MULTIPLE SCLEROSIS (Hansard, 7 June 1957)

§ Mr. D. M. Keegan (Nottinghamshire, South)

It is with a sense of gratitude that I rise to discuss what I believe to be a subject of very considerable importance, that of multiple, or disseminated, sclerosis. This disease is one of the most debilitating that is known today, but there is considerable lack of public knowledge about it.

I should like to make quite clear that it is not my intention, by virtue of this debate, to spread alarm and despondency, nor do I wish it to be inferred that this disease is any more prevalent now than it has ever been in this country or that it is on the increase. I do not think that there are any grounds at all to support that contention. My reason for bringing the subject to the attention of the House is to try to assist the Multiple Sclerosis Society in its work of Looking after sufferers and to put into proper perspective the relationship of the community to the sufferers of this disease.

Perhaps of all serious diseases in this country this is the one which is least known to the man in the street. I think that most people know what infantile paralysis is. Everyone has heard of cancer, but very few realise the crippling nature of the disease of multiple sclerosis. Yet it is extremely important not to bring the spotlight of publicity on one disease, but simply to inform the public what is 1666 the nature of the disease, so that the proper community relationship can be fostered and, I hope, the cause of the sufferers furthered.

To deal with the incidence of this disease in the country today, I would point out that one person in every 1,200 suffers from multiple or disseminated sclerosis which gives a total number of sufferers of between 40,000 and 50,000 people. It is, therefore, a much more prevalent disease than infantile paralysis. The highest number of sufferers in any age group are in the young adults' category. This fact in itself makes the disease perhaps more tragic in many ways than diseases which attack children, because it takes out of circulation people of mature years at a time when their earning capacity is at the highest and it may, in the course of years, completely debilitate them to the point of absolute paralysis.

The first thing, therefore, that I should like to be widely known about this disease is its incidence and, secondly, that it attacks people in the prime of life. Thirdly, I think that it should be known that this it not, as such, a killing disease. It does not manifestly shorten the lives of those who have it; it leaves them, although paralysed, mentally as active as they were before. The worst feature, perhaps, is that it is a progressive disease. It is one which goes on from year to year, which means, as I shall try to emphasise when I discuss the question of rehabilitation, that, because it is progressive, it is a great deal harder to find useful things for these people to do.

We have had this afternoon, at the instigation of my hon. Friend the Member for Leeds, North-East (Sir K. Joseph), a short debate on the subject of rehabilitation, and I do not wish to overlap anything which has already been said, but I submit that there is a very special problem of rehabilitation among the sufferers of multiple sclerosis for the very reason that it is a progressive disease. If a man loses an arm or leg through industrial injury, or has the misfortune to be blind or deaf, he knows the extent of his injury and of his disability, and there are societies—and, indeed, the Government themselves—which do a great deal to rehabilitate that person into a useful job which he can, with luck, continue for the rest of his life. I do not say that there 1667 are no other complaints which cause a progressive degree of disability, but, on the whole, most disabilities at a certain time become completely known and people can learn to live with them and a useful job, which takes into account their disability, can be found for them.

The sufferer from multiple sclerosis does not know from day to day, or even from month to month, what the extent of his disability will be. Therefore, when he knows that he has contracted this disease, the problem of employing him is very acute indeed. The disease may well take many years to reach its fullest pitch and all those years could be spent in useful employment, but employers cannot be blamed for fighting shy of employing people who, one day, will be fit and well enough to do a job, albeit suffering from a disability, but who, next day, might well become extremely prone to industrial accident because their disability has progressed to a stage which makes it dangerous for them to do their work. When that is taken into account with the fact that the disease attacks the young adult, one realises how serious is the problem of rehabilitation.

I ask my hon. Friend the Parliamentary Secretary to say a word about the special question of rehabilitation of the multiple sclerosis sufferer and whether he will pass on my remarks to his right hon. Friend the Minister of Labour, who, of course, has an interest in this subject, too.

These facts bring one into contact with the whole problem of the young chronic sick. It is the sclerotic who forms a large part of this category. It is well known that we have excellent facilities for dealing with both the young and the old chronic sick. I do not wish the Minister to think that the Ministry's services are necessarily perfect, but services of a specialised nature exist for both these categories.

For the young chronic sick, however, it is a difficult question. When a man of, say, thirty years of age is completely paralysed because he has suffered from this disease, one can imagine what this must mean for his family. It might be impossible for him to remain at home, which, medically speaking, probably would be the best place for him; but this might not be possible because his wife has to go out to work and there is simply 1668 nobody at home to look after him. If he goes into an institution of any sort, it is more than likely that he will find himself in the geriatric wing of a hospital, where he will be among senile, old people.

