PHYSICAL DETERIORATION.

HL Deb 20 July 1905 vol 149 cc1304-52

*THE LORD BISHOP OF RIPON

My Lords, I rise to cull attention to the Report of the Inter-Departmental Committee on Physical Deterioration, and to suggest further inquiry on the subject of infant mortality. The Report deals with a matter of very great importance. Perhaps I may be allowed at the outset, in calling your Lordships' attention to the Report, to say that on examination of it I feel sure that there are very few people who will not say that it betokens that the members of the Committee have shown the greatest care and every desire to be impartial in the conclusions at which they have arrived. But I think it is perhaps desirable to remind your Lordships that the Report does not in any sense pretend to be exhaustive; it does not cover the whole ground, and there are many points on which further investigation is needed. The Report itself frankly acknowledges that there is much ground which has not been covered, and, therefore, when we are considering this Report and also what further steps are to be taken there is ample reason for suggesting that inquiry and investigation should not cease with the publication of this Report.

There are certain points, too, on which I think the Report touches too lightly. In the first place there is what is said about the serious statement made in some quarters that the population of this country tends to decline, and to decline more rapidly among the intelligent classes than among the poorer and more illiterate classes. The Report calls attention to a solemn statement made by a professor on that subject, who warns us that in the development of civilisation it is a very ominous matter when the illiterate and ignorant classes tend to increase and the cultured, or at any rate intelligent, classes do not keep pace in the same degree. That statement is passed by as being an almost unsupported statement. I was surprised to notice that because that statement, or one very parallel to it, was made many years ago by Professor Marshall, who called attention to the fact that in France for a long time, in America in recent times, and lately in our own country, there was a tendency amongst the abler and intelligent body of the working classes not to have large families, and this, he said, constituted a danger. It seemed to me, therefore, that the subject was worthy of further consideration.

It has been stated by one who may be looked upon as a careful student of statistics that if all our large towns were divided into wards or districts it would be found that the birth-rate was higher in the poorer districts than it is in the more well-to-do districts. Taking one district, including Bethnal Green, Poplar, and Stepney, and adding the immense and poverty-stricken district of Bermondsey to it, and another district as including Kensington, Marylebone, Paddington, and Westminster, it is found that in one decade—1880–1890—the diminution of the birth-rate in the first, the poorer district, was only .5, whereas in the second, or wealthier district, it was 1.9; in other words, not only was it true that the birth-rate was lower in the wealthier district, but the decline was much more rapid amongst the affluent classes. I say, therefore, there is sufficient evidence to warrant our asking that further inquiry should be made into the matter.

But I pass from that. The other point the Committee seem to me to pass over with somewhat undue lightness is the question of the relative decline of the population. When two years ago this subject was brought before us I know there were many who hesitated to accept the statement that there was any real retardation in our population. I think if anyone had a doubt then he can have no doubt now on that point. You have only to take up the 66th Report of the Registrar-General to find that every statement that was made in that debate has been abundantly borne out by statistics. This seems to me not merely a matter of national importance, but also of great Imperial importance, because this retardation of the birth-rate, this slow checking, as it were, of the strength and populous vigour of the race, is not confined to this Island. It affects all our Colonies. The diminution of the birth-rate is as strongly marked in Australia as it is anywhere, and it is equally strongly marked in certain portions of Canada.

For one moment may I ask your Lordships to consider some of the statistics put before us on the authority of the Registrar-General? We all know that the birth-rate has dropped in the last thirty years from thirty-five in 1,000 to twenty-eight; but the Registrar-General points out that in estimating the diminished birth-power of the country it is not enough that you should compare the birth-rate with the rate of population, but with those who are possible mothers; and, taking the number of women from fifteen to forty-five years of age, and comparing the birthrate on this basis, you get the real figures of the decline of the birth force of the country. Having investigated that, what was the conclusion of the Registrar-General? He says that if the birthrate had continued as it was some thirty years ago there would have been an addition in thirty years of 2 per cent. in the population; or, in other words, the population which to-day has shown an increase of 948,000 ought to have shown an output of 1,250,000. On his statement, therefore, you have a dead loss of 300,000.

I am quite ready to admit the statement in the Inter-departmental Report that this is a feature which is common to all European countries; but the point of importance for us is not to ask whether other nations are showing a decline in the power of birth-rate, but whether, relatively to them, we are holding our own. The diminution of birth force is represented in Norway by 4 per cent.; it is represented in Germany by 10 per cent.; it is represented in France by 14 per cent.; it is represented in the United Kingdom by 15 per cent.; it is represented in England and Wales by 17 per cent.; and it is represented in Australia by 30 per cent. We look forward sometimes to the future, and, when experts tell us that we are rapidly approaching what may be called an almost stationary population, I ask myself to what end is it that providence has put into our hands these vast territories to rule. It is easy for us to speak of the number of acres which belong to the realm of the United Kingdom; it is easy to speak of an Empire upon which the sun never sets; but surely this is a question which ought to agitate and interest our minds: Will the English-speaking people in fifty or sixty years time be able to populate, be able to direct, be able to govern, be able even to hold these great inheritances?

I only refer to that to point out more emphatically what seems to me to be a crucial point arising out of this Report. If it is true that we belong to a race which is slowly slackening in its speed and diminishing its output of power from year to year, then surely it behoves us to take care that the precious little lives entrusted to us shall have the best opportunity of surviving and becoming healthy and robust. The most important feature in the Report is that which deals with infant mortality. While there have been enormous improvements in sanitation, while medical and surgical skill have made great advances, while the adult population have received the great benefit of those advances, it remains practically true that those who have received no benefit at all are the little children who are entrusted to our care. The mortality of infants, which was 154 per 1,000 forty years ago, remains at the same figure to-day.

When one takes up that very interesting Report concerning the change which has taken place in the mortality of children arising from certain diseases, one or two features strike one as having a very strange significance as bearing on this matter. Smallpox has been nearly stamped out, except in some quarters where they have peculiar views of their own; scarlet-fever has also been greatly diminished. The same is true of bronchial affections and meningitis; and, when I ask what is the gain to infant life owing to the great improvement in medical skill, I find that among boys in the town districts there ought to be twenty - eight more lives per 1,000 and among girls twenty-three more per 1,000. That, however, is far from being the case. We who know how public-spirited, how absolutely indefatigable the doctors of this country have been in this matter, cannot say otherwise than that they ought to lie honoured for what they have done. Yet, in spite of the labours of that honourable profession, not only has the gain been entirely wiped out, but the death-rate has been increased. Instead of being twenty-five per 1,000 better, we are twenty-nine per 1,000 worse.

Can we draw any inference concerning the conditions of this infant mortality? The people of this country are flocking into the towns. We have 77 percent. of the population resident in towns. An examination of the statistics shows that Blackburn, Leicester, and Preston have a mortality of 218 per 1,000; while Dorset, Wiltshire, and Hereford have a mortality of only ninety - seven per 1,000. Here we have put graphically before us the more healthy condition of the counties as compared with the towns. The mortality in twelve months in those favoured counties amounted to ninety-seven per 1,000, whereas the mortality in the three towns to which I have referred amounted to ninety-one per 1,000 in three months; that is to say, the death-rate in three months in the towns was almost equal to the death-rate in one year in the country. These are matters which make us pause.

In towns where women are employed in mills and workshops I find that the mortality among children shows a sensible increase. A certain medical officer interested in this matter grouped together three classes of towns. In the first class he put towns where women are largely employed in mills and workshops; in the second class he put towns where women are more or less employed; and in the third class he put towns where women are seldom employed. The result was that in each of these classes the death-rate amongst children dropped considerably. Another statistician took the same class of groups and found that in towns where over 15 per cent. of the women were workers there were 155 deaths, and in towns where under 10 per cent. were workers there wore only 134 deaths.

In every case where you find women working in mills there is an appreciable increase in the mortality of children. This statement has been challenged, but not, I think, in any substantial way. One medical man who challenged it only did so in the sense that he held that employment of this kind was not the sole canse which gave rise to infant mortality. We are not so foolish as to say it is the sole cause; of course there are other causes. Insanitary aieas and overcrowding may cause it; but nevertheless it is our duty to consider all the causes, and everyone who investigates the case must admit that the employment of women in mills is one of them. Women who work in mills cannot nurse their children, and the substitution of artificial for natural deeding is accompanied by an increase of infant mortality—a fact which is established by statistics relating to various countries. In Norway and Sweden, where the mothers nurse their children, the death rate is from ten to thirteen per 1,000. In Middle Europe, where the mothers nurse their children, the death irate is thirteen per 1,000; but where they artificially feed them it is forty-two per 1,000, and in lower Bavaria, where few mothers feed their own children, the rate of mortality is as high as fifty per 1,000.

One of the doctors in our children's hospitals tells us that 90 per cent. of the deaths of children occur among artificially-fed children; and, therefore, when we are dealing with this question of infant mortality we have a right to ask that the conditions of women's labour should be considered. The recommendation in the Inter-departmental Report which urges that no woman should be allowed to go back to a mill to work after childbirth without a medical certificate that she is fit to do so, is surely a very wise provision. There should also be some indication or certificate that the child is being properly cared for. Allied with that is the other question which is of such great importance, the feeding of the children themselves. The Report reminds us that a great deal can be done by utilising existing machinery. That seems to me to be one of the things that ought to be impressed more and more upon the public mind.

