HC Deb 10 November 1955 vol 545 cc2114-28

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

8.54 p.m.

Mr. Hugh Gaitskell (Leeds, South)

It is, I realise, somewhat unusual for those of us who sit on the Opposition Front Bench to raise matters during the half-hour Adjournment debate. To avoid any possible misunderstanding I hasten to explain that I do so as a private Member and on behalf of one of my constituents. This is a sad, indeed a tragic, case of a young woman, Mrs. Patricia Horton, who died of acute leukaemia within a fortnight of being discharged from the Women's Royal Army Corps.

I think it will be best if I tell the story of the last part of her life as I have heard it from her sister, so that the Under-Secretary will know exactly what is in my mind. Mrs. Horton—she was then unmarried and her name was Whitehead—joined the Women's Royal Army Corps about two years ago. I think she was about 17½. She was due for discharge in August of this year. Until the summer, there is no record of anything being wrong with her. She certainly did not suspect it, and the Army authorities equally had no reason to suppose that she was not perfectly fit and healthy.

However, at the beginning of July she volunteered, as she had done before, as a blood donor, and, of course, as a result she subjected herself to a blood test. The persons concerned, when they took the test, told her that they did not wish to have her as a blood donor. They also gave her a letter to take to her medical officer about her condition which, I understand, they diagnosed from the blood count as anaemia.

Mrs. Horton went to her medical officer and gave him the letter. Apparently, he did not take any further blood test, nor, so far as I can make out, conduct any detailed examination. He gave her some iron tablets, which, I believe, is a common method of treating anaemia, and she went on with her work. However, according to her sister's story, she was continually sick. She fainted at work and she returned to the sick quarters on several occasions. The medical officer, discovering from this that the tablets he had originally given to her obviously disagreed with her, gave her some others. But, so far as I have been able to ascertain, apart from a week in the sick bay, she continued at work, though on light duties, right up to the moment of her discharge early in August.

I understand that there have been some reports, which I think appeared in the newspapers when this case was reported, that she had refused all medical treatment. I am assured that this is not so and that, certainly throughout July, she was, as I have said, going to the medical officer, but not, so her sister felt, receiving any proper attention. It seems clear that throughout the whole of this period no specialist advice was sought and no further examination made. The assumption seems to have been that she was suffering from anæmia; that it was not serious and that no further action was called for on behalf of the Army authorities. Yet again, according to her sister, during these six weeks she lost no less than three stones in weight, so that she must have been looking ill by the end of it.

On 8th August, Mrs. Horton went for her medical examination immediately prior to demobilisation and only then, according to my information, did the medical officer say that she was seriously ill and that she ought to be in hospital. Even then he did not alter his previous diagnosis that she was anæmic, but merely thought that she was not responding to the treatment very well.

Mrs. Horton refused to go to hospital at that point, not because she did not realise that she was ill but, again according to my information, because she felt that she had not really had any adequate treatment from the medical officer there, and because, since she was to be demobilised in a few days, it was obviously sensible to wait and see her own civilian doctor. It is also true that she did not want to go to hospital because she was intending to get married and that would have meant putting off the wedding. Accordingly, as I say, she did refuse the suggestion that was then made—but had not been made earlier—that she should go to hospital for proper treatment.

A curious feature of this case is that after this examination she was given the medical category which she had held during her period of service when she was perfectly fit, the medical category F.E., or fit for general service. I am bound to say I find that very difficult to understand. Two days later, she wrote to her sister saying that she was very ill and that they would get a shock when they saw her, because she had lost so much weight.

Mrs. Horton left the Service. She got married. She reached home on 18th August—ten days after the medical examination. Her husband was also in the Regular Army. This young married couple came to stay with Mrs. Horton's sister in Leeds, in my constituency. By the time she got to her sister's home, Mrs. Horton was unable to walk—her husband actually had to carry her upstairs. Naturally, they sent immediately for her own doctor, who immediately ordered her to hospital. She died ten days later of acute leukæmia.

