HC Deb 08 April 1960 vol 621 cc743-73

11.5 a.m.

Mr. G. W. Reynolds (Islington, North)

I beg to move, That this House calls upon Her Majesty's Government to give urgent consideration to the provision within the National Health Service of improved facilities for clinical research into the treatment of medical diseases of the kidney. We hear very little about the treatment of kidney diseases; in fact, very few people have heard of nephritis or Bright's disease until someone they know, or they themselves, are suddenly struck down with it. Then it is amazing how many other people they find who have diseases of this kind.

I must also draw the attention of the House to the fact that in 1949 6,546 people died of nephritis, according to the medical tables in the Report of the Registrar-General. By 1958, the latest figure available, such deaths had dropped to 4.078. That was a considerable fall, but there have been even larger falls in the number of deaths from certain other diseases, the most notable being tuberculosis, from which 24,538 people died in 1949. By 1958, however, with the special facilities which have been made available in recent years for the treatment of that disease, the number of deaths had dropped to 6,860, a fall of 18,000 throughout the year. Deaths from other diseases, such as cancer, have increased considerably.

I draw particular attention to the age distribution of deaths from nephritis and other forms of Bright's disease. If we look at the figure for deaths from all causes recorded by the Registrar-General in the medical tables, we find that 5 per cent. of the deaths occur between the ages of 15 and 44. If, however, we look at the figure for deaths from nephritis we find that 16½ per cent. occur in the age group 15 to 44. In fact, in that age group one finds that out of every 100 deaths among people aged between 15 and 44 four were due to nephritis. In looking at this figure, we must take into consideration the fact that the Registrar-General lists in his returns 500 diseases of various kinds which cause death and sub-classifications of such diseases. In the age group to which I am referring, four out of every 100 deaths are due to nephritis.

In fact, in that age group nephritis as reported by the Registrar-General is probably the fifth largest killer disease in this country. I stress, as reported, because I shall refer to it again in a moment or two. It ranks only after tuberculosis of the respiratory system, malignant neoplasms, chronic rheumatic heart diseases and arterio-sclerotic heart diseases. Next in importance as a killer we have the kidney diseases, Bright's disease and nephritis. I maintain that the figures recorded by the Registrar-General do not show the full extent of this problem. Thousands of deaths every year in this country, and indeed throughout the world where the international classifications are used, masquerade—I use the word deliberately —in mortality tables as heart and vascular diseases. I am certain that many of these are the end-result of kidney trouble and the resultant of hypertension. When the person dies, his death is attributed to heart disease although, if we looked back into his medical history, I believe we should find that in many cases heart disease is the result of a kidney disease which was not diagnosed while the person was alive.

Routine autopsies on people who have died from accidents and other causes tend to show that a large number of the people concerned had defective kidneys although they had not be aware of it and this had not been diagnosed. On the other hand, routine autopsies on older people of 80 to 90 who have died from accidents or other causes often show that they had perfect kidneys. This tends to show that if one is going to live to a good old age it is probably more important to have sound kidneys than any other major organ in the body, because defective kidneys can cause trouble with the other major organs.

Taking this into consideration, I think I can quite definitely say that Bright's disease and the various kinds of it, including nephritis, are probably the cause of more deaths per year than any other disease or group of diseases. I make this claim in the knowledge that if people do not accept it, and if it is not accepted by this House, at least no one is in a position to disprove it, and that is one of the reasons why this particular group of diseases needs greater study than it is getting at the present moment.

There has, however, recently been a slight new awakening into the treatment of diseases of this kind. One of our universities has appointed someone to a chair of metabolism, which will include certain aspects of the treatment of kidney diseases. There is being held in Evian in the autumn of this year the first international conference, so it is claimed, on nephrology. Nephrology is a word which has appeared in the Oxford Dictionary for many years, but which is still not fully accepted as a medical term. Nevertheless, in Europe this year we are to have what is alleged to be the first international conference on nephrology, which is to be attended by delegates from a very wide range of countries, and I hope that the Minister of Health will ensure that this country is adequately represented, because this is claimed to be the first international conference. This is not strictly true, because one was held about four years ago in London and was arranged by the United Kingdom Branch of the Renal Association.

It is worth while looking at the treatment of kidney diseases, Bright's Disease and nephritis, which has been neglected, because these are not what I might call popular diseases, like cancer, heart disease, tuberculosis and rheumatism, which catch the public imagination because the results can be seen so quickly. They are diseases which have been backed up by national organisations collecting money in order to carry out research into their treatment and final cure. Because nephritis is not popular, though that is not exactly the correct word to use, one does not hear a great deal of it, and it is this factor that is one of the reasons why research into the treatment of these diseases has so far lagged behind the research into the treatment of other diseases which have a more popular appeal.

There are many vagaries of nomenclature. For example, there is a wide range of diseases under the heading of Bright's disease, which does not help in drawing public and medical attention towards these diseases. There is inadequate knowledge of the underlying causes of various forms of kidney diseases, and, what is more important, there is no simple and spectacular remedy which can suddenly be announced one morning in the national Press which would make readers think that here was something by means of which his disease could be cured by some wonderful new treatment or other. There also seems to have been in the medical profession for a long period of years almost an acceptance of the apparent hopelessness of the case of an individual who has fallen foul of chronic nephritis. This method has militated against advancement in the treatment of this disease.

Another factor is that the onset of nephritis is often slow and completely without pain. I have heard of a case in which the first indication that there was something wrong with his kidneys was one morning when the man found he could not put his hat on, whereas in the evening he was perfectly well able to do so. It has been amazing during the last twenty years to find the number of instances in which young men of 18 or so, called for medical examination for compulsory military service, were told by the doctors of the Ministry of Labour to go home and see their own doctors because of the apparent kidney disease, of which they had had no knowledge at all until they were called for their medical examinations.

