§ 4.22 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
I wish to raise during the next few minutes the problem of pneumoconiosis in north Staffordshire. There we have two groups of workers who are specifically at risk from silicosis or pneumoconiosis; they are, of course, the pottery workers and the miners.
Because our time is limited and the Parliamentary Secretary must have an opportunity to answer as fully as is possible, I will deny myself the opportunity of speaking about pneumoconiosis and silicosis among the pottery workers, and limit myself in the main to speaking about the problem of pneumoconiosis among coal miners. I do so because pottery workers, in any event, have been alerted for a longer time than have coal miners to the dangers which they run from dust disease and its complications. Because they have been alerted longer—indeed, I first gave evidence on this matter in 1928 when legislation was first brought forward—there is an awareness of the dangers which they run that I do not always note among the miners in north Staffordshire. There is a willingness on the part of pottery workers to accept examination and case-finding which is not always noted in other parts of the country among the mining communities.
§ Mr. Harold Finch (Bedwellty)
Might I interrupt my hon. Friend? I think it will be helpful to do so. I am on the executive of the National Union of Mineworkers, and I want to point out that the miners of the country fully endorse what my hon. Friend has said and desire full-scale examinations in the mining districts on the lines that he is suggesting.
§ Dr. Stross
I cannot imagine anything that would be more helpful than such an intervention. I know that the Parliamentary Secretary and her colleagues on the Government Front Bench will be only too happy to have heard what my hon. Friend the Member for Bedwellty (Mr. Finch) has just said. He told me a few minutes ago that he speaks with the full authority of the National Union of Mineworkers. That is most helpful.
788 I want to speak this afternoon about prevention rather than treatment. If what I say be true for north Staffordshire, it must be true for every area in the country, and it must also be true for communities all over the world who have to work below ground.
I will not give many figures, but these are of some interest. The Digest of Statistics for 1954 shows that of 74 cases of pneumoconiosis complicated by tuberculosis which were discovered and suspended from work in that year, 25 came from the West Midland region; and of these, 10 came from north Staffordshire. The total number of cases of all forms of pneumoconiosis diagnosed in the West Midland region was 737, of whom 435 came from north Staffordshire alone, where only 19,000 men are employed.
The Minister wrote me a long and most interesting letter which explains to some extent why the figure for north Staffordshire and the West Midland region as a whole is high. It is because of the consciousness of the men and their willingness to come forward for examination.
I accept fully the fact that unless these cases of pneumoconiosis are complicated by an added infection—tuberculosis—the progress of the disease is very slow indeed and incapacity may not show itself sometimes for a lifetime. That has to be remembered. Indeed, of the 435 cases in north Staffordshire in 1954, only 58 were under 40 years of age. Some 387 were advised that they might remain at work in approved dust conditions, and only 33 were advised to leave the industry. Those are significant and helpful figures, and should give miners a great deal of consolation if they look at them fairly and squarely.
For a long time we have suspected—I used to speak about it before the war—that the most disabling form of pneumoconiosis, which we speak of as progressive, massive pulmonary fibrosis, is due to the action of tubercle bacillus on lungs which are already dusty. It is either in a late stage one or at stage two of pneumoconiosis that the effect of the tubercle bacillus on that kind of lung causes a flare-up and a rapid worsening, which brings about incapacity in a fairly short time—within a few years, and sometimes within two or three years.
789 One of the greatest experts in the world is Dr. Fletcher, Chief Medical Officer of the Pneumoconiosis Research Unit, near Cardiff. When lecturing in America, his lecture was reported in the "Archives of Industrial Health," January, 1955, published by the American Medical Association. At the end of two most interesting articles he states:By a combination of these three measures—dust prevention, periodic examination of miners and strict control of tuberculosis in mining communities—we would be able to ensure that our miners are in future completely protected against the present serious disabling consequences of coal miners' pneumoconiosis.That is a remarkable thing to say, and I think we all now accept that it is true.