I must ask the Under-Secretary of State a number of questions about this case which, as I know he will understand, has caused her relatives a very great deal of distress. It is, as I have said, a tragic one. My questions are these. Were the Army authorities—or the medical officer—themselves aware of the nature of her illness? Why was she not sent to hospital as soon as she came back from the blood test—or, at least, why was she not given more care and attention? How was it that they allowed her to continue with light work?

How was it that this went on, according to her sister's story, even though she was losing weight very quickly indeed? Why was no specialist called in? If the medical officer had any doubt about the matter, or was worried that, perhaps, he had not diagnosed correctly, would it not have been possible to get some other advice? Finally, why was she graded fit for general service when she was obviously desperately ill?

The relatives, and indeed people generally, are entitled to answers to those questions. This case attracted a good deal of publicity shortly after she died, because there was, of course, an inquest, and comments were made at that inquest. I hope, therefore, that to satisfy her relatives—and if I may say so, in a sense the reputation of the Army is involved—the Minister will be able to give satisfactory answers to my questions.

9.4 p.m.

The Under-Secretary of State for War (Mr. Fitzroy Maclean)

I should like, first, to say that I am very grateful to the right hon. Gentleman the Member for Leeds, South (Mr. Gaitskell) for raising this case, because I hope that it will give me an opportunity to clear up these tragic events. I think that it would be useful if I started by giving our version of the facts, which does not, I think, differ to any very great extent from that given by the right hon. Gentleman, but which does differ in several matters of reference.

As the right hon. Gentleman said, Private Whitehead, as she then was, joined the Women's Royal Army Corps in February, 1954, and her health remained good until July of this year. I should like to add that she was an unusually keen and unusually promising member of her corps.

On 11th July she volunteered as a blood donor, and a blood test was then taken. This blood test, which was taken by the National Blood Transfusion Service, was a different type of blood test from that which would have been necessary to diagnose leukaemia. They took a blood test for their own purposes, which seemed to reveal that she was suffering from anaemia. The National Blood Transfusion Service therefore gave her some iron tablets, which were the normal treatment for anaemia, and advised her to see a doctor. At the same time, they informed the unit medical officer, who was a civilian, of the conclusion which they had reached. When the unit medical officer received their letter, he instructed Private Whitehead to report sick. The move, I think, came from him and not from her; she did not make the first move.

She duly reported sick on 19th July. After she had seen the medical officer, he decided to continue the iron treatment and to keep her under observation. During the following week—from 19th to 26th July—she suffered from minor upsets of a gastric nature which were compatible with difficulty in assimilating the medicine she had been given. Accordingly, the treatment was slightly modified and slightly different medicine was given to her. On 26th July, the new treatment being continued, she was put on light duties.

The next development was on 8th August. At that time she had been treated for anaemia, which, after all, is quite a usual and not very serious disease, since 19th July, and since 26th July she had been on light duties. On 8th August, she reported to the medical officer for a release medical examination prior to leaving the Army to get married.

The medical officer carried out the usual release medical examination, which is a thorough medical examination, and found her condition normal in every respect—that is to say, her heart and lungs were quite normal—but he found her very anaemic. There had, I think, not been a very sharp deterioration at that stage—in fact there had been some signs that she was yielding to treatment—but her condition was still very far from satisfactory. There were some signs that she was yielding to treatment, but it could not possibly be said that the medicine had produced the desired results.

Accordingly, when he saw this, the doctor told Private Whitehead that she appeared to be very anaemic, that her condition was not satisfactory and that the medicine had not produced the desired results, and he advised her as strongly as he could to go into hospital for full investigation. This she declined to do on two grounds—first, that she was shortly getting married and, secondly, that she felt perfectly well. "Perfectly well" are the words which she used, and although she did not sign a written statement refusing to go into hospital, she said that she was feeling perfectly well and said it in front of a witness.

I have explained that the doctor was a civilian medical officer. He was a youngish man, but a man who had had experience both as a doctor in the Royal Army Medical Corps—he had been decorated for gallantry while serving as a doctor in Korea—and for three or four years in his present appointment. All he could do was to make her promise that when she had been released from the Army, as she would be on marriage, she would at once consult her civilian doctor.

