PENICILLIN (SUPPLIES) (Hansard, 2 November 1944)

§ Mr. Kendall (Grantham)
I regret that it has been necessary to raise this question of penicillin on the Adjournment, for two reasons: first of all, I believe that I have a case for civilians suffering from bacterial-endocarditis which should have been taken into consideration by the Minister's representatives some time ago; and secondly, because in the House on the Adjournment I have not much time to make my case nor has the Minister much time to answer it. Let me look at the very brief history of penicillin. It was discovered by a very eminent scientist in 1929. He got no encouragement at that time from the Government, and had to go to the United States of America for money which would help him to continue his experiments. From the Rockefeller Foundation he got £500 so that he could continue his studies, and it eventually proved that what he had discovered would, indeed, be of the utmost importance to civilisation in the treatment of various diseases, and, in particular, blood poisoning. We in Britain, again unfortunately and regrettably, have not started producing this very important disinfectant until recently.

§ Dr. Haden Guest (Islington, North)
It is not a disinfectant. Will my hon. Friend tell us what blood poisoning is, because there are two doctors here who do not know?

§ Mr. Kendall
If the doctors do not know, how am I to give an answer?

§ Mr. Reakes (Wallasey)
It was a silly interjection.

§ Mr. Kendall
Anyhow, there is a large factory, costing £1,000,000, which has started operations to-day.

§ The Joint Parliamentary Secretary to the Ministry of Supply (Mr. Peat)
That is not true; that is a mis-statement in the Press.

§ Mr. Kendall
Well, perhaps the Minister will tell me when, in fact, really high production of penicillin did start. The fact is—and I do not think this can be disputed—that all the information available as to the manufacture of penicillin, and treatment by it, was given to the United States of America. They picked it up very quickly, and have done a wonderful job in producing it. I believe their production to-day is something like 1,200,000,000,000 Oxford units per annum, or 1,200 billion if you like. Indeed, had it not been for their tremendous production and for the enormous supplies they have sent over here, representing about 200 billion Oxford units, there would have been, and would be now, a great many of our Servicemen suffering from various war wounds, because of our lack of foresight, and maybe, in certain instances, man-power, during the last couple of years. These wounded men are now being treated with the drug, which is being obtained under Lend-Lease from America. I am also given to understand that Germany has been given all the information regarding the production of penicillin. That may or may not be true, but in any case it would not be a bad thing if she had, because she could treat not only her own people but, more important, our men who are in her hands as prisoners of war. I have no objection to that.
Bacterial endocarditis is a disease which hitherto has been fatal, with no hope and no chance of life until this great discovery came along. There are not a tremendous number of cases. I do not think the Minister knows the number—neither do I—but without this drug there is no hope for these people at all. With it, life has already been saved both here and in the United States. It may well be that as many as 80 or even 90 per cent. of those suffering from it may die, even with penicillin treatment, but at least they have a possibility of living. In particular I refer to young people who have already been helped. One is a 21-year old boy at Middlesbrough, who is getting along 1095 very well. There is a 15-year old girl somewhere else who is also doing very well indeed. There was an easier case of a young boy at Manchester who, according to the advice of half-a-dozen very good medical men, would have died but for the fact that the War Office, after a bit of persuasion, gave penicillin for his treatment. He is now back at school. I have studied this very closely. I am a layman and an engineer and do not profess to be a medical man, but I still go to the trouble of doing my best for those who appeal to me.

§ Dr. Morgan (Rochdale)
So do all of us.

§ Mr. Kendall
You are not doing your job—

§ Dr. Morgan
I do my job better than the hon. Member does his and I am not making a profit out of it.

