HL Deb 23 June 1892 vol 5 cc1819-27

QUESTION—OBSERVATIONS.

*LORD SANDHURST

My Lords, I have brought forward the question which stands in my name on the Paper of your Lordships' House, owing to the very great interest which is taken in the subject in the district of Fulham, and at the same time to strongly support the petition for inquiry into the case from the district, and also because of the danger which I think may occur to the successful working of the prevention of the Infectious Diseases Act of 1891. And what I am about to say to the House I have taken from the local Press where the case is reported verbatim. In regard to part of the question that I have put down, I have already got an answer, owing to the courtesy of the Permanent Secretary of the Local Go- vernment Board; but I wish to call particular attention to the severe fine which was inflicted, and the comments of the Magistrate when inflicting, it; and also to lay before the Home Office whether they consider it is advisable that the Medical Officer of Health, with a population, of 90,000 to look after, should engage in private practice. In regard to this case I found it out because I visited the hospital where this child was taken in, and, having ascertained that there was nothing whatever the matter with her when she was taken by the Magistrate's order to the Fever Hospital, I went as rapidly as I could to the Local Government Board Office to try and ensure the isolation, of this child. I also went to the Home Office and laid the matter before the Permanent Secretary, and I am extremely glad to say that I have had a communication from the Permanent Secretary of the Home Office saying that while Mr. Matthews, the Home Secretary, considers that The action of Dr. Cooney and Dr. Bruce in a case perhaps of difficult and doubtful diagnosis does not appear to him open to criticism"— and I may say at once that I have no intention of criticising the diagnosis of these gentlemen— yet, looking to the evidence subsequently produced before the Magistrate, and to the fact that on 5th June the child was removed from her mother's house to the Middlesex Hospital, and that the requirements of the Public Health Act were there by practically satisfied, he has thought it right to advise Her Majesty to remit the penalty and costs in this case. That I think is a very satisfactory and just conclusion for the Home Secretary to come to, if I may presume to say so. My Lords, the facts of this case are as follows:—On the 19th May the parish doctor was called in to see the child, Emily Williams; he considered that she was suffering from scarlet fever and gave an order for her admission into the Fever Hospital; that was not an order from the magistrate, but merely one ensuring her admission when the child was sent there. But half an hour after this parish doctor had made the examination of this child, which I understand was rather a cursory one, another doctor was called in who certified that she had no symptom whatever of scarlet fever; and the mother, under the circumstances, when the ambulance came for this child, refused to let her go. About fourteen days later this child was again seen by three medical men, Mr. Cooney, the Medical Officer of Health; Mr. Wells, the Public Vaccinator and Workhouse doctor; and Mr. Bruce, of the Fever Hospital; and these three gentlemen, all officials, concurred in the idea that the child had scarlet fever. I might say that one medical man, Dr. Clarke, had had charge of this child for a period of ten days, and had left her convalescent after some trilling ailment, and was perfectly certain that she had no trace of scarlet fever. The Medical Officer of Health nevertheless applied, on a certificate, signed by himself and his official colleagues, to the Magistrate for an order to convey this child to the West London Fever Hospital. In the meantime one of these gentlemen who did not think the child was suffering from scarlet fever telegraphed to the well-known expert, Dr. Cayley, to come and see the child, and I might mention parenthetically that Dr. Cayley, upon whom the Magistrate afterwards cast very severe aspersions, is a distinguished expert in fevers. He went down to see this case out of pure philanthropy, and had no intention or expectation of receiving any fee. He also saw the child, and came to a very strong conclusion that there were no symptoms of scarlet fever in the case. He was applied to as to what ought to be done, and he remarked that under the circumstances he could not recommend the child going to the fever hospital; but that the best way out of the difficulty would be that she should be taken to the Middlesex Hospital, where he was consulting physician, and placed under his care, and where, if the case proved to be scarlet fever, I and to which he had no doubt whatever that there was no scarlet fever, she could be isolated. I should just like to read a note which Dr. Cayley wrote to the admitting officer at the Hospital, because of the remarks of the Magistrate. He says— I should be much obliged if you would take the child in under me. There is a local dispute as to whether it is scarlatina, and if it is not admitted into the workhouse it will be sent to