Private Whitehead, before her discharge, was also interviewed again in the presence of a witness—by her company commander, who was in possession of the medical officer's report, and who also asked her very strongly to postpone her marriage and go into hospital. Once again she refused to do that and insisted on going ahead with her plans. It might be suggested that the company commander and the medical officer should have overridden her objections, but one has to remember two things. One has to remember, first, that—for reasons which are perfectly understandable—she had deliberately minimised her symptoms. She had used the expression that she felt perfectly well. The second thing to remember is that in order to diagnose a blood disease it is necessary to take a sample of blood. In order to take a sample of blood, it is necessary to perform what, technically, is an operation. An operation requires the consent of the patient. That she was not prepared to give.

It would have been possible to refuse to discharge her from the Army and to order her to go into hospital, but even if she had gone into hospital—which we know she was reluctant to do—it would still have been impossible to take the necessary blood sample for the purpose of diagnosing leukaemia without her consent.

The rest of this tragic story is that Private Whitehead was duly married on 13th August. She took her discharge from the Army, as she was entitled to do, on 16th August. On 18th August she was admitted to Leeds General Infirmary as an emergency case and, on 28th August, she died of acute leukaemia which, as the right hon. Member knows, is an incurable disease, and which, in this case, any amount of treatment could only have produced the result of prolonging her life by a few weeks, or possibly a few months.

The right hon. Member has asked why it was that she was discharged from the Army as category F.E., which is "fit for service everywhere." The reasons for that are as follows. The medical officer gave her her release examination on 8th August, which was the last occasion on which he saw her, and there was no evidence available to him on what he could see that she was suffering from anything more serious than anaemia.

Here I should make an observation which really requires a technical expert, but I hope to make myself clear. In cases of acute leukæmia, there is a change in the internal condition of the blood. I understand that that change takes place so rapidly that it does not produce a corresponding change in the organs of the body until the process of deterioration is very far advanced—and then a sudden deterioration of the organs takes place. Therefore, when the medical officer examined Private Whitehead on 8th August no evidence was available to him—and unless she had first gone into hospital for observation and had had a blood test, no evidence could have been available to him—of anything more serious than anæmia.

Again, I would recall that Private Whitehead—Mrs. Horton—had deliberately minimised her symptoms and had stated on 8th August that she felt perfectly well. That being so, as the medical officer had no evidence of anything worse than anæmia, he was not able to change her medical category. Her health had been perfectly satisfactory until then, and she was therefore classed as F.E.—"fit for duty everywhere." He would have been able to change her category only if she had consented to go into hospital and blood tests had been taken which showed leukæmia, and a medical board had then sat and reported upon her case. That had not happened, and the medical officer had no option but to leave her category as it was, qualifying it by saying that she was suffering from anæmia.

Having heard our version of the facts, I hope that the right hon. Gentleman will agree that no blame attaches to the Army authorities or to the medical officer in this case. In fact, no blame attaches to anyone. I should like to take this opportunity of extending my sincere sympathy to Mrs. Horton's husband and other relatives in their tragic loss.

Mr. Gaitskell

I wish I could say that I thought the Minister's answer satisfactory, but with the best will in the world I simply cannot. He spent a good deal of his time in dealing with what happened on and after 8th August, which was the day when she was examined. I should like to ask two further questions. First, was the doctor who examined her not aware of the extent to which Mrs. Horton had lost weight? I do not deny that she did not wish to go to hospital, but the story I have heard is that she did not wish to go because she felt she was not getting adequate treatment there and would get far better treatment from her own civil doctor at home. Surely the medical officer must have weighed her in the course of his examination. If so, he could have compared her weight then with her weight when he examined her early in July.

Secondly, I am frankly astonished that the Under-Secretary can defend what appears to be a practice in the Army, namely, to grade somebody as fit for general service at the very same moment that it tells that person that he or she is seriously ill and ought to go to hospital. Is chronic anaemia such a mild disease that one who suffers from it is, nevertheless, supposed to be fit for general service?

I do not think that the Under-Secretary answered my other questions. It seems to me that the more serious error arose after the original blood test. When Mrs. Horton went to see her medical officer he took no further test. She was then still in the Army and, presumably, could have been sent to hospital. I can hardly imagine that at that stage there would have been any difficulty about undergoing this so-called operation.