There exist laws which, many of us are perfectly unaware of, and which the public do not know. Let me give you one illustration. Take the milk supply. If the medical officers of health take care that the milk supply coming into a town is adequate and suitable a great deal of good may be affected. Much, for instance, has been done in London during the last three or four years to increase the supply of genuine milk. Whereas three or four years ago the number of cases in which genuine milkcame into London was 209, last year the number was found to be 417; that is to say, through the efforts of the inspectors the supply of genuine milk had been doubled. Again, whereas there were eighty-three detected eases of adulterated milk three or four years ago, that number has dropped to thirty-five, which shows what can be done by vigilance and care. If I turn to the statistics of Brighton I find that precisely the same thing occurs there. There is also this very remarkable feature, that it is necessary to discriminate between the quality of the milk supplied in wholesale places and the quality of the milk supplied in retail establishments. Over and over again the change from genuine and useful milk to inferior milk takes place at the retail establishment. Whereas there were only 7.6 cases of adulteration in wholesale places in Brighton, there was as high a figure of adulteration as thirty-eight in the case of the retail; and it is mentioned in that Report that a certain substance, the nature of which I confess I do not know anything of, was present in seventy-seven cases where milk was bought from retail establishments, but in not one single case of milk purchased from wholesale establishments. If this substance is put in to give a fictitious appearance of freshness or creaminess to the milk it is in itself objectionable. I think the people of this country are entitled to have as pure a milk supply as can be got, and there is resident in the municipal authorities a great power for dealing with the, milk supply.

The question of infant mortality is a serious one in view of the fact that our population is not growing as it once grew. When I remember that in 1859 the world deplored the carnage of 63,000 in the war between France and Austria, and that in 1866 the loss of life amounted to 51000 in the war between Prussia and Austria; when I remember that the annual wastage of children's lives in this country is equal to more than the aggregate of these two terrific conflicts and amounts to 140,000 a year; when I remember these things I ask: Is it not time that we did something to preserve to the country there young lives which might grow up to be healthy, vigorous, and serviceable to this great Empire? Whatever we can do to establish the younger generation in number and in vigour ought most certainly to be done.

We should have ideal conceptions concerning the health of the population of this country. We ought not to be content to let things be and to allow rickets, pneumonia, and diarrhœa to destroy not merely numbers, but to enfeeble the health of those who survive; because an incalculable number of those who are weakened by being exposed to these ailments, though they survive, count as a dead loss among the physical assets of this country. Every child born should have a fair chance f if life and fulness of health. Our ideal dream for the country should, be that of the ancients, who desired that their oxen should be strong to labour, and that there should be no decay, no leading into captivity, and no complaining in our streets: and seeing that I believe, as I am sure your Lordships do, that all prosperity of this kind depends on lives in ha mony with the Divine order, whether physical, moral, or spiritual, I may add those other words, of the ancient prophet— Not only happy are the people that are in such a case, but blessed are the people that, have the Lord for their God.

THE DUKE OF DEVONSHIRE,

who had given notice "To ask His Majesty's Government whether they intend to take any steps to institute an anthropometric survey, with a view to the collection of definite data bearing upon the physical condition of the population, as recommended in the Report of the Committee on Physical Deterioration," said: My Lords, before the right rev. Prelate gave notice of his Motion and his Question I had already privately communicated to my noble friend the Lord President of the Council my wish to call attention to the Report of the Inter-departmental Committee, and to ask His Majesty's Government whether they had taken, or were contemplating taking, any steps in consequence of the Report. I am extremely glad that the attention of your Lordships' House and of the public has been called to tins Report by the extremely interesting and eloquent speech of the right rev. Prelate, but I do not propose to follow any part of his observations; in the first place, because those questions to which he has devoted the whole of his observations—namely, the retardation of the birth - rate and infantile mortality—have not specially occupied my attention up to the present time; but mainly because my intention was principally to call attention to the subjects which were specially entrusted to the Committee, and neither retardation of population nor infantile mortality was amongst those which were included in the reference to the Committee.

It may be desirable that I should recall for a moment the recollection of your Lordships to the origin of the appointment of this Committee. It arose from a discussion which took place in this House now more than two years ago, when the noble Earl on the Cross Benches (the Earl of Meath) drew the attention of the Government to the Report of the Royal Commission on Physical Training in Scotland, and to the Report of the Inspector-General of Recruiting for 1902, and asked the Government whether they would be prepared to issue a Royal Commission, or a Committee of inquiry, with a view to ascertaining whether the poorer populations in our large towns are exposed to conditions which, if continued, must inevitably contribute to a low national standard of physical health and strength, seeing that if such be the case it would constitute a grave national peril. As a member of the Government at that time and Leader of the Government in your Lordships' House it was my duty to reply to the noble Earl; and while I did not for a moment seek to minimise the importance of the figures and facts which he brought before us, I had to state, on behalf of the Government, that we did not think that, there would be any advantage in the immediate appointment of a Royal Commission, at all events until the scope of the inquiry and the terms of reference which should be made for such an inquiry had been carefully considered. I did undertake, however, at the same time that this important subject should not be lost sight of by the Government, and I added, after consultation with other members of the Government, these words— What my right hon. friend the Secretary of State for War and the Home Secretary propose to do is to consult on these subjects, in the first instance, the medical profession through the Councils of the Colleges of Physicians and Surgeons. They propose to consult with them as to the best means of obtaining information, not so much as to the extent but—what appears to us to be much more important—as to the causes of this undoubted physical deficiency existing in some parts of the population, and as to the best means of remedying these deficiciences and of improving the national health and strength. After some further consideration it appeared to us that this pledge might best be carried out by the appointment of a Departmental Committee, the refeience to which your Lordships will find on the first page of the Report. That reference I do not think I need read now. It was extended shortly after the first appointment of the Committee; it covered somewhat more than I had promised, but it was not directed to extend its inquiries to those interesting subjects which have been referred to by the right rev. Prelate.

I give this short account of the origin of this Committee in order to show that the Government were fully responsible for its appointment, and although they are, of course, not responsible for any of its recommendations, they are still, I think, committed by what I stated on behalf of the Government two years ago, that they did not intend to lose sight of this important subject; and I trust that we shall hear from my noble friend that the Government have given to the recommendations of the Committee, for the appointment of which they were responsible, all the attention which they deserve. I trust also that they may be able in some respects to act upon them. This Report has now been for some time before the House, and I believe it is universally admitted to be a Report of very great value. It Has not yet, I regret to say, received on the part either of Parliament or of the public all the attention which I think it deserves, but it has already excited a very considerable amount of attention on the part of a large number of those who are interested in the various social questions with which it deals.

The Report, I think, may be considered satisfactory in so far as the Committee are able to say that the alarming statements and statistics placed before them as to the percentage of rejections of recruits offering themselves for the Army and Navy, and the other evidence placed before them, did not support the belief that progressive physical deterioration of the population was going on. They were obliged, however, to add that they were not insensible to much that was grave in the state of things disclosed, and that proceeded to point out the steps by which the Government, Parliament, and the country might be furnished with periodical data for forming an accurate estimate of the health and physique of the people. It is only this part of their recommendations upon which I propose to trouble your Lordships with a few observations.

The Committee made a large number of suggestions as to the direction in which remedial measures might be taken either by legislation or to a much greater degree by administration, either by Departments of the Government or by local authorities. But I find throughout the Report repeated expressions of their conviction that the first requisite of all is that more accurate information, more accurate knowledge of the facts relating to the health and physical condition of the people than is at present available should be obtained. I will read to your Lordships two or three of the paragraphs which specially refer to this point. The first paragraphs I will read are paragraphs 40 and 41— It appeared to them that the machinery of the ordinary type of Royal Commission was both unsuitable and inadequate; it has been seen that there are not sufficient facts obtainable from the labours of past investigators to be made the subject of comparison with any that a Royal Commission might elicit, and its modus operandi would be both slow and costly. What seems to be wanted is some permanent organisation, not necessarily on a large or expensive scale, which, under expert direction, and in collaboration with all the Departments of State concerned, shall be charged with the duty of collecting and tabulating facts which throw light upon the situation, and thus provide means by which those interested in the subject may at any moment satisfy themselves of the progress of the nation one way or another. Every witness who was examined on the subject testified to the great value of such facts in determining questions relative to the physique of the people. Though opinions differed as to the amount and method of observation necessary, it was admitted on all hands that anthropometric records were the only accredited tests available, and that if collected on a sufficient scale they would constitute the supreme criterion of physical deterioration or the reverse. It was also held that the school population and the classes coming under the administration of the Factory Acts offered ready material for the immediate application of any system that might be devised. I think the only other paragraph that I need read is one in which, after examining the details of a scheme which had been submitted to them by, I think Professor Cunningham, the Committee state— Without pledging themselves to an approval of the plan proposed in all its details the Committee are emphatic in recommending the creation of an organisation on the lines indicated; and regard it of the highest importance towards the collection of authoritive information on the subject of the present inquiry that the survey should be undertaken at the earliest possible moment. Your Lordships will see that the Committee did not commit themselves to the details of any particular plan, and I need hardly say that I am not prepared to do so either. The details of any such plan can only be worked out by the experts of the various Departments concerned, but I do not think that anybody who will examine the plan which was laid before the Committee and their description of it, can entertain the smallest doubt that such a survey is capable of being instituted without any extraordinary amount of difficulty and without necessarily involving any large amount of expense.

