§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Legh.]
§ 10.20 p.m.
The Rev. Llywelyn Williams (Abertillery)
After three hours' discussion on the question of a cemetery, it may not be completely inappropriate that we should now have a short Adjournment debate on the subject of bronchitis.
Recently, we have been celebrating the tenth anniversary of the inauguration of the National Health Service. It has un- 538 doubtedly proved to be one of the great social achievements of the twentieth century. The last decade has seen the practical disappearance of some infectious diseases and great progress made in an attempt to bring to an end the ravages of tuberculosis. At the same time, it is disquieting to find that whereas the graph for deaths from tuberculosis shows a decline from 34,000 in 1930 to 24,000 deaths in 1940 and 4,000 deaths only in 1956–57, the graph for deaths from lung cancer works in the other direction: 1,489 in 1930, 5,000 in 1940 and 20,000 in 1957.
The relationship between lung cancer and cigarette smoking is definitely established. It grieves me—and I speak quite sincerely—to think that I have a number of good friends inside and outside this House who are likely to die from the horrible death of lung cancer who, if they only gave up the habit of heavy cigarette smoking could otherwise expect to live many years longer. I do beg of them to consider the urgency of the appeal I am making to them to give it up. It is not made from any attitude of virtue or busybody interference on my part, for I myself was a heavy smoker from my youth up to a few years ago. I appeal to them on the ground of established medical proof and because of my affection for them and my abhorrence of unnecessary suffering.
Smoking is also one of the factors responsible for the incidence of bronchitis in this country, although there are other factors which play a more prominent part in the development of this black spot in our national health chart. I was confronted for the first time with the facts of this scourge only last week, and they have really shaken me. The Minister of Health informed me on Monday that the number of deaths from bronchitis in England and Wales was for 1930, 19,125; 1950, 28,257, and 1955, 28,793. The figures for 1957 of 26,930 are provisional. The figures are fairly constant. There is certainly no marked improvement, and let us remember that this type of death usually follows years of anguished suffering. When the Minister gave these figures, I said in a supplementary question that in the matter of the incidence of bronchitis and deaths from that disease this was probably the worst country in the world.
539 That statement of mine seemingly made no impact whatsoever. Not a single newspaper referred to it. One would have thought that for anyone to say publicly and responsibly that this was the worst country in the world, even in any regard, would have shaken even the most phlegmatic and philosophic; but not a bit of it. I shall try to shock people again out of this ingrained fatalistic outlook in this matter.
I repeat that Britain has the worst record in the world for bronchitis. The death rate is four times as high as that in the Ruhr or industrial Belgium, and about twenty times as high as that in the Scandinavian countries. Moreover, in nearly all other countries the death-rate from bronchitis has fallen markedly since the end of the war, but in Britain the decline is slight and the real position is substantially the same as it was in 1940. Despite the introduction of new and powerful drugs, the results of treatment are often unsatisfactory. Therefore, preventive measures are now essential.
There is another aspect of this matter. The Minister was asked on Monday how many working days were lost in the past five years as a result of bronchitis. The figures were: in 1951, 26.61 million; in 1953–54, 25.62 million; in 1954–55, 25.38 million and in 1955–56, 26.87 million. The figures show no improvement in 1955–56 compared with 1951. It really is a shocking state of affairs. We depend for our survival as a great nation on the maxium industrial production, and we just cannot afford to go on like this. Some people wax indignant about the number of working days lost through strikes, but they are almost negligible when compared with the loss as a result of bronchitis. In 1951, the number of working days lost through strikes or industrial stoppages was 1,694,000, and from bronchitis 26,610,000. In 1956, industrial stoppages were responsible for the loss of 2,083,000 working days, while bronchitis was responsible for the loss of 25,380,000.
Bronchitis, of course, is highly aggravated in the heavy industrial areas. The death rate among males between the ages of 45 and 65 in 1953 shows a remarkable disparity between industrial and seaside and country towns. The rates per 100,000 were: Salford 329; Oldham 294; Dudley 540 286; Manchester 248; Wigan 246; Eastbourne only 48; Great Yarmouth 68; Southport 82; and Canterbury 86. In Salford, the death rate is three times that in the rural Lancashire. On the other hand, in Coventry where most of the industry is modern, the death rate is at the comparatively low figure of 87.
The disease is commonest among industrial workers, especially those in dusty occupations. In the mines, there is a marked difference in those employed at the coal face and those working elsewhere. Taking a standardised mortality ratio for men between 20 and 64 years of age, in 1950 the figures for mineworkers other than at the coal face were 98 and for hewers and getters 180. On the same ratio, the figure for farmers was 29.