Mr. Speaker

With every desire to assist the right hon. Gentleman, I must point out to him that he is putting me in a difficult position because he is making what amounts to a second speech. I was quite prepared to allow a question or two, but in the interests of order I must insist upon the rule of one speech to one Motion.

Mr. Gaitskell

Yes, Mr. Speaker. As I am speaking on behalf of the relatives I am, naturally, anxious to get the full facts, and I was but pressing the same questions I had previously asked, which had not been answered by the hon. Gentleman. However, I will leave it at that. If the hon. Gentleman will answer those questions about the period between 11th July and 8th August, and the other two questions, I think we may make some progress.

Mr. Maclean

Let me deal with the question of the category in which Private Whitehead was placed. The system by which a soldier remains in a category until a full investigation by a medical board has been held on his condition and has reported is a perfectly rational one. Indeed, it is the only possible one.

I think the right hon. Gentleman will agree that this was an exceptional case, of a girl anxious to get married, who said she felt perfectly well, and who refused to go into hospital. As I have said, it would have been possible to have refused to discharge her for some further weeks and to have kept her in hospital, and to have refused to allow her to get married, but I think we might have been somewhat severely criticised if we had done so in the circumstances.

We have to remember also that she did not appear to be suffering from anything worse than anaemia, and that the doctor's report on her condition on 8th August did not show any serious deterioration. Nor at that date had she suffered such a very serious loss in weight. She had not been weighed since she entered the Army in February, 1954. She was weighed again on her release. I will cause that point to be further investigated, but my information is that there was not such very serious loss of weight at that time. However, I will confirm that and write to the right hon. Gentleman.

The right hon. Gentleman has asked why no blood test was taken earlier. That would be between 19th July and 8th August. The medical officer had no reason to suspect that she had anything except anaemia at that time. A blood test had been taken by the Blood Transfusion Service, which, as I have said, was not the same blood test which would have shown leukaemia. It was a test of quantity of blood rather than quality of blood. As he had to deal with a patient who was deliberately minimising her symptoms, I do not think that the doctor was to blame for not diagnosing leukaemia at that stage, or even on 8th August.

I am assured that it is possible for a patient to be suffering from leukaemia without the symptoms being apparent, unless a blood test specifically designed to diagnose leukaemia is made. If the right hon. Gentleman still feels that there are other points which he would like me to look into, I shall be very glad to investigate the matter further. I feel that in what was a very difficult case both medically and psychologically the unit medical officer did everything that it was his responsibility to do.

9.25 p.m.

Mr. Thomas Steele (Dunbartonshire, West)

We have all listened with care to what my right hon. Friend the Member for Leeds, South (Mr. Gaitskell) said and to the Minister's reply, but I feel that the Minister has not answered the questions which my right hon. Friend put to him, and I am shocked at some of his statements. There is surely something wrong with a system which permits a medical officer to give a certificate of fitness to a woman in these circumstances, declaring she is fit for service anywhere, while at the same time and in the same place she is told that she is seriously ill and ought to enter hospital. We cannot be satisfied with that situation, whatever the Minister may say. If that is the general practice, surely it should be investigated.

According to my right hon. Friend—and the Minister did not deny it—there is evidence in a letter which this woman sent to her sister, indicating that her sister would be shocked at her appearance. That quite clearly shows that she herself knew there was something wrong.

Mr. Gaitskell

Two days after the medical examination.

Mr. Steele

The woman herself evidently knew that there was something seriously wrong which would shock her sister. Therefore, the medical officer would have been able to see for himself what the woman was like. The Minister appeared to suggest that there was no evidence, but if a young, healthy woman loses two or three stones in weight rapidly and is herself concerned about what her sister thinks when she arrives, surely, with all due respect to the medical profession, any doctor from his knowledge and experience should be able to see that there is something wrong.

