§ The Secretary of State for Scotland (Mr. T. Johnston)
After four years of the intensive strain of war, with women workers—hundreds and thousands of them unaccustomed to factory and workshop production—with blackout conditions in every home, with housing difficulties accentuated, with imports of many fruits and foodstuffs severely restricted, how fares the nation nutritionally? In pre-war years between a fourth and a third of our population is estimated to have lived on food that did not provide 2082 for all the requirements of health. Sometimes that was due to ignorance of the nutritional values of foodstuffs. There was a famous comedienne who popularised in the music-halls a song, the refrain of which went:A little of what you fancy does you good.That may or may not be gastronomically accurate, though no doubt the lady was right to the extent that our foodstuffs, can be more attractively processed and cooked. We can educate our palates in the nutritionally right direction.
At any rate, Sir John Boyd Orr has noted and commented that the war has produced a remarkable change in our food policy. The Government now control production and imports, and they arrange for the foodstuffs which can be most easily obtained to meet human needs, in so far as needs can be met under war conditions. Distribution is according to needs. Foodstuffs are subsidised to keep the retail prices within the purchasing power of the vast majority of the people. In addition to the usual rations, food is provided in works' canteens to meet the special needs of heavy workers. Additional milk, eggs, and vitamin concentrates are provided to meet the special needs of mothers and children. The total consumption of liquid milk has risen 34 per cent. since 1939. In Scotland 67 per cent. of the whole school population is now receiving a milk ration at school. In England and Wales the proportion is even higher. It is 78 per cent. of the children at school who are receiving this milk ration. One of my happiest memories is that I initiated in 1930 the milk-in-schools experiment in Lanarkshire, from which these great nutritional developments have come.
Sir John Boyd Orr says that a survey of working-class families in industrial towns in Scotland has shown that there is a definite improvement in the health value of their diets, the average intake of some of the important vitamins and minerals being over 20 per cent. higher than in the pre-war years. Over a quarter of the children attending school are given a nutritious mid-day meal in Scotland. In England the figure is 29 per cent. Vegetable consumption has remarkably increased and the result of this drive and organisation is shown in the school meal reports. Medical examination reports are 2083 a good test, or, at any rate, as good a test as we can get. In Glasgow, for example, in 1943 boys entering school life were .40 inches taller and 1¼ lbs. heavier than boys who entered school life in the pre-war quinquennium. Girls increased .28 inches in height and nearly one lb. in weight. From Aberdeen school medical inspectors' reports similar evidence is available. Tuberculosis, however, rose again upon us, but I think that clearly is due to deterioration in our housing conditions and less, if at all, to nutrition.
While it may not be possible, for perhaps four or five years more, to obtain an accurate measure of the benefits to health that have resulted from the application of the Government's nutritional plan, no medical or scientific expert has expressed a doubt that, if this plan be continued, it will ultimately have the following consequences: first, anaemia will be less common; secondly, there will be fewer premature and still-births; thirdly, there will be even less rickets and other nutritional diseases in children. There will be a continuation of the better growth and development in children, better teeth, less dental caries and better vision. There will be increased resistance to disease and a larger expectation of life. Personally, if I may say so, I think the efforts of the Ministry of Food in all these directions are most admirable, and, from a health point of view, most commendable.
About 18 months ago I drew the attention of the House to the figures of infant mortality in Scotland, and after consultation with the Council of Ex-Secretaries of State for Scotland I decided to ask the Scottish Scientific Advisory Committee to arrange for a special and urgent inquiry into the causes of the high infant death rate in Scotland. That death rate is decreasing. Last year it was 65 per 1,000 births, the lowest in our annals; but our Scottish figure maintains a ratio of about 30 to 40 per cent. higher than England's infant death rate. The report from the Scientific Advisory Committee, which has now been published, has aroused, and deservedly aroused, widespread interest. Despite some criticisms that it is unduly weighted in favour of nutritional aspects of the problem, it is, I think, a Report of great competence and importance, and we 2084 are all in Scotland greatly obliged to Sir John Boyd Orr, the Chairman, and his fellow members of the Committee for their services in collating and marshalling this evidence.
The comparative tables of infant morality in the various countries of the world are shown on page 8 of the Report. That table carries us down to the end of the quinquennium 1934–38. It shows Scotland with an infant mortality of 77 and England and Wales with a mortality of 57. The chief medical causes of that infant mortality are shown on page 19 of the Report. There it will be observed that the main cause of the high mortality is infection, epidemic diarrhoea, pneumonia, etc., and this infection is further commented upon in the Report on page 27. I will say something about this aspect of the problem later.
On page 33 Members will see references to the adverse economic and social conditions which have a direct bearing upon an infant's chances of survival. These are (1), that unemployment was higher than in England, ranging year after year from 4 to 7 per cent. higher than the United Kingdom figure. Hon. Members will see that on page 30. (2), In July, 1938, our unemployment figure in Scotland was 15.8 per cent. of the insured population. To-day it is 1 per cent. (3), According to Sir John Boyd Orr (on page 28) the people in Scotland who were living in poverty were in proportion to population twice as high as that section of the population in England. This statement, I understand, was based upon a Report by Professor Bowley to the Minister of Health in England. The Report has not been published, but I understand that Sir John Orr's comment bears reference to the fact that in Scotland twice the percentage of the population is in the under 10s. a week income group. [An HON. MEMBER: How does that compare with England?] I cannot say. There are some other countervailing considerations, however, which require measurement—for example, the higher rents paid in London and English towns generally than in Scotland diminish the disproportion between the purchasing power of respective wage incomes in the two countries. (4), Overcrowding, at the time of the last census, was six times as high as in England, but it is impossible to estimate what the proportion is to-day. I merely give the last available official figures known to me.
§ Mr. Kenneth Lindsay (Kilmarnock)
Is it six times as high in the big towns, or does it relate to the whole of Scotland?
§ Mr. Johnston
It is six times all over Scotland. Some of our housing conditions are appalling. One ward in Glasgow—the Gorbals Ward—according to an analysis just made by the Medical Officer of Health, contains 1,854 houses with newly born infants in them. Of these houses 286 are sub-lets and 191 are cases where the families are living with relatives. In other words, in 477 houses where infants are born, or 25 per cent. of the total, the parents are not themselves the tenants in chief. It is no wonder that infant mortality last year in that ward was high; indeed, it was 126 per thousand births.
§ Mr. Maxton (Glasgow, Bridgeton)
To say that so many houses are sub-let conveys nothing. I live in a flat in London of which I am not the principal tenant, but I can assure the right hon. Gentleman that it is a comfortable and even commodious residence, and when the right hon. Gentleman refers to "sublets" does he intend to indicate that they are only of one apartment with no separate sanitary conveniences?
§ Mr. Johnston
I cannot say without notice the state of affairs of all these "sub-lets," but I am sure that the overwhelming proportion of them in that ward are without separate sanitary conveniences. But bad housing, while a high contributory factor to infant mortality—and this is an important point to which I should like to direct special attention—is by no means the sole factor in infant mortality. I have consulted Sir Alexander Macgregor, the Medical Officer of Health for Glasgow, Dr. Clark, Medical Officer of Health for Edinburgh, Dr. Burgess, Medical Officer of Health for Dundee and Dr. Rae, Medical Officer of Health for Aberdeen, and they all concur that bad housing is not the sole factor in the causation of infant mortality. In Edinburgh, for example, Dr. Clark supplies figures from a new housing scheme to illustrate this point. A considerable 2086 population from the overcrowded ward and the slum houses of St. Leonards were transferred to the new housing scheme in the Niddrie area of Liberton Ward, with the result that in 10 years the infant mortality in the Liberton Ward has risen from 57 to 81, while the average rates for the City of Edinburgh have fallen in the same period from 80 to 61. It is obvious, says Dr. Clark, that neither housing nor food alone can be singled out as the primary factor in the creation of a high infant mortality rate.
§ Mr. Buchanan
The right hon. Gentleman will have us all back in the slums. This is just nonsense and special pleading.
§ Miss Rathbone (Combined English Universities)
Is the right hon. Gentleman aware, from the comparable figures in England, that where people are removed into good houses they experience the same sort of thing because of poverty?
Mr. McNeil (Greenock)
§ The Chairman
Hon. Members are not entitled to intervene unless the Minister or an hon. Member gives way.
§ Mrs. Hardie (Glasgow, Springburn)
Was that not the time when there was a large amount of unemployment, and many of the people who were moved out to this place had to pay higher rents and were not able to get the food that they needed? Therefore, nutrition has a lot to do with it.
§ Mr. Johnston
If my hon. Friend had listened, that was precisely the point I intended to make. I was only at the beginning of my explanation. I was trying to face the realities.
Is the right hon. Gentleman able to give the comparable figures for the area from which the people have been transferred so that we may know the position?
§ Mr. Johnston
Naturally, these figures are vitiated by the fact that populations from other areas have moved in since, and Dr. Clark was very emphatic that they ought not to be used to further the case in that regard. I will refer further 2087 to this Liberton Ward experiment. It to some extent confirms the remarkable analysis of infant mortality at Stockton-on-Tees published in 1936 by the then Medical Officer of Health there, Dr. McGonigle. His book is entitled, "Poverty and Public Health." He shows that, while the infant mortality fell from 172 to 117 in the new housing estate to which a slum population was transferred, the figure of 117 still compared badly with the average for England and Wales of 66.2 or, indeed, for the average figure for Stockton-on-Tees of 78. But what struck me most on studying the Stockton-on-Tees analysis was that in the new housing estate there was an increased rent of 4s. 4d. per week, and how this 4s. 4d. diminished the amounts available for food, especially among the unemployed families. Dr. McGonigle gives a remarkable table, which hon. Members should study, showing that the death rates per 1,000 of population were 26 per cent. in the income class of 25s. to 35s. per week and only 11.52 in the 75s. and upwards class.
But if hon. Members will turn to the table on page 69 of the Report of the Orr Committee, they will see that the industrial town of Falkirk has the lowest infant mortality rate among the large burghs in Scotland. I suggest that the primary cause of this is to be found on page 29, where Falkirk is shown as having the lowest rate for unemployment. That means there was in Falkirk more family income, more money for food, clothing, comforts and attention, and the evidence is overwhelming that the prime cause of excessive infant mortality is poverty; that it is insufficiency of purchasing power in the family. Down to 1935, as hon. Members know well, they were still paid only an allowance of 2s. per week for the child of an unemployed person, although 30s. a week was spent on each mentally defective child in a home and 54s. a week on each youth in a Borstal institution.
On housing we are, as hon. Members know, making preparations with the local authorities for the mass servicing of the sites for a large number of both temporary and permanent houses, and the Minister of Works assures me that by the end of May we shall have a prototype house in Scotland ready for inspection by local authorities, this prototype house being an emergency house capable of production 2088 on a large scale and of great speed in erection. These houses, it is intended, will be all publicly owned and will be licensed only for a limited period of years. We hope, by mass construction of one or two standard types, that we shall be able to hold our own in speed and construction with any foreign production whenever the capacity is available.
§ Mr. Johnston
No, Sir, an emergency proposal. There are a surprising number of varieties in component parts of houses, many of which can with advantage be dispensed with when speed of erection is so urgently and vitally necessary. I am assured, for example, that there are no fewer than 374 types of chimney-cans, but I am not in a position to make any further statement on that subject pending the erection of the prototype house and the full information which the Minister of Works hopes to be able to give us in about ten weeks' time.
§ Mr. Hynd (Sheffield, Attercliffe)
Can the right hon. Gentleman give any idea of the estimated life of this prototype house?
§ Mr. Johnston
I hesitate to answer that question. I am not a technical expert, but I am assured by people who know that at any rate they will have a life of ten years as a maximum. I do not know, and I do not want to commit myself to that at all. On nutrition on a United Kingdom basis I have already said something, but on the subject of infant mortality I should like to draw the attention of local authorities in Scotland to the fact that in January of this year our intake of welfare foods for mothers and children was still surprisingly lower than the corresponding figures for England and Wales. We are 7 per cent. worse in cod liver oil, 20 per cent. worse in vitamin A and D tablets and 18 per cent. worse in the intake of orange juice, That is a matter which I am sure will be corrected by Medical Officers of Health, and I entreat the active co-operation of the doctors, the Press and the cinemas in this regard.
Now as to maternity hospital beds. We have, as a matter of fact, rather more maternity hospital beds to births than have our neighbours South of the Border and we have more births in institutions.
2089 During the war, also, the number of hospital beds in Scotland has increased by 50 per cent. We now have 2,260 such beds and the local authorities, the larger ones at all events, are endeavouring to improve upon that figure In Glasgow 55 per cent. of births are in hospitals and nursing homes (they were 40 per cent. in 1938), in Edinburgh between 60 and 70 per cent., in Dundee 77 per cent., in Aberdeen 75 per cent. There is a vast and steady increase in the use being made of ante-natal clinics. In Glasgow last year about 77 per cent. of expectant mothers attended these ante-natal clinics. Our health visitor arrangements are steadily increasing. We have now in Scotland 970 trained visitors and we are endeavouring to see how far it is possible, even duirng wartime to get more of them trained. In so far as personal hygiene and cleanliness can be improved under existing conditions the Council on Health Education will no doubt do everything possible in that direction.
But there is one aspect of these mortality figures which still gives me considerable concern. If hon. Members will turn to page 27 of the Report they will find there the assertion that about one quarter of the total deaths in the first month of babyhood are due to infections, and in a consecutive series of 225 post-mortem examinations of children dying during the first month in the Maternity Pavilion, Edinburgh Royal Infirmary, 27 per cent. of the deaths were judged to be due to infection. Apparently, at one time there were similar outbreaks in English and American hospitals. These outbreaks there were followed by administrative action.
§ Dr. Edith Summerskill (Fulham, West)
May I draw the attention of the right hon. Gentleman to something on that page? If he reads on, he will find that it says that almost all the infants affected were bottle-fed, which means that the mother was so exhausted, from underfeeding, that she could not feed the child herself.
§ Mr. Johnston
It may be due to that and it may not. The point is that in other institutions where the children were bottle-fed these infections did not arise. As I said, these outbreaks in American and English hospitals were followed by administrative action which partly succeeded. Clearly this is something to 2090 which immediate attention must be given. I am, therefore, inviting the Scientific Advisory Committee to pursue as a matter of urgency a special inquiry into this aspect of the question. If I might, therefore, summarise what we are doing upon the conclusions of the Orr Report it would be in this wise:
And on nutrition, I make the confident claim that, despite all the adverse conditions and stresses and strains of war, there are now more people than at any time in our history getting three meals per day, and that, judged by all the available medical and statistical evidence in our schools, the health and vitality of the next generation is improving.
- (1) We are asking for a detailed examination as to why 25 per cent. of the deaths of newly-born babies are caused by infections;
- (2) We are taking every step in our power to prepare the way for a vast increase in sanitary and healthy housing accommodation;
- (3) The Local Authorities are doing their utmost to increase the intake of certain vitamin products by mothers and babies, to increase the number of qualified health visitors and home helps and the quality and use of the clinic services and the number of maternity beds;
- (4) The National Council for Health Education will assist in every way possible to inculcate the advantages of high standards of personal hygiene and conduct.
Mr. Gallather (Fife, West)
Will the right hon. Gentleman take really drastic steps to secure the necessary land in view of the enormous housing programme that will have to be carried out?
§ Miss Rathbone
Before the right hon. Gentleman concludes, might I ask him one question? He admitted in his statement that the major cause was poverty. How then is it that not one of all the various remedies he indicated cuts at the problem of poverty, which can only be met by adequate children's allowances?
§ Mr. Johnston
That leads us far afield. Many of the references which I made at the end of my statement were to remedial action which does affect poverty conditions. I should have thought that better housing was one.
§ Mr. Buchanan (Glasgow, Gorbals)
May I say a word or two in what I think is one of the most important Debates in which this House has taken part? I hope we shall not make this a Debate on a narrow issue, as if it were something confined to some isolated case. I would make an appeal to my English colleagues, for I often feel that I would like to bring a picture of parts of the industrial belt of the West of Scotland and towns like Dundee to people who are more fortunately situated, for I believe they would experience the same revulsion as swept this country when it understood what slavery was. I often think that if those English Members who are inclined to think we are irritable, over-bearing, and unjust, could picture the living conditions of these men and women they would not tolerate them for a day.
The right hon. Gentleman based his speech mainly on the On Report, which has been the subject of some criticism, most of it terribly petty. Like every other human being the author of that Report has made mistakes and has limitations, but every human being who makes mistakes endears himself to me. This fact, however, does stand out. In his Report there are facts which we should have known, and possibly did know, but he, and a number of very celebrated medical people, have sat down and examined these facts, and the result is a Report that is easy to read and easy to understand. When I used to state the facts over 21 years ago, as did also the hon. Member for Bridgeton (Mr. Maxton), especially in regard to a district of Glasgow, they were taken as if they were our beliefs, but now, these facts are simply stated in the Report, and have received the hall-mark of approval of perhaps the most eminent people in the medical profession in Scotland. To that extent I express my thanks.