There are also many cases in which people take out insurance policies in which that is the first occasion when they realise that there is anything wrong with the kidneys, and it is a well-known fact that so far as superannuation and insurance policies are concerned, once a doctor has found out that a person has kidney disease he is usually very reluctant about recommending him to the insurance companies or accepting him into a superannuation scheme. In many cases, there is probably a good reason for that, because owing to the lack of knowledge doctors are not prepared and have not got the information on which to certify that such a person is a good insurance risk, and once the fact that there is something wrong with the kidneys has been established the person is automatically regarded as a bad risk.

All this leads to a lack of interest in the treatment of these diseases, and the atmosphere has grown up that once people have got chronic nephritis there is not a great deal that can be done for them. In almost any general hospital, and I think it goes almost without exception, there are too few patients suffering various aspects of Blights disease to enable a general consultant in the hospital to study the clinical aspects of the treatment of people suffering from these diseases. There is another factor concerning the definite deficiencies in teaching in medical schools as far as kidney diseases are concerned. I have heard directly and indirectly from many doctors who have qualified in the last twenty years sayings such as "Nobody in any hospital was interested in kidney diseases," or "I saw only one such case when a student," or "We were taught nothing about the treatment of these diseases." It is not rated very high as an examination subject, and naturally anyone going into these examinations would concentrate on some of the diseases they know which are rated more highly and are more likely to occur in the examinations which they would have to undertake. On the other hand, it can quite definitely be said that the instruction in medical schools in the pathology of renal diseases is usually very good indeed, but the treatment aspect is not very good, and it is only the treatment aspect that I am criticising.

On the other hand, pure research into the various forms of kidney disease is now going on in almost every teaching hospital in the world, and every year many thousands of papers are produced in this country, the United States, on the Continent, and in other countries, drawing attention to discoveries which have been made in pure research into the various aspects of kidney diseases, but nowhere in this country are results of this work being systematically applied, probably owing to the fact that there are not in hospitals in this country a sufficient number of patients to enable them to study and apply scientifically the results of thousands of investigations carried out into kidney diseases. We have now reached a position in which the sum of knowledge in this field is so great that it is impossible for any one consultant to know everything that is going on, and yet we are still in a position in which it is automatically assumed that any good general hospital with a good general physician consultant is capable of dealing with all kidney diseases placed before him.

The last major name, and one that is important, in the medical world is that of one who specialised, although specialists are not recognised in this field, at Guy's Hospital, where Dr. Bright worked and published his major treatise on this matter as long ago as 1827. From 1827 until the 1920s, very little work was done on the treatment and application of the discoveries in this field of treatment of these diseases. In the 1920s, work was started by a physician of Guy's Hospital taking an interest in this subject. A small renal unit was developed in Guy's Hospital during that period, and as the work progressed one of the large American charitable foundations was approached and agreed to make a substantial grant to Guy's Hospital to set up a Bright's Institute which would concentrate on the clinical aspects of renal disease.

Unfortunately—this was a few years before the war—the medical committee of the hospital, like doctors throughout the country and also throughout the world, was not keen on encouraging too much specialisation. One can understand the general attitude of the medical profession against specialisation. It is the same in any occupation. At that time money would have been available for the building of the Institute but the chance was thrown away because the medical committee did not like the idea of consultants dealing solely with renal diseases. Therefore, the medical committee opposed the proposal, and the money was not made available.

Nevertheless, the unit continued in a small form within the hospital. Then the war came, and the unit, with a large part of the hospital, was evacuated to the Kent County Council Hospital at Pembury near Tunbridge Wells. There the medical superintendent and the county medical officer and his assistant, who later took over the position of medical officer, recognised the value of the unit to the people of Kent. They realised that the work being done in the medical treatment of kidney diseases was years ahead of its time. The Kent County Council in 1940 agreed to establish at Pembury Hospital a permanent renal unit of 120 beds, and voted a sum of £10,000 to equip one of the existing wards with the special facilities required.

Unfortunately, the continuation and the toughening up of the war at that period and the capital restrictions after the war meant that the sum voted to provide immediate facilities was never used. However, the unit continued to operate as part of the general facilities of the hospital until 1958 when the physician who had moved with the unit from Guy's Hospital retired.

I was amused to see that when that doctor retired the local newspaper carried a large headline which said "His work will continue". It was recognised in Kent that a terrific amount of good work was being done by the unit. Many people were being treated, and many who had been rejected by other hospitals as completely hopeless cases were being cured. The newspaper said that the physician's work would continue, but it has not continued.

That unit, which at that time had about forty beds, was the only place in the country where research into the treatment of kidney diseases was being carried out, and it has been closed down and is no longer operating. There are available a large number of records which have been kept for many years, and it is a pity that they are not being kept up and that we have not got facilities to enable doctors interested in this matter to carry on with research into the application of the great discoveries made in the pure research field in order to ascertain whether we cannot save some lives which are at present being lost through the various types of Bright's disease.

We can draw a large number of conclusions from the experience gained with the unit both at Pembury and earlier at Guy's. The first conclusion is that those who now know something about kidney diseases, especially chronic nephritis, are realising that it is not such a killer disease as was at one time thought but that certain things can be done so that a large number of patients can be enabled to live a fairly active and reasonably healthy form of life.

The unit was beginning to achieve a national reputation and patients were being sent to it from all over the country. I would say that 50–60 per cent. of the patients admitted to the renal unit under the age of 25 had been rejected by other hospitals throughout the country as completely hopeless cases, and in many cases with only months to live. A substantial proportion of them walked out of Pembury Hospital one or two years later. Others died, of course, but large numbers are still alive today.

It is also learnt from the experience of this unit that the treatment of nephritis needs closer co-operation between the physician and the pathologist than almost any other disease. There are a terrific number of tests of all kinds which must be taken in some cases daily, in other cases twice a day and in other cases weekly. In all probability 100 beds occupied by people suffering from kidney diseases would use as much of the time of a pathological laboratory as would a general hospital with 600 or 700 patients because of the large number of tests entailed if the physician is to carry on his work in the wards.

The physician has also to be able to interpret the data obtained from the tests. He has to know what treatment to apply. My main complaint at present is that nowhere in the country is there a sufficient number of patients gathered together to enable a physician to study sufficient data in order to acquire the necessary knowledge so that he shall know properly how to treat these cases.