I will not say anything about the first of those measures—the control, suppression or elimination of dust—because there is no need for me to do so. We are more advanced, I would say, than any other country on these very measures. The National Coal Board and the Ministry of Fuel and Power are not content even with the present situation, and are moving steadily forward to make sure that we get the pits as clear as possible of dust. I leave that first measure, therefore, because we know that it is being done.
The second measure—periodic examination—has not yet reached north Staffordshire. On 27th February this year, in a Written Answer, the Minister was kind enough to say:The units"—meaning mass radiography units—have already visited all mines in Warwickshire and one in Shropshire and arrangements are in hand for other visits. Requests for further visits will receive sympathetic consideration."—[OFFICIAL REPORT, 27th February, 1956; Vol. 549, c. 81.]I was delighted to have that Answer, and I am sure that I shall hear something perhaps even better today when the hon. Lady the Parliamentary Secretary to the Ministry of Health replies to this debate.
I should like to quote one other short phrase. In the Bulletin of the National Association for the Prevention of Tuberculosis, in August, 1954, the Chief Medical Officer of the N.C.B. is quoted as having said:Both management and men collaborate fully with the mass radiography units of the Health Service.790 I know that that was said in absolute good faith, but I must advise the Parliamentary Secretary that up to date in north Staffordshire, where the number of men employed by the N.C.B. is 19,000, only 22 per cent. have attended the centre. That compares with 80 per cent. for the pottery workers and 90 per cent. for the workers in the rubber industry. Not one survey at the pithead has been asked for by the N.C.B., or permitted.
§ Dr. Stross
It must be apparent that in the past the men, just as they were once in South Wales, have been nervous and reluctant to subject themselves to case-finding. It is my plea that, for the sake of themselves and their colleagues, they should not be so nervous. Up to now there has not been any survey except at the Leycett Colliery, which is part of the field research scheme.
The proposal by the N.C.B. to X-ray all entrants into the industry will not help us from a short-term point of view. It is a good thing to do in itself; it is good in isolation, but it does not mean very much if we really want to get rid of massive pulmonary fibrosis, the crippling form of this disease. It is apparent that in this debate I am pleading not only to the Parliamentary Secretary but, through her, to the N.C.B. and the men. Having heard what was said by my hon. Friend the Member for Bedwellty just now, I feel very much happier than I did two hours ago, before I heard that that was possible.
It is apparent from the figures that we have discovered a rather high percentage of cases afflicted with tuberculosis in the north Staffordshire pits. In the past three years the average suspensions for pneumoconiosis complicated by tuberculosis in north Staffordshire were 4.83 per 10,000, compared with 1.03 for the whole of Great Britain—in other words, nearly five times as many. There may be special reasons for that. These mines are deep and hot, and there has not been much case-finding conducted there.
The third proposal about the strict control of tuberculosis in mining communities implies that there shall be mass miniature X-ray of miners' families. If a second unit were made available in 791 addition to the one which is now in the area, I think that all the miners and their families could be X-rayed and all cases of tuberculosis could be attended to, treated and eliminated from the industry within a year or two. If the work is left to the one unit, which is doing such excellent work, as it has done since 1952, it must take more years than we should like. I beg the hon. Lady to bear that in mind.
The results of what I am asking for would be threefold. First, there is the worker himself. If he is infected he can be given treatment and cured. I beg the workers to remember that we can cure them, and that in curing them we protect their kinsfolk at home from infection. Secondly, it means that we can prevent the infection of other workers who work side by side with them in the pit. Thirdly, it means that we guarantee to the young folk who come into this very great and essential industry that they can work there for a long and healthy lifetime. That is an important thing which we want everyone to understand.
Once we take steps of that kind, which are easy to take—they are not costly—we can eradicate this scourge in its crippling aspect within two or three years and keep it out of the pits for ever.