But what of the future? The right hon. Gentleman is right in saying that poverty is the cause. He has stated quite truly that up to 1935 only 2s. was paid to an unemployed man for one child. Please bear this in mind, that at the height of the unemployment period the figure rose to over 2,000,000, but that figure turned over three or four times in a year, so that the actual population affected by it was at least one in every four. Glasgow Town Council gave in Poor Law relief, until shortly after the 2092 Assistance Board took over, to a man and his wife, no matter how big their family, 40s. a week to maintain the lot. That was the maximum, whether they had four or eight children, and that maximum, laid down by the Poor Law authorities, continued for about two years after the Labour Party took office in the town council. It was a shocking and outrageous state of affairs.
Let me give a comparison between two towns, Falkirk and Greenock, both of which I know well. Falkirk is situated in the middle belt of Scotland, while Greenock, in my view, is perhaps one of the best situated towns in the whole of Britain. What is finer than the Firth of Clyde? On health grounds Greenock ought to beat Falkirk. But what do we find? The death rate in Falkirk is 71 per 1,000 and in Greenock it is 102 per 1,000. Nobody can convince me that the Clyde, or the different character of the people in the two towns, is responsible for that difference. One of the few things that are common to rich and poor alike, to people of different religious or social standing, is that when once a woman has given birth to a child she will do everything she can to preserve its life. That is common to all. Yet one of the terrible tragedies of it all is that mothers are being underfed. What is the explanation of the difference in the figures I have given for Falkirk and Greenock? Greenock is, in the main, a ship-building and a heavy industries area and at one time unemployment there rose to such height that almost half the people were unemployed. Falkirk makes light castings which are used in the housing and building industries and has never suffered the same blast of unemployment as Greenock. I always feel that Socialists are inclined to accept new ideas, which in itself is not a bad thing. Until I read the Boyd Orr Report I took the view that bottle-fed babies, with the best milk, were, on the whole, the best—
§ Mr. Buchanan
I know that the hon. Gentleman does not need to read Reports, because he knows everything. I am only saying that I learned something from reading that Report.
§ Mr. Buchanan
The hon. Member is so clever that nothing matters to him. I was surprised to find that breast-feeding is much preferable to bottle-feeding. That shows how absolutely vital is the necessity to feed the mother who is to have a child. I like to see good-looking women and well-dressed men. I have seen women of about 50 on the terrace here at Westminster and then I have gone back to Glasgow to see women of about 30 looking very much older and very care-worn. Why? Because of their poverty. My right hon. Friend the Secretary of State says that the problem is being tackled now, but are we sure that we have marched away from the time when little more than 2s. was provided in order to keep a child? Have we reached the stage when decent food can be given and proper housing conditions can be provided? Take the Minister of Pensions' scale of 18s. a week for a woman, plus rent. Divide that sum and see how far it goes. There must be coal, light and payment of insurances. Talk about it as you may you cannot produce good children on such a miserable income. I have noticed that the authorities always seem to tip the balance towards keeping people as poor as they can instead of tipping it the other way.
The Ministry of Fuel and Power are responsible for the coal allocation. What is the position? [An HON. MEMBER: "We have not got any coal."] Yes, I am coming to that. The total allocation, if you are lucky enough to get it, is one and a quarter bags per week. Do not forget that that is the allocation for everybody. I have no children, I live in a tenement and I have what nearly everybody in my position would have—gas and electric fires. I can store a little coal. I am entitled to get one and a quarter bags each week. Within 100 yards of where I live is a man with three children, aged one, four and seven. He has no gas or electric fire. In a country like Scotland and a city like Glasgow warmth is just as important as food, clothing and housing. Yet many people there are not getting it. I say, give the children coal before anyone else. My right hon. Friend the Secretary of State ought to be protecting the child life which is now being endangered.
I would like to say something about housing. My right hon. Friend's statement on this matter was very disappoint- 2094 ing. A strong case has been made out for Scotland and the Government ought to proceed with housing now. Glasgow has a population of 1,000,000, half of whom have no baths and one-third of whom share lavatory accommodation with other people, sometimes to the extent of four, five and six families. My right hon. Friend quoted figures of sublets. Let me put them another way. In Gorbals where my parents were married and I was born, the Glasgow Corporation sent out skilled health visitors, who visited 1,800 houses. Out of that number one out of every four families with young children of 12 months and under were either living in over-crowded houses with relatives or were living in what were even worse conditions, in sub-lets. The word "sub-lets" does not convey a very graphic picture of what I mean. A sublet is merely a big house with no privacy, the door always open, no sanitary conveniences, no place even to wash, and nowhere to cook.
The Secretary of State is not taking enough steps. He has to do far more for housing now than he is proposing to do. There is a move in certain quarters to get higher rents for houses now. When we asked in the past for 5s. for the unemployed man's child, we were met with the argument of the financial position of the country. To-day no one will believe that. We believe you have told lies, because in the past four years you have spent sums which make our previous expenditure look insignificant. The moment American soldiers come here, as they have done in large numbers, up go huts and houses to accommodate I do not know what number of men. The American soldier is housed quickly and, compared with some of the places our folk have to live in, is housed well. But when I say that a man returning from the Army should have a decent place, you say, "We cannot do it now." The funny thing is that you cannot do it for the wives and children, but you can always do it for the man while he is in the Army. There is a terrible responsibility upon the Secretary of State, and I am not going to make it more difficult if I can avoid doing so. The future population will not judge him on his excuses, for not going on with it. They want him to go on with it, and they will expect it.
One of the things that we never hear mentioned is the steps that he intends to 2095 take to see that poverty does not again play the part that it has played. I wish the Government could have announced a definite policy of raising the standard of nutrition for children. The scales of unemployment assistance for women and children and the Poor Law scales need revision. One must feel sad on reading this Report. I do not know the future of Scotch politics, but I warn the Committee that anything might happen. I should not be surprised to see a militant movement at an early date. I can almost feel its undercurrents and rumblings now. They are very small, but all movements grow in that way. The test that they will apply will not be how much you can do and how much you cannot. The test that they will apply is the only one that is worth while, the standard of life, and that has nothing to do with the number of battles you have won and the kind of ships that we have to sail the seas in. The test of the nation is the homes of the nation. Imagine Scotland, with its infant mortality worse than that of any country in Western Europe except Spain and Portugal, and the appalling death rate. The reforms that my right hon. Friend has recommended are only partially good. They are nothing like big enough. There are two essential things that he has to do now, to start an ambitious building programme even during the war and to institute a minimum standard to ensure that everyone shall have a decent home and a decent income to keep it up.
§ Mrs. Tate (Frome)
We have all listened with sympathy and real feeling to the hon. Member's speech. There is no one who does not appreciate his intimate knowledge of his constituents and his deep interest in their welfare. I hope he will forgive me if I concentrate my remarks in the main not on infant mortality in Scotland, serious as that is, but upon the general level of health of the nation because, ghastly as the infant mortality figures in some places are, I think we are often far too complacent about the general level of health in the country as a whole. Year after year, when we listen to Ministry of Health Debates we are told that there is a great improvement in the health of the people. They live to be older, and we are given figures to show that certain diseases are far less prevalent than they were. I agree that people live for a longer 2096 period of life, but I think that is in the main due to prophylactic measures, better sanitation, better hygiene, in parts of the country better housing, and better education with regard to those aspects of health, but I do not subscribe to the view that the health of the nation as a whole is better than in the past, because I think the contrary is the case. People live to be older, but I wonder whether they are really healthier specimens than many of our ancestors were. When you dig up old skeletons you generally find that they have their teeth, and were of comparative fine physique.
I maintain that the general level of well-being of the people is not particularly high. We lose our teeth at a very early age, a vast proportion of the country is tired and listless, pallid and by no means in a physical condition that you could call even adequate, let alone satisfactory. I think it is quite time we examined the causes, because I believe that, taking the general level of health of the people who survive, there is a deterioration, and we take it far too much as a matter of course that each year we should be afflicted by infectious diseases, both as children and as adults. The hon. Member drew a true and terrible picture—the Report shows how true and terrible it is—of the number of infants who die, but I think the number of infants who live permanently disabled by indifferent health is an equally terrible picture. There is no doubt that the most important period in a child's life for building up its health is from six months to a year. It is a most critical period in a child's life from the feeding point of view.
The hon. Member said he was struck by the very great importance, as shown in the Boyd Orr Report, of breast-feeding. I do not know that one can lay too great emphasis on it, and I heartily endorse everything he said as to the vital necessity of building up the health of the mother if you are to encourage breast-feeding. I also endorse what he said that it is a common, though not universal, practice for a woman, once she has brought a child into the world, to be prepared to make almost any sacrifice in the interests of the child. We often hear people deploring the amount of tinned food that is eaten and the amount of tinned milk which is drunk. When I have worked, as I have done, amongst people who live in some of the housing conditions of the country I do 2097 not marvel that so little fresh milk is drunk or so much tinned food eaten. I marvel that the women have the courage to try to cook or to keep homes going at all. Everyone who knows the circumstances knows that fresh milk is often not drunk because of the lack of any place where it can be stored without going bad.
To return to breast-feeding. We had a policy of encouraging ante-natal and post-natal clinics, where women were encouraged in and educated as to the importance of nursing their own children, and the advantages of breast-feeding. What have we done since the war? All over the country we have set up war-time nurseries. I am the most whole-hearted advocate of the nursery school for children from two to five, or preferably seven, but I deplore nurseries which take children from the age of nought to five. If nurseries are set up to take children from birth to five years, it is a direct encouragement to bottle feeding, because if a woman can take in her baby when it is a few weeks old and leave it in a war-time nursery, it is impossible for her to breast feed the child. I know that the Parliamentary Secretary does not agree with me and that she consistently encourages, as the policy of the Ministry of Health, nurseries for children from nought to five.
§ Mr. Gallacher (Fife, West)
Is not the hon. Lady aware that it is possible to have creches associated with industry to which mothers can go at regular intervals to feed their children?
§ Mrs. Tate
I am obliged to the hon. Member for reminding me of that. I am well aware of it, and approve such places; but I am sure he will agree that there are also a large number of nursery schools where children have been kept apart from the mother for the entire day from the age of a few weeks, and where it is therefore impossible for the mothers to feed their children. That system is expensive and deplorable. Suppose a child is breast fed and weaned, and then goes on to ordinary feeding, why is it that its health is comparatively indifferent in so many cases? I admit that it is often due to poverty, but poverty is not the only cause of malnutrition. I regard a large percentage of the people as mal-nourished considering the general health level, and I think that that is because we have had a wrong policy in regard to feeding. There is far too little co-operation between the Ministry of Health, the Ministry of Food, 2098 the Ministry of Agriculture, the Board of Education and the Home Office, all of which are involved.
Now raw milk is one of the most important foods that can be produced. I know that in another moment I shall be attacked by the hon. Lady the Member for West Fulham (Dr. Summerskill). I see her eagle eye upon me, but I still maintain that pasteurising milk is a wrong, retrograde and deplorable policy. I agree that infection may be carried by milk and that people can suffer from bovine tuberculosis. The cure for that is healthy herds and a clean milk supply, but also a clean water supply, which we are very far from having in this country. Our water is neither adequate nor pure. If the Committee were really cognisant of the amount of water that is already polluted by sewerage, they would be quite appalled. We have got not only impure water, but inadequate water. Therefore, before we begin to tamper with milk, let us produce it in a way it should be produced, as a really clean raw food and do not let us half boil it, thereby killing the vitamin C content and destroy some valuable hormones about which we are very ill-informed. We should first produce good healthy milk and then permit people to have an adequate supply of the right kind of food.
There is a great deal of ignorance about food, and the Ministry of Food, although it has done a magnificent job in the war in the distribution of food, has done very much less than it might have done to ensure the quality of the food, largely because the Ministry is run by vested interests. There is not only misapprehension about the type of food we eat, but there is a lamentable laxness about the way in which the food we do eat is prepared. Anyone can go out, and, if provided with a sufficient number of points, can buy breakfast foods like puffed wheat and puffed rice. But what is the actual nutriment content of half these foods when they reach our breakfast tables? The nutriment lies only in the milk and sugar we take with them, because they have been prepared at such a degree of heat that any nutriment they had has been in the main destroyed and anyway they are only starch. Yet the Minister of Food allocates large food supplies to these manufacturers of breakfast foods which are in a large number of cases practically worthless.
§ Mrs. Tate
Very few people in this country know how to prepare porridge properly, and in a large number of the houses, certainly in Scotland, it would be more difficult to prepare porridge than to take prepared food on the allowance of coal to-day. [Interruption]. Does the hon. Lady the Parliamentary Secretary dispute that? Does she say that it is very easy to cook porridge properly in all of our houses? If she thinks that, she knows nothing about it.
The Parliamentary Secretary to the Ministry of Health (Miss Horsbruģh)
As the hon. Member has asked me about porridge, I will tell her that I can cook it on a fairly small fire. I would sooner have porridge than a good many other foods.
§ Mrs. Tate
I am very glad to hear that the hon. Lady can make porridge. So can I, but in a great many of the houses in the country it is exceedingly difficult to cook porridge or anything else owing to the housing conditions and pressure of time. To return to the allocation of such food supplies as are available, it is a lamentable thing that so much of the sugar is allocated to the makers of synthetic soft drinks. What is the actual food value of a half the synthetic soft drinks that are on the market to-day? If there is no food value in them, why have they been given such a large allocation of sugar?
§ Mr. Mathers
Is there not a much greater food value in the soft drinks that remain, adulterated as they are, than there is in beer, in which there is also sugar?
§ Mrs. Tate
No, I do not think so. I do not for one moment think that in some of these synthetic soft drinks there is any food value at all. Whether people approve of beer or whether they do not, I believe that it is a fairly nourishing drink. It would be extremely difficult to put on weight with some of the synthetic orange beverages, but nobody denies that you put on weight by drinking beer. I dare not drink it for that reason.
§ Mr. Mathers
The hon. Lady will admit that in making such a statement she is not supported by reliable medical evidence?
§ Mrs. Tate
I would love to know when medical evidence is reliable. It varies 2100 from day to day, from medical practitioner to medical practitioner, and from age to age. A medical truth of one day is a medical lie of another, and the less we talk about reliable medical evidence the better. Of all the changeablé professions where reliability is concerned, give me the medical profession. That brings me to another point. Why, if the medical profession have such an intense interest in our health, is it that such large supplies of the few drugs which are available are given to the enormous vested interests which produce quack medicines? To-day on every hand we see advertisements for pills which everybody knows are largely made of soap, which the housewife is very short of, or some other worthless or even deleterious substance. The amount of material that is going to the large vested interests in patent medicines, which are often half poison, is one of the scandals of our country.
§ Sir Edmund Findlay (Banff)
It is nonsense to say that patent medicine manufacturers are making great profits. Most of the so-called patent medicines have their formulae on the bottles. In any case, soap is a valuable substance.
§ Mrs. Tate
I am sorry that the hon. Member has so completely delivered himself into my hands. He says it is nonsense to say that patent medicine manufacturers are making great profits. Well, if that is so, I am deeply sympathetic and extend my sympathy to the poor Beecham Trust and other patent medicine manufacturers. He says that each patent medicine has its formula on the bottle. Does he in his innocence believe that the formula really means anything to the layman? The majority of people do not read the formula, and they would not understand it if they did. They have, therefore, very little knowledge of the value of the contents. I imagine only a very poor brain could not produce formula that would pass. Does anyone go about testing medicines to see what the contents actually are? Are all the formulae on the bottles the same as they were before the war?
§ Mr. Gallacher
Is the hon. Lady aware that the vested interests are allowed to poison people because the Conservatives are in power?
§ Sir E. Findlay
On a point of Order. May I ask whether it would not be possible for a Member of the Government to state whether the formulae on medicine bottles are the correct formulae and whether the manufacturers are not carrying out their proper legal responsibilities?
§ The Temporary Chairman
Someone will doubtless be replying for the Government to this Debate, but it is not for me to say what line that reply should take when the time comes.
§ Mrs. Tate
I hope that if the Government do reply on this point they will say how often the formulae are tested and who does it in wartime, because it would need a large staff. I do not know why the hon. Member has this passionate interest in patent medicines. He looks very well, so I can only imagine that he takes extremely few of them.
To return to the co-operation between the Ministries of Food, Health, Education and Agriculture, and the Home Office, I think it is a very great pity that, owing to the difficulties which the farmer has in making both ends meet, and owing to a mistaken and parsimonious Government agricultural policy, the emphasis is all too frequently on how much milk you can make a cow produce and how many eggs you can make a hen lay. It is not a subject on which we have sufficient knowledge, but it is quite time that some investigation were made into the quality of milk in relation to different types of feeding, and into quality of eggs resulting also from different types of feeding. There was an extraordinarily interesting article, which I would commend to any hon. Member, which appeared in a magazine called "The Guild Gardener," for February, 1944. The article is entitled "At Last we Learn to Farm," and it describes experiments that were carried out on the feeding of cattle and the amazing change in their resistance to disease. Those experiments are worthy of more notice than they have had.
2102 It is high time that some official investigation were made along the lines I suggest. For example, there is what is known as the battery form of keeping poultry. I find it difficult to believe that there is not more nourishment in an egg laid by a hen on free range than in an egg laid by a hen kept in a cage very little larger than that in which you would keep a canary, and in which the hen is, in very many cases, fed on 80 per cent. house scraps, 10 per cent. whale oil and 10 per cent. sawdust. That is being done very successfully, commercially, in many parts of the country, to-day, but I wonder whether it is so successful in building up the health of the people who eat the eggs.