It is well known in the medical profession that one aspect of the treatment of kidney diseases is the use of doses of alkaline salts. I find that unless a physician knows exactly what tests are required and is able to interpret the results of those tests it will be impossible for him to give the vast, massive doses of alkaline salts which are sometimes required. Very often physicians prescribe doses of 100 units a day of the various alkaline salts, but that may not be enough. On the other hand, if the physician knows what he is doing and has the necessary data, and if it is the type of kidney disease which warrants the treatment, he will often push the dose up to 1,800-2,000 grains per day.

Some doctors when they hear of doses of this kind say that it is more than the human frame can stand, but the physician, if he understands what he is doing, knows that in some cases this treatment produces excellent results.

There is an urgent need at the present time to gather together a sufficient number of patients in one unit and to have the necessary staff there so that the patients can be observed and so that the remedies which are becoming available more and more and faster and faster can be tested and the reactions of the patients studied over both long-term and short-term periods. This is the reason why, in my view, a unit is required at the moment, to enable clinical research into the treatment and the causes of these diseases to be continued.

I see no reason why the unit could not be reopened at Pembury where I have no doubt a certain number of the staff have experience of the operation of the unit which closed some two years ago. My belief in this is strengthened by the fact that it is a 590-bed hospital with 233 beds empty at the moment. It has probably a bigger percentage of beds empty than any other hospital in the country, and these beds have been empty for many years.

This would not be difficult. It would not entail the expenditure of a great sum of money, although certain capital works of a minor nature would have to be carried out to adapt certain wards to this purpose. At all events, at Pembury we have a hospital which is half empty but which has been used in the past and could be used again for this type of work. I would not grumble if the unit were opened at some other perhaps more suitable premises within the National Health Service, but Pembury has had experience of the treatment of the disease and I should have thought that it would have been the first place to turn to.

I am not asking the Government to say here and now that they are prepared to open such a centre. I am merely asking that they should give urgent consideration to the matter. I realise that the amount of information which I have given the House today is not sufficient to enable a decision to be taken on a matter of this nature, but I hope that the House will accept my Motion and that the Government will accept it in the light of their having a look at the matter with some urgency and bearing in mind, if the Motion is passed, that it is the general wish of the House that something should be done. I put the matter no stronger than that. I hope that, on that sort of understanding, the hon. Lady the Parliamentary Secretary to the Ministry of Health will accept my Motion.

I have a particular vested interest in this matter. It was at Easter, 1941, that I myself first became ill with acute nephritis. After some three or four weeks I was admitted as a patient to the Radcliffe Infirmary in Oxford, which, with all due respect to my right hon. Friend the Member for Warrington (Dr. Edith Summerskill) and her known attachment to the school across the river, is probably one of the best medical schools in the country.

Nevertheless, in June, 1941, the disease having proceeded and passed through the acute stage to the sub-acute stage and something having gone wrong, I was discharged from the Radcliffe Infirmary as completely incurable and with about three months to live. This was from one of the best known teaching hospitals in the country. I was in an experimental unit under the care of one of the most eminent professors in that school, and yet I was discharged with about three months to live. I had 4–5 stone of oedema, with swelling of my arms, legs, back and everything else, and I was put into a cottage hospital to spend the remaining three months of my life.

By pure chance my parents heard of the work being done at Pembury, and on the 11th July, 1941, I was admitted as a patient there. On the 10th July, 1942, one day short of a year—I was discharged from Pembury and have been perfectly fit ever since. I spent twelve months there. I went back at two-monthly intervals for a week, and then at six monthly intervals for a week, and at various times have spent a month or six weeks there to see if any general improvement would be obtained. I have suffered no pain or inconvenience since being discharged in 1942.

Whilst there I saw patients being admitted who had been discharged as completely incurable from other hospitals. I know some of them who are still alive today and knew others who were able to leave the hospital but who later died from that disease or other diseases because the collapsed kidneys eventually caught up with them. Nevertheless, because of the work there, they were able to live several years longer than anyone would have thought, and to live fairly comfortable lives.

The amount of work at Pembury has been terrific, but it is now stopped at a time when international interest in this matter is beginning to grow. I hope that the Government and the House will accept this Motion, so that now that that interest is beginning to grow we in Britain can lead the way. We had the experience of 130 years ago when Dr. Bright, of Guy's Hospital, led the way. I hope that the Government and the House will take the opportunity of leading the way once again.

Dr. Donald Johnson (Carlisle)

On a point of order, Mr. Speaker. I did not wish to interrupt in the middle of the excellent speech of the hon. Member for Islington, North (Mr. Reynolds), to which we listened with the greatest sympathy, but he did not at the beginning read out his Motion correctly. It reads: To call attention to the need for greater facilities being made available for medical research …

Mr. Speaker

It does not. That is the notice. It goes on: "…and to move …" We derive the terms of the Motion from the words following "and to move".

Dr. Johnson

May I have a Ruling as to the scope of this debate? I came here under the impression that we were to have the debate on medical research in general. Would medical research be included in this debate, or is it to be confined entirely to kidney diseases? In any case, it is five years since we had a debate on medical research.

Mr. Speaker

The length of time since we last had a debate on medical research does not govern what I have to rule in the matter. On the terms of this Motion, the debate must be reasonably related to research into treatment of medical diseases of the kidney, and not medical research into other topics such as tuberculosis or cancer. The debate must be reasonably related to that particular research.

11.34 a.m.

Sir Hugh Linstead (Putney)

Like my hon. Friend the Member for Carlisle (Dr. D. Johnson), I regret that the debate is extremely circumscribed. I listened with great interest and sympathy to the hon. Member for Islington, North (Mr. Reynolds), and I am sure the whole House will understand that, when he looks back on his personal experiences, he feels extremely strongly about this aspect of medical research, and quite naturally desires to put it in the forefront of his advocacy.