When one considers that multiple sclerosis does not necessarily attack one's mental capacity and that, although completely paralysed, these people may have their wits about them entirely, one can imagine the living death that it is for the young chronic sick to find themselves, perhaps for the rest of their lives, for a large number of years as patients in a geriatric ward of a hospital. This poses a very special problem and I should like my hon. Friend the Parliamentary Secretary to give his Department's view on what is the best thing to be done in this acute problem of the young chronic sick who cannot be cared for at home.

I come now to another question, which arises from Section 29 of the National Assistance Act, 1948, with which I will deal by quoting, first, subsection (1). It states that A local authority shall have power to make arrangements for promoting the welfare of persons to whom this section applies, that is to say, persons who are blind, deaf or dumb, and other persons who are substantially and permanently handicapped by illness, injury, or congenital deformity or such other disabilities as may be prescribed by the Minister. It will be observed that that Section gives power to the local authority to provide services for people in this category. I should like to say at once that most local authorities do provide generous, efficient and humane services founded upon that Section of the Act but, regrettable though it may be, there are some local authorities that have not seen fit to take any powers under the Act to provide services for the crippled people living within their community. This means that, in some parts of the country, there are those who suffer from disabilities such as multiple sclerosis who are not getting the attention given to their more fortunate neighbours.

I have here a letter written to me by the Secretary of the Multiple Sclerosis Society, which reads: Many counties and county boroughs have welfare schemes which they pursue with varying enthusiasm and finance. Some are quite wonderful in the help, the compassion and the generosity they bring to this task. Others, including one or two notorious examples with 1669 bloated budgets, do not yet have these welfare schemes, and the sufferers who live in these areas are at great disadvantages compared with their more fortunate neighbours. It would be wrong and, indeed, out of order were I to ask for any change in the National Assistance Act, and I do not intend to do so. But I would ask the Minister to try to promote in those local communities where these facilities are not yet present a desire to help. I am quite sure that the local communities generally wish to see that cripples and those disabled for any reason are satisfactorily cared for, but, of course, the local authority is the proper authority to do this, because it has the local knowledge and the community sense for putting these things into effect. As I say, there are some that have not done so, and I ask my hon. Friend to do what he can to foster a better condition in that sense.

I have mentioned the Multiple Sclerosis Society, and I should like to say just one or two words about it. It was formed in 1953. My right hon. Friend, now the Minister of Labour and then Minister of Health, attended its inaugural meeting. From that day it has continued the excellent work which it started and, I think, with much success. It has about 6,000 members and would best describe itself as a mutual aid society.

Those who do not suffer from a disability tend too often to take a far too academic view of disease. They tend to ask whether or not there is a cure, and forget that to be disabled in the way in which multiple sclerosis disables is, in fact, to have one's whole life altered in every aspect. For instance, it can be difficult for a sufferer to walk up and down stairs, and in many cases he suffers from double vision.

It is in all the little practical problems that must be solved that this Society gives so much help, not from the medical but from what might be termed the self-help point of view. A man who has suffered from this disability for ten or fifteen years acquires an enormous amount of experience in overcoming these minor disabilities, and the Society's aim is to bring mutual aid to all sufferers of the disease.

Not long ago I was privileged to attend the annual meeting of a branch of the Society in my constituency. It was a 1670 very heart-warming occasion, because I saw how the Society brought these sufferers together to assist them in their task of overcoming their handicaps. The greatest thing that the Society can teach them is that they must learn to live with the disability. That is something that no doctor or research can do. It can be done only by friendship and understanding.

In conclusion, I should like to mention perhaps the most important feature of this disease. There is no known cure for it, and its causes are very obscure. I know that the Minister may not be in a position to give any very encouraging answer this afternoon—indeed, I am not competent to discuss the question of research here—but perhaps he would be kind enough to say a few words about what is being done to find a cure for this most depressing and distressing of diseases.

§ The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)

I welcome very much indeed the initiative which has been shown by my hon. Friend the Member for Nottingham, South (Mr. Keegan) in raising this subject today. I have two reasons, the first being that my hon. Friend has the honour or privilege, if one may so call it, of being represented in this House by myself. The second is that he has chosen quite rightly to concentrate the attention of the House on this little known and particularly sad disease. He has done it with a very right sense of perspective, neither exaggerating its extent nor minimising its consequences.

It is, in fact, one of the commonest organic diseases of the nervous system. It is commoner among women than among men. It starts, as my hon. Friend said, in early adult life, progressing, often with many relapses and remissions, to permanent paralysis and crippling. The main advance in treatment of late years has been the discovery and the demonstration that to avoid strain and fatigue helps to prevent relapses. My hon. Friend was 1671 quite right in the statistics he gave. He was correct in saying that there are about 40,000 cases in the country and about 1,500 deaths a year, due either to the disease or to its complications.

