime to start in the right direction. We have started. [Interruption.] I am not dealing with illusions at present, I am dealing with sets. We have provided 30 sets, to facilitate early diagnosis. Also, special financial assistance has been provided, to induce patients to accept early treatment. The Committee, in recommending this, pointed out that tuberculosis is a special case, the needs of which the ordinary National Health Insurance scheme is not designed to meet. It is clear, from the description in the Report of the special character of the disease, that they were dealing with pulmonary tuberculosis. They say: It affects the productive groups of the population. It usually extends beyond six months. I would remind the House that the point of that is that the full sickness benefit under National Health Insurance of 18s. ends then, and is superseded by disablement benefit of 10s. 6d. That tends to reduce the standard of living of the patient and his family, although the patient requires a high standard of living for successful treatment. If the disease is treated in its early stages there is a good chance of full recovery and restoration to work. A scheme for special financial assistance was announced, in accordance with suggestions made by the Committee, so as to contribute, both directly and indirectly, to the control and the prevention of tuberculosis. That was the basis of the scheme. Directly, an adequate standard of living would aid the conquest of the disease and lessen the risk of its developing in the family, and, indirectly, it would make it easier to persuade the patient to complete his treatment, and not to return to work prematurely. It would remove some of the fear that prevents many adult home contacts from attending for examination, and would increase the acceptance by workers of mass radiography schemes. We have not taken away from the local authorities their responsibility for dealing with this disease. That remains with them. The scheme is worked through the local authorities. Neither have we imposed any new burden upon the local authorities.

Mr. McNeil

A financial burden.

Mr. Westwood

No, we have not imposed any new burden on them. We have taken away some of the financial responsibilities they had. We say that if a case can respond to remedial treatment, if it is in its early stages, instead of coming only under the system which allows in Scotland a grant of approximately 25 per cent. of the cost to be made to the local authority, we will provide 100 per cent. of the cost of allowances if they can induce people to leave off work and to take advantage of the scientific treatment which is available, provided that, in the opinion of the medical officer, they can respond to that treatment. It is still the duty of the local authority to be responsible for that treatment, but when the medical officer decides that the case is able to respond to the treatment, the State will bear 100 per cent. of the cost of the allowances. So far as I understand local administration, there is nothing to hinder them providing exactly the same allowance for the other cases which they have not passed.

Mr. McNeil

Through the Poor Law?

Mr. Westwood

Not necessarily through the Poor Law.

Mr. Buchanan

What is the other method?

Mr. Westwood

My impression is that under the 1929 Act, in Scotland at any rate, provision might be made for payments to sick persons under the health account, as it is. I am not going so far as to say that it would take in the dependants.

Mr. McNeil

rose—

Mr. Westwood

I have not interrupted anybody else, and I am trying to state the case.

Mr. McNeil

You have been very provocative.

Mr. Westwood

It is not the same scheme. I am dealing with the question of allowances. We have not added anything to the cost to the local authorities; we have taken away some of the financial responsibility, by providing 100 per cent. grant for cases approved by their medical officers. On 8th October, 1942, the Minister of Health said in the House that: Where facilities for diagnosis and treatment are available it is important that those who give up work temporarily for treatment, which is in the interests of the public health no less than their own, should be able to do so without financial anxiety as to the maintenance of their dependants. Local authorities are accordingly being authorised to grant financial assistance in such cases, to provide for the maintenance of the dependants and to avoid the break-up of the home while the breadwinner is undergoing treatment. This assistance is administered by the Public Health authorities as a part of the approved treatment under the tuberculosis scheme, and the cost incurred by them, in accordance with detailed arrangements which I am now working out with their representatives, will be repaid from Exchequer funds.—[OFFICIAL REPORT, 8th October, 1942; col. 1353, Vol. 383.] I am trying to meet the point made by the hon. Member for Gorbals, who mentioned the scale. The local authorities can also make special discretionary allowances; and we reimburse them, both in Scotland and in England, to the extent of 100 per cent. Special allowances are made, according to need, to meet standing commitments, such as rent, insurance payments and hire purchase payments. Superimposed on that again, there are special payments which the local authority can make, again according to need, to cover travelling expenses of relatives visiting patients in hospital, to provide domestic help where the patient is a housewife, and so on.

Mr. McNeil

Without limit of time or of amount?

Mr. Westwood

All I say is that I know of no case that has been put up to us so far. I am not saying that the scheme is perfect. Neither the hon. Member nor I are perfect; at least I am not.

Dr. Summerskill

Can the right hon. Gentleman tell us what is the limit imposed in providing a substitute for the housewife?

Mr. Westwood

The limit will be 10s.

Dr. Summerskill

Will the right hon. Gentleman tell the House how to find a substitute for the working housewife for 10s. a week?

Mr. Westwood

I am pointing out that this is an experimental scheme, and we shall find that there will have to be adjustments.

Dr. Summerskill

But surely you cannot find a substitute for 10s. a week.