Despite the fact that bronchitis is aggravated by non-industrial factors, such as smoking, the causative rôle played by industry appears to be substantial. The three main reasons for the high prevalence of bronchitis in industrial towns are, first, atmospheric pollution; secondly, dust at work; and, thirdly, overcrowding, leading to infection. Preventive measures are surely called for here. Atmospheric pollution is worse in Britain than elsewhere, and though we await the beneficial results of the Clean Air Act, 1956, the responsibility under that Act is not rightly placed. Local authorities vary so much in the discharge of their responsibilities. There must be a more stringent limitation of the damaging sulphur oxides which our power stations, gas stations and railways are daily discharging into the air. We are treating God's clear, pure air like a sewer.
Failure to deal adequately with dust at work is particularly common amongst the smaller industrial concerns who, as a rule, have no industrial medical officers. Why cannot we have medical inspectorates under the Minister of Health to supervise these industrial establishments? The Ministry of Labour inspectors of factories cannot possibly perform the function properly as things are today. What we need is an occupational health service, and the time is ripe to put forward a functional scheme.
My chief complaint is that the liaison between the Ministries of Health, Housing and Local Government and Labour is not what it should be. The Ministry of 541 Health, in particular, should not be isolated in its thinking from social problems. It should have as much to do with the Clean Air Act as has the Ministry of Housing and Local Government, and as much to do with the medical inspection of factories as has the Ministry of Labour. Industry need not be as dirty and dangerous as it now is, and much of our respiratory illness is unnecessary.
Finally, I would refer very briefly to the very unsatisfactory way in which we deal with the people who contract bronchitis. In bronchitis there is often no radiological change, even in the presence of severely impaired functions, and thus there is no compensation, for bronchitis is not a scheduled disease. The law at present does not admit the connection between exposure to dust at work and the bronchitis which results although this condition, with its accompanying loss of elasticity of the lung substance—emphysema—is much more disabling than straightforward pneumoconiosis. In Australia and South Africa miners' claims are more soundly tested, because the authorities there have recognised the limitations of radiological examination on its own, and increasing attention is being paid to other tests which reveal the extent of functional impairment of the lungs. In this country much bitterness can be traced to the anomalies that arise from decisions taken by panels relying on X-ray evidence alone.
One day we shall have to recast our ideas about what is fair and just compensation for workers who suffer from these respiratory diseases. In the meantime, the Ministry must spare no effort on the preventive side. It will be a very rewarding task.
§ 10.34 p.m.
§ Mr. A. Blenkinsop (Newcastle-upon-Tyne, East)
I want to emphasise our very real concern with the points made by my hon. Friend—a concern which I think would be shared by members generally. The seriousness of the situation has been recognised for a long time, and I want to ask the Minister whether, in considering the matter, he cannot call more effectively for the full support of general practitioners throughout the country in a real drive in research into the detailed work. It is the general practitioners who see these cases in the earlier stages, when it is still possible to 542 do something about them. Once the cases reach the chronic stage the task becomes almost impossible. Therefore, in addition to the preventive side of the matter, I hope that the Minister will think seriously about the possibility of getting the co-operation of general practitioners in research work.
§ 10.35 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)
The hon. Member for Abertillery (The Rev. Ll. Williams) has raised a very important question this evening, far transcending the ordinary constituency kind of interest which so often dominates Adjournment debates.
When we speak of the problem of bronchitis, we usually mean chronic bronchitis; that is to say, we are not thinking of a single or pure disease, but a condition resulting in the main from episodes of acute respiratory illness in the past of various types which result in a loss of the normal respiratory defence mechanism so that in future infection tends to descend to the chest. The respiratory tract also becomes unduly sensitive to infection or irritation. Unfortunately, once this has happened treatment becomes very difficult since it can only consist of alleviating the patient's condition and so far as possible preventing or forestalling very acute episodes.
This problem has to be tackled under three heads, research, which is all important, prevention so far as we can, and, of course, treatment. Since the condition of chronic bronchitis is irreversible, obviously we want to stop it from happening at all if we can. For this purpose we have to establish what is not yet fully known, the cause of the disease. A large body of research is being devoted to this under Government auspices, besides other work being done independently by universities and elsewhere. In reply to the hon. Member for Newcastle-upon-Tyne, East (Mr. Blenkinsop) who referred particularly to the co-operation of the general practitioner, and before coming to Government research, I might mention here a study being undertaken by the College of General Practitioners, with the support of the Nuffield Provincial Hospital Trust. This is a long-term survey, and we cannot expect quick and dramatic findings, but it is of particular interest because it is based on the 543 family doctor, who is in an especially good position to realise the extent and effect of bronchitis in daily life.
The main Government agency is the Medical Research Council, which has a number of groups at work on different aspects of the problem. Its researches are directed partly to the assessment of health hazards which result from atmospheric pollution. For instance, it is concerned with the presence and effect of sulphur dioxide in the air, and the epidemiological aspect of the matter; conducting field surveys to discover the specific relationships between the incidence of the disease and various external factors.
It is impossible to comment in detail on the lessons which the figures the hon. Gentleman quoted appear to suggest, for instance, in industrial versus rural incidence in the figures for men and women, and the difference between countries. It is to elucidate such problems that research is being undertaken by the various groups into many aspects and factors. There is no reason to doubt that industrial incidence is higher than rural. In itself, this is suggestive of possible causes, and investigations are in hand to see which are in fact involved.