There is another matter which should receive far more enlightened attention. The hon. Member for Gorbals (Mr. Buchanan) said that it was the common practice for a woman, once she had brought a child into the world, to be prepared to make great sacrifices; but there is a proportion of women in this country who are feckless and incapable of looking after their children adequately. That small proportion sometimes comes before our police courts; and what is the punishment meted out to them for their neglect? The children are sent to an approved school, or to more suitable care, while the mother is sent to serve a short term of imprisonment. What good is that? I believe there is nothing more pitiable, as a corrective measure, than sending anyone to prison for a very short term. Certainly, it is no way to educate a mother in the care of her young. I believe that it would be far better for those women if they were sent to homes where they could be given careful and intelligent instruction in housewifery and the care of children.
Where a woman neglects her children, there is often a deficiency in character, but far more often there is a deficiency in education, training and opportunity. When we are considering the nutrition of the nation, I beg the Committee not to believe that it is only a matter of income, or even only a matter of food. I believe that one step to enable us to build up the health of the people of this country as it should be built up, is to have compulsory school feeding. Where we have it, the children should be compelled to remain in the school and have the school meal, not given a small sum of money 2103 and permitted to go to the nearest town and spend the money in a snack bar, which it is perfectly natural that children should do if allowed, but exceedingly unsuitable that they should be permitted to do. I beg also that some measure may be brought in to ensure that our children have a more adequate allowance of sleep. That is more important to-day than ever before, because, with the introduction of double summer time, the hours until which children are allowed to run about are growing very late. Mothers are busy, and fathers are away, and there is no one to see that a child goes to sleep at a proper time and has an adequate number of hours in bed.
§ Dr. Russell Thomas (Southampton)
I would like to say first that I am inclined to agree with the hon. Lady who has just spoken when she says that doctors are prone to change their views, and that what was a truth for one generation is an untruth for another, but I would ask the Committee to believe that in some degree that is inevitable. It must be so, with the changes that constantly go on in scientific development. But I entirely agree that any one generation of doctors seems too dogmatic about these matters, and is often inclined to speak as though it had found a philosophy and a treatment for all time. I was a little surprised at what was said by the hon. Member for Gorbals (Mr. Buchanan) but as he is not now in his place, I shall not say anything very much about him except that he said he had recently discovered that human milk was better for children than bottle milk. Surely it is obvious that human milk must be the best. What is natural is clearly what is right. Because I emitted a grunt at his discovery of what seemed so obvious he told me that I was one who always seemed to know everything but I do not believe that is so, because for nearly the whole of my later life I have constantly asked myself the question which Pontius Pilate so tersely propounded, and I am still seeking a satisfactory answer to-day.
Perhaps I might turn the Committee's attention back to one particular subject, which has not yet been discussed at any length, but was mentioned by the Minister, and that is infant mortality. It is a very important matter indeed. I do not want to weary the Committee with many 2104 figures, but I must refer to a few figures for the sake of my argument. First, I should like to say that the Boyd Orr report is a good report, and although it does not cover the ground completely and absolutely, it produces a large number of comparative figures which are intensely interesting and from which a great number of deductions can be made. I want to discuss how far it is possible to reduce infant mortality until it gets to the level below which it cannot go. What is the hard core? How far can we, in the next 10, 20, 30 or 40 years get down to that hard core?
I would just remind hon. Members of the mortality figures for England, Wales and Scotland, although I think they are well known. During the five-year period 1934–38, they were 77 per thousand in Scotland and 57 in England and Wales. In the period 1936–40 they were 76 per 1,000 for Scotland and 55 for England and Wales. A partly overlapping period, but showing a very small drop indeed. However, the figures were very much better for England and Wales than for Scotland. That is a very high rate and was excelled in Europe only by countries like Spain, Portugal and Hungary. Most of the countries in Europe were a great deal better, Holland in particular, with a figure of 39. But the best figures of all were in New Zealand with 32.7 per 1,000, and I want to take that country as a standard in this respect. If the Committee would turn to page 20 of the Report and look at the excellent tables prepared they would see, by table 12, that there has been a great reduction of mortality during the first year of infant life, from 1906 to the present day. It has been reduced in England from 117 to 56 and in Scotland from 112 to 77. A most curious thing is that in in 1906 the infantile mortality rate was less in Scotland than it was in England.
Let us now turn our attention to the considerable number of deaths due to infective causes. Table 12 includes the whole of the infectious or infective diseases, divided into three categories. There has been a considerable death rate from these infections. The categories are: first, ordinary infectious diseases like whooping-cough and measles; secondly, respiratory diseases, which have a considerable killing capacity in this country, and thirdly, gastro-intestinal 2105 diseases, which also are somewhat devastating. In regard to the respiratory diseases, the Committee will know that bronchitis and broncho-pneumonia account for a large number of deaths indeed in children under one year. I would like to point out that bronchitis and broncho-pneumonia are frequently associated with the other infectious diseases. In a later column, hon. Members will see that there is a considerable death rate also from convulsions, but these are probably related in many cases to some of those infective complaints.
There is no doubt that from 1906 to the present day, the reduction in infant mortality from these diseases is due to the fact that there are fewer slums and far less overcrowding, improved hygiene, better food, better public health administration, pre-natal care, and so on; but there is still considerable scope to reduce it further. Slum clearance surely must proceed, but one point I want to make about the prefabricated houses which are going to be put up for 10 years is that we must be very careful that those temporary houses are not rapidly turned into slums, with an adverse effect on the figures of infant mortality about which I am speaking. We shall, in future, in order to control this death rate from infectious diseases, or general infective diseases, as I would rather call them, have to see that a considerable amount of education is given to mothers in the care of their infant children. I think that is most important. We shall, as previous speakers have already pointed out, also have to see that mothers during the time of pregnancy and after the birth of the child are maintained upon a high level of nutrition. I think that if we can proceed with these matters in regard to housing, if we can proceed in these general public health measures, there is not the slightest doubt that we can reduce the infant mortality due to these infective diseases to a very low level. I note that therapeutic methods are coming to the front to-day such as the vaccine given for whooping cough, which is so highly successful. I hope to see further progress in the next few years in regard to that aspect of the question. There is not the slightest doubt that this cause of infantile deaths can be reduced enormously.
If hon. Members will turn to table 14 on page 21 they will see that infant mor- 2106 tality is divided into five separate classifications according to the social status of the father, which is based, I believe, on income. If one adds up the columns vertically one will see that in column 5 infant mortality due to infective complaints is 35.6. The second column deals with the second class, which is a good social class—I am not dealing with column 1, as I think it would be a great task to attain that level for many years to come—but there is no reason why, eventually, class 5 should not become class 2, class 4 become class 2 and class 3 become class 2. The result would be that we would reduce the death rate in infants under one year due to infective complaints to 12 per thousand. I think that is the figure given in the second column. At 12 per 1,000 we have a hard core beyond which it would be very difficult to reduce the figure still further.
Let us remember that infective diseases can be reduced—it might take seven years or it might take 20, 30, 40 or 50 years, I do not know; it depends how social movements go ahead—but I think they might be reduced to 12 per 1,000. I shall now turn to rather less promising figures of the table to which I have referred on page 20, that is figures relating to congenital malformation. I do not think we have much chance of reducing that. On the contrary, it is to me rather alarming that we find that in Scotland in the period 1906–09 there were 4.9 deaths per 1,000 in the first year from congenital malformation and in 1937–39 this had risen to 6.2. in England and Wales the corresponding figures were 4.9 rising to 6.1. This is very disturbing. I hope that hon. Members will dwell upon this particular point. What is meant by congenital malformation? It is not malformation of the limbs but of the internal organs such as the brain, the heart and the stomach, which frequently cause death in the first year. Then we have that condition often associated with mental deficiency. We do not know how many children are born mentally deficient and whether that is increasing or not. They do not die, but I am afraid it is. I fear we have very little opportunity of reducing the infant mortality rate in that direction. We must leave the figure of 6.1 as a hard core, as it were, of deaths due to congenital malformation. I hope it is not going up any further. If we look at the New Zealand figures given, we shall see that deaths from 2107 congenital malformation in children under one year have definitely increased too in the last few years. I think they have reached a figure of 5.9.
Another cause of infant deaths mentioned in the Report is congenital debility. Deaths from that cause in England and Wales from 1906 to 1910 were 15 per 1000. They have been reduced—and I think it is remarkable and very much to our credit—to 2.1 in the period 1937–40. The figures for Scotland are 12.6 per 1,000 the period 1906–10—again less than in England at that time—but unfortunately in Scotland the figure has not gone downwards in anything like the same way as it has done in England, and 1937–40is represented by a figure of 7.6 instead of 2.1. Now turn to the table representing the death rate in the different social classes of the community and it will be found that it should be possible to reach the standard of class two in regard to congenital debility. It should be possible to reduce that in Scotland to the English level of 2.1 per 1000. Beyond that I do not think it would be possible for us to go. There we have a hard core of infantile mortality, at a figure of 2.2, shall we say. There is no doubt again that proper food for the mother with the resulting high quality natural food for the child will help in this direction.
I come to another factor in regard to infant mortality in the first year, that is mortality due to injuries at birth. From 1906 to 1940 there was an increase due to injuries at birth. In Scotland the increase was from 1.3 per 1,000 to 3 and in England from 1 per 1,000 to 2.5 per 1,000. I do not think we can get rid of a hard core there of less than unless we take certain measures, and I do not wish to say anything which is too far reaching or too high. But the injuries at births are due to two general causes, to prolonged birth—I do not want to go into details on that—or, perhaps, to instrumental interference. I think a word of warning should go out regarding the position we are facing at the present time. The ordinary confinement is now, normally, attended by the district nurse. The consequence is that the doctor does not go to the ordinary confinement—he is only called to the difficult ones—and must lose some of his skill and experience in this respect. If he loses the experience which he will get 2108 from ordinary simple confinements then indeed there may possibly be a lack of skill developing in the practitioners of the country. I do not wish to put it too high, as I said—I am not clear. I put it tentatively and nervously, but I think that is a point we should consider. There is, too, a tendency, I think, by many in hospitals towards instrumental interference although obstetric teaching is against that if it is possible to avoid it. Things are so ready for action in a hospital that instrumental interference at birth does occur which might account for some part of the figure. Without pursuing that matter further, I put the hard core of infantile mortality due to inevitable accidents at birth at about 2.
I come to the last heading, that is premature births, which account, as Members will see if they look at the table, for a very large death rate during the first year of life.
§ Sir E. Findlay
Surely premature births are not dealt with in this report. It is on infant mortality.
§ The Deputy-Chairman (Mr. Charles Williams)
I understood that we were dealing with the whole question.
§ Sir E. Findlay
That is the difficulty we are up against. Premature births and abortions, so called, do not come within this Report.
§ Mr. Buchanan
In spite of the fact that premature births may not come over the border line, surely the Report all along is dealing with the matter.
§ The Deputy-Chairman
Yes, but after all we are not discussing the Report; we are discussing the whole question. Therefore, it is quite immaterial whether it is in the Report.
§ Dr. Thomas
Premature birth is one of the main causes of infantile mortality in the first year. It is a matter dealt with by a fairly considerable number of figures in the columns in the Report. The most striking thing there, is the very high figures for premature births. There has been very little improvement from 1906 to 1940. The number of deaths from premature birth in 1906 in Scotland was 18 and in England and Wales 16.9. In 2109 England the improvement was not very marked, being less than one point—from 16.9 to 16.4 and in Scotland it has gone up to 19.9.
This is an extremely difficult subject. On page 26 of the Report it is pointed out that of 73 cases of premature births in which death had occurred 15 had occurred in the case of twins; and we know that when more than one child is born the other sometimes has not the grip on life that the other has; 13 were associated with toxaemia and so on—in 34 out of the 73 cases in the Report the cause could not even be associated with any particular disease. There is also the whole physiological mechanism of childbirth which itself might go wrong such as premature rupture of the membrane. We cannot control that. It just happens. Turning to Table four again in regard to the social classes it will be found that deaths from premature birth is less in class two than in class five. It is about 19 per 1,000 in class five but in class two in the social scale it is 14.4. I suggest 14.4 is the hard core beyond which we cannot go in saving life due to premature births—at least until our knowledge has increased.
I have given certain fundamental figures which, perhaps, we cannot get below but we can go a long way until we reach those fundamental figures. I will try as simply as possible to summarise these figures under separate headings. What we would find is, I have suggested, that the hard core from definite infective diseases, the whole category of infective diseases, could be reduced by great social improvements in this country—improved housing accommodation and so on, and that possibly over a period of years—it may be reduced to 12 per 1,000. The basic figure for congenital malformations I have given as 6.1 per 1,000; for congenital debility as 2; for injury at birth 2; for premature birth 14.4. Adding these figures up we get down to the more satisfactory figure of 36.5 per thousand which should be the hard core of deaths in the first year of life in England and Wales. This we shall find compares very favourably with the figure far New Zealand. The New Zealand result is 32.7, the best result in the whole world. A striking thing occurs. If we look at the previous results, we shall find—
§ Mr. Georģe Griffiths (Hemsworth)
The hon. Member said that New Zealand had the best results in the world; is that so?
§ Mr. Griffiths
I suppose the reason is that the Labour Party have been in office there for 10 years.
§ Dr. Thomas
It must be remembered that New Zealand is a new country, with a small population of under two millions and an excellent climate. Here we have 45,000,000 people, crowded into a country of similar size. In New Zealand large quantities of highly nutritious food are also readily available. I think then it is due to a combination of circumstances. I want to make my argument not on a political basis, but on sound, logical lines. The difference between my ultimate figure of 36.5 and the New Zealand figure of 32.7 is accounted for by the greater amount of respiratory disease which would obtain in this country, probably for climatic reasons. Apart from infective diseases of 12 per 1,000, my figure for other causes is very similar to the New Zealand figure that is 24.5 per 1,000 against 23.7. I do not say that my figures are absolutely correct, but they represent an attempt to make a comparison with New Zealand. I think we can get down to that point, but it may take many years, as much requires to be done. I have tried to make a difficult argument as dear as possible, and I hope that any hon. Member who is interested will look up those figures. I will not go into any philosophic dissertation, in the presence of my hon. Friend the Member for North Islington (Dr. Haden Guest), who once rebuked my philosophic bent, and speculate whether if public health, medicine, surgery, social services, and all the rest of it had not reached so high a standard as they have that many of us in consequence would not have reached maturity and whether that would have been better or worse for the world; but I ask hon. Members to turn that point over in their minds, and perhaps they will be able to come back to this House later and tell us at some future date whether they deserve their place in life or not. I shall consider it for myself.
§ Dr. Edith Summerskill (Fulham, West)
I am sure the Committee are grateful to the hon. Member for drawing attention to these very important figures, but I am sorry that in his final remarks he has not drawn the obvious conclusion, that the infant mortality rate can be traced to poverty.
§ Dr. Summerskill
I have followed every table to which he has drawn attention, and I think that, apart from the figures of congenital malformation, he will find them all very difficult to explain away. The others can all be traced to poverty, bad housing, under-nourishment, and other such circumstances. I would like to mention malnutrition. In this House last week there was a considerable amount of heat engendered when we discussed soldiers' pay and family allowances. Many Members, rightly, felt strongly that the allowances in particular should be increased. Why? Because the rates of pay to our men in the Services, when interpretated in terms of human misery, cannot be defended. Here, a week after, we are concerning ourselves with certain aspects of the human misery which inevitably follows low family allowances. At the moment I think the figures are these. The Service man is paid 9s. 6d. a week for his first child, 8s. 6d. for his second child, and 7s. 6d. for his third child. It is quite impossible, even in an institution, where clothes and food are bought quantitively, to maintain a child on those scales. Therefore, surely I am not exaggerating when I say that the children of the lowest-paid men in our Services are all suffering from malnutrition; in other words, it is the common lot of the children of the men who are to-day giving their lives in order that we may sit here and discuss matters concerning the State, to be undernourished. You do not have to be a doctor to know these things, you do not have to know what is a balanced diet, you do not have to know what are the objective symptoms of malnutrition; you simply have to know how much a shilling buys in the shops to-day.
§ Mrs. Cazalet Keir (Islington, East)
My hon. Friend, I suppose, is taking into account school meals and so on?
Certainly, but my hon. Friend will agree that we are not giving school meals to all children in this country. I am concerning myself particularly with those who are not having these extra allowances. The average mother who goes out shopping to-day, when she is thinking how to keep a child on 75. 6d. a week, concerns herself with cheap food; and cheap food means potatoes and bread, which are the foods that give warmth and energy. The soldier's wife must exclude the proteins, the protective foods, the body-building foods, because those are the expensive foods. They are the foods which the child needs. I find it difficult to understand why the Prime Minister, the Leader of the House and the others who are deciding Government policy, when they are thinking of the nourishment of the children of the country, do not also remember that, while a soldier fights on his stomach, he also fights on the stomachs of his children. During the next few months, when things will be very difficult, when men will be wondering when they are going to return—
§ The Deputy-Chairman
I have listened with very great care, and we really must not in this Debate—which is very wide, going into the whole question of health—deal with the question of Service pay and allowances. It would be unfair to previous speakers to start upon that subject.
§ Dr. Summerskill
This Debate is on nutrition, and nutrition is a very wide subject. We cannot discuss nutrition properly unless we discuss what foods are to be bought.
§ The Deputy-Chairman
Yes, but it is quite outside the scope of this Estimate to discuss Service pay and the Prime Minister's inquiries into it.
