HC Deb 20 January 1944 vol 396 cc500-8

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

Dr. Summerskill (Fulham, West)

The Parliamentary Secretary in the closing words of his speech in the previous Debate said: "Let knowledge grow." My purpose in speaking is to echo that appeal. This is the first time during my period of membership of the House that I have raised any matter on the Adjournment, because I fully realise the time of Ministers is very valuable and I would never take up the time of the Minister unless I thought the matter I wished to discuss was of grave importance. I want to draw the attention of the House to the serious menace of the increase in the incidence of venereal disease in this country. I am very pleased to see the hon. Lady the Parliamentary Secretary to the Ministry of Health here, because I fully realise she has knowledge on this subject, but I feel it is a great pity that our new Minister of Health has not made a great gesture and come here at this time in order to show us that he thinks this matter is serious. I raise this matter because of the persistent refusal of the Minister's predecessor to take more effective action to reduce the incidence of venereal disease in this country.

Last year the Minister of Health felt that this matter was so grave that he decided to introduce a Regulation known as 33B. That Regulation, however, could only be brought into operation if two contacts came forward and gave information against the infected person. I would like to remind the House that some of us prayed that that Regulation should be annulled because we felt that it would be ineffective, first because it would be, extremely unlikely that an individual suffering from venereal disease would add to his or her difficulties by revealing the source of infection, and secondly because it was felt that this Regulation would discriminate against women. I felt that men are less reluctant to disclose the source of infection than women are. I should like to remind the House of the figures. I have asked the Minister how many individuals have been treated during the year as a result of this Regulation 33B. The latest figures given in this House, in, I think, October, were the figures which the Minister had for the period up to last June. After six months of this Regulation being in operation, two men were informed against and 64 women. It simply bare out our contention last year that this Regulation would be ineffective, that it was waste of time, that it would do nothing, because people would not reveal that kind of thing voluntarily. Again we have been proved right by the fact that two men and 64 women were informed against. In other words, men were willing to disclose the source of infection, but women were very reluctant to do so. The Minister also mentioned, when I asked the Question, that 1,780 people had been reported but only by one person in each case, which means that Regulation 33B does not operate, as it applies only when a person is informed against by two people.

What is the magnitude of the problem? I am told that the number of fresh cases in 1942 was 120,000. Think of it, 120,000 infected people transmitting the disease to men and women and unborn children. The reason why I feel so strongly about this is that it is not just the guilty person who suffers: this loathsome, crippling, blinding disease infects unborn children. What is the result? After pressure from this House, this ridiculous Regulation 33B was introduced, and two men and 64 women have been treated in consequence. I come to the House and ask again, and I shall keep on asking again and again, that now we should have compulsory notification and treatment of this disease. I only wish that the Minister were here. It is most unfortunate that he is not here. He should have come in order to show his interest in this scourge, this menace to the public health. Any other disease which is a menace to the community is notifiable. Why not this? These are the reasons we were given last year when I pressed for compulsory notification. I was told that it would drive the disease underground. Has 33B brought it to light? It is underground; the two men and the 64 women prove that it is underground. Could anything be more underground? The other thing I was told was that public opinion is not ripe, that the people are not ready. I say that that is not so. I believe that the Ministry have had resolutions on this subject. I myself have had resolutions from small groups of people; but there is something which. I think very important. The lead in this matter is coming from Scotland.

Mr. Kirkwood (Dumbarton Burghs)

An intelligent place.

Dr. Summerskill

Scotland may be a little shy and perhaps it is a little prudish on these matters but that is really not so as the lead is coming from Scotland. I have had a letter from Sir Henry Keith, who is well known by local authorities in Scotland. He says: I have pleasure in informing you that the County Council of the County of Lanark, and the Burghs in, Lanarkshire, have agreed to petition, or at least support, a scheme of compulsory notification and treatment of venereal disease. The Association of County Councils in Scotland, and the Convention of Royal Burghs have both agreed to act similarly. The City of Glasgow is also moving in the same direction, and I have written to the Secretary of the Committee concerned in Glasgow, asking that he might endeavour to get the support of the Association of Counties and Cities. Surely, this is an indication that men and women throughout the country—because Scotland is not only reflecting the feelings of Scotland—desire something to be done in this matter. I appeal to the hon. Lady to take this seriously. It is only those of us who are in contact with the young product of this loathsome disease who realise that action is long overdue.