As I have said, this Report has received a good deal of attention from those interested in the subjects which it discusses. A very weighty memorial has, I am informed, been presented to my noble friend by the Anthropological Institute of Great Britain and Ireland, in which they express their warmest approval of the Report, and state in one or two sentences which seem to me so exactly apposite the advantages which may be expected from the institution of such a survey as has been recommended by the Committee, that I think I may be allowed to read a very short extract from their memorial. They state that— Without a continuous physical record of the people we cannot tell with certainty whether physical deterioration has taken place, or its extent, nor can we determine the conditions which influence the physical development of the population. Until these conditions are determined no remedies can be applied intelligently. It is estimated that the cost of an anthropological survey would not be greater than that of the geological survey, and a survey of the geology of the country, however useful, cannot be of greater value to the State than a survey of the physical condition of the people themselves. It is important that we should endeavour to get at these facts. It is not a question merely of deterioration; it is a much larger question than that. It is the question of the physical unfitness of a certain considerable portion of the population—the unfitness which possibly arises to a large extent from preventable causes; the question of the extent to which this unfitness prevails, and of the possibility of measures which might remedy it.

I think, my Lords, that in the discussions which have already taken place on this subject there has been some little confusion in consequence of the somewhat lax use of the words "deterioration" and "degeneration," a laxity which has, I am afraid, not been altogether removed by the instructions which were given to the Committee or by the terms of the Report of the Committee itself. Those terms appear to imply the idea that the physical condition of the people is becoming progressively worse. As I have pointed out, the Committee do not consider that that allegation is established; at all events, it is not proved. But the fact that no progressive deterioration is going on is not inconsistent with a state of things under which an increasing proportion of our population may be subject to conditions which have always existed and have always produced a certain amount of unfitness. For instance, a careful inquiry might possibly show that the physical condition of the slum population of our large cities was actually improving, and yet at the same time might show that owing to the migration of large numbers of people from the country to the towns, a larger proportion than formerly were now living under conditions unfavourable to their health and strength, and certainly there is nothing in the Report which precludes the existence of such a state of things.

This point was, I think, most effectively brought out by the evidence of Sir William Taylor, the Director-General of the Army Medical Service, which is quoted by the Committee in the second page of their Report— Sir William Taylor expressed the opinion that the idea of 'progressive physical deterioration' had occupied a much too prominent position in the minds of those who had had to consider and report as to the advisability of inquiry. The Director-General went on to say:—'Whether or not there has been, or is, progressive physical deterioration among the classes now in question is a matter of very great importance, no doubt; but, in ray opinion, it is not the chief question from a practical standpoint. To my mind the principal question for the Committee is to inquire into the causes and present extent of the physical unfitness that undoubtedly exists in a large degree among certain classes of the population. The question dealt with in my original memorandum was not that there was evidence of progressive physical deterioration of the race, either in whole or in part, but that it 19 a moat disturbing fact that from 40 to 60 per cent. of the men who present themselves for enlistment are found to be physically unfit for military service. Even if the proportion is no greater than in the past, surely it is a state of matters worthy of the closest investigation, and one which no thinking man can wish to see continue. Moreover, it would be out of keeping with the progressive spirit of the times we live in for us to be content with the consolation that we are no worse off than we were fifty or even twenty years ago. I trust that the inquiry may end in suggestions that will lead to the institution of measures which will result in bringing about a marked improvement of the physique of the classes from which our recruits are at present drawn. I do not think any of us will dissent from the views thus expressed by the Director-General of the Army Medical Service, and whether it be a progressive, or a stationary, or a diminishing evil, no time ought to be lost in putting a stop, if a stop can be put, to such unfitness as may be shown to exist among our people.

The Committee have indicated in very considerable detail a large number of measures which they think would tend to the improvement of the physical condition of the people. They are summarised in more than fifty recommendations which are to be found at the conclusion of the Report. I have, of course, no intention of going into any of those recommendations to-day; but they deal with such subjects as overcrowding in our cities, the preservation or provision of open spaces, the prevention of smoke pollution of the atmosphere, the enforcement of responsibility of urban and rural authorities, the medical inspection of factories and workshops, the feeding of school children, rural housing, and allotments, instruction in elementary schools in cookery and other health subjects, the milk supply,—which has been referred to by the right rev. Prelate—health associations, physical exercises in schools, and for boys and girls after school age clubs and cadet corps. Some of these recommendations, no doubt, would involve legislation; but by far the greater number of them, as has been pointed out by the Bishop of Ripon, might be carried out by more active administration on the part of Government Departments, and a still larger part by more active and energetic administration on the part of local authorities. It is certain that we shall obtain on the part of those authorities neither the energy to make use of the powers which they already possess, nor the capacity of using those powers wisely and usefully, without more accurate knowledge than we now possess of the extent and nature of the evils which have been dealt with.

The advantage of the knowledge of such facts as could be obtained by such a survey as has been suggested by the Committee is demonstrated by an instance of this kind. If a careful survey were to show that a striking difference between the physical condition of populations of certain large towns and districts living under very similar conditions existed, and if that could at the same time be traced to differences of administration on the part of the local authorities, there could be no doubt whatever that when public attention was called to such facts pressure would soon be applied by public opinion to those local authorities whose administration might appear to have been lax. At all events, there is no subject, in my opinion, from the point of view either of our military or industrial efficiency, on which it is more desirable, and I may say more essential, that all the knowledge should be acquired which can be acquired by systematic and scientific inquiry; and I trust that His Majesty's Government may be able to assure us that they are giving their attention to the important recommendations of this Report, and will be able to state what measures they contemplate taking upon them.

*THE EARL OF MEATH rose "To ask His Majesty's Government whether they had taken steps, or proposed to take steps to act upon any of the recommendations mentioned in the Report of the Interdepartmental Committee on Physical Deterioration; and, if so, upon which recommendations they had acted, or proposed to act, and what steps they had taken, or proposed to take, in order to carry them into action."

The noble Earl said: My Lords, although it is true, as the noble Duke has just informed you, that I was responsible for bringing to the knowledge of your Lordships on July 6th, 1903, the subject which is under discussion to-day, still I doubt whether I should have intervened in this debate had I not seen from the Notice Paper that the right rev. Prelate and the noble Duke were about to touch upon certain specific points mentioned in the Report. As the noble Duke has told you, there are over fifty recommendations made by the Interdepartmental Committee, and a good many of those recommendations were of such very great importance that I should have been sorry if any Answer had been given from the Front Bench alluding only to the subjects mentioned in the notices standing in the names of the Bishop of Ripon and the noble Duke. I hoped, by putting down the notice on the Paper which is in my name, to draw the attention of His Majesty's Government, not only to the most important, subjects already referred to, but to the others upon which the Committee submitted recommendations, in the hope not only that His Majesty's Government would consider very carefully what could be done in the matter, but that the whole subject might be thought over by the public outside.

I fully agree with the noble Duke when he says that this question is a larger one than that of the deterioration of the people. In fact, I do not know who is responsible for the title of the Report. As far as the right rev. Prelate, who seconded my Motion two years ago, is concerned, and as far as I am concerned, we did not, in this speeches we made, allude to the subject of the deterioration of physique as a progressive one and as a general one. What we said—at all events what I said—has already been quoted by the noble Duke. I asked His Majesty's Government whether they would be prepared to issue a Royal Commission or a Committee of inquiry with a view of ascertaining whether the poorer populations in our large towns are exposed to conditions which, if continued, must inevitably contribute to a low national standard of physical health and strength; and I went on to say— I do not contend that physical deterioration is taking place among all classes in this country, nor, indeed, that any class is actually deteriorating, for the exact reverse is certainly the case in regard to some sections of society. And further on I said— Nor do I even assert that degeneration has taken place among the poorer classes in either town or country. What I desire to emphasise is that even should it be proved that the average individual member of a poor town population is physically the equal or even slightly the superior of his poor town predecessor, the overwhelming increase which has taken place in recent years in the numbers of poor men and women who live in towns has completely altered the physical condition of England, and turned a negligible national defect into one of the most serious gravity. That will at once be apparent to your Lordships when you consider that the urban population of England at this moment is 77 per cent., and that of Scotland 75.6 per cent. What I desire to-day is to ask His Majesty's Government whether they have taken steps, or propose to take steps, to act upon any of the recommendations mentioned in the Report of this Committee, and, if so, upon what recommendations they have acted or propose to act, and what steps they have taken or propose to take in order to carry them into action. Excluding the subjects on which information has been requested by the right rev. Prelate and the noble Duke, the principal headings under which recommendations have been made are, first of all, a "register of sickness," not only for infectious cases but for non-infectious cases. Another very important recommendation is that of the appointment of an advisory council, which should advise His Majesty's Government and any Department interested in regard to the physical well-being of the people. In France there is already such an advisory council, which is called the ComitéConsultatif d'hygiene. Another subject of great importance is building and open spaces. I have served for some six years on the London County Council, and I do not think there was any subject in connection with which I found greater difficulty to know what was the wisest action to take than the question first of all of pulling down slum areas, and then rebuilding on those areas. Often and often I have been terribly puzzled to know what was the proper course to take. In many cases it really seemed as if there was hardly any difference, and that in either case evils must occur. The same feelings permeated many of those who acted with me, and we should have been exceedingly pleased if we could have had some sympathetic guidance and direction, and even information in regard to what had been done elsewhere, and what could and might be done.