I am not satisfied about the blood test. The Minister indicated that there was need for an operation, I suppose a minor one, but we should have some idea of what that means. The Minister rather indicated that the operation would require the consent of the person concerned, but surely there is something wrong there. What kind of blood test was involved? I am a layman, but I have had blood tests, and they did not take long. If the medical officer was so concerned, he could have arranged for this test to be made. In any case, when the Blood Transfusion Service indicated the position to the medical officer, I think it called for more consideration than was given. There are features about this case which are very unsatisfactory, which have not been cleared up by the speech of the Minister tonight.

9.31 p.m.

Mr. J. T. Price (Westhoughton)

Like my right hon. Friend and my hon. Friend the Member for Dunbartonshire, West (Mr. Steele), I share the apprehensions that have been expressed as the result of the statements we have heard from the Box. The Minister has made a bald and unconvincing statement which does not bear much examination. There is only one point I want to comment upon, his reference to the blood test, when in reply to the queries of my right hon. Friend he told the House that it was conducted not for the purpose of defining the quality of the blood but merely in order to ascertain the quantity—

Mr. Maclean

For the Blood Transfusion Service.

Mr. Price

Precisely, for the Blood Transfusion Service. But this is a revolutionary explanation of how blood tests are taken for that service, and I am certain that the professional men interested in this question will be astonished to hear that this is the purpose of a blood test taken for the Blood Transfusion Service. I have always understood that it is to ascertain the category of blood before it is put into the blood bank for use on different patients of different types.

Surely some account is taken of the number of corpuscles in the blood? The one outstanding symptom of leukaemia is that the white corpuscles multiply at a much greater rate in relation to the red corpuscles which form the body of the blood. Surely any check of the blood stream of this poor woman taken by a competent doctor, who put it into the laboratory and had it examined by a pathologist, or whoever was to do the job, would immediately show the unbalance between the white and red corpuscles?

This ought to be pursued. The obvious objective symptoms of loss of weight, of unsatisfactory blood and, later on, of vomiting and debility, ought to have indicated to any reasonably competent medical man who conducted these examinations that this girl was not fit to be certified fit for general duties. I understand that there is an old saying in the Army, medicine and duty—M. and D.—and that outlook of the Army ought to be one which the hon. Gentleman with his own gallant experience, if I may say so, in the late war ought to be very zealous in his office as Minister of the Crown to correct if he has the power to do so.

Mr. Speaker

It would have been more convenient if the speeches of the hon. Members for Dunbartonshire, West (Mr. Steele) and Westhoughton (Mr. J. T. Price) had been made before the Minister replied. It puts me in a difficult position, but if the Minister wishes to say a few words, and has the leave of the House, I will permit him to conclude.

9.34 p.m.

Mr. Maclean

Thank you, Sir. Perhaps I may clear up one or two of the points that have been raised. First, the question of weight. Mrs. Horton was weighed on 5th March, 1954, that is, immediately after entering the Womens Royal Army Corps. She then weighed 133 lb. She was weighed again on 8th August, 1955, when she weighed 123 lb. She had, therefore, lost exactly 10 lb. during that period. Those are the only figures that we have. I do not think there is really any evidence to support the suggestion that she lost three or four stone. Our records show that during the whole of her service in the Army—admittedly, there may have been fluctuations—from the beginning to the end, she lost 10 lb. I would add that anaemia would have been enough to account for a loss of that extent.

On the question of the exact nature of the blood test to which Mrs. Horton was subjected by the National Blood Transfusion Service, it is not really for me to say exactly what sort of test it was. First of all, I am not technically qualified, and, secondly, it would be for my right hon. Friend the Minister of Health to discuss that further. Therefore, I confine myself to saying that it was a test designed simply to tell whether or not the donor was suitable for giving blood. It was not a test designed to show from exactly what disease she was suffering. However, on the test, as it was, the doctor of the National Blood Transfusion Service and the medical officer were, I am advised, perfectly justified in concluding that what she was suffering from was anaemia.

