HC Deb 19 December 1961 vol 651 cc1317-28

Motion made, and Question proposed, That this House do now adjourn.—[Mr. J. E. B. Hill.]

11.58 p.m.

Mr. Leslie Hale (Oldham, West)

The Royal Commonwealth Society for the Blind is an institution which has won the admiration and respect of everyone who has come in touch with its work either here or abroad. It prides itself—and I am not now making a political point—on being a Commonwealth organisation in the true spirit of the Commonwealth. I came across its work in Kenya in 1952. For some years I had no connection with it, and certainly the Society has had nothing to do with the inspiration of the debate, although it would be true to say that its work has inspired it.

Some years ago I met Mr. Wilson, the director, himself a sightless man but nevertheless one of very great vision and a forceful and charming personality, who, on a small budget, has been rendering service to the most distressed people in the world, and who has a right to be proud of the work the Society has achieved in face of a very distinct limitation of means and of expenditure.

When I was in Nigeria in October last year, driving one day along a country road, I came across a sign which said "Royal Commonwealth Society for the Blind." So I paid a wholly unpremeditated visit and was shown through the little station where one woman was in charge of a settlement of totally blind and totally incurable people, most of them suffering from onchocerciasis. Many of them were being trained in a station which was providing them with the best housing conditions they had ever known. Nevertheless, it was not very much better—and one would not expect it—than the accommodation we might provide for convicted prisoners.

In a small, open brick built home, with a table and two beds were two totally blind men who would be there for a four-months' training period. Thanks to this brilliant and devoted woman, they would be able to go back to their native villages, but then they might well find there was no welcome for them and that wives had gone because the harsh realities of poverty often impose hard decisions. They would go back, blind, and try to win a subsistence from a piece of bush; to cut away the brush and plant the seeds which had been provided for them and try to practise the techniques taught them at the centre, where the work was on hard and tropical ground and where they had to obtain added silt in order to enrich the soil. It was a most wonderful thing to see, and that developed my own interest in these matters.

I read in the Bibliotheque Nationale M. Toulart on the "Ocular manifestations of human trypanosomiasis", but I do not propose to develop that because there are conclusions not confirmed by Dr. Rodger on his most recent survey in West Africa. He has stated that Tryparsimide used in an attempt to cure trypanosomiasis often produces ocular symptoms.

I will not develop that, but rather say one brief word about the general medical conditions. In a racy and attractive book, Dr. Robert Collis has described some of his work at Ibadan and a visit to the World Health Organisation when penicillin was being injected for yaws. At one small village there was a queue of 1,400 people, nearly all infected with yaws. There were three men to give the injections—one to identify the disease as yaws, one to scrub the buttock, and another to jab the hypodermic needle in; and the patients went away with an almost certain cure from a single injection. That was 1,400 people treated in one day. It must have looked rather like one of the German extermination camps during the last war, with the great difference that the one gave death and the other gave life.

At Ibadan there was a wonderful teaching hospital, but the moment it opened mothers and children came in hundreds every day, and the staff had to abandon its plans, saying, "We cannot turn these sufferers away". It is in that spirit that I turn attention to this dreadful disease. The magnitude of it is partly shown by the size of the figures which are often uncertain. In Malaya, the number of blind people has been variously estimated in a few years from 5,000 to 74,000. The Royal Commonwealth Society has published a figure of 650,000 blind people today in the thirty-nine countries of the Commonwealth. Dr. Rodgers' computation shows that 1 per cent. of the population of Nigeria was blind; and perhaps 3 per cent. in Ghana, with a smaller population.

Those are terrible figures, and one is entitled to ask what is being done about a disease of which, as every report says, still very little is known and towards a cure for which still little progress is being made. I therefore optimistically put down on 11th December a Question to the Minister for Science. The Parliamentary Secretary for Science replied: Research into the causes and treatment of onchocerciasis and the control of the vector fly is being actively pursued in a number of centres in West Africa and elsewhere and I am advised that there is no reason to believe that shortage of funds is inhibiting research in this field."—[OFFICIAL REPORT, 11th December, 1961; Vol. 651, c. 16.] I read that reply with the feeling that I could not express my views about it in Parliamentary language, so that there was nothing more to do about it except, perhaps, to recall the story of the man who wrote, "My shorthand-typist, being a lady, cannot take down what I think. I being a gentleman, cannot say it. You, being neither, might be capable of guessing."