Taking the local authorities throughout the country, I think those of your Lordships who come into contact with them must feel that there is an immense amount of ignorance in regard to the actual condition of the law, and even on the magisterial bench I have met with ignorance in regard to the statute law of these realms. Magistrates do not always know their powers, and local authorities do not always know their powers; and I cannot help thinking that the recommendations which have been made in this Report, that the Local Government Board should take a more active, sympathetic, and instructive part in enlightening local authorities in regard to their powers and duties, and the most advisable course they should take, are so important that they should receive ample consideration.

Another subject mentioned is that of smoke pollution. I have taken some interest in that subject in the Metropolis, and know that there has been a great improvement. Perhaps your Lordships may not think that is so, but I can assure you that there has been a great improvement in regard to smoke pollution in London in the last few years owing to the fact that the London County Council have had powers by which the local bodies who are unwilling occasionally to act owing to local influences are compelled to do so and fined; at all events, they are fined in this sense, that the London County Council has the power of putting the law into force and of making them pay for it. That is a case, not of ignorance, but of local influence, which prevents the local authority from doing its duty. Then, again, the Commissioners recommend that legislation should strengthen the hands of those who have to carry out the law in regard to smoke pollution.

Another very important subject which has been mentioned is that of the keeping of a register of the owners of houses. Now, this is a most important matter. If we could obtain an accurate register of the owners of houses, a great many social questions not necessary for me to enter into now would be solved. One of the great difficulties met with by all social reformers is that of knowing to whom property and houses belong, who is responsible and who is not; and it appears to me that it would not be such, a very difficult thing for the Legislature to insist upon an accurate register being kept of the owners of houses.

Important also is the recommendation with regard to medical officers of health. It must often have come to the knowledge of your Lordships that medical officers of health are unable to? act up to their consciences. They are removable by the very authorities that they ought to be able to direct by advice, and if they advise those authorities contrary to the interests of certain of the members, they know quite well that their tenure of office will be a very short one. Therefore the Committee, to my mind, very wisely recommend that these medical officers should be irremovable except by the Local Government Board. Another important subject is the medical inspection of factories. The Committee desire that the power of certifying surgeons should be extended so that they should be able to examine employees as regards their health beyond the age of sixteen, and that there should be co-operation between the inspectors of factories and medical officers of health, so that there should be no clashing of powers.

A subject of perhaps even greater importance than any I have mentioned is that of over-fatigue. The Committee recommend that a scientific inquiry should be made into the question of over-fatigue of workers in this country. I believe a great many more women lose their health through over-fatigue than is at all known to your Lordships, and, if so, legislation ought to be passed preventing women from working during the times before and after child-birth. You may say there is legislation. There is legislation to a certain extent, but it is legislation that is not carried out and which requires strengthening. Coal mines are mentioned by the Committee. They think that the medical examination of young persons should be extended to coalmines and workshops. Employment should be dependent on a medical certificate. If a medical certificate is required in the case of factories, why should there not be a similar certificate required in the case of workshops?

Then comes the question of alcoholism. Can any question be more important than that? The Committee ask for more scientific training of teachers in the laws of health. Next comes the question of education in rural schools. I am sure your Lordships will agree with me when I say that the education in rural schools at the present time is not what it ought to be, and there are many reasons why it is not. One reason I dare say has not struck many of you. It is that large numbers of the teachers in these rural schools come from the towns and know absolutely nothing about the country and care less; and when they are asked to teach the children country subjects and give them an interest in country pursuits they are absolutely at sea. I am not here to say how the remedy is to be found, but the Committee distinctly say that some steps should be taken to combat the influences which lead to the influx into the towns of the population from the country. I am persuaded that one of those influences is the fact that we have teachers in our country districts who are not in sympathy and in touch with the rural population.

Many of your Lordships last year were thinking over the question of rural housing, and I do hope that something will be done to prevent by-laws being made by local authorities which are absolutely absurd in regard to rural districts. Rural districts and town districts are completely different, and it is ridiculous that we who live in the country should be forced to build houses which are very suitable, no doubt, for the centre of London, but which are absolutely out of place when situated in country districts. Food and cookery is another most important subject, and there the Committee recommend compulsory continuation classes. I hope His Majesty's Government will not be afraid of the word compulsory. If we are to keep pace with the nations of the world we must compel our children to learn those things which are absolutely necessary to keep us in the forefront of the race of nations. Ourgirls should be taught how to prepare food and how to cook it. An admirable address was given the other day by Mrs. Flora Steele on this very subject, and she named the girls who ought to be learning these subjects, but who are not doing so, "Tam o'Shanter girls." She said she advertised the other day for a carpenter at 18s. a week and for a kitchenmaid at 17s. 9½d. a week, and received 120 applications for the position of carpenter, and not one single application for that of kitchenmaid; and yet she knows, and we all know, that if you travel about the country you meet large numbers of j these "Tam o'Shanter" girls doing, nothing for their living but simply amusing themselves. Then there is the question of adulteration. I shall not go into that, for it has already been touched upon.

With regard to medical certificates of death, the Committee recommend that these certificates should be confidential, and should be sent by the local registrar to the Registrar-General. I need not dwell upon that. The object must be apparent to all of your Lordships. Then with regard to the feeding of infants; what, I ask, can be more important than the training of mothers in this respect? Cannot the Local Government Board do something to encourage local authorities and direct them as to how this important subject is to be taught. Physical exercises, open spaces, gymnasia, clubs, cadet corps—in regard to all these local authorities want information and guidance; and I hope His Majesty's Government will do what they can to give them that guidance.

Lastly, the Committee recommend that some legislation should be passed in regard to juvenile smoking. I do hope that a Bill will next year be brought in by His Majesty's Government to prevent cigarette smoking by young boys. If there is one thing that all medical authorities are agreed upon more than any other it is that cigarette smoking is destructive of the health of young boys, and I do hope something in that line will be done. I have only drawn your Lordships' attention to a very few of the recommendations of the Committee. I repeat that local authorities need information and guidance in regard to the powers which they possess, and they should be shown what is wise and proper to be done.

LORD SHUTTLEWORTH

My Lords, all who have read and taken interest in the admirable Report which is under discussion to-day rejoice that the three Members of your Lordships' House who have spoken to-night have taken up this subject. I think if anything was needed to show how wide and large is the subject which we are discussing it would be the speech of the noble Earl who has just sat down, who has dealt with an enormous number of points, many of them of very great importance. Whilst I am extremely anxious to support the recommendation of the Committee as to an anthropometric survey, which is certainly a matter of the urgency which the noble Duke has described, I desire more particularly to call attention to certain other points on which it seems to me there is equal need for immediate action—points on which we have information of so startling a character that steps should be taken as soon as possible.

I shall confine myself almost entirely to the subject which was touched upon with so much eloquence by the right rev. Prelate in the latter part of his speech. Living as I do in Lancashire, among a great manufacturing population and with one of the great manufacturing towns which has been the subject of special inquiry in this Report at my doors, I cannot help having two matters brought constantly under my notice, both largely due to the same causes—I mean the heavy infant mortality in certain great towns of England and Scotland, and the enfeebled and unsatisfactory state in which a large part of our young population grow up. In the Report which is before your Lordships, and which we are discussing to-day, the causes of both these evils are shown to be largely neglect or improper feeding, or nursing out in infancy—the want, in fact, of intelligent mothering of the children. One of the causes of this is the work of the mother, and another is the nature of the home. Slums, back-to-back houses, cellar dwellings, and bad sanitation unfortunately still exist, and the statistics are perfectly appalling.

I have here, but I will not trouble your Lordships with them, statistics from thirty-three large towns for ten years, and I am sorry to say that the statistics as to infant mortality of four of our great Lancashire towns—Preston, Burnley, Salford, and Blackburn—are specially terrible. Take Burnley. I cannot help taking Burnley because it is a town immediately close to my own home; and I should like to say, at the outset, that nothing impresses me more than the extreme desire of all the authorities in Burnley to cope with and improve this state of things. I shall presently venture to suggest that they might have more help than they now receive. I am not imputing any blame; I am only suggesting that for the future, in meeting this terrific problem, this fearful state of things, they do need and would welcome aid from the central authority, In the last ten years, out of every hundred children born in Burnley twenty-one died in the first year of life. That is the average for ten years, and I am sorry to say that the evidence is that this is not getting better; if anything, it is getting rather worse. I am not speaking of the present year, about which the corporation are hopeful that certain measures they have taken are producing an impression; but taking 1904, 232–7 was the death-rate out of every thousand children in the first year of their life.

In Burnley I can myself bear witness to the fact that there has been a great advance in sanitation. The general death-rate has been much improved in recent years, but it is reported to the town council that the mortality among infants is as high as it was fifty years ago. It would take a long time to go into all the causes, but two causes seem to stand out. The first is that in the case of working mothers too short an interval is allowed at the time of confinement. The second is ignorance; and, if we are disposed to blame the mothers for their ignorance, I think we ought to remember that Parliament itself has a responsibility in this matter. Why are these mothers ignorant? Has every step been taken that might have been taken in the schools and by other means to bring the knowledge of how to feed infants to the young women of this country? One fact comes out very clearly in this Report and in the evidence which was taken by the Committee, and that is the great desire of the mothers to learn. No doubt that desire is stronger at the moment the woman becomes a mother, and when the health visitor can get at her in time the difficulty of persuading and instructing her is not great. She is willing to learn, willing to adopt the measures recommended to her by a sympathetic and kindly woman, an official employed by the corporation, if only that information reaches her in time.