Alas, so far the cause of the disease is unknown. The treatment which can be given to it is merely palliative, but research is going on the whole time and I respond to my hon. Friend's invitation to say a few words about research. A great deal is being done under the auspices of the Medical Research Council and otherwise to try to find the cause of this curiously intractable disease. Social and geographical studies have suggested that there is a variation in the incidence of the disease, but the reason for it is not known. Fortunately, there has been no significant change in the incidence in recent years. In other words, it is not increasing but, unfortunately, it is not diminishing.

One curious feature which makes it difficult to find a cure is, as some hon. Members may know, that there are spontaneous improvements and then relapses after them accompanied by the feature that often in the course of the disease's progress the sufferer has a compensatory sense of well-being. That is making research difficult. The main effort is being concentrated on fundamental work in shedding more light on the nature and causes of demyelinisation, which is a form of degeneration of parts of the central nervous system which, in turn, leads to the appearance of symptoms of the disease.

Work is in progress at a number of centres. About £1,000 was provided by the Medical Research Council in 1956–57 towards the expenses of work of this type. One of the Council's six Rockefeller travelling fellowships in medicine has been made available to Dr. G. C. Webster of Guy's Hospital Medical School to enable him to study in the United States certain bio-chemical problems which may have a bearing on the cause of disseminated sclerosis. The need for further research on multiple sclerosis is fully realised, but it is the intractable nature of the problem rather than lack of funds which hampers progress at the moment. if I can put it more simply, it is lack of bright ideas and not of cash which is holding us back.

1672 Now I turn from research to what can be and is being done for the sufferers from this disease. The full range of the services provided under the National Health Service is, of course, available to them and they share with others in benefiting from the expansion of the Service which has taken place. The domiciliary service, home nursing and home help services, are the most likely to be of benefit to them, and it is good to report in this connection that the number of home helps has trebled in the last nine years.

None the less, there are many cases for which it is not possible for the local authorities to give as full help as they desire. Behind the domiciliary services lie hospital and local authority residential services. A growing feature of both those services is the taking of a chronically ill or handicapped person into a hospital or local authority home for a period in order to give the relatives who have been looking after that sick or handicapped person a rest or break and a chance to have a holiday. It is a service the extension of which I know my Department welcomes and wishes to encourage.

Regarding hospital accommodation, my right hon. Friend is considering how far it will be practicable to group together the younger chronic sick, a category which includes sufferers from multiple sclerosis. The idea is to try to group them in one or more hospitals in each area. There are difficulties. because their numbers are comparatively few and one would wish to get them as near their homes as possible. It is, however, a matter which is under active consideration at the present time.

Lastly, there are the welfare services which the majority of local authorities are beginning to provide under Section 29 of the National Assistance Act for persons substantially or permanently handicapped. The provision they make is for visiting, for helping them and encouraging occupational activities. I noted what my hon. Friend said about local authorities which are not using their present powers. Any extensions would generally meet with the approval of the Department but these things are best initiated locally. I will see that my right hon. Friend the Minister of Labour and National Service is made aware of the views of my hon. 1673 Friend on the matter of finding jobs for those who have been rehabilitated.

I turn now to the Multiple Sclerosis Society, and I wish to echo and support everything said about its work by my hon. Friend. It organises branches and local groups all over the country to arrange mutual help and comradeship and to assist those suffering from this disease. It is desirable that local groups of the Society should always seek to work in collaboration with the county and county borough councils responsible for local health and welfare societies. Friendly liaison with these authorities is of the utmost importance in the work which the Society is trying to do. I wish it every success in its efforts to arouse wider public understanding of the disease and bring together groups of volunteers willing to render personal service to ease the lot of those afflicted.

I hope that this short debate will achieve publicity for this Society and those who suffer from this disease. I hope that attention will be drawn to the existence of the Society in the medical journals because in the long run it is the general practitioner who can help the sufferer to get in touch with the Society and to see that he has the companionship of his fellow sufferers. It is perhaps unusual at this Box to give a "puff" to a monthly newspaper. But I would draw the attention of my hon. Friend to the June issue of an admirable publication called Family Doctor which contains most sensible and balanced articles on this disease and the need to encourage patients with help and sympathy.

I congratulate my hon. Friend on bringing this matter to the notice of the House and I am sure that hon. Members will demonstrate their sympathy for those who suffer from what is at present, unfortunately, an incurable disease.