I therefore decided to put down Questions to find out in detail what Her Majesty's Government were doing in this matter. I received an Answer from the Secretary for Technical Cooperation—the matter having been transferred after the Minister for Science had mucked it up—and the answer, in verbose detail, was "Nothing". I had a long written reply that this was being done in Kenya and that was being done in Ghana—but by the local Governments. "I am not my brother's keeper," says the Secretary for Technical Co-operation. "These people have self-government; they should do it themselves." The right hon. Gentleman said that things were being done in Uganda, in Kenya, and so on, but always by the local Government. Here at home there are two scientific workers partly on this and partly on other subjects, and, roughly speaking, about £3,500 a year might cover the lot. To the Question about how much is contributed from public funds to the Royal Commonwealth Society for the Blind, the answer is "Nothing". The Secretary says that he would not even put in the Library Dr. Rodgers' magnificent report. He says it is of no general interest. But it is one of the most moving documents I have ever read, and in the two days that it has now been in the Library it has already fascinated those hon. Members who have read it.

The problem of onchocerciasis has, of course, a somewhat complex history. The onchocerca is a microfilarial worm or parasite which infects the blood in a morbid condition. The figures show that about 400 million people in the world suffer from filariasis. The vector fly in onchocerciasis is the Simulium damnosum, about which we still know very little, although a great deal of work has recently been done. It varies its habitat. We thought that it bred in waterfalls and rushing rivers, but it has been found in slow streams. Its condition and habitat in Guatemala are different from those elsewhere. It is extremely difficult, on the evidence available, to give any real information about the habitat of the Simulium.

The onchocerca develops inside the thorax. One gets the vector fly sucking the blood and absorbing the microfilariae, which develop by some curious chemical process into adult worms in its thorax, and, when it sucks blood again, injecting them back into human beings and, possibly, into animals, in a developed condition with a life of 12, 13, 14 or 15 years. They gradually make their way round the body. If they go to the scrotum they can cause elephantiasis or lymphodecanthopy. They largely go to the head, and cause this dreadful disease which, in adults, nearly always results in permanent, total and incurable blindness.

The Parliamentary Secretary for Science says that a great deal of knowledge has been acquired, there is no need to do anything else, and everything is going nicely. Every report I have read—I have seen a dozen in the past week—has a sentence which, in effect, says, "We do not know enough. Of course, this was too small an experiment. We did not have a chance." That magnificent researcher, Dr. Rodgers, said that owing to the illness of their one entomologist they were not able to deal with one of the most important points in the research, though it is fair to add that it was subsequently done on another occasion.

Professor Augustine of Harvard said: While there is no aspect of onchocerciasis on which our knowledge is complete, lack of precise information on the relation of the parasite nymphadenopathy and elephantiasis is particularly striking. Dr. Satti and Professor Kirk, in observations on the chemotherapy of onchocerciasis in the Sudan, described three cases of treatment by Hetrazan and said that, of course, three cases were quite inadequate, but they were so short of drugs that they could not study any more. That was a question of the destruction of the filaria.

I had intended to say rather more, but, in view of the time, I will try to shorten what I have to say so that the right hon. Gentleman may have ample time to reply. I shall have to pass over what I had intended to say about try-panosomiasis and the use of that research as a model, and deal mainly with the proposals which are practicable in this connection.

The Rodgers report condemns the answer which the Parliamentary Secretary for Science gave. This is an extremely difficult condition to diagnose. The onchocerca themselves are nocturnal variants. Anyone wishing to examine them must do it at certain times. The Simulium bites at certain times, and so on. Children do not easily describe symptoms, and, of course, these are symptoms which are not noted. From the time the nodule is formed, it looks very much like an ordinary tumour. Until the spread over the body, a long period elapses, and for long periods the worm achieves something like symbiosis.

The second vital fact is the predisposing condition. It may be measles, it may be illness, but it nearly always is a vitamin deficiency. One of the most hopeful things I saw in Nigeria was a group of condemned but reprieved murderers in the prison at Lagos being used for dietetic experiments in order to discover protein substitutes which could provide a little extra nutrition for the children and people of Nigeria who are short not so much of calories as of proteins and vitamins.

The Simulium damnosum in West Africa is both anthropophilic and zoophilic, but in various other parts it alters, sometimes anthropophilic, sometimes zoophilic. No one has yet found out whether the filaria are transferred from animal to man. No one knows about the relationship with animals. No one knows why some varieties are active in the Sudan, some in Tanganyika, others dormant in Kenya, and so on. No one knows the true pathogenesis of the ultimate blindness. The accounts of the affection of the anterior and posterior parts of the eye are different. Many experts feel that there may even be a different originating cause. The main suggestion in regard to the anterior part is that the damage is done when the worm dies: in the process of decomposition it produces chemical changes which rot the vital connections.