Here is a very great difficulty on which I shall wish to say something in a moment; but I can illustrate the fact that they are willing to learn by a recent report of one of the ladies who acts as health visitor in Burnley. She says— It is generally on our first visit that we find the mother giving the baby 'just what we have ourselves'—meat, bacon, potatoes, and even beer and whisky. I hope this will soon be unheard of in Burnley. Then she says, with regard to the feeding of children— I am pleased to say many of the mothers are now following our advice and giving the babies nothing but milk for the first ten or twelve months. This is the result of our constant visits and a great amount of persuasion. I may illustrate the lack of knowledge which prevails on this subject among the people by a short quotation from the health visitor's report. Speaking of the ignorance which still prevails in the poorer parts of the town in regard to storage she says— It is a common practice for people to keep milk on the sink, and bread under the sink to keep it moist. These extracts bring home to one's mind the depth of the ignorance which exists among these poor people, and we are told by the reports that they are perfectly willing to learn, and it is on the first visit of the health visitor that she finds these terrible conditions.

This brings me to one of the greatest difficulties in the way of the health visitors. They cannot get sufficiently early news of the birth of a child. The Jaw requires registration within six weeks, and very often the birth and the death are registered at the same time The health visitor becomes aware of the birth of an infant at the same time as she becomes aware of its death. Registration is generally postponed until very near the end of the six weeks, and information six weeks old is too late to be of use to those who try to induce the mothers to take better care of their infants. What the authorities and their health visitors desire is that in some way or other they should get much earlier information of the birth of a child. Interesting experiments are being made at Glasgow, and will shortly be made at Huddersfield, on this subject. The Glasgow authorities are offering, and the Huddersfield authorities are about to offer, a shilling reward to anyone who will bring to the authorities the earliest possible information of the birth of a child, and we shall watch with considerable interest the result of that experiment. The first suggestion I want to offer is this, whether the present six weeks for registration is not an antiquated system, and whether there is any real reason for leaving so long an interval as six weeks. It seems to me that we might supersede with advantage that system by compelling registration at a much earlier date.

But while I make that suggestion I should not like to be misunderstood. I do not think that that would have any appreciable effect upon saving the lives of children. Unless very much earlier information can be obtained by those who visit the home and use their influence on the parents, the saving of life in the case of these young infants will not be very great. What the Mayor of Huddersfield suggests very strongly, is—and he has paid special attention to this subject—that there should be compulsory notifi- cation to the health office or sanitary authority of the birth of each child within two days, very much on the same lines as infectious disease is notified. There does not seem any special reason why, if notification of infectious disease is insisted upon at the earliest possible moment, there should not be similar insistence upon notice of the birth of a child, especially as we have before us these appalling facts as to the early death of infants, for the deaths occur, to a large extent, among infants in the first week of their lives.

Another experiment is being made at Huddersfield, which I think will interest your Lordships. The mayor, by a private scheme of his own, has started a system of offering £1 as a sort of prize to every parent who can produce a child after a certain date that has lived one year. There are now seventy-four on his list which have been born since he made the offer. He writes to me that he is more than satisfied with the result so far. One result is that he hears of the birth of a child at once in most cases. Then there comes the opportunity of doing good; and, moreover, the mother is profoundly grateful. The curious feature of this scheme is that when he comes upon a mother who I is on his list she expresses great delight because the mayor has interested himself in her baby. With earlier information still better results can be obtained.

I have spoken of the fact that mothers are ready and anxious to receive instruction and guidance with respect to their infants. Local willingness for guidance, however, does not end here. I am satisfied that the local authorities themselves would welcome such information as could be afforded to them by the central authority. In the Report there is a valuable suggestion on page 24, paragraphs 120 and 121—I will not trouble your Lordships by reading them—that on evidence of some abnormal state of things as regards health, such as this tremendous infant mortality, the Local Government Board might intervene. There are many analogies for such intervention. Local inquiries are held on certain subjects when there seems to be need of them. Surely there could be no stronger reason for a local inquiry than when it is shown that for two or three or more years an exceptional death-rate is prevalent, especially among infants.

The Local Government Board are constantly giving guidance which is welcomed—I can speak from my own experience of how much it is welcomed—to boards of guardians. Their inspectors go down, sit with the boards of guardians frequently, and give them guidance on important matters with which they have to deal. I venture to suggest that the time has come when similar guidance is needed, and would be welcomed by the local authorities—the other great bodies with which the Local Government Board have to deal—on health matters. I would like to ask whether that subject has been deliberated by the Local Government Board, and whether they have considered the issue of a statement such as is suggested in paragraph 136 of the Report. In that paragraph the Committee say— Nothing has been brought more prominently to the notice of the Committee than the ignorance that prevails, even in quarters that ought to be well informed, as to what the law and the powers it confers are. A statement on this subject was prepared for the information of the Committee, with the assistance of the Local Government Board; and it appears to them that the Board could not do better than issue it, with such additions as they think proper, to all local authorities. There is another suggestion to which I should like to call attention on page 59, paragraph 302. After giving facts as to conditions attending the life of the juvenile population, infant mortality, employment of mothers, and improper feeding, the Committee suggest various remedial measures. They say— The Committee desire to press these considerations with all the earnestness at their command upon the most serious attention of the community, and they would further suggest to the Local Government Board the desirability of issuing to local authorities a circular explaining the objects to be sought and the means by which they can best be attained. I do not know, and I should like to ask, whether this recommendation has been carried out.

There are two other points to which I should like very briefly to refer. The statistics show that a large number of the deaths of infants are due to pre- mature birth. I am speaking particularly of the manufacturing towns. The right rev. Prelate referred to this subject in a very pointed way, and therefore, I need only mention it shortly; but where a large proportion of women work in mills a terrible number of deaths are reported as following on premature births, and that surely affords a strong argument in favour of the contention that women should, as far as possible, be prevented from working during the last weeks before confinement as well as after. It is a subject, I admit, full of difficulty; it requires careful consideration, and we have not the full facts before us. I am struck with the mention in the Report that it is a defect in our law that there is no registration of still-births, and until we know fully about the stillbirths we shall not fully know what are the consequences which flow from the over-fatigue of women employed in factories. I should like to ask what is the view of the Government on this question of restricting women's labour before confinement, and also on the question of registering still-births.

There is one other point closely connected with the last, und that is as to the law to prevent women working in factories within twenty-eight days after confinement. If noble Lords will turn to paragraph 252, page 47, they will find these words— The existing law requires that no occupier of a factory shall knowingly allow a woman to be employed within four weeks after she has given birth to a child. Thus no legal offence arises unless the occupier, with a full knowledge of the facts, is yet responsible for the employment, a situation which, in the ordinary conditions attending factory labour, it is almost impossible to prove. It is needless to say that in these circumstances prosecutions are infrequent or abortive, and though there may be a pretty uniform observation of the law, cases in which it is broken are numerous in some districts, amounting, it is thought, to general evasion. It is often objected, when it is proposed to strengthen the factory laws in any particular, that it is unfair because other countries are not under such severe factory laws. In this particular we impose less restriction than is imposed efficiently in many other countries. In Switzerland there is a very much stronger law than in this country, and in Belgium, Holland. Denmark, Germany, and Austria there are apparently efficient laws in force to oblige women not to work too soon after their confinement. I fear that this is a point on which further legislation is needed. The other points I have touched upon can apparently be dealt with by administration. I thank your Lordships for listening to these observations, and I venture to express an earnest hope that the Report of the Committee on Physical Deterioration will receive the attention it deserves and will lead to wise administrative and legislative action.

*THE LORD PRESIDENT OF THE COUNCIL AND PRESIDENT OF THE BOARD OF EDUCATION (The Marquess of) LONDONDERRY

My Lords, I am sure your Lordships will agree with me that we have had four extremely interesting speeches, and speeches of a most practical and earnest character. The right rev. Prelate, whose eloquence in opening the debate we all admired, was followed by my noble friend and predecessor the late Lord President of the Council, who with perfect justice asked whether the Government intended to take any steps to carry out an important recommendation in the Report of the Committee on Physical Deterioration which he was responsible for appointing. The noble Duke explained to your Lordships the reasons which induced him to appoint that Committee. He told you it was due, in the first instance, to the Report of the Royal Commision appointed to examine into these matters in Scotland, and he also stated that he was strengthened in his determination to appoint this Committee by the speeches of the right rev. Prelate and my noble friend Lord Heath, who has delivered to-night a practical speech ranging over a great amount of ground.

The Inter - departmental Committee was appointed in fulfilment of the noble Duke's pledge to consult the various Departments concerned. It was appointed— To consider in what manner the medical profession can beat be consulted on the subject with a view to the appointment of a Royal Commission, and the terms of reference to such a Commission, if appointed. Those were the original terms of reference which were given to the Committee appointed by my noble friend after his statement in your Lordships' House two years ago. That part of the terms of reference, however, has never been alluded to in the Report. There is no recommendation with regard to the appointment of a Royal Commission, or the terms of reference to a Commission, if appointed. That omission was due to an extension of the original terms of reference, which extension practically gave to the Fitzroy Committee such terms of reference as would have been given to a Royal Commission had such a Royal Commission been appointed on the recommendation of the Committee set up by the noble Duke. I have no doubt the noble Duke will tell you if he was responsible for the alteration of those terms of reference. I am bound to say that I am a little hazy on the point. I think they were settled either at the conclusion of the noble Duke's term of office, or almost immediately on my succeeding him. At any rate, the difference in point of time is so small that in all probability the noble Duke will say that he had made up his mind on the matter before he resigned the office to which I succeeded.