§ Mr. G. Griffiths
The soldier's wife and children are part and parcel of the nation. and we are discussing the nutrition of the entire nation. Surely the hon. Member is in Order in pointing out that these children are under-nourished?
§ The Deputy-Chairman
The whole question of nutrition can be discussed, but we cannot bring in the question of raising Service pay, which we are getting very near to doing. Nutrition, yes; I allowed the hon. Lady to go on quite widely on the question of nutrition.
§ Dr. Summerskill
I am willing to leave out Service pay if you will allow me to discuss money. The experts discovered last year that 30 per cent. of the population of this country were under-nourished. This must be related to poverty. If the Treasury say that they are unable to provide further allowances—I am talking not only about allowances to our Service men, but children's allowances—in order to improve the nutrition of the country, if they say that this country is not rich enough to feed its population, I suggest that they should postpone the expenditure on the new medical services which are outlined in the White Paper, and expend the money on children's allowances, in order to improve the nutrition of the country. In my opinion, most ill-health can be traced to underfeeding and bad housing rather than to the want of a bottle of medicine. The Government's policy is a short-sighted one, in view of the fact that after the war we shall need a healthy, virile body of young workers to offset the middle-aged and elderly population. We are becoming a nation of old people, yet we are short-sighted enough to tolerate this waste of young life and to underfeed the younger generation.
We were told by the Secretary of State for Scotland how things have improved in the last few years. We are not denying that. We must remember that 100 years ago the expectation of life in Lancashire was 30 years. In India to-day it is 26 years. The expectation of life in New Zealand to-day is 67 years. This, in itself, indicates the importance of nutrition. The right hon. Gentleman the Secretary of State for Scotland told us that things have been improved, but that is not enough. Our men to-day are fighting for freedom from want: they are not fighting for the bad old days of child starvation. My final word on nutrition, before I come to infant mortality, is this. It can be proved conclusively that a low standard of health in certain parts of the country can be traced to poverty. I get a little tired when I hear that different Ministries are about to set up other Committees to discuss this question when we all know what is the reason.
On the question of infant mortality, again, it has already been said, and I think the Committee agree, that the high death rate, particularly in Scotland, can be traced to poverty, malnutrition of the mother and to bad housing. I do not 2114 think that the malnutrition of the mother has been emphasised enough. We knew at the beginning of the war that the expectant mother was underfed. I remember sending to the Ministry of Health certain documents which were sent to me from an obstetrician in charge of a large hospital just outside London proving conclusively that the expectant mothers in this country should be given increased rations. What was the result? Nothing was done in this country until about a year ago. When I read this Report, and when I read so many of the things I already knew, that the expectant mother too often stinted herself in order that her husband and children could be fed, I was reminded of that case last year, which perhaps the Committee will remember, when a woman appealed against the decision of a judge that she should hand her housekeeping savings to her husband. In the Appeal Court a learned judge said, when a woman barrister protested that the woman should be allowed to keep the savings she had made out of the housekeeping because she was entitled to them: "Do you think that a woman in a home should have a legal right to a share of the family economy? If you gave the housewives of Britain that right they would feed their husbands on corned beef rather than roast beef." That was said in the Appeal Court in this country.
When we read this Report we realise how little our learned judges know about women. I read on page 47 that it is a common observation in poor families that where food is short the mothers deprive themselves for the other members of the family. Whenever it has been found that a diet is inadequate for the family as a whole, it will usually be true to say that the mother will suffer most. This is the answer to the gentleman who said that women would starve their families if they were given a legal right to share in the family income. I think it important that the Committee should give attention to the condition of the expectant mother. We have made very few surveys of the condition of the expectant mother, of her physical condition, but one was made of family incomes in which families were divided into five groups. On page 48 of the Report of this survey it says:Only the two highest groups approached the necessary standard for protein and iron, and only the highest for calcium. The supply of vitamins A, B and C was inadequate ex- 2115 cept in the highest group. The position became progressively worse towards the lowest income group.Just think of that. We are now discussing expectant mothers. Of the five income groups, the three lowest income groups were deficient in some of the most important diet constituents. I was not surprised when the Secretary of State for Scotland reminded us of what we all know, that tuberculosis is increasing among our young women. Of course it is. If we allow this kind of thing to exist these women cannot possibly resist tuberculosis. Their health is undermined and they are easily attacked.
The question of bottle-fed babies has been raised. I reminded the Secretary of State, when he told the Committee that 25 per cent. of the infants who died, died from some infection, of the very important point contained in that paragraph. Practically all these children are bottle-fed. What happens? Their resistance is undermined and the different categories of infection which the right hon. Gentleman read out to the Committee easily attack fire bottle-fed infants. Here we come again to poverty and under-nourishment, the same old vicious circle—bottle-feeding, death of the child. I feel that all the hon. Members opposite who attack pasteurised milk have been influenced by the producer-retailers rather than by the farmers of the country.
It is quite obvious to us why the child is bottle-fed and yet the Ministry, I think, has had to set up a separate ad hoc committee on bottle-feeding when it is quite obvious that if these women were properly fed bottle-feeding would be reduced. Furthermore, what is paradoxical is that last week we set up a Royal Commission on the birth-rate. Here we have the most appalling wastage of infant life, and instead of saving these lives we are wondering how we can encourage women to produce more babies. I find it very difficult to understand why this wastage is not stopped. According to these figures, by reducing Scotland's still-born rate to that of Holland we could save 1,570 infants a year, and with a possibility of saving more live-born we could save a total of 5,210 lives unnecessarily lost each year in Scotland alone. Should not we try to preserve these infants instead of devoting our energies to persuading women to have more babies?
2116 In case the Committee is not familiar with it, I want to give one aspect of the life of the expectant mother. I want to tell them what is our treatment of the poor expectant mother in Britain in wartime. I am very anxious for the Secretary of State for Scotland and the hon. Lady to listen to these figures, because I feel that this is an indictment of our whole system. Hon. Members will forgive me if cite the expectant mother, the wife of the Serviceman. This expectant mother, in receipt of these ridiculous allowances, finds she is pregnant. She finds she cannot carry on financially and must do something about it. She goes into industry. She stands for long hours in industry in order to make a little extra money to see her through the confinement. Think of her life standing in a factory, coping with the blackout, queueing for food, struggling on to a bus, getting home and doing the housework. When she is about seven months' pregnant she feels exhausted; she is physically incapable even of struggling at the bus stop, and she goes to her doctor. The doctor looks at her and says, "Well, now it is time for you to draw the National Health Insurance benefit until your confinement." The doctor gives the expectant mother a certificate and on the certificate he writes that she is suffering from advanced pregnancy. She is in the seventh, eighth, or ninth month of her pregnancy, after carrying on as long as she can. Shortly afterwards the doctor receives a note from the approved society to this effect:Dear Sir or Madam, The above-named member has submitted a first certificate, the diagnosis being 'advanced pregnancy.' I would respectfully point out that sickness benefit is not normally payable in respect of pregnancy and, in connection with this matter, I am enclosing a circular issued by the Minister of Health.And this is the circular which I find it difficult to believe that any man could ever have drafted or any printer ever printed. It is one of the most inhuman documents that has ever been issued by any Government Department. In very black letters, so that no doctor can overlook it, it says that pregnancy does not necessarily give rise to incapacity for work and pregnancy without incapacity for work is not sufficient to entitle a woman to sickness or disablement benefit. I am talking about advanced pregnancy, 2117 the seventh, eighth or ninth month. Later, in big black type, it says:No woman is entitled either previous to her confinement or during the puerperal period to receive sickness or disablement benefit as a matter of right for six weeks as appears sometimes to have been supposed, or for any other length of time. These benefits can only be paid, as stated above, if there is incapacity to work.I hope the Committee realise what this devilish document means. This, in my opinion, is the, death warrant for thousands of infants in this country. This woman has to go on until she can stand or work no longer. It says here, in effect, that we must get it out of our heads that any pregnant woman is entitled by right to have six weeks' rest. She has to go on. Incapacity for work means that there must be some pathological condition associated with her pregnancy before a doctor can issue a certificate. In case hon. Members think that I am speaking theoretically about this, I want them to know that the last two documents to which I referred were received from approved societies in January and February of this year, and both of the women to whom they refer were examined by me. They came to me exhausted. They were eight months' pregnant. They had had a long day in the factory, struggled on to the bus at night, got home to do the housework, queued for food, were separated from their husbands and had to undergo the strain of air raids at night. The men who sent me these communications were too ashamed to let me think that they were responsible and they had to enclose this communication from the Ministry of Labour.
Here we are discussing the infant mortality rate. Here we are wondering why women are so exhausted that they cannot feed their babies. Here we are wondering why 30 per cent. of the babies in the country are bottle-fed. These women are worn out. I have seen them; I have treated them. We read in this Report that our women need more food and more rest, and yet the Ministry of Health issued this document, the death warrant for babies. I feel very indignant for this reason: These women are inarticulate; they are unorganised. They can do nothing in their helplessness but go to their doctors for help and advice, and the doctors' hands are tied. How can the 2118 doctors help them? They can give them certificates. They see them exhausted and worn out. You force them, as you forced me, to put a lie on certificates. I have said that I was sick to death of receiving these documents and I have put down "advanced pregnancy," "varicose veins," or "oedema of the legs" in order that these poor women should have a chance to rest. Other doctors in my position have met together, but we are hopeless in face of this difficulty which ties our hands and makes these women suffer in this way. We meet here to-day and what hypocrisy and humbug when people on the Front Bench opposite and in the Department of Health know what is wrong. Why ask people to come here and waste the time of the Committee and of the country when this should be put right immediately? I ask the Minister of Health, who is new to his office, to come here, as I believe he does, with an open mind. His wife and I have been through what these women have to go through. Do you think that we have had to suffer like this? We know what pregnancy means, the exhaustion and so on, and yet we allow these helpless women to suffer in this way. I ask the Minister of Health to address himself to this matter and to give these women a chance, at least two months' rest. The Soviet Union do it and every civilised country in the world does it, but Britain still allows her women to work in the factories until their confinement.
§ Mr. Linstead (Putney)
It is proper that from this side of the Committee there should come, a statement, following what the hon. Lady the Member for West Fulham (Dr. Summerskill) has said and the very moving speech that we heard from the hon. Member for Gorbals (Mr. Buchanan), that we recognise as much as any other section of the Committee that the conditions that have been disclosed in the Orr Report of 1935 and in the recent White Paper on Infant Mortality in Scotland, are both a reproach and a challenge. It is something for which the whole of this Committee must accept responsibility, and not any one section.
§ Mr. Linstead
I was somewhat sorry that the hon. Lady should have allowed 2119 herself to be carried away by special pleading. [HON. MEMBERS "No."] Hon. Members must allow me to develop this. One remark, for example, which she made was to the effect that every child of every serving soldier on the lowest rate of pay was, undernourished, and it is not right that a statement as broad as that should be allowed to go unchallenged. She also referred to the fact that the wives of serving soldiers who were in an advanced state of pregnancy spent their days standing up in factories. That, again, is a universal accusation which is not true. I could take the hon. Lady to an office in London where there are three such women who are given a sedentary job because of their condition, and it is not right that we should be led to believe that all these women spend their days on their feet.
§ Mr. Linstead
I have taken particular cases within my knowledge and I am only saying that it is not right that it should go out to the country that the pregnant wives of soldiers are being treated in the way that the hon. Lady suggests.
§ Dr. Summerskill
Really, that is a misinterpretation. How can the wife of every soldier be standing in a factory? I am quoting from my own experience that women do go to factories and nobody can justify that sort of thing.
§ Mr. Linstead
I am grateful to the hon. Lady for saying that. She is now saying no more than I hope she meant, but it is certainly not what she said when she was speaking. The point I am making is that she is prejudicing her own case, which is one with which we on this side have as much sympathy as anyone else, when she finds it necessary to introduce emotional appeals when we should be dealing with facts. I want to emphasise what it has been found possible to do constructively in regard to improving the nutrition of the people of the country, admitting that it is a challenge and a reproach that nutrition should be as bad as it is, let us recognise that a very great deal has been done. The Boyd Orr Report of 1935 came out in time to enable the Ministry of Food and the Ministry of Health to take some very practical steps, which ought to be recognised, in order to maintain the health 2120 of the community during the war. That Report pointed out that the deficiencies in the nutrition of the country were in calcium and in three of the vitamins. The Minister of Food got to work on those facts. He has added calcium to our bread, in spite of divergent views on the subject in this House.
§ Mr. Linstead
I do not think that I can be drawn into a physiological discussion in this Debate. One can only say that the Minister of Food has acted on the findings of that Report both by the addition of calcium to the loaf and by the addition of vitamin B.
§ Mr. Wootton-Davies (Heywood and Radcliffe)
Will my hon. Friend tell the Committee how many people have subscribed to that Report?
§ Mr. Linstead
That Report is a report from the Director of the Rowett Institute and is accepted generally as being a reasonably objective picture of the nutritional state of the country in 1935. I will not develop that point further, beyond saying that the Ministries concerned have taken advantage of the disclosed facts and that the nutritional state of this country is probably far better to-day than the nutritional state of most other countries in Europe. We shall be faced, after the war is over, not only with our own national nutritional problem but also with a very grave international nutritional problem. There was a very cogent article in "Nature" in 1942 by Geoffrey Bourne, in which he urged that certain preparatory steps should be taken to prepare for the international famine when the war is over. He called for an accumulation of stocks of wheat, of dried skimmed milk, dehydrated butter, dehydrated meat and fish and concentrates of A and D vitamins for children and pregnant mothers. I hope that when the Minister replies to the Debate he may be able to tell the Committee what has been done by way of accumulating stocks of those preparations which we shall undoubtedly need for the occupied territories. I hope that when the relief measures get going in these territories an attempt will be made to send one or two small research units of bio-chemists to study the actual nutritional reactions of the people to the food that is given. We learnt in Vienna after the last war a very great deal from the feeding of school 2121 children there and it would be wise if we were able to have the same sort of scientific oversight when we begin our rehabilitant work on the Continent after this war.
If this country is to continue rationing for a long period after the war, as it very well may have to do, it will be important that the ordinary citizens should be educated as to the need for that rationing. I hope that arrangements can be made for that to be done. The people here will put up with rationing if they know that the reason for it is to feed people in the occupied countries. They will be restive if that reason is not made abundantly clear to them.
If one looks forward to the nutritional state of this country when the war is over, the first thing that strikes one is that it ought not to be left to haphazard chance, as has been the case in the past. I would call first of all for the continuation of the Ministry of Food, preferably amalgamated with, and I think given priority over, the Ministry of Agriculture and Fisheries. It should be the duty of that Ministry to prepare the food policy for the country and, upon that policy, to build up our agricultural policy, because the two go hand in hand. If the farmers can be told clearly exactly what we need for nutritional purposes then they can plan their farming.
§ Dr. Haden Guest (Islington, North)
Does my hon. Friend mean that the Ministry of Food should continue to have powers about purchase?
§ Mr. Linstead
The primary responsibility of the Ministry of Food will obviously be to see that there is sufficient of the essential nutrients available for the people here. I myself see no reason why there should not be a prosperous agriculture in this country, together with the absorption, as imports, of what Canada, Australia and the Argentine can send us. There should be room for both those in the light of the bad nutritional conditions of about half our population. The two things might very well go together.
We shall also have to bear very much in mind after the war the need for research, both in agriculture and in nutrition. There still seems to be far too much misunderstanding about the relative values of artificial and natural manure, for example. Evidence seems to be accumulating that if you get a soil 2122 that is rich in humus you get crops which are far better nutritionally than crops which are forced out of poor soil by artificial manures. However, that still has to be worked out. Then there is much research to be done in the methods of keeping and transporting food. We have had the experience of frozen vegetables during this war, and that has opened up a completely new field of preservation. I had the privilege a short time ago of examining vegetables and milk which had been preserved by subliming water out as solid ice—it is lifted straight out of vegetables as ice—and the quality of that milk and those vegetables is excellent when you replace that ice at any later stage with water. That, again, has revolutionised what can be done in the way of transporting and keeping food, but again further research is needed. Most of all after the war we shall need to educate the ordinary citizen, to translate the terms of the laboratory into the terms of the kitchen. There is still far too much demand for fish and chips and white bread and margarine and jam.
§ Mr. Linstead
There is a French motto which says every man has his own taste. I think, however, the nutritional experts would agree that a diet of white bread and margarine and fish and chips is not the means of building, shall we say, a healthy Front Bench. [An HON. MEMBER "They are not normal people."] There is a revealing paragraph in "Our Towns," the review of the evacuation of our towns, which points out the demands made by the children in the country for town food. The report says that they clamoured for fish and chips, pickles, ice-cream, biscuits and sweets, and were too often used to drinking strong tea or beer; that they were quite unaccustomed to eating green vegetables, and that some of them said they had never seen their mothers cook at home. That, I think, is a fair picture of the outlook of the children in some of our big towns.
§ Mr. Linstead
That does seem to show a need for education among the ordinary 2123 people, particularly the ordinary housewife, in what food she should give and how she should prepare it.
§ Mr. Linstead
If the hon. Member will come home to supper with me, I will give him a lesson in cooking which may surprise him.