As to Mrs. Horton's appearance, I would say, first, that the medical officer, as we know, was dissatisfied with her condition and recommended her very strongly to go to hospital and have a full investigation, which she was not able to have, which she declined to have, and which he did not force her to have. It is quite clear that he was not satisfied with her appearance, but I would also say that in the last stage of leukemia the deterioration in appearance and in health generally, when it comes, is very sharp, terrifyingly sharp and sudden. Therefore, it is possible—in fact, it is certain—that between 8th August when the medical officer saw her and nearly a week later when her sister saw her after she had been discharged—I think she went to Leeds on 16th August—the deterioration must have been very sharp and sudden, and that, I think, would account to some extent for the shock which Mrs. Horton's appearance gave her sister.

The right hon. Gentleman said that Mrs. Horton herself said that she had written to her sister telling her that she did not feel well. We know that she did not feel well, and she could not possibly have felt well in the state she was in, but, equally, she would not have felt well if she had been suffering from anaemia and if the anaemia from which she was suffering was not responding to treatment.

Against that, as far as the medical officer is concerned, it was really impossible for him to ignore completely, first, Mrs. Horton's statement that she felt perfectly well, and, secondly, the fact that she did not wish to go into hospital, a refusal which she maintained even when more strongly urged by her company commander that she should postpone her marriage and go into hospital. The tragedy in this case is that she must have known that she was ill. If she had not known it, the medical officer was there to tell her, but she ignored that, and she preferred—and who is to criticise her for her choice in this matter?—to get married and leave the Army rather than go into hospital.

In the face of that attitude, it would be wrong to criticise the medical officer for the decision that he took. He did his best to persuade her, and got the company commander to do the same, not to leave the Service.

9.40 p.m.

Mr. Thomas Fraser (Hamilton)

I do not want to make a speech and cause the Minister to seek leave once again to make yet another reply, but I feel obliged to make a comment. The hon. Gentleman has rendered great service to the British Army in the past as a high-ranking officer. Most of us who have listened to the debate will now go home feeling that the hon. Gentleman has rendered a great dis-service to the Army by what he has said. Most of us will be convinced that adequate care was not taken to diagnose the condition from which this woman was suffering between 11th July and 8th August.

The Parliamentary Secretary to the Ministry of Food might say that his hon. Friend is not responsible for that, but the Under-Secretary has rendered a disservice by not recognising that there was inadequate care during that period, and in defending the medical authorities in whose care the woman was during that period.

The Under-Secretary of State is sending us home tonight with the knowledge and the belief, and with his assurances, that it is the normal practice for a person having a medical examination in the Army to get a certificate issued by the unit medical officer saying that that person is fit for service anywhere in the world, although in the opinion of that same unit medical officer the person ought to be in hospital. That is why he has rendered a great disservice to the Army and has shaken and scared us all.

It would have been far better if the hon. Gentleman had responded to the instinct that he must have had by admitting that perhaps—suppose that he did not go any farther than that—the medical officer had taken inadequate precautions to ascertain the girl's condition between 11th July and 8th August, What he said about going to hospital and there having a blood test was quite beside the point because the suggestion was made on 8th August, when the woman was already on her way out of the Army. I wish the Minister had not been so desperately anxious to—

Mr. Maclean

The medical officer had to try to treat her for the disease from which she appeared, not only to him but to the National Blood Transfusion Service, to be suffering. It was only natural that he should try, as he did, first one medical treatment and then another medical treatment, and that he should give himself and his patient time to see how she responded to that treatment. She reported sick only on the 19th July, and it was not much over a fortnight later that she was discharged. By then he had had time to come to the conclusion that she was not, in fact, responding to treatment. But he had to give the treatment a chance first.

Mr. Fraser

I think that the blood test, such as it was, was on 11th July. Most of us have had the kind of blood test that one gets when one offers a pint of blood to the Blood Transfusion Service. It seems to me that the Minister might have admitted that possibly the medical officer was at fault in accepting a blood test which was carried through for quite another purpose. He might have, if he had thought that it was probably anaemia, sought to find out for himself by taking a blood test some time on or after the 19th July.

Let the Minister think again about the shock which he has given the House in assuring us that it was perfectly normal for this woman, on her discharge from the Service, to be given a certificate saying that she was fit for service anywhere, when the medical officer issuing the certificate strongly advised her to go into hospital.

Adjourned accordingly at fourteen minutes to Ten o'clock.