Mr. Westwood

This is an experimental scheme, and I am merely pointing out what the scheme is. An allowance scheme is being applied for pulmonary tuberculosis cases because of considerations of national importance. It is true, and it was pointed out by several speakers, that many sufferers from pulmonary tuberculosis delay or avoid seeking treatment because they fear it may mean a long period of absence from work and subsequent hardship upon the dependants. The object of the allowance is to remove that anxiety.

Mr. Buchanan

Where does it remove it? If you give a man with a wife and two children £2 10s. 6d. at the very most, and he has been earning £4 or £5 per week, I cannot see how you can remove fear and want.

Mr. Westwood

I have not said that we have, but that the object of the scheme was to do that.

Mr. Buchanan

Has it achieved its object?

Mr. Westwood

The allowance would remove that anxiety and allow sufferers to seek treatment at the earliest possible moment. As I have already indicated, the object of the scheme is in the interests of the patient and of the community as a whole. By undertaking early treatment the patient has a better chance of full restoration to health and working capacity, and the allowance assures the well-being of his dependants in the meantime. That is the object of the scheme. It is of at least equal importance in the interests of the community as a whole that sufferers from pulmonary tuberculosis should seek early treatment. A person in industry suffering from this disease may be aware of his condition or he may carry on work unaware of it and to all appearances be in full health, but in either case his condition is likely to deteriorate progressively. Therefore adequate and timely treatment is of the utmost importance from the point of view of maintaining the public health. This, I submit, is a fundamental justification for making allowances available in pulmonary tuberculosis cases.

Mr. McNeil

The right hon. Gentleman does not make allowances available for pulmonary tuberculosis. That is what we have been talking about.

Mr. Westwood

I am pointing out that the scheme provides relief for pulmonary tuberculosis cases.

Mr. McNeil

Only relief for acute pulmonary tuberculosis cases.

Mr. Buchanan

The schemes does not apply to all people.

Mr. Westwood

The scheme does not apply to all. It applies to those who can respond to treatment and who, if they will leave work in the early stages of the disease, have a chance of complete recovery. As far as Scotland is concerned, it means that three persons out of every four who have applied for assistance have been granted it.

Mr. Gallacher

We want four cases out of four.

Mr. Westwood

That is a matter for argument afterwards, but this is a scheme to induce individuals to get early treatment. The main purpose of the allowances scheme is to rehabilitate those who can be rehabilitated. The scheme, however, allows considerable latitude. Allowances are payable for six months after leaving a sanatorium to all patients who are not fit to resume full work in that period. Thereafter allowances may be renewed on the certificate of the tuberculosis officer for two further periods of six months if remedial treatment is to be continued. If treatment is still required in individual cases thereafter, the Departments have to be informed, but allowances may continue until the Department advises against it up to a period of 12 months. Allowances may be paid to patients where the tuberculosis officer considers that the equivalent of approved sanatorium treatment can be carried out at home under his direction. The Department has to be consulted if it is proposed to continue this form of treatment beyond 12 months. We recognise that the scheme is in its experimental stage, and we are examining the experience of its working up to date with a view to seeing what improvements can suitably be made in it within the limitation imposed by available hospital resources. We shall look into the position closely.

Meanwhile I sincerely hope the advice given by the hon. Member for Greenock will not be accepted by medical officers of health, when he said that he hoped they would try to make the scheme unworkable. I want everyone to help in making this scheme a success, even although it does not meet all the desires of all my hon. Friends opposite. I was asked whether I could justify it on Christian grounds. I am justifying it here as a Minister of the Crown, but also on Christian grounds

Mr. Gallacher

And on Mohammedan grounds too?

Mr. Westwood

I was not asked on Mohammedan grounds. I cannot speak on Mohammedan grounds. I only speak on Christian grounds. I can defend it anywhere. It does not deal with social security as such. That is a problem to be dealt with in a comprehensive scheme which will deal not merely with the chronics of one disease but, I hope, the chronics of all diseases. This is a remedial measure for the purpose of assisting rehabilitation where it can be made a success, and I have no hesitation in defending the scheme anywhere, believing that it is a step in the right direction. It has benefited three out of four cases in Scotland. We are closely watching the scheme in its operation with a view to finding out where remedies can be applied in any general scheme in the future.

Mr. Cocks

Will my right hon. Friend consider including incurable cases in the consideration that is to be given to the question in future?

Mr. Westwood

I cannot say that I can do that. I said that I hope incurable or chronic cases will come within the general security scheme and will not apply only to those suffering from one disease but for all diseases.

Dr. Summerskill

The right hon. gentleman said that the scheme had benefited three out of every four cases in Scotland. Does he mean it benefited three out of every four cases recommended for the allowance or three out of every four cases of patients suffering from pulmonary tuberculosis in Scotland, as that is a very different thing?

Mr. Westwood

I cannot say that it is three out of every four cases of people suffering from tuberculosis, but it has benefited three out of every four cases where application has been made. They have to make application.

Dr. Summerskill

Those are the acute cases. What is the number of cases?

Mr. Westwood

There were about 2,700 cases. If I had sufficient time, I would give all the details. I am always willing to give exact figures if desired. I have them here, but I know that I have almost exhausted my time under the arrangements made for other hon. Members to raise another subject, and I wanted to give way to them. There have been approximately 2,700 cases for which application has been made.