§ Mr. Linstead
There is one other point which is really part of the educative process. We have found that the various methods of communal feeding developed during the war have helped very greatly to bring home to ordinary people what they should eat, and how it should be prepared. One hopes they will be continued when the war is over, but I would say this with regard to the British Restaurants—I see no reason why British Restaurants should be continued solely as local authority organisations. Surely it should be possible for local authorities who want to continue these British Restaurants to do so by contracting with local caterers? If those caterers can be given the facilities, by way of reduced rent and so on, that are available for the local authorities, I am sure they can do the job as well as the local authorities, and can do it possibly with more variety and by giving a better personal service. However, one way or another, we shall see, I think, the continuation and development of community feeding when this war is over.
In conclusion, freedom from want of food, which is really what we are discussing to-day, is no mean goal for the first piece of reconstruction machinery that has been set up. I am thinking of the machinery created by the Hot Springs Conference, which seems to me to be the herald of a better state of affairs internationally. There you have a certain number of nations getting together with a specific job to do, and creating machinery to do that job in a spirit of co-operation. International relationships after the war can very well be built up on that sort of basis—tackling a practical piece of work and getting on with it, rather than creating machinery first and then trying to find work for it to do. Coming back 2124 to the picture painted by the Orr Report and the White Paper, I would say that it is not a matter of party politics; it is not for one side of the Committee or the other to try to gain party advantage from this matter; it is a national reproach, and a national challenge which all men of good-will have got to take up.
§ Mr. Alexander Walkden (Bristol, South)
We have had some very interesting speeches to-day following the statement by the Secretary of State for Scotland. Some of us are a little disappointed that he did not deal with the two themes in a rather more extensive way, and that he rather restricted himself in his survey of evidence to Scotland. I can understand why he did so, for the case of Scotland is a terribly bad one and lies deep in his heart. It was probably for that reason he concentrated mainly on the Scottish section. I hope, however, that the hon. Lady, or the Minister himself, whoever winds up this Debate, will be prepared to deal with English and Welsh questions, those which affect the country as a whole. I was, of course, delighted that the right hon. Gentleman approached and handled the matter with the right attitude of mind. That is characteristic of him. I think it actuates everybody who has been speaking here to-day. A right attitude of mind is of first importance in all things.
The two themes selected for to-day are nutrition and infant mortality. I would like to get clear in my mind for what purpose we are concerned about nutrition. I suppose the national purpose is nutrition for fitness, about which we have heard a lot for some years past. But I also want nutrition for happiness, and I agree with the hon. Lady the Member for Frome (Mrs. Tate) who said that people were not as full of life as they should be. I am fond of reading, but I like to read faces as well as newspapers. Whenever I am in a public vehicle, or walking about a public thoroughfare, I look at all the faces. They are most interesting. What strikes me most to-day is the very marked contrast between the careworn faces of the people who work indoors in factories, in offices and in mines and those who are in the Forces. Our young fighting men and women look superb. Their faces show that they are properly treated, properly fed, have fairly good conditions and, as far as possible, are reasonably 2125 happy. Surely we can try to attain that standard in civil life. We must try to ascertain why there is that marked difference. Enough attention has not been paid to these matters in years gone by and as a result we are suffering to-day.
When I was in the railway service I used to assist a man who was in charge of a huge goods depot. At that depot there was a large stable, full of magnificent horses, which the directors always looked at on the rare occasions when they came down to see whether any new buildings were required, such as warehouses, expenditure on which, I might add, they would not sanction unless it would bring in a 10 per cent. return. The horses we had were always worth looking at. They were like brewers' horses or those belonging to a good corporation. But sometimes a horse did not look very well and I remember that the late Lord Banbury always wanted to know why. He would cross-examine the horse-keeper and say, "What the horse needs is more beans and more oats and more rest in the meadow." But those directors never came to look at the workers in the sheds, or in the offices, where there were the pale-faced clerks. Those bad offices were the cause of much consumption and this matter was not dealt with until years later, when we got busy through our trade union.
The great magnate or the great employer still does not know very much about the thousands of people who are in his service. What does he know about his employees' children? I have not much evidence that large-scale employers know very much about their workpeople. There are one or two firms, who advertise it a lot, who do concern themselves with their workpeople, and they are, in the main, the Quaker firms. They and others have welfare officers who are concerned with the health and welfare of the employees. But these officers cannot do any more than arrange for a little more ventilation or cleanliness of the premises. They cannot pay the workers a shilling a week more, or reduce their hours, or do the things which have been proved in this Debate to be the things that are vital to the health and well-being of the work-people of this country. I suggest that the interest of powerful people is not sufficient in the welfare of the nation as a whole. Until the Factory Acts passed through this 2126 House and until trade unions became powerful there was very little change in the way in which employers treated their workpeople. It was mainly trade union action which caused them to be concerned and take measures which helped to bring about the progressive improvement of which the Secretary of State spoke to-day.
There was a certain amount of public effort and State assistance before the war, notably through the "Keep Fit" movement, towards which the Government voted a sum of money. Some good people devoted themselves to helping our young people to keep fit, but not much was done to enable the mass of the population to get fit. Many people were in a sub-normal standard in health and strength, which is what my party and I are concerned about. The tragic irony of the position is that only a war causes some people to concern themselves about the condition of the generality of the people. When we recruited men for the South African war it was found that many were below the required standards. The 100 years following the industrial revolution had so lowered the physique of the country that the standards had to be reduced. The minimum height for a soldier had to be reduced from 5ft. 6in. to 5ft. 3in. and then to 5ft., above which we have not been able to get since. That shows the dreadful results of the change which took place from the time when people lived mainly in the country, on good home-produced food, to the time when they worked on large-scale mass production for the benefit of somebody else. In the last war it was stated that we were still a C3 nation. The researches of Sir John Orr show that 200 years ago, when butter was 2d. per lb. and eggs were 2d. per dozen, many people got good food and their physique was up to standard. This standard has been falling ever since, due to artificial and harmful urban conditions.
§ Sir E. Findlay
When butter was 2d. per lb. and eggs were 2d. per dozen did people get them? The hon. Member was not there.
§ Mr. Walkden
I reckon they did. At any rate, it was easier to get them than it has been ever since. Between 1918 and 1939 much research work was carried out by scientists. I was glad to hear the tributes which have been paid to scien- 2127 tists, because we are greatly indebted to them for the revelations they have made as to the reasons for the falling standard of health and strength of the people of the country. Their advice has largely been followed and alongside with it there has come a raising of the standard of health of the nation through the action of the people themselves operating through their trade unions and this House of Commons. But notwithstanding the improvement which has admittedly been made, Sir John Orr shows in one of the simplest pamphlets called "The Nation's Food" that even as recently as in 1935 the average diet of the poorest people was between 10 and 20 per cent. deficient in proteins and the most important vitamins and minerals. Such improvements as took place in the diet were accompanied by a corresponding improvement in the national health anddiseases due to inadequate feeding such as rickets, have almost completely disappeared. The same was true of scurvy and sore eyes. Children leaving school were between two and three inches taller than their parents at the same age and the infant mortality and tuberculosis death rates, which are both profoundly affected by the state of nutrition of the people, have fallen by about 50 per cent.He goes on:Although this great improvement has taken place there was still a large part of the population whose diet was not up to the standard for health. An inquiry made in 1935 showed that the diet of nearly hall the population was below the standard. One inquiry completed just before the outbreak of the present war shows that in the few intervening years the proportion of the population not enjoying a diet which was adequate to health had fallen from a half to about a third and the diet of this third was not so grossly deficient as it had been in 1935.That showed the remarkable progress made between the last war and this. We are all glad that progress has been made but the report given by Sir John Orr shows that where a lower physical standard of the people exists it is entirely due to poverty and malnutrition and that it is curable by effective action taken in the right way.
We now come to the question of infant mortality, and I hope to make a few suggestions which I trust will be worthy of consideration. The simplest and briefest publication which gives a clear up-to-date idea how things stand in this regard was entitled "Infant Mortality in Scotland", published by the Secretary of 2128 State—a most helpful and valuable work. Again all its analyses and tables go to show that infant mortality, just as bad health, is due to bad feeding conditions of life and bad housing. The first table shows how we are behind many of the smaller democracies. New Zealand is the lowest with an infant death rate of only 32 per thousand, Holland has only 39, England and Wales 57 and Scotland 77, a disgracefully high proportion compared with other parts of the world. Scotland is so much worse than England that I am sure the House will be generous in the assistance to which it is entitled.
On page 18, paragraph 15, there are notable analyses which show the incidence of infant mortality in various cities in England, Scotland and Wales. At Glasgow it is up to 99 as compared with 77 for Scotland as a whole, in Liverpool 78 and in Manchester 75. I am glad to see that Bristol comes down to 46. Bristol and the West of England generally suffer much less from unemployment than they do further north. The further north you go the worse you find industrial hardship. Bristol is in the centre of a large semi-rural area. It has a large hinterland with various industries which enables it to escape a lot of the trouble that is so acute in the north. Unemployment has never been very bad. Sunderland, in a typical north eastern area, is up to 80 and Leeds to 77.
It is a terrible state of affairs to find that children and mothers suffer so much. The premature death of a child mars the mother's whole life. We should bestir ourselves to do everything we can to reduce these terrible figures. A question was asked a few days ago about the infantile death rate in England, Wales and London for the years 1941, 1942, and 1943. The answer shows that whereas in 1941, the death rate for England as a whole was 59 per cent., it had come down to 49 during the war. In the case of Wales it had come down from 70 to 51, and in London from 58 to 49, which shows that with all its horrors and terrors war gets everyone employed and no one misses a meal and that this results in an improvement in infant mortality.
What we should aim at is to see that everyone should have good meals, a good healthy life and a good home to live in. We should regard all these revelations as 2129 a dreadful disgrace to our country and those who share in its public life. A lot of figures have been given and analysed during this Debate but I always feel that the really necessary thing to do is to indicate what ought to be done to improve the state of affairs that we have been reviewing. The first is that we must not imagine that the splendid scheme which the Minister himself has tabled in the White Paper for a national health service will be enough. It is a splendid thing in itself but it is only a national medical service. We want something to ensure a national health service to provide that everyone can be healthy, fit and happy. Therefore, I suggest that we must have a continuing forward policy, and that should be stimulated always by the Ministry of Health. I was glad that the Minister has been supported to-day by the Minister of Agriculture. The Parliamentary Secretary to the Board of Education was on the Bench at one time, and also the Parliamentary Secretary to the Ministry of Food. All these Departments are concerned with the question of health. Single-handed the Minister of Health cannot do all that is necessary. He must keep the co-operation of all these other Ministries. He should call them into conference whenever he feels it is desirable with the hope of getting something more pushed forward.
The first thing, which has been brought out in a dramatic way to-day, is to improve the housing of the people. That must stand as first priority in all the efforts we make for the betterment of the country. All housing schemes should provide for every household who desires it to have a rood of land. We really ought to have more gardening ground attached to houses. A rood is only one quarter of an acre. On that land a householder could grow more fruit and eat it directly it is ready, and so avoid having to have fruit from overseas when it has lost a large part of its quality. Perhaps that provision cannot be made everywhere, but allotments can be provided away from houses. Those that have been arranged for during the war have done a lot to help the health of the country, and they should be retained as far as possible wherever they are desired.
One or two other things should be encouraged. The Minister of Agriculture has quietly developed a large-scale enterprise in the simple matter of domestic 2130 poultry keeping. I hope that that will be kept up. On the rood of land which I suggest a man could produce poultry and fruit and vegetables round about his house. I want to see more poultry keeping because our children and the people as a whole need more eggs. My only criticism of the Minister of Food is that he has rather ruled out eggs. He has been good on milk, but he has put out of action many large-scale poultry farmers, with the result that the country has not had enough eggs. If we had not had the imported dried eggs we could not have had any pancakes on Pancake Day. Children are very fond of custard, but it should be the real custard not stuff made from some mysterious powder. It should be made from eggs and milk. That is the stuff to give the kids. It is much better than anything I can think of and they take it "like one o'clock." You cannot have good custard without eggs, and often you cannot get eggs unless you keep a few hens. I hope that the Minister of Agriculture will encourage the continuance of domestic poultry keeping.
I would like to commend the milk policy which the Minister of Health has carried out. I remember with great pain that a previous Minister made a cut in what had been arranged to be provided for expectant mothers and children. It was reduced in the cruel economy period of 1931. There was great concern to keep up the interest on public money to 5 per cent. instead, of letting it come down to 3½, and all sorts of cruel economies were practised. In 1934, following the urgent recommendations of the party with which I am associated, the Minister of Health instituted a new milk policy. Since then progress has been made, until the provision of milk to expectant and nursing mothers and children is much more abundant than it has ever been. I hope that that will be kept up and further improved.
In whatever way may be thought best, I hope that the British Restaurants will be continued. I do not think it is necessary to call in private caterers to run them; they have been run very well under the local authorities and they are greatly appreciated by the people. I hope that factory canteens and feeding the miners at the mines will be continued. Our broad general aim should be to see that every child at school and every man and woman at work should have at least one good 2131 square meal a day. The children want more than milk and they should have a good meal every day. That ought to be the standing dish, as it were, throughout the nation every day. If we want health, strength and happiness, we want something to promote digestion. We therefore want more playing fields. The working people want to play more instead of only watching football matches. They want to play more to keep themselves physically fit and to make their lives happy. There should also be more facilities for physical culture.
I now come to something more. The Government of the day should always promote and encourage a policy of high wages. Low wages mean under-consumption, unemployment, inefficiency through inadequate nourishment, falling birthrate, a rise in death rates and everything going worse under the curse of poverty. We ought to have a war on poverty. Then the problem of nutrition, the loss of babies and the rest will diminish in a remarkable way. Along with all these things we should legislate—I think it can best be done by legislation rather than by industrial action—for reduced hours of labour. The five-day week with eight hours a day should be the national standard. It can be done by co-operation. Saturday and Sunday should be free for relaxation, gardening and all the things that make people stronger, healthier and happier. There should be better holidays. The holidays-with-pay movement is increasing and should be encouraged—
§ Mr. Walkden
Finally, I would urge that we must develop our own agriculture. Miracles have been worked in agriculture in this country during the war period. With mechanisation, the application of fertilisers and better organisation by practical men under the Minister of Agriculture, himself a farmer, the produce has pretty well doubled during the war. I want to see that increased, and not merely in heavy things like grain and potatoes; we want to grow more meat, eggs, milk, fruit and vegetables so that people can benefit from the consumption of them, and also because it will mean more people being employed on the land. There are deplorably few people rooted in the soil to-day. That is one of the cardinal things 2132 that is the matter with our civilisation. Out of about 20,000,000 employed persons in normal times, only about 500,000 were employed on the land. I know there were also about 400,000 farmers working too, but the main point is that there were only about 1,000,000 rooted in the soil. We need a far higher proportion. We cannot expect to have that proportion unless we develop agriculture and make it better worth while for people to be employed in it. Agriculture is a most fascinating occupation. The farmer needs to be a scientist at the present day. He needs to understand many things about which his forebears never dreamt. Together with the marvellous processes of nature these things make farming, in my bumble opinion, one of the most fascinating of occupations. This aspect should be brought out in our educational system and it should be part of the policy of every Government to strengthen that development which has taken place during the war period. With the adoption of these measures we should have a very much better and happier country.
§ Major Markham (Nottingham, South)
I hope that the Committee will forgive me if I do not follow the hon. Member on the lines of his interesting speech, largely because I agree with so much of it. I would much rather go back to the speech of the Secretary of State for Scotland and base my arguments upon what he said. He made a broad, statesmanlike survey of the whole position. I thought it was an excellent survey. It gave new attention to many of the factors that are the cause of the high infantile mortality in Scotland. I felt that he put nutrition in its right place in relation to many other factors, and that he gave a needed emphasis to questions such as housing. I was very glad to hear the tribute that he paid to Sir John Boyd Orr and his colleagues. I differ from him as to the value of the Report that they produced, but I agree with him that those gentlemen should be thanked for the services they have given in producing this Report. Whether we agree with it or disagree does not alter the fact that they spent considerable time in producing a Report which has stimulated world-wide interest in the infantile mortality rate of Scotland.
I disagree with many of the conclusions of the Report and I disagree with some 2133 part of what the Secretary of State for Scotland has said. For one thing, I find it very hard to reconcile the facts of the case as we see them, and the facts in the Boyd Orr Report, which is almost entirely, based upon pre-war facts. The whole of the Report's conclusions are based upon those facts, but we see them contradicted at almost every turn by alterations in circumstances due to the war. Let us take one or two of the major points, and first of all the question of nutrition. The Boyd Orr Report flogs the nutrition horse as if it were the only champion in the race. I would remind the Committee that, only two months ago, Lord Woolton, who to my mind is as eminent an authority as Sir John Boyd Orr on the question of nutrition, spoke to the Parliamentary Science Committee upstairs. In the course of his speech—and I want to quote him exactly—he said:We have improved the Vitamin 'A' and 'C' content of our food; and there is now no vitamin or iron deficiency owing to National Bread. In addition, calcium has been added; consequently the pre-war deficiencies in food have disappeared. Moreover, special provision has been made for the supply of fruit juices and cod liver oil to vulnerable classes, and this has materially protected the health of mothers and infants.The conclusion that we gathered from his speech was that the whole of our national diet had been so re-organised that it was now completely free of vitamin deficiency, and that, in addition to vitamins, other elements such as calcium and iron had been added to our daily diet.