The noble Duke has put very clearly before your Lordships, both in the Questions on the Paper and in the speech he has delivered, what he desires to know from His Majesty's Government with regard to the action they have taken in reference to the recommendations of the Committee which he appointed. I hope I shall be able to show the noble Duke that we have given that attention—I think "attention" is the word he used—to some of the recommendations which they deserve and which undoubtedly he was anxious they should receive. He laid great stress on the question of the anthropometric survey. The noble Duke asked us what we were doing in regard to that recommendation. There are certain difficulties in connection with the carrying out of such recommendations which I hope to explain to your Lordships before I resume my seat.

On page 84, paragraph 423, the Fitzroy Committee state— With a view to the collection of definite data bearing upon the physical condition of the population, the Committee think that a permanent anthropometric survey should be organised as speedily as possible upon the lines indicated in Part I of the Report. In the first instance this survey should have for its object the periodic taking of the measurements of children and young persons in schools and factories, enlisting for this purpose the assistance, among others, of school teachers and factory surgeons, supplemented by a small staff of professional surveyors. Besides this, a more comprehensive and specialised survey, spread over a longer period, of the population of the country at large might be undertaken. In the earlier part of the Report—on page 11, paragraph 56—the Committee recommend that two ages should be selected at which every child in school attendance should be measured by a teacher or other officer selected by the education authority for the purpose, the particulars being recorded on a card provided by the central bureau.

THE DUKE OF DEVONSHIRE

What is the noble Lord reading from?

*THE MARQUESS OF LONDONDERRY

From page 11, paragraph 56 of the Report. Undoubtedly, this seemed to the Committee to be a very practical proposal, but I do not think they foresaw the difficulties that would lie in the way of carrying out such a proposal. It they did, they would have been bound to recognise that where such a great mass of evidence had to be collected and so vast a number of children dealt with, the cards alluded to would have to be collected under some supervision other than that of the local authorities. Possibly they did foresee that, and perhaps it was for that reason they suggested that there should be appointed in London a central bureau. But when we go on a little further and find them suggesting that, in addition, there should be an advisory council, I am inclined to think that they imagined that the bureau, which would be composed entirely of officials, would not have sufficient expert knowledge of itself, and that to supply that expert knowledge an advisory council should be appointed in addition to the bureau. From this line of reasoning I deduce that there was no wish for an advisory council without a bureau, and that the bureau would be of use only if the measurements as shown on the cards were of such a character that it was absolutely impossible for the local authorities to deal with them.

Now, my Lords, how is this possible? According to paragraph 56 on page 11, the Committee recommend that every child in school attendance should be measured by a teacher or other officer. That is a very difficult thing to carry out. Though, perhaps, in the great majority of cases no objection would be raised, yet because of the minority who might object compulsion would be necessary, and to attain that end legislation would be required. Now, I do not hesitate to say on behalf of His Majesty's Government that they do not see their way at the present time—I do not know that they would at any time—to institute legislation for the purpose of making such measurements compulsory, and that is what paragraph 56, if taken literally, must mean. So much for the question of the anthropometric survey.

Then the noble Duke has asked what the various Departments concerned are doing to meet the recommendations of what I have called the Fitzroy Committee. With regard to the Department with which I am associated—the Board of Education—I can say that we have not been idle. In March last I appointed a Committee to inquire into some of the recommendations, and to see how far the matter could be met by administration without resort to legislation. The Committee was a Departmental Committee on medical inspection and the provision of meals for children attending public elementary schools. The portion of the terms of reference dealing with the question of medical inspection is as follows— To ascertain and report on what is now being done, and with what result, in respect of the medical inspection of children in public elementary schools. What we want is to be told exactly what is being done at the present time and to see how far we can act on that. I may as well read the second portion of the terms of reference; it is not exactly relevant to the point with which lam now dealing, but it may save my having to allude to it later on. It is as follows— To inquire into the methods employed and the sums expended in the relief given by various voluntary agencies for the provision of meals for children in public elemontary schools and to report whether any relief of this character could be better organised without any charge on the public funds both generally and with special regard to children who, although not defective, are by mal-nutrition below the normal standard. I mention these points to show that the Board of Education has not been idle since the presentation of this Report, but are endeavouring to see what they can do without having recourse to legislation.

But Questions were asked as to what the Government are doing. The three Departments chiefly affected by the Report of the Fitzroy Committee are the Board of Education, the Home Office, and the Local Government Board. My noble friend behind me who represents the Local Government Board will deal with their side of the question. I shall begin by stating what the Board of Education have done, and afterwards, on behalf of the Home Office, I shall say a few words on the question of infant mortality, which was raised by the Tight rev. Prelate.

The subjects dealt with in the Report have, to a certain extent, been referred to by Lord Meath. My noble friend drew attention to the dangers of alcoholism, as alluded to in the Report. With regard to that, I can say that the Board have been giving very special attention to methods of instruction in temperance and some of the simpler points as regards the physiological effects of alcohol. With the co-operation of certain eminent medical and scientific men the Board will shortly issue suggestions for a syllabus for use in public elementary schools.

Another question dealt with by the Report, and referred to by my noble friend, is that of rural education. Upon that I have to say that the Board of Education have established a new post and appointed a specially skilled expert adviser in this subject, Mr. T. S. Dymond, who is now investigating the best methods of developing rural education in various directions. The Board are also seriously urging the attention of training college authorities to the importance of nature study and other practical subjects for rural schools.

My noble friend next inquired about the training of teachers in cookery and domestic hygiene. In this matter the Board have been making very special investigations, having appointed five new women inspectors specially chosen for this purpose, and having established a new post of chief woman inspector with the special object of improving the existing organisation for the teaching of domestic subjects. The various training schools of cookery and domestic training throughout the country are being specially inspected with a view to requiring considerable improvements in their methods. The instruction of children in elementary schools in these subjects is also undergoing special revision. The Board have issued new instructions in regard to the teaching of these subjects in training colleges for elementary school teachers, and special attention has been drawn to this new departure in respect of our training college work.

Another recommendation of the Committee referred to school attendance in rural districts. As President of the Board I have frequently drawn the attention of local authorities and other to the possibilities of allowing boys of suitable age and qualifications to be exempt to some extent from school attendance with the view to healthy employment in rural districts. Another recommendation is with regard to special schools for retarded children. The Board have made new arrangements in the Code for facilitating the provision of special schools with specially devised courses and arrangements for "retarded children." The Committee also made a recommendation on infant management and of instruction in municipal crèches. The Board have been conducting, through their women inspectors, a special investigation into the present methods employed in infants' schools and into improvements which are most needed in the management and handling of infants in public elementary schools generally. Very instructive reports from the women inspectors will shortly be issued on this matter.

Another point dealt with in the Report is the question of continuation classes for persons of both sexes where physical exercises for boys and domestic training for girls shall predominate. The Board have made a new arrangement by which grants are specially made to encourage courses in physical exercises in continuation schools throughout the country. Similar encouragement is also given to continuation classes in domestic subjects for girls and young women at times carefully chosen to be convenient for those who are already earning their living. In this way great encouragement is being given to really practical instruction in domestic subjects to those classes of the population which specially need it.

Another recommendation is in regard to partial exemption from school under special conditions. This matter has been carefully considered, and so far as little children are concerned the Board have now removed the obligation for the attendance of children under five years of age. Local authorities will now have complete option in this respect, and several authorities are already deciding that children under five shall not be taught in school. As regards the exemption of older scholars, on the lines of recommendation 38 on page 96 of the FitzRoy Committee's Report, the matter has been thoroughly discussed in the House of Lords, but the Board have not yet seen their way to introducing legislation on the subject in view of the heavy burden of expenditure which would of necessity be thrown upon local authorities were any large provision of continuation classes made obligatory. With regard to physical exercises for children in elementary schools, which was another recommendation of the Committee, the Board have given the matter special attention. We have appointed a special adviser, and an admirable syllabus of physical exercises for elementary schools has been issued.

Therefore, my Lords, on behalf of the Board of Education, I may say that there were ten recommendations made by the Fitzroy Committee, all of which have been attended to and acted upon by the Board. I attribute this largely to the fact that the noble Duke, at my instigation, placed on the Committee one of the permanent officials of the Board of Education, who discharged his duties with such ability that I think we can say it is to him we owe the satisfactory position we now occupy with regard to the recommendations of the Committee. I have said all I have to say with regard to my own Department, and I hope I have shown that the Board of Education, at any rate, have not been idle, but have done their best to carry out the recommendations of the Committee.

Now, my Lords, I have to speak for a few moments as the deputy of the Home Office on this occasion, and I turn naturally to the question raised so pathetically and eloquently by the right rev. Prelate—that of infant mortality. Most of the points which he has raised concern the Local Government, Board and will be dealt with by my noble friend Lord Kenyon, but the right rev. Prelate has touched on one point which more especially concerns the Home Office. I refer to the question of the employment of women in factories after childbirth. The suggestion of the Committee would require legislation, and it does not touch the real difficulty, viz., that of proving knowledge. If the suggested alteration of the law were made, the employer or his agent would still plead that he did not know that it was for her confinement the woman was absent. This plea is very often justified, because the women conceal the fact themselves in order that they may get back to work soon, and when they choose to do this it is hard to find a way of securing the observance of the law.