I am not going to say anything about treatment now, because I have not the time to do so. We have our plans in north Staffordshire, and I think that the Parliamentary Secretary knows of them. It is a matter for the hospital management committee and the regional board. We are planning to have some 70 or 80 beds made available by the organisation. I do not believe that we should take pneumoconiotics and segregate them as though they were lepers. It is part of a chronic chest and heart disease. Therefore, they should be treated with other non-tubercular cases, if they themselves are not infected, and given encouragement and assistance of both a physical and psychological nature, so that they can be made better than they are. That is what we shall do. What I have said about north Staffordshire also applies to every mining community in this country, in Europe and in the world.
§ 4.36 p.m.
§ Miss Margaret Herbison (Lanarkshire, North)
I should like to congratulate my hon. Friend the Member for Stoke-on-Trent, Central (Dr. Stross) on choosing this subject for the Adjournment debate and on the very fine way in which he dealt with it. We all expected that that would be the case. In the two minutes to which I am limiting myself, I would say that I am convinced that everything that my hon. Friend has put forward for consideration will be backed up not only by the officials of the National Union of Mineworkers, but by almost every miner in Great Britain.
A great percentage of my case work is in dealing with these men, and sometimes with their widows and families, who are deeply affected by this disease. It seems to me that anything that can be done for the alleviation of the sufferers of this disease, and certainly to take preventive measures so that fewer and fewer will suffer from this disease, will be very worth while. Indeed, it is because of my own very deep experience of these matters, and the great unhappiness and sometimes tragedy that I have witnessed as a result of this disease, that I stress to the Minister of Health—and I am sure that the hon. Lady will convey this to the Secretary of State for Scotland—that everyone in the mining areas will be grateful for anything that can be done on the lines suggested by my hon. Friend.
§ 4.40 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
I am grateful to the hon. Member for Stoke-on-Trent, Central (Dr. Stross) for the way in which he has initiated this important debate, and not least because, judging from a series of Questions over the last few weeks, I think there have been misunderstandings which this debate gives us an opportunity to clear up.
There is no difference of opinion whatever between hon. Members and myself about the absolute need to eradicate pneumoconiosis and to provide treatment for those who need it. There has clearly been some difference of opinion as to the extent of the need and of the treatment and facilities available, and how best the need could be met. I should like first to clarify the position which was only 793 touched on by the hon. Member but which has given rise to several Questions regarding hospital treatment in north Staffordshire. It was suggested that the number of available beds should be increased, but I would emphasise that we have no evidence at all that there is any shortage of available beds to treat any case which may be referred for hospital treatment.
At the moment the number of beds available in north Staffordshire for chest cases over the four principal hospitals is 452, and 64 of them are empty. During 1955 a total of 63 patients with pneumoconiosis were treated in those beds, and at the time the survey was taken on 27th February, there were only 27 of those beds occupied by patients with pneumoconiosis. So there is not a shortage of beds.
As the hon. Member pointed out, pneumoconiosis may be detected in what might be described as three categories. It may be detected at a stage when the best course is for the man to work in "approved dust conditions,"—an expression which I always think is a contradiction in terms. He is then subject to periodical medical examinations by the pneumoconiosis medical board. I welcome the tribute paid by the hon. Member to the work which is being done by my right hon. Friends whose Departments are responsible, and by the Coal Board, in dust extraction.
Secondly, it may be detected at a later stage when associated with infection, for example tuberculosis, and for those suffering from tuberculosis sanatorium treatment may be appropriate, and is available in the area. Pneumoconiosis may be detected associated with other pathological conditions, such as disease of the heart. In those cases the appropriate treatment is given in the general wards of a hospital, where those associated pathological conditions are normally treated.
The regional hospital board has assured my right hon. Friend that facilities are available for all cases requiring hospital treatment. Cases complicated by tuberculosis are admitted to one or other of the hospitals receiving such cases. Cases where pulmonary tuberculosis is suspected are admitted for observation to the Cheshire Joint Sanatorium, in cubicle accommodation. Cases clearly not so 794 complicated, but in need of hospital treatment, are admitted to a special ward in the Stanfield Hospital, to the City General Hospital, the North Staffordshire Royal Infirmary and, in the case of older people, to various geriatric units in the group; so that there is adequate hospital accommodation available.