Immediately following that speech, the Boyd Orr Report was published, based on pre-war facts and figures, and banging the good old nutrition drum for all it is worth. [An HON. MEMBER: "There will not be a war all the time."] No, but it makes one wonder whether the authors of the Report are or were aware of what Lord Woolton has done. No reference is made in their Report to the vast changes in the national diet beyond a footnote or two. I would prefer to take the view that, as far as science at the moment can advise us, the diet of this country is as good as the Government can make it, but not yet as good as the cooks are able to make it. It is not entirely a question of Government action, so much as of a programme of education among the mothers and wives of this country. That point has already been 2134 brought out by previous speakers. It is a very great deficiency in the Boyd Orr Report that they make no more than just a passing reference to the very many changes that have been brought into the national diet by Lord Woolton and his colleagues.
§ Mr. Kirkwood (Dumbarton Burghs)
Before the hon. and gallant Member leaves that point, I want to be quite clear about it. Is he saying on the Floor of this Committee, that English women are better mothers than the Scots mothers? Is that what he is saying?
§ Major Markham
No, I am not saying that at all. My remarks are addressed to the mothers and the wives of this country and I would develop them in detail if the Committee wishes. I think they apply with equal force to the North of England, Northern Ireland, to certain parts of Wales and to certain parts of the East End of London. I hope that I can leave the matter there for the moment.
§ Mr. Buchanan
How does the hon. and gallant Member explain that Greenock has an infant mortality rate of 102, while Falkirk has only 71, with more or less the same type of population? Taking it more close to my constituency, how is it that Cathcart has less than 20, while Gorbals has over 100? Would the hen and gallant Member say that the difference is in the cooking?
§ Mr. Kirkwood
Scottish women can knock spots off any of the English mothers, mentally and physically.
§ Major Markham
May I deal with another point on this question of nutrition? I wish the Committee could have read the recent speech by Professor Sir Jack Drummond, scientific adviser to the Ministry of Food. I think he is right in saying that more humbug is talked about nutrition nowadays than about almost any other subject under the sun. He makes the point that the patent medicine firms are making an enormous profit out of a ramp in vitamins—
§ Major Markham
—of almost any letter from A to Z. Professor Sir Jack Drummond went on to say:I am greatly concerned at the growing habit of swallowing a so-called vitamin pill three times a day by people who believe it gives them pep. It does not. You cannot add pep to a nourished person in that way. Vitamin pills have, however, their proper place, which is in the treatment of deficiency conditions. But go per cent. of vitamin pills go into the stomachs of the properly nourished, to whom they cannot make the slightest difference. It would be appalling if we acquired the pill habit. America spends £37,500,000 on the commercial exploitation of vitamin pills, of which nearly £34,000,000 are utterly wasted. We have tested on factory workers and schoolchildren here in this country if there are beneficial results to be gained. No detectable benefits followed.I have a very great admiration for Professor Sir Jack Drummond and I would like to see the attitude of this Committee in regard to nutrition have a little more common sense added to it.
Let us be quite sure on that point, that this problem of infant mortality may, to a very tiny degree, be related to vitamin this or that but in its essence, in the main, it is due to other causes which I hope the Committee will permit me to make some reference to. The Secretary of State for Scotland in his review, came to the conclusion in the end that the main cause for the high infant mortality rate was poverty. Let us analyse that. Poverty means lack of spending power within the family, and since 1940 there has not been poverty in the accepted sense of the word in England, Scotland or Wales. Therefore, anyone who can get up in this Committee and speak of the disgracefully high rate of infant mortality of 65 in Scotland, as the Secretary of State did to-day, ought to come here in sackcloth and ashes, for an infant death rate like that—twice as high as that of most other civilised countries in the world. Anyone who has had anything to do with industrial areas knows there is not a shortage of money in households to-day. High death rates are not now a question of poverty.
§ Major Markham
For four years there has been entire abolition or at any rate a great diminution of the poverty factor as a cause in infant mortality.
§ Dr. Haden Guest
Poverty also includes the provision of housing accommodation, 2136 and housing accommodation in Scotland has not been changed in the war, and is abominably bad.
§ Major Markham
That is a very good point and if the hon. Member will permit me I will deal with that in turn. As I say, on this question of poverty it is a fact, I think an indisputable fact, that since the war poverty in the normally accepted form of words is non-existent in the British Isles. Yet in spite of that infant mortality remains at a disgracefully high rate in Scotland, in Northern England, in Northern Ireland and in some parts of Wales. What this Committee would have welcomed in the Boyd Orr report would have been an up to date analysis of the causes of infantile mortality, and any body of men, scientists, doctors, call them what you will, asked by the Government to go into the problem should not have brought down the shutters on 3rd September, 1939, and said, "We will not consider a single fact after that date." It was a crime against humanity, a crime against the mothers of the 5,000 children who die every year in Scotland, a crime against the mothers of the 30,000 children who die every year in England. For a scientific body of that kind to come to such a conclusion was really shocking and beyond all credence. That is why I criticise the Boyd Orr report as I do. It is deplorable that they should have brought down the shutters at that point in time.
If you make an analysis of this question you are left with certain causes which one realises continue and have continued for many years, and war has not changed them. As the hon. Member mentioned, housing is one of the causes; there is no arguing about it. I think the whole body of medical opinion will be with me when I say that all infections are greatly increased the worse housing gets. There is no doubt that the housing problem in Scotland has deteriorated during the war years. It has also deteriorated in England in the war years, particularly in the North. It has deteriorated in the London area, but although the housing problem has got worse in the London area and other places like Birmingham, infant mortality has had one of its almost spectacular drops in England inspite of overcrowding. There is overcrowding and overcrowding, and the worst conditions in England are infinitely better than the worst conditions in Scot- 2137 land. I am convinced that if one could bring the level of housing in Scotland, and in Northern England, and Northern Ireland, and certain parts of Wales up to that of Hertfordshire, Wiltshire and Dorset-shire you would strike one of the deadliest blows at the causes of infant mortality. Yet we find, listening to an earlier Debate to-day, that the various Ministries concerned, and this of course includes the Ministry of Health, are to take no action to remedy this housing scandal until after the conclusion of the war.
I honestly think that the first way to tackle infant mortality on a large scale is to tackle the question of housing. It should be done, and I would not accept, if I were the Ministry of Health, excuses from other Ministries about shortage of labour or material. Speaking from the point of view of the Army, I know we should be far better off if some men were put on to that work rather than doing some of the jobs they are doing in the Army. That applies to other Services and to many other Ministries and to many industries. There is nothing more important under the sun than the question of providing decent houses now, particularly for Scotland, the North of England, Northern Ireland and parts of Wales.
When we have dealt with the housing question we are still not at the end of infant mortality. There is, as I have mentioned before, the additional problem of pure air. That was not mentioned in the able survey by the Secretary of State, nor was the allied question of the influence of atmospheric conditions on the people. It was deliberately ignored. No reference was made to climate or its control indoors, which is one of the permanent facts with regard to infant mortality. In this country or any other country with a comparable climate there is the swing in the death rate from summer to winter. The winter rate is almost from 50 to 100 per cent. higher than the summer rate. Yet these other things, housing, education of mothers, health services, and so on remain at the same level over the year, but this rise occurs of 50 to 100 per cent. every winter. That rise is largely accounted for by respiratory diseases. What is the answer to that? New Zealand has found it. So have Chicago, New York, Utah and Iceland. They found the answer in adequate attention to the indoor conditions of temperature and humidity. It is only in 2138 Scotland, the North of England, Northern Ireland and parts of Wales that you find these atmospheric conditions which influence our life every minute are regarded as being unimportant. They are not regarded worthy of mention in the speech of the Secretary of State for Scotland. They are, as it were, beneath contempt by the authors of the Boyd Orr report, something of so little value that they are entirely outweighed by Vitamin plus X or something else.
The facts are that infant mortality goes up very considerably in the winter months. Take a day-by-day, or week-by-week analysis of the weather and you will find that as the weather gets worse and fog, smoke and cold increase, deaths go up, The worse the spell of weather the sharper the death rate. From the time when the Greeks deified Prometheus the greatest boon man has against the elements is that of fire. We have gradually built up defences against the outside influences until to-day we can say that enlightened men and women in this country can, at an economic rate, get complete shelter from the adverse influences of the atmosphere. If that is true of the ordinary man or woman how much more true is it that a new-born baby should be protected against cold and damp. Why should it be subjected to conditions which cause its death?
Mr. Montaģue (Islington, West)
The hon. and gallant Member disregards the fact that the incidence of infant mortality presses very much more heavily among the poorer than among the more well to do where the atmosphere is the same.
§ Major Markham
I am quite willing to give the hon. Member that point about general climatic conditions, but it ought not to apply to indoor conditions. If you analyse it it comes down to the fact that you have to consider their environment. Adequate heating for the average family costs about 6s. or 7s. per week; and three to four times that amount is spent in beer and spirits; so that it is not so much a question of poverty as of wise spending. I agree that in the past there were people who could not afford protection against the elements, because the family income was not sufficient, but that has not been true of the war years.
The most important element of this problem is the energy which the Ministries have at their disposal. I ask whether 2139 the Secretary of State for Scotland and the Minister of Health have behind them sufficient drive and energy to produce the required changes. Let me first deal with Scotland. The Secretary of State, as he has confessed, is very much at the mercy of the Scientific Advisory Committee. That committee should be reconstituted. There are too many old medical men on it, with settled medical convictions; there is no room on it for any fresh ideas. The administrative machine behind the committee and behind the Secretary of State is the most rigid in the British Empire. The Secretary of State, obviously, has to rely on these officers and this staff. I would ask the Committee to consider the record of that Advisory Committee and the staffs since 1929. Whatever problem has been tackled has been tackled without energy. Very important reports have just been pigeon-holed, for lack of drive on the part of the men behind the Secretary of State, such as the fine Report on Scottish Health Services issued in 1936. The basic law relating to public health in Scotland still dates from 1897. That for England dates from 1936. It would have been the easiest thing in the world to bring Scottish legislation into line with that of England. Scotland is working ancient legislation with ancient men and an ancient machine.
§ Sir E. Findlay
We are not working with ancient men. Our people in St. Andrews are not ancient. They may be old, but they are not ancient.
§ Major Markham
They are far too rigid. There are many things I would like to suggest to bring the Scottish system up to date, but, in the interests of brevity, I will cut my remarks short. I want to make one suggestion to the Secretary of State and the Minister of Health together. It has come very much to my notice that both these great Departments of State are not only considerably overworked, but have not the chance to do the thinking that is necessary for a great progressive policy. It is nobody's job, either at the Scottish Office or at the Ministry of Health, to sit down and read the most important medical journals of the United States, New Zealand, and elsewhere. It is nobody's job to be a liaison officer or intelligence officer for the Minister with the rest of the world. Science is not national, it is international; and a Minis- 2140 try of Health should be as knowledgeable as anybody else at the moment. There should be somebody at both these Ministries, a really qualified man, with pushing power as great in his field as Sir William Beveridge has in his own field, whose duty it should be to keep the Ministries up to date with the rest of the world. I apologise for having taken up so much time, but I can say that the Debate has been, apart from my own contribution, of an exceptionally high standard, and I am sure it has done a great deal of good.
Mr. McNeil (Greenock)
I do not want to pursue the hon. and gallant Member for South Nottingham (Major Markham) to any great length, because I am certain he must consider that he was well answered by the drafter of the Report, Professor Dugald Baird, in the "British Medical Journal" last week, but I really suggest that anyone who comes to this Committee and says that the Boyd Orr Report is a crime can hardly expect to have reasonable treatment. My hon. Friend the Member for Gorbals (Mr. Buchanan) said what many of us feel and many of us have said, that Boyd Orr did something that needed doing, and that we are under a debt to him for having assembled the principal causes of this deplorable rate and stated them plainly and vigorously. But there was a second part of his work. He was asked to suggest lines of dealing with causes. It is quite true that the hon. and gallant Member suggests that something can be done about temperature, but he did not tell us any short-term method of dealing with fog and with humidity. I cannot see that Boyd Orr would have been doing this Committee any service if he had dealt with causes which were not principal ones, and to which he could suggest no remedy. Moreover, I cannot understand why my hon. and gallant Friend has come back time and again to hammer at the fact that the figures are pre-1939. Presumably, this Committee was trying to deal with normal conditions, and I hope it is not going to be argued that the conditions since 1939 are normal.
The hon. and gallant Member said, in opening, something with which I greatly agree. He deplored that a great deal of stuff and nonsense is being put across, mainly by commercial firms, about alleged vitamins. He said that he could not believe that by adding a vitamin here or there 2141 you could undo the effects of years. Similarly, we cannot expect that the increased purchasing power and the food policy of the Ministry of Food can offset the effects upon mothers that are still being demonstrated in these figures. My hon. and gallant Friend has not shown, in two attempts in this House and various attempts in the Press, that poverty is not a fundamental cause of this high figure. Indeed, I think that, by inference, he admitted that it was, since he argued that the drop in the last few years—with which none of us is satisfied—is due to the fact that there is purchasing power in the community. If he went on to examine how that purchasing power might be continued, he would be doing more to arrest this rate than by this vague and, to me, slightly irrelevant talk about weather conditions and their effect. We know that they are there. Professor Dugald Baird talked about the rate in Iceland, and in the Report we have the rate in Orkney and Shetland. If weather were an important factor we might expect to find a rate in those two areas comparable to the rate in Scotland, but, of course, we do not. The hon. and gallant Member who sits for Orkney and Shetland (Major NevenSpence) has fairly strong opinions upon it, and he thinks that the basic explanation is a plentiful supply of good food, and we would naturally accept that. Boyd Orr and his colleagues have done very great service to this Committee because, with a fair amount of scientific evidence, they have shown us that we can produce the 70s. birth. The evidence is there to show that our country, compared with England, is deficient in hospitals, beds, clinics, nurses, obstetricians, work and food. We were shown plainly that we were only prepared to spend on the average 70s. on the birth of a child. And England, which is far from having a satisfactory service, manages to get 104s. Let no one in this Committee think that because he does not sit for a Scottish division he is absolved from responsibility. Several speakers have referred to the close relations between the unemployment grant and the infant mortality rate and no one can escape from that. The unemployment grant in Scotland is not the concern solely of the Scottish Member; it is the result of the policy of the whole House of Commons. If we are to try to set out a balance-sheet on the cost of 2142 births, it will be incomplete if we put down only 70s. We have to put on the other side—I do not know how you would put it—the 3,400 infants that the Committee calculate could annually be saved by reasonable methods.
The main question before the Committee, in the light of this Report, is, What steps can we take immediately to alleviate this position? Like every other speaker, I am glad to pay tribute to the right hon. Gentleman for his speech to-day and for his work, and I compliment him on being the initiator of this Report. But I feel a little distressed that his preface to the Report dealt only with post-war measures. The right hon. Gentleman, in commending the Report, said that remedies and alleviations must be found for our infant mortality position in the immediate post-war years. But I am sure he did not mean it.
That is a quality that I wish was more common in this House. He was talking about post-war years. He was saying how we might continue the Ministry of Food policy which has had such beneficial results in the last few years. My right hon. Friend puzzled me very much. I took him to say, when discussing the figures for Aberdeen, Dundee and Edinburgh with regard to the provision made for confinements, that the percentage born in hospitals was round about 75 in the three towns. In the report we are shown that the average figure for the country is 33 per cent.
§ Mr. Johnston
The figures I gave were, that in Glasgow 55 per cent. of the births are in hospitals and nursing homes, in Edinburgh between 60 and 70 per cent., in Dundee 77 per cent. and in Aberdeen 75 per cent.
Obviously you cannot have a mean figure of 33 for the country if Glasgow, Edinburgh, Aberdeen and Dundee vary between 55 and 70. We talk about 1,250,000 plus another million, which is 2,250,000 all above 55, leaving 1,500,000 below that figure, so that we get a figure of 33 per cent. for the whole of the country. Will the Secretary of State consider what methods he could use to make more beds available? The benefits are obvious. We might by these 2143 methods manage to restrain the area of infection and achieve a better convalescence for the mother. We certainly could tide the infant over the worst period. We could have better obstetricians and trained nurses although I agree that you cannot just pull these people out of a hat. I am told—and I have seen some figures on the subject—that there are some obstetricians in the Army who are not employed in obstetrical work of any kind, and I shall be delighted to let my right hon. Friend see some names.
Will he consider whether the 1907 Public Health Act could not be amended in respect of notification? The notification forms are of a very simple type and, indeed, give only the sparest information. Glasgow, for example, only asks for the size of the house. Obviously, there would be very great benefit from amending the Act so that the form gave a complete picture such as this Committee would like to have. They cannot give us a complete picture. I end as I began by reminding the Committee that the whole story is here and that health relating to these infants can be bought. There are so many places where you could develop it. The Committee pointed to the great difference in obstetrical care between Classes 1 and 5. People may for the price of £50 or £100 per confinement cut their death rate by rather more than 10 per cent. If this Committee is in earnest it will be prepared to find considerably more than 70s. for the average birth.
Mrs. Beatrice Wriģht (Bodmin)
There are certain Debates in Parliament which remind me of a game I used, as a child, to play with my grandmother which was called Mont Blanc, in which you travelled the length and breadth of England, you crossed the Channel, you travelled through the entire country of France and ascended Mont Blanc, and you won if you reached the top first. The reason why I am reminded of it is that we have covered a very wide range of topics on this problem, and also because I always used to play that game just before I was sent to bed after having had an enormous tea as a special treat, and was therefore somewhat dazed throughout the entire performance. I have sat here throughout to-day's Debate and am even now in a similar state to that of my childhood days, only minus the tea.