The answers to these problems are to be found, again, in terms of the Commonwealth and in terms of service. We keep sending expeditions these thousands of miles, yet nearly always they are inadequately equipped, however brilliantly they are organised, because money has to be raised, and it is not there. Why not a mobile unit? Experiments have taken place in Labrador on the destruction of the ovae, larvae and pupae of the Simulium by aeroplane. In Leopoldville there was an experiment using an Oxford plane distributing D.D.T. while flying at a height of not much more than 10 metres.

The areas in which there has been a planned attack on trypanosomiasis and destruction of the tsetse has shown that the destruction there does not greatly affect the Simulium fly. All too little is known about this. A mobile unit with a small but effective staff could do all of this effectively and really could make a great contribution towards solving one of the most serious, heartbreaking, most moving human problems that can be found anywhere in the world today.

12.15 a.m.

The Secretary for Technical Co-operation (Mr. Dennis Vosper)

I join with the hon. Gentleman the Member for Oldham, West (Mr. Hale) in paying tribute to the Royal Commonwealth Society for the Blind. That Society recently did me the honour of electing me vice-president and I am, therefore, well aware of the great interest it has in this subject.

The hon. Gentleman said that the Government had refused to make any contribution to the Society's funds. According to the information available to me, no contribution has ever been requested by the Society. I think that should be put on the record, although it in no way alters my appreciation of the Society's services.

Miss Joan Vickers (Plymouth, Devonport)

When the Society was originally formed the Government gave £10,000 to it.

Mr. Vosper

I was aware of that, but I thought that the hon. Member for Oldham, West had in mind continuing or annual contributions. I do not think that that has been in the mind of the Society. I know that my hon. Friend the Member for Plymouth Devonport (Miss Vickers) has an interest in the Society. I realise that the hon. Gentleman, in pursuing this subject, has found himself moved from Department to Department, but overseas research in developing countries is a particular interest of technical co-operation, and those knowledgeable about these two diseases generally work in association with my new Department. I hope that the Department for Technical Co-operation will be a means of focussing more attention than has been the case in the past on the problems which the hon. Gentleman has raised.

I was first aware of the interest of the hon. Member for Oldham, West in this subject when he managed to inject a reference to it into his speech dealing with the repeal of the North Atlantic Shipping Bill, and I welcome the fact that he has now had an opportunity to develop his arguments at greater length tonight.

I wish to refer particularly to one of the two diseases named in the subject of tonight's debate, trypanosomiasis, because I think that it is against the background of the progress made in respect of that disease and because it is, perhaps, the better known of the two, that one can see the progress which still must be made in respect of the other.

They are both very crippling diseases only too well known in Africa. Much progress has been made in the case of trypanosomiasis in recent years. I will, therefore, say a word about that because it will guide us when considering the second problem. If one looks at the research one finds that it is divided into two heads; firstly, the study of the life and habits of the fly, directed to the devising of means of eradication or control, and, secondly, the study of the trypanosome and the development and trial of prophylactic and curative drugs.

There have been two approaches in respect of the first disease. In Africa, research into this work has been on a co-operative basis. Countries in Africa, and countries which have interests in Africa, have all participated, and this sense of co-ordination and co-operation in respect of trypanosomiasis has been an integral part of the achievements that have been made.

About seventeen years ago the then Secretary of State for Colonial Affairs set up a Committee in this country to go into this question. It had the title of the Tsetse Fly and Trypanosomiasis Committee. It has been very active during these seventeen years. It still is active and it will become responsible to my Department as soon as arrangements for association with this work have been redefined.

The British share in trypanosomiasis research has taken three forms. In the first place, we have been associated with the setting up and maintaining of the East African Inter-Territorial Research Station in Uganda. Secondly, we have assisted with the setting up and maintaining of a similar station in Northern Nigeria. Thirdly, largely at the instigation of the United Kingdom Committee, work—this is a fairly new addition—is now being carried out in various centres in the United Kingdom as well as in overseas laboratories.

At home, these research projects are at the London School of Hygiene and Tropical Medicine, at Liverpool University, at the Liverpool School of Tropical Medicine, at the Lister Institute of Preventive Medicine and at Aberdeen University. We are in process of building a special laboratory at Bristol University, which should come into operation at some time in the coming summer.