So far as diagnosis is concerned, I welcome the suggestions which have been made. I agree with the hon. Member that from analyses we have seen that there has, at any rate in the past, been a tendency among the mining community to be more reluctant to take advantage of the radiography service facilities than has been the case among the pottery workers, a high percentage of whom have responded. I welcome particularly the fact that the Coal Board is most anxious that everything should be done to encourage miners to take advantage of the facilities offered.
Mass miniature radiography will not always detect simple pneumoconiosis. It is best to use mass radiography to detect tuberculosis, and, for this, treatment is available. If we can detect tuberculosis in its early stages before it has led to massive fibrosis we shall have overcome a great part of this problem. The House will be aware of, and the hon. Member made reference to, the statutory requirements for medical examination in the mining industry. I understand that by the end of 1956 arrangements will be complete for all new entrants in the Staffordshire coal field to be radiologically examined. I know that that does not go so far as the hon. Gentleman would wish, but it is a substantial start. That is the responsibility of the Coal Board and of my right hon. Friend.
Mass radiography, in providing early diagnosis, and medical science which has discovered new drugs and new treatments, have jointly made so successful an attack on tuberculosis in this country that we are encouraged to believe that within a few years it could be wiped out as a major disease in this country. To that end and with all the encouragement that can be given from the much greater turnover of the patients, from the complete cures of patients and diagnosis in the early stages, I hope we shall be able to eradicate this long-standing and now old-fashioned fear 795 among certain industries that it is undesirable or unwise for whatever cause to take the opportunity of early diagnosis.
I want to emphasise that the earlier the diagnosis and treatment, the better chance there is of a complete cure. Beds are available, and although the old fear of diseases of the chest dies hard in the mining community, I cannot endorse too strongly the pleas of all three hon. Members that miners and their families should co-operate fully in the mass radiography or any other form of diagnosis in a concerted effort to minimise and ultimately eliminate these diseases.
May I say at once that the mass radiography units have never refused invitations to mining areas and are anxious to cover as much as possible of the population. A request has very recently been received by the Birmingham Regional Hospital Board from the National Coal Board that pithead surveys should be carried out in the region and arrangements made for a radiological examination of miners' wives and families. The Board has asked the director of the mass miniature radiography unit to get in touch with the medical officers of the Coal Board to discuss how this can best be done.
The units are booked some way ahead, but every effort will be made to meet requests for pithead surveys, and the Board thinks it may be possible for a unit from Birmingham to be sent to north Staffordshire in the autumn to supplement for a short period the unit already there for that specific purpose.
The hon. Member mentioned the experiment undertaken in Smith Wales where a special effort was made to bring X-ray facilities to the whole of the population. He will, of course, appreciate 796 that that community, consisting overwhelmingly of miners and their families in a relatively small area, presented particular opportunities for an investigation of that kind. I can assure the hon. Member that every effort will be made to attract as big a response as possible from the miners, and, in that, the full support which I know we shall have from hon. Members on both sides for this, and, indeed, the exhortation and example of Members who have mining communities within their constituencies, will be an enormous help in encouraging the maximum possible response to these investigations as they take place.
I am sure that the miners' unions will do all they can to encourage their members to participate. I endorse the remarks of the hon. Lady the Member for Lanarkshire, North (Miss Herbison) though she will know, having held a similar position to mine, that my writ does not run North of the Tweed. However, I can assure her that the Government are most anxious to do all they can to help eradicate tuberculosis.
I believe that the Board is also considering the possibility of appointing a physician to the Stoke group who would have a special responsibility for research in chronic lung diseases. Generally, therefore, the Board is fully alive to this problem. It has in its work the full support of the Ministry, and I can assure the hon. Gentleman that there is no lack of facilities for treatment, and, with the co-operation of the miners taking every advantage of the preventive measures offered, I can also assure him that we will do our best to help in this problem.
§ Adjourned accordingly at eleven minutes to Five o'clock.