I suggest, however, that if we are considering research into diseases of the kidney in relation to medical research as a whole, we must keep a sense of proportion. I am sure he would be the first to agree that when one examines the morbidity statistics for what I may crudely call "killing diseases" in this country, one finds—and I take the 1957 figures—that renal diseases are not very high in the list of those responsible for deaths. In 1957 the figure for kidney diseases was 4,359, whereas in some of the other diseases malignancy of various kinds was responsible for 126,000, diseases of the central nervous system 73,000, heart diseases of various kinds 165,000, and respiratory diseases 55,000.

In relation to these four groups, the figures for kidney diseases are substantially smaller, and it would be my argument that, in so far as the facilities of men, money and material were available for medical research, they ought to be directed to the particular points in the morbidity experiences of the country which are most likely to be rewarding in a major sense.

Though I recognise the hon. Member's point that these figures of deaths must, in fact, reflect the total illness and the total incapacity of people from kidney diseases, nevertheless I think we have to put kidney diseases in perspective in relation to the far more dangerous killing diseases which equally have claims on our medical research facilities.

Mr. Reynolds

I do not know whether the hon. Member was here earlier, but it is my contention—which cannot, I think, be disproved, even though I cannot prove it—that in a large proportion of deaths due to vascular diseases and diseases of the heart, in all probability weakness of the heart can be traced back to a non-diagnosed kidney disease of some kind. The fact that this statement cannot be disproved stresses the need for greater research into this aspect. I should explain that the reason why the Motion is so circumscribed has nothing to do with the Motion itself, but that a large number of Members are anxious to discuss another Motion on the Order Paper.

Sir H. Linstead

I am grateful for that explanation. The hon. Member would, I think, agree with me that one of the things reflected in what he has just said is the absence of extreme accuracy in the morbidity statistics available. Very often death is oaused not by one condition but by a series of conditions and it may be pure chance which item figures on the death certificate. Always we are groping in a fog in trying to interpret accurately the statistics that are available. The hon. Member will find that the General Register Office is analysing statistics as profoundly as it can, and the facts are likely to emerge with greater accuracy.

His main contention should be looked at very carefully. He proposed that the best way of tackling the problem of kidney diseases was by the creation of special units of quite a substantial size. I think that that is wrong and that there are certain dangers in it. The general tendency today is to expand the conception of the general hospital at the expense of the special hospital, and on the whole to try to treat patients, no matter from what they are suffering, in general hospitals—it may be in special wards in general hospitals, but not in too-highly specialised institutions. Perhaps his answer to that would be that what he has in mind is a unit in a general hospital rather than a hospital specifically devoted to this purpose, but, even so, the concentration of patients could sometimes be extremely awkward for the patient and his relatives, and that has to be weighed against the advantages of creating a highly specialised unit.

Mr. Reynolds

And the other way round.

Sir H. Linstead

Yes.

The Motion refers specifically to research facilities in the National Health Service. I would have liked to hear a little more from the hon. Gentleman about the facilities for research which the general practitioner in the Health Service, given encouragement and direction, might be able to offer, particularly in this work. As the hon. Member himself would say, I am sure that there is a great deal of sub-acute renal disease of various kinds, and it is the general practitioner more often than the hospital doctor, who is in touch with the disease, at any rate in its early stages. The development of clinical research by general practitioners, under the guidance of specialists, is something which in many subjects, of which this is a good example, should be encouraged more under the National Health Service.

I go a stage further and remind the House that some fundamental medical research has to be done outside the administrative responsibility of the Minister of Health. That is why a heavy responsibility rests upon the Medical Research Council, of which I happen to have the honour of being the House of Commons member, because the Medical Research Council is to some degree removed from the Executive. In medical research, we must not regularly concentrate upon the National Health Service doctors and forget that they are under the direct control of the Executive.

There is much to be said for certain specialist research in medicine being outside the control of the Executive. Very often a discovery can cut right across Government policy and it is extremely important that there should be a body which has a scientific responsibility to make unpleasant facts known to the public and to the Executive against the wishes of the Executive. That is seen with the Medical Research Council in relation to the hazards of radioactivity, for example, and from time to time in relation to the testing of polio vaccine where the Council has published results which are embarrassing to the Executive, but has published them because it has a scientific duty to do so.

In considering a subject of this kind, therefore, we should look to a partnership among the Medical Research Council, the hospitals under the National Health Service, including the teaching hospitals, and the general practitioners, all of whom have something to bring to a common problem. I am bound to say that when I consider the whole range of disease, I would not give the same high priority to diseases of the kidney as the hon. Member has done. I rather think that there is a danger of getting the picture out of focus. A great deal of research is going on, although it is not pinpointed in any particular institution.

When the hon. Gentleman reminds us that the result of the sort of concentration which he has in mind would be that for every 100 beds there would be a demand on the pathological service equivalent to 600 beds of other patients, one gets some idea of the distortion which might come about within the Health Service if the hon. Member's wishes were to be carried out.

Mr. Reynolds

Surely the hon. Gentleman is not using as an argument the fact that we would need a much larger pathological service at any hospital which had a large number of these patients, saying that that would distort the structure of the hospital against giving proper treatment to patients of this kind. I hope that he is not putting that forward as something desirable.

Sir H. Linstead

I am not putting it forward as something desirable, but there are various bottlenecks in some hospitals, and one of them is the pathological department. Another is the radiological department. The more demands which a specialist unit puts on radiology or pathology, the more other patients are deprived of those services, and I am using the expression "distortion" only in that sense.

I would not disagree with the hon. Gentleman if he says that more recruits are needed for the pathological service and for radiology and radiography, but we have to face a situation in which they are not there. We have to face the fact that when there are bottlenecks in the hospital service, the resulting services have to be spread fairly over all the patients who need them and must not be entirely concentrated upon one special group. I did not want to go any further than that.

I am sure that the hon. Member has done a service by drawing the attention of the House to this narrow but important matter. I hope that the time will not be too far away when we survey what badly needs surveying—the whole, general effect of medical research in this country.

11.46 a.m.

Dr. Edith Summerskill (Warrington)

We should all thank my hon. Friend the Member for Islington, North (Mr. Reynolds) for focussing the attention of the House on this aspect of research. Having listened to the hon. Member for Putney (Sir H. Linstead), who is a member of the Medical Research Council, it must be clear to the House that every fact which my hon. Friend has elicited about this disease is accurate, because the hon. Member for Putney is in a position to tell the House precisely what facilities are provided. The House must have been very shocked by what he has just said. I shall refer to his comments later.