§ Mr. Kendall
I am talking to the Minister and not to the hon. Member. Young people suffering from this disease might be given the opportunity of being put under a panel of doctors and given a hope and a chance of living.
There is not enough penicillin at the present time to make it available in the public market for anybody who wants to use it. It obviously has to be controlled until production is such that it becomes available for public purchase. While the control is on, I ask the Minister to take into consideration something which I believe is fair and reasonable. That is to take regionally the few cases that will come along under his own experts and in relation to the doctors whose patients these young people may be. There has been a lot of publicity about penicillin, but the numbers of people who have applied through various other Members of Parliament and to me directly are not numerous. I should not think that there have been more than 20 or 30 letters Asking for help.
If the Minister sees his way to accept my suggestion or something similar, these cases will be taken care of and it will stop my having to try and get penicillin, which will take a tremendous headache away from me. It will also more than help to give those people who have given me penicillin—because I neither manufacture it nor pur- 1096 chase it—and who have let me have some 4,000,000 or 5,000,000 Oxford units, the kind of public thanks that they deserve. I have been only an intermediary in this business. It has not been my penicillin, arid none of the cases have come from my constituency. I think that the people who have given me this drug should get the thanks that are due to them because it was a grand and kindly act that they performed. If the Minister can do something along the lines I have proposed I would like to give him the name of a brilliant young doctor who already works for his Department and has done tremendous research work on this specific disease and on the case I had handled as intermediary. He is a grand young man, full of enthusiasm and real practical ideas which are so much helping the people who would die from bacterial endocarditis except for the near miracle that penicillin might work on their disease. I hope that the Minister can meet me on the one point of regional control. He could get his experiments in there, he could get the doctors trained in the use of penicillin through his experts, and he could really get down to helping the people who have no chance without the aid of penicillin.

§ The Minister of Health (Mr. Willink)
I am sorry that I should appear to be cutting out other hon. Members who would have liked to have taken part in this short Debate, but the matter which has been raised is one of very great importance. I am most anxious to make clear to the House—

§ Mr. George Griffiths (Hemsworth)
Does the right hon and learned Gentleman intend to speak until 7.30 p.m.?

§ Mr. Speaker
The House rises at 7.28 p.m.

§ Mr. Willink
As I say, this is a matter of very great importance. This is a very precious drug, and I am most anxious to relieve the anxiety of any who believe there has been some undue rigidity, or even some inhumanity, about the administration of our supplies. The subject, as I understand it, is the supply of penicillin to civilians rather than the history of the production of penicillin. I can cover only one of the two subjects in the time at my disposal, but I would like to make a little of the history clear. It is an English dis- 1097 covery, and the first supply came from British sources. It is a fact that in 1941, 1942, and indeed in 1943, the resources of the United States of America were less hardly pressed than our own.

§ Mr. Woodburn (Stirling and Clackmannan, Eastern)
A British discovery?

§ Mr. Willink
Yes, a British discovery. Most mercifully, from the beginning of this year, owing to the American supplies provided under Lend-Lease for the use of the Armed Forces and civilian air raid casualties—those were the terms—we have been able to do a wonderful lot for those two classes of people. It was in August, 1942, that the Ministry of Supply, which is the Department responsible for supplying drugs and other medical requirements, set up a general Penicillin Committee to consider the production of penicillin. They had difficulty. Everybody knows the strain on this country in 1942, but whatever the developments in that field may have been, I can tell the House that in the early part of 1944 it became clear, to our very great relief, that during this vital summer our total supplies, home production and imports, would probably be more than sufficient for the needs of the Armed Forces.
The first allocation for clinical trials—and I would like the House, which is always interested in questions of research, to know that the clinical trials were under the control of the Clinical Trials Committee of the Medical Research Council—was in January, 1944. The business of that Committee is to arrange for the use of this very precious substance in cases where it is likely to be beneficial, and to record the quantities needed for a particular type of case, and the results. By August, 1944, supplies had increased, and we were able to provide a general supply, though on a very restricted basis, for the use of civilians. I would like the House to appreciate that penicillin is a biological product, and is production is by no means easy. One has uncertainties, one has disappointments, but in the three months from August to now, we have been able to maintain the amount we hoped for in August. I will mention the future in a moment. I take full responsibility for the arrangements which have been made in this field. The allocation is, as my hon. Friend has suggested, really, as it should be, on a regional basis, 1098 and the decision as to how the allocation should be used is not made by me. That right is given by me to the university medical schools, and I am sure there could not possibly be a better quarter in which to place that responsibility.

§ Mr. Kendall
Is it not a fact that definite orders have been given to these regional authorities that no penicillin can be used for bacterial endocarditis?