Another matter touching the Home Office is the recommendation that there should be a special magistrate for juvenile cases. The Home Office say that this proposal is not regarded as feasible. The provision of a special Court, or Courts, and magistrates, would usually result in children having to make excessively long journeys to and from the Court, besides entailing extra expense. In London at the present time excellent arrangements are made for hearing children's cases. They are taken, whenever possible, first in the day; and in any event the children are kept during the whole of the time entirely separate from adult prisoners. This for some time has been the practice of the Metropolitan Courts, and has lately been embodied by the Home Secretary in a set of definite regulations which he has issued to those Courts; and he is now considering the question of issuing a circular to Courts outside the Metropolis, with a view to bringing the same practice into operation so far as possible in places where it does not at present obtain. With regard to the sanitary inspection of workshops, the Home Office are of opinion that the local authorities are more fitted than the central authority to deal with the extremely numerous places of this class. The Factory Department, however, receive and examine the reports of medical officers of health. With several of the other findings of the Committee the Home Office are not in agreement. They are not satisfied that sufficient evidence was received.

I am afraid, my Lords, that I have trespassed at considerable length upon your patience with what I must call a very dull speech, but I have endeavoured to prove, on behalf of the Department with which I am associated, that we have not ignored the recommendations of the Committee, but that we have studied them and are considering how far it is possible to give effect to them.

LORD KENYON

My Lords, on behalf of the Local Government Board, I will do my best to deal with the various matters which have been referred to in the previous speeches, but the ground covered has been so very wide that I must ask you to forgive me if I omit to deal with the whole of it. First of all, in answer to Lord Meath, who touched upon matters relative to the Local Government Board. The noble Lord asked about a register of sickness, and said that the Committee thought that such a register was very desirable. The Poor Law district medical officers do keep a book showing the cases attended by them, which specifies the nature of the disease. But the object of the book is rather to show what they do, and in what cases extra food, etc., is recommended by them. No return of the entries is made to any central authority, and the books are not kept in such a way as to afford any record of sickness on which reliance could be placed. There fore a thorough recasting of the books would be required, and the work of examination and tabulation would be very heavy indeed. Moreover, when done it would only apply to a particular class, and it is quite as important to obtain information as to sickness in other classes. No such information could be compulsorily required without legislation, and at present the Board do not see their way to taking such action in the matter.

Then my noble friend Lord Meath also asked about the advisory council which the Committee recommended. That is a question which more directly concerns the Home Office, but it is suggested that the council should advise the Government on legislative and administrative matters concerning public health. The setting up of such a body to undertake functions of this kind would require the most careful consideration, and in the opinion of the Board the model upon which the Committee suggest that the council should be based, viz., Le Comitè Consultatif d'hygiene publique de France does not appear to be one which could be usefully adapted to the machinery of local government in England, because a great deal of their work is of a distinctly administrative character.

The next point upon which Lord Meath dwelt was the question of overcrowding, and he said that the Committee suggested the fixing of a standard. The local authorities at present have no power to fix a standard of overcrowding generally. Overcrowding is a nuisance which may be dealt with under the Public Health Acts by summary proceedings before justices; but it would rest with the Court to determine whether a nuisance had or had not been committed. Legislation would be necessary to enable the Committee's suggestion to be carried out. The Committee also recommend that the Board should send local authorities statements as to the law on the subject of their powers as to overcrowding and insanitary property. The Board have from time to time issued to local authorities digests of the law relating to the housing of the working classes and as to nuisances, including overcrowding.

With regard to labour colonies, a Departmental Committee was appointed by the Local Government Board last year, with the concurrence of the Home Office, with regard to vagrancy, and one of the matters which is being investigated by that Committee is the question of labour colonies and the detention of persons in them. The Report of the Committee is expected to be made this year.

The next point, I think, had regard to building and open spaces. The Committee think that local authorities in contiguous areas which are becoming urban should co-operate in securing proper building regulations, and that the making of building by laws should be made compulsory on urban and rural authorities. The present position is, as your Lordships know, that every urban authority can, subject to the consent of the Local Government Board, make by-laws, and practically they have all done so. At present there is a Committee sitting which is inquiring into the whole question of by-laws in the country, and the view expressed to the Committee on the whole has been that the by-laws err in the direction of too great stringency rather than too little. As Lord Meath very well pointed out, houses that are suitable for erection in London may not be suitable for erection in rural areas. I have no doubt that the Bill brought in by Lord Hylton will be returned to your Lordships' House in a few days, as amended in Committee. There are difficulties in the way of compelling local authorities to make by-laws. They cannot be prevented from submitting inadequate by-laws for confirmation. If the central authority refuses to confirm, the local authorities say the responsibility no longer rests with them but with the Local Government Board. If the central authority do confirm, they are placed in the position of confirming by-laws which they know to be inadequate, because they cannot get better ones made.

Then with regard to smoke pollution, the Committee advocate that cases of complaint of pollution by smoke, etc., in manufacturing districts should be heard by a stipendiary magistrate, and that higher penalties should be imposed. Summary proceedings can be taken under the Public Health Acts for the abatement of smoke nuisance, and when there is a stipendiary magistrate the complaint would come before him. The real difficulty is that in manufacturing districts the local authorities consist largely of manufacturers, who are not anxious to take proceedings in respect of smoke nuisance arising from manufactories. It may be doubted whether an increase in the penalties would much help matters, but at all events legislation would be needed for the purpose.

With reference to a register of owners of houses, the chief difficulty is that is would entail a compulsory registration of titles. The question of compulsory registration of titles has been brought up several times, and not very successfully. It would open up a very large question, and I do not know that this House is prepared to deal with it.

The next point is with regard to medical officers of health. The Board agree with the suggestions of the Committee as to the expediency of whole time appointments where the population is large, and the officer is properly I qualified. In cases where the population is above, say, 100,000, and the circumstances of the district are such as to make considerable demands upon the officer, the Board urge that his whole time should be given to his duties, or, at all events, to public health work, i.e., that he should be debarred from private practice. But the question is largely one of cost. The Board think that where a medical officer of health gives his whole time he should have a salary of at least £500 a year. I District councils, however, are not always willing to pay this, and the salary would obviously be burdensome except where the rateable value is large. As regards permanency of tenure, the Board's view is that if the medical officer is a competent man, properly qualified and duly remunerated, and gives his whole time to his duties, there is an advantage in giving him permanency of tenure, so that he may act independently, and without fear of losing his office if he offends people by discharging his duty. Where an officer does not devote his whole time, the Board have sometimes sanctioned a permanent appointment where he has held office for some years and has shown himself efficient. There is a danger where a man has private practice that his official duties will be sacrificed to them, and there are objections to making the appointment permanent. The Board have, however, encouraged appointments being made for a term of years—say five or seven—where the circumstances justified it, although the officer does not devote his whole time to his duties.

The next question is with regard to reports from local authorities. I think it was Lord Shuttleworth who asked whether the reports were given to the local authorities. I have to say that at the present time each medical officer of health makes an annual report to the sanitary authority as to what is being done and left undone in the district, and copies are sent to the county council and to the Local Government Board. Special reports are also made when outbreaks of infectious disease occur. The reports when received by the Board are examined by them, and if necessary they correspond with the sanitary authority upon heir shortcomings. The Board do, therefore, watch closely local administration, and endeavour constantly to level up backward districts. Moreover, the Board cause local inspections to be made by their medical inspectors, so far as the staff allows, where the circumstances appear to call for it. Whether it would be practicable to increase the number of such inspections is a matter which is receiving the Board's consideration at the present moment.

I come now to the Question dealt with so ably by the right rev. Prelate, and I am sure all Members of this House will agree with every word he said. Lord Shuttleworth also asked some Questions on the subject, viz., with reference to infant mortality. The Board concur in the view that still-births should be registered, but an amendment of the law would be necessary for this purpose. They also think that an amendment of the law is desirable as to the certification of deaths, so as to make more stringent the requirements as to the obtaining of medical certificates and the investigation of cases where there is no certificate.

They have for some time past been considering a measure for dealing with this matter, but there has been no opportunity for legislation. As regards milk supply, urban and rural district councils are empowered to make regulations with regard to dairies, cowsheds, and milk shops dealing with the inspection of these places, regulating their ventilation, cleansing, etc., and other matters. The local authorities are not bound to make these regulations at present: they are only authorised to do so. But the Committee suggest that where they do not make regulations, their powers should pass to the county councils, and that in the last resort it should be the duty of the Local Government Board to intervene. It may be observed, however, that out of 1,794 local authorities empowered to make regulations under the Dairies, Cowsheds, and Milk Shops Order, no less than 1,255 have regulations in force in their district. As regards the suggested supersession of these bodies by the county council where the local authority do not make and enforce regulations, regard must be had to the friction which would almost certainly arise, especially where the defaulting authority was a borough or urban district council. In any case legislation would be necessary to give effect to the recommendation of the Committee.