He said that there were certain bottlenecks and not enough scientists to meet the demands. That is a deplorable admission. That is what I intended to talk about when I came here this morning and considered precisely with what aspect of the Motion I should deal.

I am sure that the House will agree that my hon. Friend has made an exhaustive study of research into renal diseases. He said that he had found that there were very limited facilities in this country, whereas in other countries this condition is taken very seriously. In the middle of the twentieth century, the hon. Member for Putney cannot approach any disease in the way he approached this, by saying that there are other things which are so much more important that we must see kidney disease, which can be fatal, in proper perspective. A fatal disease of this kind, a disease with a high morbidity rate, a disease which has disabled very many people, must be approached by the scientists with the same keenness, enthusiasm and determination to relieve humanity as they approach other diseases.

In countries like the United States of America, the U.S.S.R. and European countries, the climate of opinion towards medical research of this nature is very different from that in this country. In this country, there is a little suspicion of the individual in medicine who likes to remove himself from the human element. As a brilliant surgeon said to me last night, there is a little suspicion of research workers in medicine, rather as there is suspicion of Socialist doctors in medicine—they are a little curious and a little long-haired. In a hospital, for instance, where a medical student is sometimes chosen for his prowess in "Rugger," as we know, it is quite understandable that the individual who wishes to devote his life to research is sometimes a little suspect.

The hon. Member for Putney said that there is a shortage of research workers. In the middle of the twentieth century we all recognise that science plays an important part in research. Indeed, day after day we are told on the radio that other countries are putting weird and wonderful machines into the air. That shows the tremendous importance other countries attach to research.

Sir H. Linstead

I did not say that there was a shortage of scientific personnel. That may or may not be true, but I did not say so. I said that there were bottlenecks in hospitals in the pathological and radiological departments.

Dr. Summerskill

The hon. Gentleman knows as much about the world as I do. He knows that pathology attracts a certain kind of man who may not be encouraged. The man who devotes himself to pathology—I am thinking of my own hospital—is often a person who feels a little remote from the world and prefers to devote his mind and original thinking to pathology. The hon. Gentleman has proved the point that I have been making.

Because of the British approach to research, it is inevitable that Government research is under-financed. It reflects this curious, carefully hidden British suspicion of the individual with an original mind. As has been said by my hon. Friend and by the hon. Gentleman, the more spectacular pathological conditions, those that make the headlines, may command more attention from the research worker. Cancer and cardio-vascular diseases, particularly coronary thrombosis, may stimulate more interest than renal disease. The mortality and morbidity rate is greater.

Against that, anybody who has worked in a hospital knows that what determines the student's approach to a disease is very often the influence of a teacher. If teachers in hospitals stimulate their students—and we have the example of that great man Bright—one inevitably finds that, stemming from a brilliant teacher, there is a collection of graduates who devote themselves to a certain field of research.

I see that the hon. Member for Putney has the 1958 Report of the Medical Research Council. It is surprising that in the index to the main subjects of the research programme no mention is made of nephritis. Of course, there are dedicated individuals pursuing their researches in universities and hospitals who are concentrating on certain aspects of the disease, which, as my hon. Friend said, need not necessarily come under the index of nephritis and renal disease. Nevertheless, it is surprising that in the index to the Medical Research Council's Report there is no guide to any individual who is interested in this matter.

I have made inquiries on this subject from many people who are knowledgeable in the world of medicine. They have spoken rather as the hon. Member for Putney spoke. I forget some of his comments, but he made it clear that, although this may be touched on in certain places, he could not tell the House where a great deal of work was being done. That is wrong. We should be able to say precisely where this work is being done.

It is very pleasing to know that regional hospital boards can make grants for research. Are the various grants made by the regional hospital boards and other sources recorded together anywhere as grants for a specialised branch of research? What element of co-ordination is there between the various bodies responsible for research?

We have heard that very little is being done, and yet we know that research is being decentralised. Not only is the Medical Research Council in a position to undertake research and make grants for research, but the National Health Service and the regional hospital boards can make grants. Can we be told whether any regional hospital board has as yet made a grant for research into kidney diseases? If it has, what co-ordination is there with other organisations which are already making grants?

Last night I spoke to a rather brilliant doctor who said, "Of course I really should not complain. The regional hospital board has been very good to me". He is a brilliant man. He is not only brilliant academically, but he has a rather forceful manner and puts a case very well. I rather thought then that if the right amount of pressure were applied a grant would be forthcoming, but that renal disease may not attract a grant for the reason mentioned by my hon. Friend. There are too few people actively interested in the disease to apply sufficient pressure.

Is there any method of preventing duplication of effort? The hon. Member for Putney said that there were so many other things to be inquired into. We all know about cancer, mental disease, dental disease and cardiovascular disease on which we must concentrate our efforts. However, let us argue from that premise, which I do not accept. If that is so, if the number of people available to do the work is small, and the amount of money is limited, what do we do to prevent duplication of effort? I am well aware that there are meetings of scientific societies and that the publications of these societies are very well known, but there is an impression among many brilliant graduates that our approach in this matter is haphazard. When a grant is made by a regional hospital board how will the grant be distributed? What criteria are applied before a grant is made? What, for instance, will those interested in renal disease have to prove before a grant is made? Will the attitude that has been adopted by the hon. Member for Putney, that we must see this thing in its proper perspective and concentrate our available resources on other aspects, be adopted? That attitude is not adopted in other countries.

Two things are wanted for research. The second is money. The first is men and women with original minds. This is an important point, which relates to what the hon. Member for Putney said. Is effective action being taken to prevent brilliant young people being tempted to go to the United States of America? Yesterday I received a letter from a brilliant young man who is interested in this subject. He sent it from the United States and enclosed a photograph of a beautiful house with a streamlined car in front of it. Last year he said that he was coming back to this country in a year. It is quite clear that an attractive net has been woven round him from which he will find it very difficult to escape.