2144 I want to refer to a remark made by the hon. Lady the Member for West Fulham (Dr. Summerskill) who mentioned poverty as being one of the primary causes of infant mortality and malnutrition. I thought she made a very good point, which I realise that I cannot repeat as she herself was called to Order, in reminding the Committee that unless and until the child of the man in the Services has better provision in the form of allowances, mothers will sacrifice much of their needed food and nutrition for them. Those who are investigating the problem at the moment would do well to visit the homes where there are three or four children, a father serving overseas, and the mother having to go out to work in order to eke out what we generously give in the form of pay to the serving man.
I would also like to agree with what the hon. and gallant Member for South Nottingham (Major Markham) said, that there is very little poverty in the country to-day. That is true, but we must not let the bad old days come back again. Recently I made a trip through a mining area in Yorkshire to see the ante-natal and post-natal clinics, where I had a long talk one afternoon with a woman medical officer of health who had served that area ably and well for many years. I asked her what group instruction she gave to pregnant women before and after their babies were born, and after having explained what they did, she said: "You know, instruction is all very well, and the vitamins we give are all very well, but there is one thing I want you to understand. Mothers coming in here before the war did not have enough to eat, and their children were born under-sized and many of them died. The mothers lost their lives in the process as well. It is all right now, because there is money enough in the homes to buy decent food." I do not bring up this point to be over-critical of whatever the Government may have in mind for the postwar years, but as a reminder that we must never again allow the women and children of this country to suffer the real pangs of hunger which were suffered in the bad days of unemployment.
I want to deal more particularly with another aspect of the same problem. I deplore the lack of recognised benefits for pregnant women in industry. I have 2145 spoken in the House on that point before, but I want particularly to raise the question of the pregnant housewife in a home where there are three or four older children and who can get no outside help. Although the hon. Lady the Member for West Fulham drew a sad and debilitated picture of the wretched woman working in industry when she was seven or eight months pregnant, I want the Committee to turn their mind to the position of a woman in the home seven or eight months pregnant who has three children to be cooked for, probably a husband to be looked after, and who has to go out to work in order to eke out an income. I wonder whether, in replying, the Minister would consider looking into the possibility of extending the ante-natal hostels which are now available for women to go into a month or earlier before their babies are born, where they can have a good rest and good food and good care, and the short-stay homes in which the older children can be housed and cared for during this time. In my own constituency, in the town of Looe, there has been a fine maternity home of this kind, installed originally for evacuees and now taking some local cases. The women go there some time before their babies are due. They are well fed and well looked after, they have their babies peacefully and quietly, and they go out healthy, strong women with healthy, strong babies. The Minister, I am sure, would be interested, and he would be very welcome if he cared to visit this home and see it for himself. I admit that it was started through the enterprise of his own Department, and I am only asking that this enterprise be extended.
I would draw the attention of the Committee to what I consider to be one of the basic aspects of the problem of both nutrition and infant mortality. I have studied this problem in some detail and have come sadly to the conclusion that, as a race, we are desperately uneducated for parenthood. We seem to feel that this is a craft which needs very little preparation, and yet we have untold opportunities for giving instruction to parents. I would like the Committee to look with me for a moment at the opportunities which now exist for teaching mothers to be better parents, to look after 2146 their children better and to use what is available in the most efficient manner.
This education must start in the schools. The children of this country must never be allowed to grow up uneducated in hygiene and allied subjects. The girls must not leave school without knowing how to be efficient housewives, how to cook and give a nutritious diet eventually to their children. I would even say the boys could do with a little of this instruction. It is a matter of amazement to me that in a series of brains trusts held in my constituency recently I was asked on each occasion whether or not I advocated that men should do housework in future. I thought the attention which was being given to this showed up the fact that before it had been considered too ignominious a task for the male sex. However, I found that many of the men had become very interested in helping in the house, and were extremely proud of their efficiency. I really feel that this lack of understanding of the dual responsibility of parenthood is a deficiency in our schools, and is a matter not emphasised sufficiently in our educational programme.
Furthermore, while we are discussing infant mortality we find that a great many children in this country grow up with disabilities which, if they had been discovered in their school life, would never have become permanent disabilities, and they would therefore be in a position to produce far healthier children. For that reason I hope that the Ministry of Health and the Board of Education will together see that our children in the schools are medically examined twice a year as a minimum, from the time they start going to school until the time they leave and go to young people's colleges, and even there as well. But probably the finest opportunities that the Health services offer for instruction to mothers is to be found in the ante- and post-natal clinics. I sometimes wonder whether sufficient advantage is taken of this great opportunity, where you have women gathered together who are, by force of circumstance, interested in the best possible way of looking after their children when they are born. I wonder whether or not the Ministry of Health is sufficiently ambitious in its programme for group instruction in these clinics. Women's organisations afford another opportunity.
2147 The hon. Lady the Member for Frome (Mrs. Tate) mentioned war nurseries rather discouragingly. None of us wish to see the tiny baby taken away from its mother. A purely war-time extremity has had to be met, but in many instances these war nurseries have given good care to these children during war-time and have already been a means of bringing great interest into the home and has educated parents on how to bring up their children successfully. As the President of the Board himself said in connection with nursery schools, they can reinforce rather than replace the home.
Last, but not least, I feel that parents can be most ably helped by the midwives and health visitors, with whom they come personally into touch. To these two members of our health services I think the country owes a great debt. We have not enough of them, and I think we may need in the future a different curriculum for training them M some respects, but, at any rate, we are deeply grateful to them. But I feel that above all else, if you are to have good nutrition in the home and reduce infantile mortality, the whole status of mothercraft, parentcraft, housewifery and homemaking must be raised to the level which makes it what it is—the most honourable task for anyone in the country. We need every possible help in future legislation to re-inforce the home. It takes time and patience to be a good mother, and women need more help in their homes in order to give them that patience and time. My hon. Friend the Member for Frome mentioned a point which is near my heart, and one which is relevant to this subject, namely, the supply of water, which should be extended and made more hygienic. Many Members have spoken of housing, which has a definite bearing on this problem, but the point which arises out of all these speeches is that this is not the work of any one Government Department. It is, like so many other of our plans for the post-war period, the work of many Government Departments, and I would beg once again for far greater co-operative effort as between one Department and another and courage, foresight and determination to get over the real prejudice which exists against co-operation between Departments so that a plan might be evolved which will give decent employ- 2148 ment, wages and food to our people and will give to women, especially, that sense of responsibility they must have, an understanding of the services available to them and an appreciation of the high calling of motherhood.
§ Sir R. W. Smith (Aberdeen, Central)
There is no doubt that the Report we have been discussing to-day has shown a very serious position, not only because it means a loss to the nation of valuable lives but because, if children are not looked after properly, they will grow up to be unhealthy subjects. If only we can bring down the infant mortality figures the situation will be enormously improved. Much has been said about housing and poverty. The country must deal with these questions, whether we do anything about infant mortality or not. I would like to agree with the hon. Member who said that you may have people receiving a perfectly good wage, not on the poverty level, who may employ their money in such a way that they are not getting the best value for it. I believe it was Lord Woolton who said that what we are suffering from in this country was lack of good cooking. There may be many people above the poverty line who are not being properly fed, because women do not know how to cook properly. That is the first thing we must remember.
I want to draw attention to the table on page 29 of this Report, to which the Minister referred. My right hon. Friend said that Falkirk had the smallest percentage of unemployed and that its infant mortality rate was only 29 per 1,000. If this table is correct—and I suppose it is—what is meant when it says that in Dumfries the percentage of uninsured population employed is quite low, only 11.3 per 1,000, that the percentage of overcrowded people is only 14.2 per 1,000 and yet the infant mortality rate is 51, against Falkirk's 29? The figures for Perth show that the percentage of overcrowded is 12.7 per 1,000, of unemployed is 11.1 per 1,000 and of infant mortality 39 per 1,000. The same kind of thing applies to Inverness. An hon. Member opposite said that we must thank Sir John Orr for having assembled these facts. That being so, I would like to ask the hon. Member for Greenock (Mr. McNeil) and other Members to study pages 4, 5, 6 and 7 of this Report, which I think it would be worth while to reprint in the form of a leaflet.
§ Mr. Kirkwood
The hon. Member is disputing our statement that the cause of infant mortality is poverty. Why is it, then, that infant mortality is among the poor? Comparatively speaking, there is none among the hon. Member's class.
§ Sir R. W. Smith
There is. My point is that we have to deal with poverty and housing; we must put that right and if we do that it will help infant mortality. But we must go further, and it will take us some time. It will, for instance, be some time before the Socialist idea of supplying all our people with proper wages and food from the State is ever put through. The summary of evidence of this Report says that infant mortality is partly due to faulty feeding and poor housing. The Minister took the same line in his foreword, but there is something more necessary than that. What is the machinery at our disposal now? We have maternity hospitals, maternity beds, health visitors, clinics and various other means of trying to improve the position. Page 5 of the Report says:Scotland has lagged behind in the provision of maternity and child welfare services.What does the Minister intend to do? Does he intend to increase the provision of child welfare services? He mentioned this matter at the end of his speech, but that was all. The Report goes on to say:Clinic premises are often poor, ill-equipped and overcrowded. Nutritional supervision is inadequate. Liaison between the hospitals, the family doctors and the child welfare service is poor.Is not that an indictment of the present situation? To-day we have been dealing mostly with towns and not with rural areas but this matters to the rural areas quite as much as to the towns, and that is where health visitors can be of enormous use. Further, it says:Powers to supply extra food and domestic help are not sufficiently used by local authorities.An hon. Member referred to New Zealand. Glasgow, which is one of the black spots in Scotland, has a Socialist town council. Under a Socialist régime we have a very serious position.
§ The Deputy-Chairman
I have already intervened. I think the hon. Member had better not pursue that line of argument.
§ Mr. Mathers (Linlithgow)
Surely the hon. Member must agree that the present 2150 Town Council of Glasgow has succeeded to non-Socialist housing.
§ Sir R. W. Smith
I am not allowed to go further, but I am quite willing to reply if you, Mr. Williams, will allow me. I rather agree with the hon. Member for Bodmin (Mrs. Wright) in her remarks about mothers in the country going into nursing homes for three months before the child arrives, but it is hardly what happens in my part of the world. Very few mothers could leave their husbands and families and sit in nursing homes for three months. There was at one time a class of nurse who, when she was attending a case, prepared the dinner and cleaned up the house as well as looking after her patient, and the system worked well. That has been swept entirely away under the midwives regulations, and nurses are not allowed to do any work. They cannot even wash up a cup and saucer except for their patients. When they are looking at this question in connection with rural areas I hope the Government will consider this point. Here is another point from the Report:The maternity bed accommodation in Scotland is inadequate.We are going to have a National Health Service. What is going to happen about more maternity beds?The rules laid down by the General Medical Council and the Central Midwives Board for the training of doctors, midwives and maternity nurses in obstetrics and the care of infants are satisfactory but they are not complied with and the training is therefore inadequate.The Ministry has not told us anything about that.Insufficient attention is paid to the teaching of children's diseases and the principles of child health, and to the teaching of the principles of nutrition or their clinical application. Trained experts are required in all the maternity and child welfare services for supervision, consultation and advice in both of these subjects. For such training there are not enough teachers and suitable teaching units do not exist.Again:Education should be provided in schools in the general principles of health and preparation for parenthood.I would draw attention to the word "parenthood." Many people read this Report as only applying to the mother and not to the father. It seems to me that the father could be of enormous assistance if he realised his responsibility. There is 2151 one thing that we do not come across which is very important, and that is the spacing of the family. It will make a lot of difference to the health of the children if there are, say, three children, whether they arrive within the space of three years after marriage or six. That is where a proper education would be of value. On page 68 the Report says:There is in Britain practically no instruction in medical schools in the principles of child health. In countries with low infant mortality rates such instruction has been part of the routine for from 50 to nearly 100 years.There is no suggestion that we are going to adopt it. These are the points which I specially wanted to call attention to and for which a tremendous lot can be done. I would press very strongly the question of the education of mothers, and I hope that the Minister will see his way to give us some outline of what he proposes to do with regard to the other recommendations about housing and unemployment.
§ Mr. Thomas Fraser (Hamilton)
The hon. Member for Central Aberdeen (Sir R. Smith) mentioned the inadequacy of maternity hospital accommodation in Scotland. I hope the Minister will be able to give us some figures to indicate what accommodation we have in Scotland as compared with England. In going through the Report which has been so widely quoted to-day, I find that some big towns in England have infant mortality rates that approximate to that in Scotland. Many of the industrial areas in England have rates that approximate to the worst in Scotland. I wonder whether those towns have better maternity hospital accommodation than we have in Scotland, although I do not doubt that an improvement in this service would result in some improvement in the figures, of which we can hardly be proud. I regret that two or three hon. Members in the Debate have indicated that we have no longer any substantial degree of poverty in this country, inferring that poverty has nothing to do with this high rate.
Another point mentioned by a number of hon. Members is that so much is dependent on the better training of mothers in child nutriment and the need for better cooking. Here we ought to have more information and some comparisons. Earlier in the Debate the hon. Member for Gorbals (Mr. Buchanan) drew attention to the fact that in the Cathcart area 2152 of Glasgow, which is the better class and well-to-do part of the town, the infant mortality rate is down to about 20, whereas in his part of Glasgow it is up in the region of 100. It is probable that most of the child nursing and cooking that is done in Cathcart is done by the women and girls from the working-class area where they have a high rate of infant mortality. That ought to be borne in mind. The Secretary of State for Scotland indicated his belief that the malnutrition was, to a considerable degree, the result of ignorance of how to cook a meal. I submit that that is incorrect and just nonsense. We all know that poverty has a great deal to do with it. I have said that many of the industrial areas in England had a rate approximating to the Scottish rate of infant mortality. I think that as we examine the purchasing power of the people in these areas we will discover that there is less continuity of employment and that wages rise and fall more than they do in areas where there is a smaller rate.
It is regrettable that the areas where, in the main, the rate is highest are the areas that produce the wealth of the country which gives to the country its greatness. The hon. Member for Dumbarton Burghs (Mr. Kirkwood) mentioned the rate in his part of the world. What is the work of the people there? In the main, they are engaged in building the best ships in the world and they are making a great contribution towards the greatness of this country. Yet in that part there is a higher rate than in other less productive areas which are less creditable to this country. We find in the Report of the Boyd Orr Committee that Newcastle and Gateshead have a rate of 83 per 1,000, Sunderland 80, Nottingham 78, Liverpool and Birkenhead 78, Dundee 77, Aberdeen 76, Manchester and Stoke-on-Trent 75. These areas have all made a great contribution to the total well-being of this country, and they deserve better from us than they have hitherto. It may be that we can do something for them in the way of providing better services and better training and of educating them in the schools to do this, that and the other thing. It may be that we can provide added vitamins to their food and so give them a better expectation of survival. But there ought not to be the disparity between area and area. As the hon. Member for Gorbals indicated, the differ- 2153 ences between Falkirk and Greenock are repeated throughout the country, and the examples he quoted put to ridicule the suggestion that our climatic and atmospheric conditions have so much to do with the high rate.
The worst area in Britain is the West Central Scotland area, the hub of industry, that part of Scotland which has produced the wealth of Scotland. In that part of the country, however, we have less continuity of employment than in other parts and we have had far too much unemployment in the past. From the early 1930's until almost the beginning of the present war we had something like 20 per cent. of our insured population unemployed. If we are to go back to that sort of thing after the war, in spite of attempting to build more houses and of any other efforts we may make to deal with this matter by providing new clinical and medicinal services, I am afraid we shall not seriously disturb the very high and deplorable figure which we now have.
The Report which we have before us has indicated that, associated with infant mortality, are always found unemployment and overcrowding. All of us have always been aware of that. I am not discrediting the Boyd Orr Committee for placing it on record in the Report, but we have unfortunately done very little about it. I suggest that the problem is economic and that the change necessary is far-reaching. I do not think for one moment that these figures can be reduced to a level of which we could be proud, if only the Ministry of Health and the Department of Health for Scotland concern themselves about it. Let us consider how far we have travelled in the years gone by in dealing with this matter in Scotland as compared with other countries.
Some 60 years ago, the figure in Scotland was 118 and the figure for Holland was 181, very much worse than ours. In the period 1936–40, the figure for Scotland was 76, while that for Holland was 37. In that period, Scotland had improved by only 40 per cent., while Holland had actually improved 80 per cent., on the figure of 60 years ago. We cannot be satisfied with tinkering with this matter, and I must again argue that we are only tinkering with it if we do not get back to the chief causal factor and attempt to deal with it. If we only go ahead and provide 2154 new services of one kind and another, and allow poverty and the resulting malnutrition to exist in the home, so long will we have these high figures. I hope that we shall get some evidence of anxiety and earnestness on the part of the Government to deal with our deplorable housing problem. The Government could assist in that regard, but if we are to go back after the war to the old system of unemployment, spasmodic employment, booms and slumps, I am very much afraid that we shall have a continuation of this deplorably high figure.