one of the Asylum Board Hospitals. I am satisfied it has not got scarlatina. Of course it must occur in a general hospital sometimes that a patient is taken in ailing from something or another which may eventually become scarlet fever; but there is provision made in these hospitals that, as soon as anything of the kind occurs, the patient is isolated; communication is made with the London Fever Hospital where patients pay for their treatment, and the organisation of that institution is very good; an ambulance is rapidly at the door of the place from which the communication has come, and probably in an hour or so the patient is in the hospital. This child was under the supervision in the Middlesex Hospital of Dr. Cayley and his assistant house physician, the latter of whom watches the cases during the former's absence, and also under the care of another officer called the resident medical officer, a man of considerable experience. But Dr. Cayley did not rest there. He sent to the Fever Hospital for the principal physician, a certain Dr. Phillips, who came to the conclusion, as Dr. Cayley did, that there was no symptom of scarlet fever. I do not of course defend the mother for evading this Magistrate's order; but there is ample evidence in the case that the child, when taken away, was as well as any one of your Lordships is at this moment. And your Lordships will find it difficult to believe that an officer was sent to that hospital who carried that child away to the fever hospital, where she is at this moment located. Then, in regard to the remarks of the Magistrate, he first of all characterised that letter which I have read from Dr. Cayley, as stating what was very far short of the case; and he doubted Dr. Cayley's honesty and his motives in attending this case. I do not think Dr. Cayley's reputation is likely to suffer owing to what I must term the intemperate remarks of the Police Magistrate, who appeared to be suffering from some irritation; but, as the Police Magistrate said he should like to know what the hospital authorities would say, and what the public who subscribe to the hospital would say, and what course the College of Physicians would take—I may say that I was not myself present at the next meeting of the Board of that charity—but they immediately passed a vote of confidence in Dr. Cayley; and as regards the admission of the case, I should be glad to defend his conduct against any body of subscribers who might be called together. And, more than that, I have had an opportunity of speaking to the distinguished President of the Royal College of Physicians, Sir Andrew Clarke, and he says that Dr. Cayley is one of the most highly esteemed Fellows of the College, and is undoubtedly one of the highest authorities in cases of fever that exists in London. In regard to the absolute legality of the action of the Magistrate I should like to call to the attention of the Home Office that the Act provides that, where there is not means of isolation in a house, a child or patient may be removed by the order of a Magistrate; but this patient was in a hospital where, as I have said there are means of isolation, and the patient could be well treated, in fact as well treated as if she was in the fever hospital itself. To that point I invite the attention of the noble Lord who will reply to the question. As regards isolation in a doubtful case, I went to see the Permanent Secretary of the Local Government Board, and he was good enough to make a special communication, that this child should be isolated, and Dr. Brydges, the Medical Superintendent, informed me that every care had been taken already, before my notice went to the Local Government Board, and that everything as regards isolation was satisfactory in that respect. Further, in regard to this Act, the Magistrate said that in future he should grant these orders on the certificate of the Medical Officer of Health, without allowing any discussion whatever. Now the Act says that on the certificate of any duly qualified practitioner an order may be granted. But, my Lords, does not that seem a tremendous power to put into the hands of the Medical Officer of Health, who will virtually issue all these orders himself? And, considering the very large population that this Medical Officer of Health, who is also the parish doctor, has to superintend, which really means that he has to do with a population considerably over 90,000, I do ask your Lordships whether it is advisable that the Medical Officer Health should continue in private practice as well. What I very much fear is that, if some very careful inquiry, for which I understand a Petition has been presented and very strongly supported, is not made into this case, we may succeed through the arbitrary action of officials, in making this Act, which is intended for the benefit of the whole community, extremely unpopular and almost unworkable. In support of this Petition I have thought it well to lay these facts before your Lordships. I have taken everything I have said from the public Press; and I hope the Home Office will give serious attention to the matter, which is I think one of very great importance, and that the inquiry desired may be instituted.