Dr. Haden Guest (Islington, North)

I should like to intervene in the Debate because I was one of those who supported the bringing into force of Regulation 33B, but I am forced to the conclusion that the Ministry has not exercised sufficient pressure or stimulated sufficiently the activities of medical officers of health and health authorities generally in this matter. Unless the Parliamentary Secretary is prepared with figures which will completely contradict those brought forward by my right hon. Friend, Regulation 33B has been a complete failure up to the present time. I believe that that is due partly to the fact that it has not been administered with sufficient vigour. The local medical officers of health and health authorities are often not particularly interested, unfortunately, in the prevention of venereal disease.

A little time ago I was approached by an organisation in the country, a women's institute, who were very concerned—because their village was near a large camp—about giving instructions to the girls of the village with regard to protection against venereal disease. They came to me to ask how it could be done. I said, "You have only to ask the medical officer of health"—and I gave them his name and address—"how to get into touch with the proper authorities, who will give you a lecture and show you a film and enable you to tackle the matter properly. He will tell you all about it and put you into touch with the right authorities. "I gave that information in good faith. They got into touch with the medical officer of health, who gave them a completely evasive answer and up to the moment they have not been able to get any information at all out of that health authority with regard to the giving of lectures and the showing of films on venereal disease. How can we expect that in that area Regulation 33B will be properly administered? That reflects very considerable discredit on the Ministry of Health, which should have administered this Regulation with much more vigour.

In the circumstances, I feel that my hon. Friend, who introduced the subject, has made out a strong case for the introduction of compulsory notification at the present time. I do not think that that is by any means the whole of the case. There are other things that one should do and some are very unpopular. There is a difference between the question of venereal disease in the Services and venereal disease in the civilian population, and I will say in particular a few words about the Services. I remember very well, when a Divisional Officer in France in the last war, that one of my duties was to go through all the statistics of diseases of various kinds, including venereal disease in the Division. I noticed with great satisfaction that in our Division, the strength of which at the time was 22,000, there were practically no cases of venereal disease at all, or very few.

In analysing the matter, I and other medical officers came to the conclusion that it was partly due to a regulation which was in force in France at that time, that other ranks were not allowed to take any spirits to drink, though they could have wine and beer. The view was that spirits made men much more careless in their sexual relations; they were not careful about ablutions afterwards, and therefore got venereal disease much more than they would have done otherwise. I believe that if we prohibited spirits to other ranks in this country, at any rate in certain town areas, and made a rule that no licensed establishment, no club or other place to which soldiers went, should be allowed to supply spirits, that would have a very sensible effect on the incidence of venereal disease on other ranks of the military population. I am quite prepared to agree that it should be applied to officers as well if necessary, but it is much easier, and certainly essential, to apply it to soldiers, to eliminate the effects of spirit drinking. It would have to be applied to Allied troops, of course, for there have been complaints in Allied circles about the number of their troops who have been affected in this country, especially in London.

I venture to congratulate my hon. Friend on bringing this matter forward because it is time it was frankly discussed. It is a very serious danger to the community. It is quite true that, at present, both gonorrhea and syphilis can be treated much more effectively than they ever were treated before, and part of the difficulty in dealing with the matter at the moment is the fact that a very short treatment masks external symptoms altogether. But if it were made compulsorily notifiable at the present time, it would be a definite advantage to the community, and unless the Ministry is prepared to bring forward something of a very different character I think the House ought to insist on that and the Ministry should explain why, up to the present, they have not enforced the proper administration of this Regulation, because undoubtedly the figures quoted by my hon. Friend show that the Ministry have in that matter failed in their duty.

Dr. Morgan (Rochdale)

Some people have a bee in their bonnet about this subject, and I hope that the hon. Lady in replying will put up the adequate defence which I know can be put on this subject. I want to warn this House, and especially hon. Members on this side, to beware of compulsory measures in medicine. If there is one thing that will drive humanity to the dust it is compulsory treatment from the point of view of medicine and especially with regard to venereal disease. I hope the hon. Lady will say to those who are now praying for compulsory notification that she cannot experiment. Where there was rampant disease in Chicago and there was compulsory notification and treatment, the figures of venereal disease went up higher not because of the notification but because the disease became more rampant than before the measures were taken. It is not only in Chicago; it is all over America that these things have been tried, and in each case where they have been tried they have failed. I only wish we could have half a day instead of half an hour to discuss the whole problem, because it is impossible to deal with it in the space of half an hour. It is a very intricate and difficult subject. I hope the hon. Lady will give us a reply now but that on some other day we may have more time to discuss the subject.