I think I have now dealt with most of the matters referred to, except that of the training of mothers, with reference to which Lord Shuttleworth asked some Questions. The Committee suggested that mothers should be trained in matters of hygiene and domestic economy. The Board have considered this subject, but there are difficulties in the way of local authorities undertaking the instruction of mothers in these matters, though some of them have undertaken it by means of health visitors, and there is an increasing tendency to make such appointments. The Board sympathise with action of the kind, but in the present state of the information on the subject they have not felt able to issue any circular with regard to it. With regard to the general question of giving further powers to sanitary authorities in connection with infant mortality, it may be observed that advantage might possibly accrue if an earlier notification of births could be secured, more especially in industrial areas. At present a birth need not be registered for six weeks, but if the sanitary authority are to intervene with a view to advising mothers, e.g., as to the feeding of a child, it is essential that they should have early notification of the birth—say within a period of forty-eight hours. To render such a notification compulsory legislation would be required. In some places it is understood that arrangements have been made for a voluntary notification, but any proposal to make it compulsory would need careful consideration. In the event of such legislation being proposed, it would perhaps be advisable to make it in the first instance adoptive at the option of the local authority rather than general.

On the question of rural housing, the Committee suggested that rural district councils should remedy the dearth of cottages by the exercise of their powers under Part III. of the Housing of the Working Classes Act, 1890, as amended by the Act of 1900. Rural councils can adopt Part III. with the consent of the county council, and can then provide cottages. They are reluctant to do so, but the Act of 1903 enables the county council to supersede them if the parish council ask the county council to do so. The Board have called the attention of the rural district councils and county councils to their powers in this matter.

With regard to adulteration, the Committee recommend that the Board should be authorised to fix a standard of purity for all foods and drinks. The Board have considered this matter, and as a preliminary step have appointed a special food inspector to obtain information as to matters connected with adulteration, and to communicate with and supervise the action of public analysts.

I hope that what I have said will show that the Local Government Board are considering the Report, and doing what they can to carry out such portions of it as do not require fresh legislation.

*THE EARL OF CREWE

My Lords, I feel that it is impossible not to sympathise with the two noble Lords who have just spoken, in view of the enormous range of the subject with which they have been attempting to deal. The fact is that any person trying to deal with this Report, if he does not take all knowledge as his province, must, at all events, take all social knowledge, because it deals with almost every conceivable social question that can confront a statesman of the present day. There are included the question of education, the question of housing, the question of overcrowding, the question of the bringing up of children, and a great number of kindred subjects. But, in spite of that, we on this bench do not feel that the whole question has been dealt with in a very sympathetic spirit by either of the noble Lords who have spoken for the Government. In the first place, the Question raised by the noble Duke on the Cross Benches received, I think, rather a short shrift at the hands of the noble Marquess the President of the Board of Education.

*THE MARQUESS OF LONDONDERRY

I am afraid I must interrupt the noble Earl. I stated that we were not in a position to know how far the proposals of the Fitz Roy Committee with regard to an anthropometrical survey could be taken up; that if measurements were to be taken to the extent they propose it would have to be made compulsory; and that we were not in a position to bring in legislation to appoint an advisory council.

*THE EARL OF CREWE

I quite understand, but I do not gather that the Committee in their Report regarded it as absolutely certain that compulsion would be required. If my recollection is right, there was no evidence to show that serious objection would be taken by any large number of parents to such measurements as would be required for this purpose. I noticed with some approval the evidence of one witness, to the effect that pedantic accuracy ought not to be striven for, and that if general measurements could be obtained the result aimed at might be to a very great extent achieved. But I confess I was sorry that the noble Marquess threw such a jet of cold water on the recommendation of the noble Duke. What I think he really intended to convey was that in his opinion, and in the opinion of those who advise him, such a survey would cost some money, and that they did not consider it was worth the money it would cost.

As regards the other questions with which the noble Marquess dealt, I cheer-fully recognise that the Board of Education have made some very considerable and real attempts to deal with the minor matters recommended by the Committee. I will not occupy your Lordships' time by going through them, but it certainly does seem to be a welcome evidence of activity. I also agree with the noble Marquess that it is to be accounted for by the fact that an eminent official of his Department was one of those who were called upon to consider the question.

But, my Lords, when we come to the questions affecting the Local Government Board, the field is too wide for me to attempt to deal with it at all. I rather regret that the noble Earl on the Cross Benches—although I largely sympathise with his enthusiasm on this question—endeavoured to deal so fully as he did with the matter. I think if he had adopted the course taken the noble Duke and by my noble friend Lord Shuttle-worth, and had concentrated his attention and the attention of the House more particularly on one or two points, the result would have been more satisfactory, as it would have made it possible for His Majesty's Government to give a more detailed reply on the points raised. As it was, it was hardly possible for the noble Lord opposite to do anything else than give very brief, and I am afraid I must call them rather perfunctory, replies to a number of the Questions which were raised. I could wish, for instance, that the Government had found it possible to go a little more into detail on the question raised by the right rev. Prelate, and by my noble friend—the crucial and important question of infant mortality. I gladly recognise, however, that if the Departments are prepared to proceed with the provision for the earlier notification of births a very considerable step in advance will have been taken. I am bound to say that all through I was struck by both noble Lords saying in almost horror-stricken tones that legisla- tion would be required to carry these proposals into effect. Well, what if it is? After all, legislation is required for many things, and it seems to come with poor grace from noble Lords who have the whole time of both Houses of Parliament at their disposal that they should complain of the fact that legislation is required in order to give effect to certain valuable provisions. What I hope is that the Departments concerned, and those in charge of them will take very careful note of the points upon which they have spoken to-day, and that they will register at all events an inward determination to bring forward at the earliest possible opportunity a Bill containing these provisions, which are undoubtedly of great value in themselves.

*THE SECRETARY OF STATE FOR FOREIGN AFFAIRS (The Marquess of LANSDOWNE)

My Lords, I do not desire to prolong this debate, and I rise merely for the purpose of repudiating as strongly as I can the idea that His Majesty's Government regard the contents of this Report with indifference, or its recommendations without sympathy. I take it that the object of the noble Lords who have addressed us this evening is to obtain an assurance that this Blue-book is not going to meet with the fate of many Blue-books, and be pigeon-holed and forgotten. That assurance I am prepared to give, and I think the right rev. Prelate who spoke first this evening put the case in appropriate language when he expressed a hope that inquiry and investigation would, not cease with the publication of this Report. But we do consider that further inquiry and further investigation will have to be made before many of these recommendations can be taken up. On many facts we desire fuller evidence than has yet been collected: we should be better assured that the proposed remedies will be appropriate to the disease, that they are remedies the patient will take, and for which the public will be ready to pay.

We must, indeed, all have been struck by the vastness of the programme which has been put before us by the Inter-departmental Committee. I will not attempt to enumerate the fifty-four subject dealt with in the Report. They have to do with the housing and distribution of the population of this country; they have to do with the regulation of factories, shops, and mines; they have to do with education, with the hygienic condition of the houses of the poorer classes, with disease, and drink; and, lastly, with the great question of the collection of statistics dealing with these important subjects. That is, as I have said, an immense programme, and I am bound to say it is a programme which to my mind extends considerably beyond the scope within which it was originally proposed that the Committee should confine its labours. There is a certain amount of mystery as to the origin of the expanded instruction under which the Committee set to work; it is not quite clear whether it first saw the light during the last moments of the noble Duke's official career, or in the first moments of my noble friend's term of office; but, whoever was the parent, the Committee proved itself a most vigorous bantling, and proceeded on its career with an energy and courage that must command admiration.

One thing will not be disputed by the Committee itself, that when it was first appointed it was intended that its investigations should be preliminary to a wider inquiry to be undertaken by a Royal Commission. The appointment of the Committee arose, as the noble Duke has said, out of the conclusions he had arrived at with regard to the physical condition of the British Army, and from that it grew until instead of being a mere inquiry preliminary to a larger inquiry, it, perhaps in spite of itself, became seized of a number of subjects sufficient to have afforded work, not for one Royal Commission, but for half-a-dozen Royal Commissions. It seems to me to follow from that that we must proceed with a certain amount of caution in acting upon the recommendations of the Committee; and I think it is perhaps a little hard that after the statements made on behalf of the three Departments concerned there should be complaint that the subjects have not been more vigorously dealt with. My noble friend who has charge of the Education Department was able to tell your Lordships that every one of the ten educational points dealt with in this Report had occupied the attention of the Board of Education.

THE MARQUESS OF LONDONDERRY

Had all been acted upon.

*THE MARQUESS OF LANSDOWNE

And had all been acted upon. In the same way my noble friend who represents the Local Government Board was able to show that at many points matters comprised within the Report of the Committee had been administratively dealt with. Therefore, my Lords, I do not think that we are open to the charge of having brushed aside the recommendations of the Committee, and I am very glad in closing the debate to assure the House that we shall certainly bear in mind what the Committee have reported; and that we recognise the value of its services in directing the attention of the public and Parliament to a number of most vital points affecting to the root the well-being of the people of this country.

*THE DUKE OF DEVONSHIRE

My Lords, I do not think there can be any doubt on the point of the two references to the Committee. I have not a very accurate recollection of how the amended reference came about, but I have no doubt whatever that I was myself responsible for it. I have also a clear recollection that the original reference and the proposal to appoint a Committee were submitted to the Cabinet, but I could not undertake absolutely to assert that the extended terms of reference were also submitted to the Cabinet. It is quite possible that in the press of business at the close of the session that formality may have been omitted, and I am prepared to undertake responsibility for the extension of the terms of the original reference. I am extremely indebted for the sympathetic manner in which the noble Marquess referred to the recommendation to which I chiefly called attention, and I trust that in the further consideration intended to be given to the Report that essential point, the collection of accurate statistics, will not be abandoned. Difficulties there are, I admit, but I am sure they will not be found insuperable.