*LORD DE RAMSEY

My Lords, the noble Lord has put his case so clearly and so well, and has stated the details of this sad case so very fairly, that I shall detain your Lordships but a few minutes. There is hardly anything that the noble Lord has said, with the exception of the matter that I shall deal with presently relating to the Magistrate, in which I do not myself cordially sympathise with him. My Lords, this has been a bad and certainly a very sad case; and I think the very fact of the noble Lord having brought it forward in this temperate way, knowing as we all do that he is chairman of a hospital, and that a large part of his time is devoted to good works, will do a very great deal of good. With regard to the question that he has asked me, as regards the medical officer taking private practice when he has the supervision of a very large number of human lives, I cannot off-hand give an opinion upon that; I am not prepared to answer him upon the point; and that point, I think, has not been raised in his question; but with regard to what he said, towards the close of his remarks, as to the effect that the action taken in this matter may have upon the working of this Act, I think he was perfectly justified and right in what he said. The Act of course that he refers to, and which your Lordships doubtless know, is the Public Health (London) Act, 1891, and if, as the noble Lord truly says, the authority which is wielded by public officials becomes so arbitrary as to tear children away from their parents, the symptoms in those children being subject to great differences of opinion amongst doctors, then I say it is only another case where it is most absolutely necessary to have the supreme control of the Home Office to keep those officials in order. The noble Lord knows as well as I do, that the Medical Officer of Health has to be very careful in this matter as regards taking in time any cases of contagion, which may rapidly spread into disease and cause a very great amount of misery; but, at the same time, there is no question about it that when, in this case, there was a very large difference of opinion amongst most competent men on both sides, although I daresay the diagnosis of the case may have been difficult, it would have been more advisable for the Medical Officer of Health to have waited a little; and especially with such a weight of evidence against the child having scarlet fever at all. My Lords, with regard to the question which the noble Lord has put about the Magistrate, I desire to speak with the utmost caution. The Secretary of State has not had the benefit of hearing the Magistrate's views on this case, as he is away on leave of absence, and therefore I am sure the noble Lord would not wish me to make any remarks without our having been able to hear what the Magistrate has to say. The unfortunate part of this business certainly arose in what the noble Lord has called a local dispute. It was also of course intensified by the mother's refusal to allow her child to go; and, in passing I would say that although, of course, the mother behaved wrongly, at the same time she behaved most naturally; and one cannot help regarding her action with some amount of sympathy in such a case as this. My Lords, I think I have answered every part of the noble Lord's question except one, and that is with regard to isolation. The noble Lord wishes to know whether there is every means of isolation in the West London Lever Hospital. That is so. There is every facility for isolation in that Hospital.

THE EARL OF KIMBERLEY

My Lords, I merely wish to make one remark. I think my noble Friend behind me has not at all exaggerated the importance of this case. There is nothing in the world that is more dangerous, and more to be deprecated, than the unwise administration of these somewhat arbitrary laws. I entirely approve of the laws for the protection of the public health; but, if you administer those laws in the spirit in which this case was dealt with, you will set the whole population against the laws, and you will entirely fail in enforcing them at all. My Lords, the point that I do not understand at all—and I daresay the noble Lord is not in a position to answer is this: How could the Magistrate come to a decision that the child should be removed from the Middlesex Hospital where there are every means of isolation? I am not a lawyer, and I do not pretend to interpret the Act; but I am confident, as a layman, that I express the opinion of everyone who knows that. Act when I say that I believe no one ever for an instant supposed that it could be possible that a child, who was in a house where there was ample power of isolation, could by a medical officer's order be taken to a fever hospital. Undoubtedly, if there were means of isolation in a house in which I had a child ill, and I was advised by the proper medical authority that there was every means of isolation, nothing would induce me to comply with a Magistrate's order except force. I should like to know what possible ground there could be for an order to remove this child from one of the principal hospitals in this city, where there is ample means of isolation. I maintain that the child must have been complying with the provisions of the Act. With regard to the Magistrate's conduct I agree with the noble Lord that we should exercise the greatest caution in judging of magistrates doing their duty. One can only judge from the reports in the newspapers. But this I will say, that I am extremely glad the Home Office have remitted the fine; and, if they should find, as I hope they will not, from an examination of the Magistrate, that he has at all acted in the manner which the newspapers represent, I hope the Home Office will, in some way or other, endeavour to prevent such vagaries in the future. Things of this sort occur to anyone who is a Justice of the Peace and has to administer the law; but nothing in the world is so foolish as to deal with cases arbitrarily, and, where there is a doubt, to enforce the law against the feelings of the people, and with a chance of bridging the magistrate's decision into considerable opprobrium. On the other hand, I wish to say that the Magistrate's explanation may be amply sufficient to clear him of all blame, and I only say what I have said upon the supposition that it may be possible to explain what has been reported in the papers.