Surely this Report should be an answer to those hon. Members who, in their week-end speeches, have so much to say about State intervention, bureaucracy, and the need for removing all controls and getting back to the old days at the earliest possible moment. The Report should bring to their notice the results of the good old days, and the cost in infant life of the system to which those people are so keen to get back. It should show them the sort of economy that they think is so very good for the country, and which is nevertheless a disgrace, because it has certainly resulted in the elimination of many thousands of our people who would have been able to make a contribution to our effort to-day.
§ Mr. Wootton-Davies (Heywood and Radcliffe)
Coming in to bat on a very worn wicket, I want to say one or two things about nutrition—or rather malnutrition, for that is the real subject of the Debate. This can be divided into two parts, underfeeding and over-feeding. Not everybody will agree with that classification, but I have had some connection with the work at a hospital in Liverpool where a tremendous amount has been done to reduce blood pressure. Those authorities found that some people can be fed too much, and that no two men or women require the same amount of food. Too much food is as bad as too little.
§ Mr. Wootton-Davies
As I say, no two men or women require the same amount of food and it can be proved that human life cannot be supported except upon a definite amount of food and especially protein, but it must be good protein. We may have vegetarians, but, by and large, we must have animal protein. 2155 Now I want to come to the point which has been mentioned so often, which is that malnutrition is caused through poverty. I agree, poverty, but not, at this present time, poverty of money; it is through poverty of wisdom, ignorance in buying and ignorance in cooking. Go round the country and look at the tins in every dustbin. That is where your malnutrition is caused, and explains the vitamin pills. We have to get back to vital, live food to build a healthy nation. That is where the poverty is—the poverty of ignorance of correct feeding.
There is another thing to inquire into. Even the advocates of vitamin pills would agree that if we can get fresh, vital and—as I was taught in my youth—nascent food, living vital food, we shall have no need of those nostrums. We must ask ourselves whether eating food out of tins and synthetic foods of all kinds is not having a bad effect on this nation. I would point out to the Committee that, in the last 100 years, although the death rate has dropped some 2.4 to 2.5 per 1,000, that fall is entirely due to the saving on infant mortality. The span of life of middle aged people is not getting longer. The span of life of older people is not getting longer, and we must inquire if we are eating the right sort of things. I have asked a question of the Ministry of Food: Is this margarine the stuff to live on, are these synthetic cooking fats the stuff to live on? Where are we going? What are we buying? The food we have in tins, the margarine and the cooking fats are designed to keep, and keep and keep. Digestion is a simple matter. It is putrefaction. I know as a chemist that I cannot split any fat, any neutral fat, easily. I have to add something to it. I know as a chemist that every food in this world is chemically acid. But where are we going? We are making all these foods neutral. We are making them all to keep.
There is a reason for the influx of advertisements in the newspapers for digestive cures. People do not sell these things without a reason, and by and large if we are to keep a healthy nation we must get back to proper, vital, fresh food. I have had some experience of this thing. My sheep last year developed a complaint called "Sway Back." The Ministry concerned were most helpful and found that 2156 it was a question of mineral deficiencies. We are refining and over-refining our food You are taking a great risk with the nation's health in the long run. What happens to-day has a future effect and I beg that the Ministry of Food will bear what I have said in mind and that someone will impress on the people the necessity for buying real live and vital food.
§ The Deputy-Chairman
It is not a matter of who is standing. It is a matter of who catches my eye. I called the hon. Lady.
§ The Deputy-Chairman
I do not pretend for one moment that my eyesight is perfect, but I stick to my point. The hon. Member I called was the hon. Lady.
§ The Deputy-Chairman
There can be no dispute in this matter. Whoever I have called I have to stick to and I have called the hon. Lady.
§ Mr. G. Griffiths
This Debate will end at the ordinary hour for the interruption of Business, will it not?
§ Mr. Griffiths
I have been here all day and have not been able to get in, because the Scotsmen have been at it all the time.
The Parliamentary Secretary to the Ministry of Health (Miss Horsbruģh)
I have listened to this Debate, except for a very few moments, since it started. A great many points have been put, and I will do my best to reply, but hon. Members will agree that we have, in this most interesting Debate, gone over the work of many Ministries, and made every effort to suggest how our people can be made healthy, wealthy, and wise. I cannot see how it will be possible for me, in the time at my disposal, to reply to every question that has been put, but I will do my best. Any other points will be noted, and definite questions will be answered by letter. The important subject of infant mortality, which was the main theme today, is one of supreme interest to all the people of this country. The fact that we have made improvements in years gone by and have made progress from the very high level of infant mortality of the bad old times is no excuse for not accelerating the pace of that improvement. I am sure that I shall have every hon. Member with me when I say it is our wish to accelerate that pace, and we ask for the support of hon. Members and of the public.
A great many suggestions have been made during the Debate, and I think they all are useful, but it is not possible to say that one single suggestion would be a complete cure for this ill. Housing is very important. We all agree with the plea put forward by one hon. Member after another, that the housing conditions in England and Wales and, above all, in Scotland, as I know full well, are appalling. We cannot have healthy people so long as they are housed as they are at present. [An HON. MEMBER: "Whose fault is it?"] In this Debate I think it would be better to look forward, to see what can be done now, rather than to spend time looking back, to attach blame to people who were in the House or who were in the Government. The situation, 2158 we agree, is appalling. We also agree that it has got worse during the war. We realise that there is not the labour and material for starting a building programme while the war is being fought. All we can do is to see that preparations and plans are made so that there will not be the delay that there was after the last war. But housing is not the only thing that has been mentioned.
I was surprised that the hon. Member for West Fulham (Dr. Edith Summerskill) talked not only of bad housing, but of bad maternity and child welfare services. I think that some credit should be given to those who have worked hard in these war years, under difficult circumstances, the health visitors, the nurses, and others, on this work. Some of the hospitals have been under air bombardment and people had to be moved during the raids. All that work has been done; and these numberless people have devoted themselves, their time, and energy in looking after the mothers and children of this country. It is hardly fair to say that the services are bad; we want to see them made better, but we can be proud of the work that has been done. The Senior Medical Officer of our Child Welfare Branch was lately in the United States of America and visited Chicago where the experiment is being tried. She said how impressed they were by the fact that in the fourth year of war the figures of infantile mortality in England came down to 49 and in Scotland to 65. We have at least done that. Hon. Members will remember that in the first two years of the war the rate went up. We owe something to these people who have worked in that service with extreme devotion, and, in some cases, heroism, in looking after the children of this country.
My right hon. Friend the Secretary of State for Scotland gave some figures about the services in Scotland. In England we have 3,000 clinics, over 3,000 health visitors, and in addition, in country districts, 2,000 district nurses. It is rather remarkable that in the last year 96.5 of the mothers who gave birth to children were visited in their homes with in a week. That is something about which we can feel some satisfaction in spite of the difficulties of war-time and the shortage of personnel. We have increased the beds in maternity homes and hospitals by 3,000 and we have in England and Wales maternity accommodation 2159 in institutions for at least 50 per cent. of the mothers in the country. Hon. Members will have been interested to hear the Secretary of State for Scotland say that there was a larger number of babies born in institutions in Scotland than in England, but I would ask hon. Members, in reading that report and studying the subject, to note that we cannot deal with this problem entirely by arranging for people to have their confinements in institutions.
The Secretary of State for Scotland gave some very alarming figures on the subject of infection in hospitals. There is no doubt at all, as everybody who has looked into this problem will agree, that to have a maternity home or hospital in any way overcrowded, where there is not sufficient isolation or not sufficient staff to make isolation as good as it might be, is much more dangerous than to have children born at home. A great deal has yet to be looked into. We hear of the figures in other countries. We have, as the hon. Member for Southampton (Dr. Russell Thomas) said, to attack the hard core of infant mortality both in England and Wales and in Scotland. Some people perhaps do not realise, with regard to the New Zealand figure, that this figure does not include the Maoris; their rate is 96 per 1,000, and that should be included in the figure given for New Zealand. A great deal has been done in America, and many people have been interested in what has been done in Chicago. Sometimes they talk of the infant problem as an organising problem.
I have not the complete figures of the United States at the moment. We have the figures for certain States, and the Chicago experiment has shown a great fall in infant mortality. That fall is greatly due—and I think that Members who will have read about it will agree—to their treatment of the premature baby. A certain amount has been done in this country. Lately I was visiting a hospital in the Midlands where they had made a speciality of dealing with the premature baby. I saw the baskets, warmed and prepared, in which the babies were brought in I saw the cots, and all the other arrangements. They have done a 2160 fine job of work there, and this is being tried out in various parts of the country.
Recently the Advisory Committee on the Welfare of Women and Children set up by my right hon. and learned Friend's predecessor at the Ministry, brought out the report of their Medical and Professional sub-committee which studied particularly this subject of premature infants. I have here the draft circular which is going out to local authorities on provisions which can be made in war-time to make premature births as normal as possible and the death rate as low as possible. I have been asked at times, "It is all very well, but have these premature babies saved in our hospitals grown up to be strong and healthy people?" We have records to a certain extent, but they are not yet very full. However, I was interested, when in that particular hospital in the Midlands, to be told that only the week before a young man in khaki called upon the matron to see the hospital, and when he was asked why he was particularly interested in the hospital, he said, "I am interested because I was one of your premature babies." They are doing wonderful work, but what we want to do is to see how we can prevent prematurity, and there is no doubt the gynaecologists and obstetricians have got to get together and find out more for us about this particular difficulty. For when you look at the figures, it is quite clear that where we have to attack is the mortality during the neo-natal period, the one month after birth.
The Secretary of State pointed out particular areas in Scotland that have this high rate of infant mortality. Hon. Members have since pointed out that there are cities in the North of England that are just as bad, and some of them worse, and I believe it is in these particular black spots that we have to make an energetic drive. In one particular place where the neo-natal mortality is high, we are arranging at the present moment for there to be inquiry into the nutritional standard. We have made these inquiries in many parts of the country and examination has been made of many hundreds of expectant mothers, and as yet, we have found that the nutritional standard at this moment is not bad. The hon. Member for West Fulham rather gave the impression that there was a high percentage of the population of this country 2161 undernourished and suffering from malnutrition, both children and adults. I do not think that is the case. Certainly, we have made these inquiries, and experts have looked into the matter, but when hon. Members speak of nutrition in connection with this particular problem I think we all agree that we have a great deal more to do.
And we have a great deal more to find out about nutrition, not only during the war, but to carry on into the time of peace.
It is rather disappointing that when arrangements are made for fruit juice and cod-liver oil and vitamin tablets for expectant mothers, nursing mothers, and babies, they do not take them up as much as we had hoped. The Secretary of State said that the amount taken in Scotland was even less than in England but the figures in England, although they are better, are not what we should have liked them to be. Only 50 per cent. of the mothers and babies in England to whom the fruit juice is available take it.
Either free or at a small charge. At the beginning it was free and that did not go well, and some people thought it better to have a small charge made. Only 25 per cent. take the cod-liver oil, and only 39 per cent. take the vitamin tablets. Perhaps what hon. Members have said in this Debate on nutrition to-day will arouse more interest in the public on the vital need for taking what has been made possible for them to have, even in these difficult days, and the enormous importance of this particular scheme. Hon. Members have talked about nutrition, and I am sure they will agree that when we come to the days after the war we want to carry on the special schemes in order that mothers and children may get the best chance we can give them. But it will mean much persuasion and education, in which we look to hon. Members to help us. The hon. Member for Heywood and Radcliffe (Mr. Wootton-Davies) said that malnutrition was either 2162 due to eating too much or too little. But it may be due to wrong feeding and I feel that we have a great deal more to learn about the right feeding of people in different circumstances. We must persuade them that if the food is available they must co-operate with us.
I wonder whether, as a result of this Debate we shall get more co-operation from mothers after they have had their babies? When a woman has a baby a health visitor visits her and only very rarely is she rebuffed. She asks the mother to bring the baby regularly to the clinic, so that they can be looked after, but we find that the mother and baby do not come. I was at a maternity home not long ago where the matron said that a few of the many mothers who went from the home and were asked to come back ever did so. This Debate will have done a great deal of good if we can make it clear to the people of this country that there is this service which can help them. But we cannot do it without their co-operation.
The nutritional aspect has been referred to by several speakers and I will try, so far as I can, to answer their questions. My hon. Friend the Member for Frame (Mrs. Tate) spoke of porridge, patent medicines, breast feeding, war nurseries, and said that fresh milk was very much batter than tinned milk. As she knows, at the moment fresh milk is being made available to mothers. Tinned milk is on points.
My hon. Friend mentioned both fresh and tinned milk, but I know that if we begin to talk about heat treated milk a great deal of heat will be engendered, and I do not want to pursue that line. As I have said, at the present moment mothers are getting fresh milk. My hon. Friend also said that she thought there should not be any child under two in war-time nurseries. The position is this: No woman with a young child is directed to work but if she does go to work, and we do not arrange for her baby to be looked after, we fear that it may not be looked after properly. There was a feeling in the country two years 2163 ago that if we did not make provision for young children they would not be properly looked after. As regards breast feeding, perhaps it would interest my hon. Friend to read a report of a sub-committee of our Advisory Committee, which was published recently, in which they said that certainly breast feeding gave the child what they called a flying start.
I also agree with what she said on the subject of sleep. The hon. Member for Southampton said we might be able to get down the infant mortality figures a good deal but there would still be hard cores. That is quite possible, but I feel that, however much we can do during and after the war, when we get the extra personnel, we want to start out with the feeling that we are going to attack the problem, investigating the blackest spots, getting down to it and seeing what the reasons are. I quite agree about poverty and housing but beyond that there must be further knowledge and further information by those who can give it, and further research. It is not simply a matter of poverty. I would urge hon. Members to look at it from a broader point of view. It is a pressing problem and we are keeping in touch with those who have dealt with it in other countries. The picture given by the hon. Member for West Fulham of undernourishment was probably rather a gloomy one. As I have already said, I think there should be some praise for the health services of the country and the way they have kept going during the difficult days of war.
No. It makes it quite plain that pregnancy by itself is not a reason for a person getting National Health benefits and leaving work. The hon. Lady knows that there may be some work with which a mother can quite well go on. [HON. MEMBERS: "Oh."] She told us of a case of someone who was tired out and said that it would be impossible to give her a certificate. That is not the case. If a doctor thinks that a person should not work, or is unsuited to work, he can give her a certificate; that is being done up and down the country.
§ Dr. Summerskill
The hon. Lady has been given this information, but I actually practise and I give the certificates. The cases that I quoted were of exhausted women. No one inquired what work they were doing. The circular says clearly that women are not entitled to six weeks simply on the ground of pregnancy and there has to be some pathological condition as well. The hon. Lady cannot tell me these things. I know, because it is my work.
I have seen many certificates. If the hon. Lady knows someone who is exhausted and ought not to be working, there is no reason why the certificate should not be given. If hon. Members will consult medical opinion, it depends a great deal on what the work is. [Interruption.] I still say it depends a great deal on what the work is.
If the hon. Lady reads the circular, she will see that she could give a certificate to an exhausted woman.
The certificates can be given, and I sometimes wonder whether the housewife working in her own home has not as tiring and difficult a job as those who work outside the home. We are anxious to provide more domiciliary help. We have a scheme for home helps, but it is difficult to get sufficient people to take on these jobs. If any hon. Member or anyone else hears of someone who would take on that job, we shall be only too anxious to get her. We have to realise that working is not simply going out to work for somebody else, but that there is heavy work in the house which makes it extremely difficult for women if they cannot get help. I remember speaking on this point at a meeting, and I had a letter a few days afterwards from a woman who told me that she was willing to leave her home as her sons were abroad, and work as a home help. If there were more like her who would help in these difficult times, we should be able to do 2165 more for the mothers than we are able to do. We are entirely in favour of the home-help scheme, but the number who come forward as home helps is very limited.
The hon. Member for Putney (Mr. Linstead) did not stop at nutrition in this country, but took us in his speech to the Continent and talked of the difficulties that will have to be overcome in those countries that are freed from the enemy. I ask him not to expect an answer on that point now, but I agree with him on the necessity for more research and education. He said that the terms of the laboratory should be translated into terms of the kitchen and that there should be an international scheme of food and that food supplies should be built up. Both the Board of Education and the Ministry of Food have done a good job during the war trying to get to the people more information as to the right food and the best way of preparing it. More and more the Board of Education is dealing with these subjects, and we hope that those who leave school in these days will have more knowledge of diet and of the necessity of preparing food in the most nutritious way.
Our own Advisory Committee has not only dealt with the subject of the premature baby and with rickets, but a report will shortly be published in connection with rickets by the British Paediatric Association. The investigation on the subject of rickets is reassuring, for it was one of the diseases we thought might be on the increase in war-time. I was glad to hear part of the speech of the hon. Lady the Member for Bodmin (Mrs. Wright), for we also have a sub-committee sitting on parent-craft. We have much to learn of what can be done. There are any number of people who do not know yet the services they can obtain and how necessary it is to obtain them. I welcome this Debate because it has given publicity 2166 to these things. I hope that hon. Members will realise these black spots will be tackled, even if they have to be tackled one by one.
I have told the hon. Member that in one particular area people are being sent to look into nutritional state because the neo-natal cases are on the increase. We cannot deal with housing until the war is over for it is a long term programme. I believe that at the end of that time we shall have a record in this country of which we shall be proud.
§ Question put, and agreed to.
§ Resolution to be reported upon the next Sitting Day; Committee to sit again upon the next Sitting Day.