The Parliamentary Secretary to the Ministry of Health (Miss Horsbrugh)

In reply to the point made by my hon. Friend the Member for West Fulham (Dr. Summerskill) when she spoke on the subject of the reply coming from me and not from the Minister of Health, and suggested that it would have been a great gesture on the part of the new Minister of Health if he had been present this evening, I would like to tell her that my right hon. and learned Friend had an engagement in the Provinces and that he left London at half past five for this engagement which was made many weeks ago. I think she will agree that on these Adjournment occasions it does usually fall to the Parliamentary Secretary to give the reply, and, as I know her opinions very well, she will perhaps think it is quite a good thing that a woman should get her opportunity.

I was surprised when she mentioned that Scotland seemed more advanced in this matter, because she has not perhaps remembered a particular Bill, which I think became known as the Edinburgh Bill, on this subject. It came before the House before I was a Member and many years before the hon. Lady was a Member. If she reads that Debate, she will agree that opinions on the subject have been put forward in Scotland on more than one occasion. On this subject, I do not know any Members who are in disagreement on the appalling nature of the disease. I need not go into this. The whole point seems to me to be this—what is the best method of getting those affected to go for treatment at the earliest possible moment? That is really what we are trying to do. The difficulty is that it is not quite the same as other notifiable diseases, because it does not incapacitate persons who have contracted the disease. If patients had to bear a tremendous pain we should not have this difficulty, because patients would come to the doctor to be cured and notification would not be needed. What we have tried to ensure is that if there are people infected they know something about the disease, for many patients with the earlier symptoms do not know they have contracted the disease, and secondly they do not know what terrible consequences there are, and the urgent necessity for taking treatment at once. The point we have to decide is whether we are going to get more of these people to come for treatment, if the disease is compulsorily notifiable and if treatment is compulsory or not. If people who first contract it know that they would have to go to the doctor under a compulsory scheme, they would decide to wait because they would not want to be caught up into a compulsory scheme; what we have to judge is which scheme will bring the best results.

When the Debate took place in December, 1942, the late Minister of Health said he had a completely open mind and would come to the House for more powers if he thought more powers would help. The Minister is entirely in agreement. It is not a matter of principle in not asking for compulsory notification and treatment. It is simply the question—Will more people come forward or shall we get more with the voluntary schemes. The hon. Lady began with the words that we heard at the end of the Debate that has just concluded, "Let knowledge grow." The campaign on this subject was not a campaign simply in connection with Regulation 33B. That was a very small adjunct. The campaign was a campaign to let knowledge grow and I think we are all agreed that there has never been so much publicity as we have had. We have been trying to tell people the facts. They have been published in the newspapers and by means of posters and the Minister and I have addressed meetings. We have had discussion groups all over the country and there have been films on this. I was sorry to hear of the case mentioned by the hon. Member for North Islington (Dr. Haden Guest) of a local authority which was not doing its job. We must go on stirring them up; we have to let knowledge grow. Unless you do that, whether you have compulsory notification or not, you do not succeed. We have tried to tell people how deadly this disease is, to make clear to them what are the first symptoms and the necessity of coming forward for early treatment.

The hon. Lady also mentioned figures on the subject of Regulation 33B. I would like to explain that notice is served on the individual only if the individual refuses after every attempt at persuasion to come forward for treatment. The figures given are those who have refused and on whom a notice has then been served. In about half the cases where there were two notifications the individuals came forward voluntarily when persuaded and, therefore, those numbers are not included. There are a recalcitrant few who, in spite of persuasion and being told of the consequences, still refuse to come forward for examination and treatment; it is then that this Regulation is put into operation. The hon. Lady said that we dealt only with contacts if two names were given. That is the case if we do it compulsorily under Regulation 33B, but not otherwise. The medical officer always tries to find the contacts as he would in a case of smallpox, in which he would say, "Where have you been and whom have you seen?"

I think a certain amount of difficulty has been experienced by medical officers who were uncertain about the legal aspect of this matter. If they interview people and ask them whether they are aware that they have this disease and whether they would come forward for treatment there is the idea, I think, that there might be subsequent actions for slander or defamation of character. This matter has been looked into and local authorities have been told that if they instruct the medical officer of health to take such action he is protected in action taken in the carrying out of his duties to control venereal disease. This tracing of contacts, this social work of trying by persuasion to get people to come forward, this spreading of knowledge will do more than anything else to achieve what we all want. But if we came to the conclusion that people would come forward more readily for treatment if notification were compulsory and treatment were compulsory we would have no hesitation in saying so. At the moment we think more people would come forward for treatment if we spread knowledge and maintain secrecy. Once you got compulsory notification and compulsory treatment people would fear that secrecy would not be maintained. One of the ways in which this disease is different from all others is that people wish to keep it secret. We are perfectly willing to make the change if we think we shall get more advantage by it but in the meantime our motto should be, as the hon. Lady says, "Let knowledge grow."

Question, "That this House do now adjourn," put, and agreed to.