When our brilliant scientists go to the United States of America they find wonderful accommodation and amenities which they do not have in Britain. It is all done on some kind of superior hire-purchase system in the professional world, but they are offered amenities and conditions of life which they cannot obtain in this country. But it is not only a question of amenities; our scientists are denied the necessary facilities for research.

The other day I read that we are trying to persuade scientists from the United States to come here. One of the most effective ways of ensuring that we have enough scientists is to make it worth while for brilliant British men and women to stay in this country. Other Departments have at long last recognised the fact that the Government must take an interest in the post-graduate activities of scientists. This shortage, even at one of its lowest levels— pathologists—might appear astonishing, but it may not be so when we realise the way in which undergraduates and graduates in the scientific world decide what their future will be. Most of the decisions are purely fortuitous. I would draw the attention of the House to the Ministry of Labour's 100th career pamphlet, published this week, called "The Scientist". Nintey-nine pamphlets had to be issued before it was discovered necessary, in the middle of the twentieth century, to publish a pamphlet called "The Scientist", which will be a guide to undergraduates and graduates.

The Ministry says that it is looking for scientists of the top rank. We have been told that there is a bottleneck in medicine. We are told that we cannot get on with the important work of investigating renal disease because we have not enough people. The Ministry of Labour has now realised that the old, haphazard method of waiting for the scientist to come along is out-moded. One hon. Member mentioned the 1956 Report of the Medical Research Council on "The Hazards to Man of Nuclear Radiation''. The brilliant men who wrote that Report, which shocked the world, said in 1956 that if we are to make further effective research there are certain figures we must have. The Report was published in 1956, which meant that it was in rough draft months before. On Tuesday of next week we are to debate the Report stage and Third Reading of the Population (Statistics) Bill, which will provide for the obtaining of those figures. They will not be forthcoming for another year or two, which means that five or six years will have passed before we have the figures necessary for further research in this very important field. That is a deplorable commentary upon our slow and cumbersome methods in approaching scientific research.

Every word that my hon. Friend said about renal disease must be accepted by the House, because he has carried out exhaustive research in the subject. He has proved once more that our methods in scientific matters are not up to date; that we are slow and haphazard in our approach; that we have failed to co-ordinate our research; that our brilliant graduates are attracted abroad, and that our brilliant undergraduates, with tremendous potentialities, merely go through their medical courses in the hope that they will be able to find themselves in a situation in which they can make a contribution to medical science. Although the Government feel that we should finance education up to the age of 25, for some curious reason they do not direct the efforts of some of our most brilliant people after that age.

If we had been doing that, if we had adopted better methods and devoted our attention to the careers of some of our most brilliant people in hospital after they left hospital, such a debate as this would not have been necessary.

12.5 p.m.

Dr. Alan Glyn (Clapham)

We are all indebted to the hon. Member for Islington, North (Mr. Reynolds) for Taising this subject. It is, however, tragic that we should be so confined that we cannot have a debate on medical research generally. The hon. Member has explained the reason for narrowing the debate, but if some of my hon. Friends had realised this they would have put down an Amendment so that the whole field of medical research could be covered. We are glad that the hon. Member has been cured of this kidney disease, and that we now have the benefit of his great services in this House.

My hon. Friend the Member for Putney (Sir H. Linstead) mentioned the question of proportion. Although kidney diseases are of vital importance, and are lethal, we must remember that many other serious diseases affecting the human body are also lethal. It may be quite right to hold the view that the total amount of money available for the Medical Research Council—which is about £3 8 million—should be increased, but although kidney diseases are important we must regard them in their proper perspective.

It has been suggested that special units should be set up for the study of these diseases. I believe that such units may be too specialised, and that it is a good thing to have a large hospital in which every form of specialisation in respect of every disease can be carried out. I am speaking not merely from the teaching point of view—although this is of great value from the point of view of students—but also from the point of view of the desirability to see that specialisation in one field is not overemphasised, and that all ailments are treated together.

I am sure that hon. Members would agree that in medical history there are many cases of people getting into the hands of specialists whose minds are focussed entirely on one subject, so that they completely lose sight of the general medical picture.

Again, it is very important that preclinical research—physiology and pathology—should go side by side with clinical work. We have hospitals in London— St. Mary's, Westminster and Hammersmith—and also the hospital at Newcastle, where this is achieved. That is the proper way to tackle the problem. Especially in teaching hospitals, if we can combine the two aspects we can go a long way towards achieving the desired specialisation within the framework of a general unit.

The right hon. Member for Warrington (Dr. Summerskill) mentioned the question of the incentives for doctors to go abroad. One cannot deny that, and I agree that some of the working conditions in this country are not as attractive as they are on the other side of the Atlantic. But there is also a question of individual taxation. Many high-grade scientists and doctors, realising the incidence of taxation in this country, may well be attracted to other countries. But that factor is more suitable for debate on another occasion.

It has been suggested that there is insufficient correlation of information, and I agree. The most important method of circulating information is by way of medical literature, conferences and personal contacts. The Medical Research Council makes grants which are particularly generous, and I pay my tribute to the Council for giving individuals the facilities they require to study in their fields of research in other countries, and also for helping them to attend various international conferences.

There is one field in which the Council can possibly help, and that is in the question of medical literature. Medical literature comes in from all over the world and very often, unfortunately, is written in the language of the country of origin and translations are not available. I think that, perhaps, the Medical Research Council could help in providing translations, because not all members of the medical profession have either the time or the ability to read in the languages in which the results of these researches are written.

If the Medical Research Council could produce some sort of machinery whereby the pamphlets and the documents are translated and even more important I think, some way in which they are correlated, it would be of great assistance. It is extremely difficult for someone who wants to study a particular subject to find out exactly where he can lay his hands on this sort of information. It is easy enough in this country, but to get one's hands on foreign literature, which has perhaps only just been printed, is particularly difficult. I hope that my hon. Friend the Parliamentary Secretary will deal with the point when she gives us the benefit of her great knowledge later in the debate.