There is no doubt that if a key can be found to the problem of acute bronchitis it will be found in the field of prevention, and although so much about the causes of the disease has yet to be discovered, it is certain that one of the factors most concerned in prevention is the condition of the air we breathe. The most important development in this connection is the introduction of the Clean Air Act, 1956. The implementation of that Act is a matter of my right hon. Friend the Minister of Housing and Local Government. I think it is common knowledge that the Act which became partly operative in July, 1956, became fully effective on 1st of last month. There are thus now very many safeguards against air pollution, and it is known that local authorities are using their powers under the legislation to achieve its aims.
Of course, I absolutely accept that we are not going to get a swift and dramatic result from that, but at any rate it seems to me that the necessary step has been taken there which should ensure in time, along with other measures, a diminution 544 of what is, perhaps, one of the basic causes of the seriousness of this problem.
Equally important in the prevention of this disease, and, of course, illness generally, is the advice and assistance which the general public gets from its family doctor and through the various preventive services of the local health authority. I suppose that I ought to say just a word here on the question of the connection between smoking and bronchitis, because the hon. Gentleman prefaced his remarks with some reference to it.
I should say that the circular which my right hon. and learned Friend sent in July, 1957, encouraging local authorities to publicise what is known of the connection between smoking and cancer of the lung will also have its bearing on bronchitis. We are about to request from the local authorities the results of the campaigns which they have been running in this connection, and I would expect that, as a result of that, we ought to get some helpful information which will have a bearing on this matter.
Now a third point—the treatment aspect of all this. Once a state of chronic bronchitis has developed, the aim of treatment must be to prevent, if possible, and at any rate to lessen, the effects of acute attacks. As a result of treatment, particularly with antibiotics and physiotherapy, the life expectancy of the chronic bronchitic has been extended. That means, of course, that his capacity for work has increased. Antibiotics have, of course, greatly improved the treatment of patients during the acute phases of the disease.
In addition, clinical treatment of patients could have the aim of sheltering them during a period of acute attack from those factors most likely to aggravate it. Two new developments in this connection have acquired some importance in recent years. The first is that owing to the very welcome decline in the incidence of tuberculosis the number of sanatorium beds required for that purpose has, of course, become markedly less. Some of these beds, especially those in rural surroundings away from the smoke and grime of cities, can be utilised for this purpose—not all, but some of them—and patients suffering from chronic bronchitis can be and are being treated there away from the harmful atmosphere that we associate with cities.
545 The second more recent development on the treatment side is that in a number of places there have been set aside on an experimental basis particular wards which have been fully air conditioned. As yet this has only been done or proposed in a few places. It is a little soon to say how effective it will be, but I want to draw attention to the fact because I am anxious to give the hon. Gentleman as wide a picture as I can of what we are doing in the matter.
The Rev. Ll. Williams
Before the hon. Gentleman finishes, could he possibly say a word about a possible change of attitude with regard to the compensatory, not the medical, treatment of workers who suffer from bronchitis?
§ Mr. Thompson
I feel that I should probably be trespassing on the bounds of order if I discussed arrangements which, I am sure, would involve legislation, but I have, of course, paid attention to what the hon. Member has said.
I was describing some of the clinical aspects of the treatment of chronic bronchitis, and the last two points to which I referred, namely, the use of ex-tuberculosis accommodation and the provision of air-conditioned wards, were discussed by the Standing Advisory Medical Committee in 1956. At that time, the Committee formulated no specific advice, but did commend the progress made by the regional hospital boards. Discussions held at the time with senior hospital officers for the regions showed that the boards were, in general, very conscious of the big problems involved in providing for adequate treatment for sufferers from this disease and had done 546 what they could to provide special facilities.
The hon. Gentleman made some reference to mass miniature radiography. I think he had in mind that there might be some hope of early diagnosis of the condition by this means and that this might make it possible to prevent the disease from developing. There is certainly a theoretical possibility here, but in the present state of our knowledge I do not feel that we should lean too heavily on it. In fact, much more research is needed before we know enough of the factors which may later affect the persons concerned, or of ways of preventing the early symptoms from turning into the chronic disease, and we need much more information before the possibility of early X-ray diagnosis can be turned to the advantage of the potential victims of the disease.
In conclusion, I would say that the crux of this problem is not susceptible of solution by administrative action. More knowledge is needed, and while the Government can, and do provide funds for research, we cannot dictate the pace at which research goes on, or the rate at which progress is made. Meanwhile, we do all we can, within the inevitable limits of our modern environment, with its atmospheric conditions, and the prompt and more effective treatment now possible for the serious lower respiratory infections which have, in the past, been the antecedents of chronic bronchitis should. I think, also lead to the reduction in the incidence of this distressing disease.
§ Question put and agreed to.
§ Adjourned accordingly at Twelve minutes to Eleven o'clock.