All this work, which is in respect of trypanosomiasis, has been financed from Colonial Development and Welfare funds and during the last quinquennium amounted to just short of £1½ million. During the year 1960–61, £76,000 was spent on this research. That is quite apart from the work which has been carried on by the Medical Research Council at Mill Hill and, of course, by Colonial Governments at their own expense.

In the last Report of the Colonial Office there is, as the hon. Member for Oldham, West must know, a fairly full chapter on the work of this research, and in the forthcoming Report of the Colonial Office, to be published early next month, there will be another chapter on the development of research in trypanosomiasis. If one studies that Report, together with the results of the work that has been done, it will be seen that notable advances have been made concerning the human aspects of this disease.

We have got to the stage—this should go on the record—where this disease can be controlled and cured wherever medical science is able to reach its victims. If there is a limit in respect of trypanosomiasis concerning humans in Africa, it is simply the provision of medical services and the willingness of the sufferers to come forward for treatment.

In animal trypanosomiasis we have not, perhaps, made quite the same progress, but techniques of insecticidal sprayings to assist in the clearing of areas from the fly and the maintenance of fly-free areas have been developed. These techniques are now being applied in large areas of East, Central and West Africa.

I should like at the end to say a word about the establishment aspect of research in Africa, but before I turn to the second disease which has formed the major part of the hon. Member's speech I want to leave the House with the impression concerning trypanosomiasis that, as the records and practical experience in Africa show, there has been much advance in this problem and it is a chapter of success.

Mr. Hale

I appreciate that.

Mr. Vosper

It is important for the House to realise that we have made achievements in this respect but that the limitations now are the provision of medical services and the willingness of the population to take advantage of them.

If I may turn against that background and that disease to onchocerciasis, this affects only humans and does not affect the animal population. The House should be clear that blindness is not normally an effect of trypanosomiasis, as it is of onchocerciasis. Unfortunately, this latter disease is widespread in West Africa. As the hon. Member knows only too well, its effects are grave, particularly in the form of blindness.

If one looks at the position in East Africa, as I happened to do when I was there last week, I think it will be agreed that in Kenya at least, the disease has practically been eradicated. In Tanganyika it has been curbed and in Uganda, the third territory concerned, it has been greatly reduced by the use of D.D.T., to which the larval forms of Simulium neavei, which is the particular virus applicable, attached to fresh water crabs, are vulnerable. Research is continuing in Uganda by entomologists in the service of and paid for by the Uganda Government. Early this year, two research workers from Britain visited Uganda to conduct field investigations and they were financed by Colonial Development and Welfare funds.

I agree with the hon. Member that the position in regard to onchocerciasis in West Africa is not so happy. There has been concentrated research in West Africa for fifteen years. The main centre for research is the Helminthiasis Research Unit of the West African Council for Medical Research at Kumba, in what was formerly the South Cameroons and which has now become pant of the Cameroon Republic. There is also an outstation at Bolga Tanga in Ghana. It is now financed by the Governments of Sierra Leone, Nigeria, Ghana and Gambia. The hon. Member will realise that, with one exception, those are independent countries.

While this unit was formerly financed out of Colonial Development and Welfare funds, the unit is now financed by the independent Governments concerned, with the exception of Gambia which, of course, is in receipt of a contribution under the Colonial Development and Welfare Scheme. Therefore, finance and control of this unit, which is now in operation, is the responsibility of the independent Governments. The unit continues to investigate most of the subjects which the hon. Member mentioned. The Royal Commonwealth Society for the Blind has itself recently made an independent survey into the problem.

The hon. Member feels that not sufficient is being done. With all research there is no limit to what can be done, but the limiting factor is generally that of ideas. I suppose that it is true that the more people there are engaged on research, the more ideas may be available, but I do not know that it is entirely true to say that more finance would necessarily find a solution to this problem. That initially now rests with the West African Governments, but if technical co-operation is to mean anything, it means that this country must be willing and able to take up any application which they may make. If my Department is able to help in this direction, we are only too willing to do so if application is made to us.

There is the very acute problem of the establishment and remuneration of research workers in the whole of Africa and particularly in West Africa. As the hon. Member knows, that is a problem which must be settled fairly urgently, and that is now under consideration between my Department and the Governments concerned. We consider it essential that ways and means be found to bring about the establishment—

The Question having been proposed after Ten o'clock on Tuesday evening and the debate having continued for half an hour. Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-eight minutes past Twelve o'clock.