I wish to pay a great tribute to the Medical Research Council because I believe that it is doing a very fine job and is helping in many fields. It has the great advantage, as my hon. Friend the Member for Putney said, of not being under Government surveillance, and therefore the choice and the freedom with which it can use its available money are very much wider. I believe that it uses it in the best possible interests of medical science.

A further point is that it was a great pity that the hon. Member for Islington, North restricted his remarks rather to the National Health Service because I would like to pay a tribute to the many trusts, such as the Wellcome Trust, which in this country carry out a great deal of medical work and are not included in the National Health scheme. Of course, the Medical Research Council with its wide field is, if it wants to, able to help these trusts by perhaps giving one person a grant to work in those fields or within the framework of the research which is being done by the trust.

There is one point which I think could be developed in this country, and that is that there should be not only a correlation of the information but some machinery whereby a much better pooling of knowledge of world science is available. I understand that in the Common Market there will be a great pooling of information among the medical fraternity. I would like to see a much closer relationship with the work done, for instance, in the Soviet Union or in America, so that the results could be brought quickly to us, because the whole point about research is that one must get the information as early as possible as otherwise one may find that two or three people are working on the same projects. I understand that the Medical Research Council is extremely careful to make sure that the money it gives for research is in no way duplicated.

In my concluding remarks, I wish to pay a particular tribute to the work done by the Medical Research Council, and I hope, like everybody else, that more money will be made available. I believe that the Council has made the best possible use of the money at its disposal.

12.14 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

May I first join in the congratulations extended to the hon. Member for Islington, North (Mr. Reynolds) on the way in which he has put over his case this morning? Obviously the personal history which he described to us has in no way diminished the vigour with which he pursues his interest and the ease with which he puts it over in the House.

On the broad question of research, I have, of course, sought the aid of the Medical Research Council, and I am advised by it that there are a number of diseases which are primarily diseases of the kidney, such as nephritis and nephrosis, the cause of which is not yet fully understood. The kidney is also commonly damaged as the result of other conditions, such as generalised infections and high blood pressure.

Many university departments of physiology, biochemistry and pathology are currently undertaking studies of the kidney as part of their programme of work, and the Medical Research Council is supporting fundamental research on the kidney with a view to increasing knowledge of the causes of renal disorders, on which advances in methods of treatment necessarily depend. The Council's unit for Research on Metabolic Disturbances in Surgery, situated in the department of Urology in the General Infirmary, Leeds, is undertaking research on renal failure and on the artificial kidney as well as on calcium and magnesium metabolism and excretion.

Other aspects of the problem are being studied clinically and experimentally by individual workers holding research grants from the Council; these include studies of the nephrotic syndrome which primarily affects the kidney, of protein metabolism in relation to this condition and of the causes and effects of renal hypertension.

In addition to these specific research projects, it must be borne in mind that the Council is undertaking a very broadly based programme of fundamental research which may throw up leads relevant to work on renal diseases. Its Industrial Injuries and Burns Research Unit, for instance, is studying the pathology of renal failure in relation to the effects of shock. In this, as in all problems of medical research, any promising line of research will certainly receive adequate financial support.

The desirability of financing additional research does not depend solely on the need to get a solution of the problem, but also upon whether promising leads for research are there, and whether people with the requisite knowledge and skill are available to do it.

Regional hospital boards, boards of governors and hospital management committees are concerned with clinical research from two angles. First, they are called upon to provide facilities for clinical research by other bodies such as the universities and the Medical Research Council. No charge is made for providing the facilities and the cost of the staff and the equipment required are borne by the body doing the research.

Secondly, boards and committees themselves have powers under Section 16 (2) of the National Health Service Act, 1946, to undertake research. The scope of this research is normally limited to the sphere of day-to-day medical practice in hospitals, and larger projects are the responsibility of the Medical Research Council on the advice of the Clinical Research Board. Boards and committees have the greatest possible freedom from supervision by my Department, and are entirely responsible for the selection of the projects to be undertaken.

A memorandum was issued in April, 1957, advising hospital authorities of the extent to which they could undertake research and the scope of the work of the Clinical Research Board.

Dr. Summerskill

Could the hon. Lady say how many have adopted projects that are related to renal diseases?

Miss Pitt

I am coming to the right hon. Lady's point. She asked specifically if there was any record of what the regional hospital boards spend on research into kidney diseases. There is no public record in relation to regional hospital boards, but in relation to the other spheres, including the universities, the Medical Research Council did provide me in readiness for this debate with notes of Medical Research Council grants for research on renal diseases, giving me the names of the individuals doing the research and also notes on the research on kidneys in university clinical departments.

If I were to read all of this out—it runs to six foolscap pages—I think that hon. Members who hope to take part in the later debate would accuse me of deliberately absorbing time. I hope that the very fact that I can produce these lists will show to the right hon. Lady that a great deal is being done.

Mr. Reynolds

I am grateful to the hon. Lady for the information she has given to the House. I am aware of all this work which is going on. But would she agree with me that the information in the six pages to which she has referred —I should have thought there would have been more—is in the main related to pure research in university departments and by neurologists? What my Motion is concerned with primarily is the application of that research and the clinical aspect in hospitals.

Miss Pitt

That is so. I hope I shall come to the second and, I believe, the main point made by the hon. Gentleman.

He admits that a great deal of pure research is going on. He is concerned with the extent to which this research is being applied. I was about to explain that in renal disease there are artificial kidney units located at St. Mary's Hospital, Westminster Hospital, Hammersmith Hospital, St. Paul's Hospital, the General Infirmary at Leeds, the Royal Victoria Infirmary, Newcastle, Sefton General Hospital, Liverpool, and Princess Mary's Royal Air Force Hospital at Halton in Buckinghamshire. Other units are being planned.

St. Peter's and St. Paul's and St. Phillip's Hospitals take genito-urinary cases only. The Institute of Urology was founded in 1950 for the study of renal disease, research and for educating and training medical practitioners and others.

Mr. Reynolds

I apologise for interrupting the hon. Lady again. I am aware of what she is talking about— artificial kidneys and other things—and I am grateful for her mention of urology and surgical aspects regarding the kidney. That work is of terrific importance. But I am interested in the medical disease of the kidney, nephrology as distinct from urology.