§ Mr. Willink
I was coming to the directions which have been given. Each of the medical schools has set up its own expert committee. Treatment is given in teaching hospitals, but not only in those hospitals: there are other hospitals which have been approved as proper hospitals for that purpose. I want to make it quite clear, because some people are under a very serious misapprehension, that it is not a drug that can be used with advantage in every type of disease. There are some diseases in which it may be the only means of saving life. There are others in which it may be an alternative to the sulphonamides, and others in which it may be quite ineffective. It is rather worrying to find that even some doctors are asking for penicillin for use in cases including cancer, mycosis fungoides, and chronic leucœmia, all of which, I am advised, are diseases for which it is quite ineffective. There is another point with regard to this. It is really suitable only in cases which are being treated in a hospital or a nursing home under continuous medical supervision. It so happens that, as I was looking forward to this short Debate, by a pure coincidence—

§ Mr. G. Griffiths
I wish it had been a couple of hours' Debate instead of only a short Debate.

§ Mr. Willink
—I happened to read an address given last month by one whose name all members of the medical profession who are present, and many others, will know, a distinguished professor of medicine, Professor Henry Cohen, of the University of Liverpool. I could not do better in making my point than to quote his own words: There is a wide and ignorant demand for its use in conditions in which it has no beneficial action and even in cases where it may have some slight value it is, at this stage of limited supplies, justifiably withheld so that it may be available for use in those cases in which it has proved to be of the greatest value. We should deprecate public 1099 clamour by responsible and influential persons' for its use in an isolated case where very large amounts may be necessary in treatment and where the results are extremely doubtful at the expense of, it may be, several cases in which the use of penicillin will almost certainly turn the balance in the patient's favour. I come to the advice which has been issued by my Department. The advice was based on that of a Committee of high experts from many fields, who can properly advise on these matters. On the basis of the advice they gave, my Department issued a memorandum of recommendations as to the conditions for which penicillin should be used, and others for which it should not be used. There were three classes of case. The first was the class which was recommended as being prima facie suitable for treatment by penicillin. The words which I am about to use are long, but I think they should be recorded. In the first class were staphylococcal infections, which included septicæmia, early acute osteomyelitis, severe carbuncle, cavernous sinus thrombosis or any other life-endangering infection. Second in this class for which its use is recommended are haemolytic streptococcal, pneumococcal and meningococcal infections and any life-endangering infection of this type which has failed to respond to adequate sulphonamide treatment. The third in this class is gas gangrene. The memorandum goes on with a list of conditions which deserve special consideration to be treated with penicillin if supplies are sufficient. It was, however, recommended that penicillin should not be used for rheumatic fever, ulcerative colitis and other intestinal infections, bacterial endocarditis, or syphilis.
The reports we have had from the hospitals indicate that the supplies have proved sufficient for all suitable cases in that first group. As to the particular disease that the hon. Member mentioned, at present there is no satisfactory evidence as to the effect of penicillin in its treatment. Some believe that if a patient who is seriously ill with this disease is given large doses he will almost certainly show 1100 an immediate improvement, but that as the condition will probably relapse, more and more penicillin must be given. There has not yet been sufficient experience to show whether the patient can be definitely cured if one goes on and on with large quantities, or whether, without being cured, he can be kept alive, or whether he will die anyhow in a slightly longer period. But even on the most favourable interpretation of results with the supplies we have, it would be wrong to make penicillin available in every case. I can, however, say to my hon. Friend, that it is now possible, and we propose, to investigate the effects of penicillin on this disease and see whether some method of application can be devised which is likely to be successful. I can also tell him this—and I know that the House will be glad of the information—the quantities allotted to my Department have been increased. They are being progressively increased, and by January there will be twice as much available for civilian use as is available to-day. I do not think that anyone would doubt that priority should be given to the Service cases. It is of paramount importance that every man in the Forces should be restored to duty this year at the earliest possible moment.
The other point I would like to press, and it is the last point of all, is that with all the generous help in this matter we have had from the United States of America, it would be utterly wrong that we should use penicillin for our civilian population on a more lavish basis than the United States are using it for theirs. We are doing our best, and with the progressively increasing supplies we believe that there will be rapidly increasing benefit in such cases as my hon. Friend has raised. We are justified in the hope that before the end of 1945 the amount of penicillin available will meet all, or nearly all, reasonable demands.