Miss Pitt

I think the hon. Gentleman would agree that it is proper that so far as I can I should tell the House all that is being done in this field of research, not only into renal disease but renal surgery.

I was saying that the Institute of Urology was founded in 1950 for the study of this type of surgery. I must also mention something which the hon Gentleman—who has a particular interest in the subject may know about— that the November, 1959, issue of the Post-graduate Medical Journal was devoted entirely to renal disease. The articles indicate the volume of research both medical and surgical which is going on.

The hon. Gentleman mentioned the fall in the notification of renal diseases. This is a point which was taken up by my hon. Friend the Member for Putney (Sir H. Linstead), who adopted the proper attitude that we must keep this thing in proportion. There has been a considerable fall in both mortality and morbidity from nephritis and nephrosis. The figures I have show that deaths in 1946 were 7,941, which was a rate per million of the population of 196. In 1957 that figure had fallen to 4,359, a rate per million of the population of 97. In 1958 it had fallen to 4,078, a rate per million of the population of 90. On the estimated morbidity the figures which I have relate to inpatients. In 1956 there were 8,862. In 1957 there were only 3,928. I wish I could give figures for the earlier years, but they are not avail able. The figures I have given show that there has been some reduction in morbidity, and that the death rate has certainly been more than halved in the last twelve years.

Again, in order to keep this matter in proportion and to amplify the point made by my hon. Friend the Member for Putney, may I say that on average, 11 people are certified as dying of nephritis daily compared with 240 from cancer and 230 of coronary diseases. So I think it is not quite true to assert, as did the hon. Member for Islington, North, that kidney diseases kill more than any other disease. I have not for gotten the point made more than once by the hon. Gentleman that in his opinion kidney disease may be cloaked by other diseases, and that in the event of death what may be shown as the cause of death perhaps conceals the fact that it originated in a kidney disease. But if the kidney disease, that is the nephritis, is the primary cause of death in the opinion of the certifying doctor, death will still be classified as due to the kidney disease. It is often a matter for argument—there is always room for argument between doctors—but it is the fact that in the individual case there may be room for argument about whether the cardiovascular condition preceded or followed the lesion of the kidney.

The hon. Gentleman also mentioned —I can well understand why—the former renal unit at Pembury Hospital near Tunbridge Wells. I am aware of Pembury and that Dr. A. A. Osman was formerly in charge. He was a consultant physician at Guy's and a man of considerable standing, and I am glad to pay tribute to him. He took a special interest in nephritis and became convinced of the advantages of concentrating such cases in special units. When Guy's was evacuated to Pembury during the war he took the opportunity to do this and called it a renal unit. I have no evidence that the treatment he gave was in any way special or peculiar. But he was an enthusiastic man and an able physician and convinced that this kind of concentration could lead to advances. On his retirement in July, 1958, the South East Metropolitan Board decided that his work could be covered by other consultant physicians in the area. There is no reason to suppose that the cessation of the special arrangements at Pembury has adversely affected the facilities generally available for the treatment of this disease.

Specialist treatment for renal disease —here I come to the main point made by the hon. Member for Islington, North—is available at general hospitals in all parts of the country, even though the clinics may not be called renal units. The growth of specialism cannot be artificially fostered. I think that the hon. Gentleman, and those hon. Members who are medically qualified, would agree that it depends on those physicians and surgeons with special interest showing to their fellows that they have something to contribute in diagnosis, treatment or research beyond what can be found in general medical and surgical departments. Doctors cannot be ordered to take a special interest in a particular organ or group of organs.

Like those of many other major organs of the body, diseases of the kidney has been recognised as a field of special interest within general medicine and general surgery for a very long time, perhaps from the time of Hippocrates, because one version of the Hippocratic Oath includes the phrase: I will not use the knife, even on sufferers from the stone, but will give place to such as are craftsmen therein. So there must be a very long history of treating this as a speciality.

The surgical aspects of renal disease have become more specialised than the medical aspects. The most important reason why renal disease is not treated as a completely separate speciality is that it so constantly affects other organs, and indeed the whole body. Also it is, as often as not, secondary to other diseases. For example, in the treatment of nephritis due to diabetes it is more important for the diabetes to receive treatment than the nephritis. A streptococcal infection of the throat may result in merely a sore throat, in scarlet fever or in renal disease. Again, renal disease very often affects the heart and arteries, producing cardio-vascular disease, which is the province of the cardiologist and the general physician.

All over the country, however, many general physicians are "specialists" in renal disease in the sense that they take a special interest in it or some aspect of it. For instance, I believe that the present President of the Royal College of Physicians—I am sure that the hon. Member for Islington, North will be glad to learn this—is a specialist in renal disease in that sense, and I understand that the College is to hold a Symposium on Renal Disease in the near future.

May I say a brief word on the subject of artificial kidneys. Facilities for haemo-dialysis, which, I am told, is the medical name for the action of the so-called artificial kidney, have been increased greatly in the last two to three years, and, with other planned, are considered to be quite adequate. The concentration and grouping of renal cases is already done by those physicians with a special interest, and also in connection with artificial kidneys. Clearly, where an expensive piece of apparatus such as an artificial kidney is available, there is a need to concentrate the appropriate cases which can be treated by it, but, of course, an artificial kidney needs a team of skilled technicians and should be placed in large general hospitals.

I think I have shown that research into renal disease and, more particularly, the application of that research is a continuing and expanding process. I am prepared to accept the hon. Gentleman's Motion, but I would, however, add this warning note, that the question of providing beds and facilities for any special purposes in hospitals is entirely a matter for the hospital authorities. I do not say that in any way to detract from the very useful and interesting debate we have had this morning, nor do I wish to diminish in any way the personal interest of the hon. Gentleman, which I can well understand. I should like to end by saying that I am very glad that a skilled physician enabled him to come here and make his contribution to the House.

Question put and agreed to.

Resolved, That this House calls upon Her Majesty's Government to give urgent consideration to the provision within the National Health Service of improved facilities for clinical research into the treatment of medical diseases of the kidney.

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