PUBLIC HEALTH (SCOTLAND) AMENDMENT BILL [H.L.] (Hansard, 31 July 1907)

LORD HAMILTON OF DALZELL

My Lords, this Bill introduces certain Amendments into the Public Health (Scotland) Act of 1897. The effect of those Amendments is slightly to relax some of the provisions of that Act, and to make them more elastic in their action. These provisions are contained in three consecutive sections of the Act —Section 57, which lays down the form of certificate which must accompany any child which has either had an infectious disease or has been exposed to the risk of infection, on its return to school; Section 58, which prohibits any person suffering from an infectious disease from carrying on any trade or business in regard to food or from milking any animal; and Section 59, which prohibits any person suffering from infectious disease from entering any public conveyance, or train, or ship. Those clauses have been found to be unduly restrictive in the case of the milder infectious diseases. There is no doubt that they would be absolutely intolerable if they were to be applied to consumption; and it is believed that it is this fact which has prevented the local authorities from including consumption in the list of notifiable diseases, though on other grounds they are fully aware of the desirability of doing so. When the Act was passed consumption was not generally recognised as being of a highly infectious nature, and therefore the Act was not drawn up with any idea that consumption would be included under its provisions; but the march of medical science is so rapid in these days that even in ten years a great change has taken place, and the great bulk of medical opinion is now in favour of that being done. There is no need to have any special legislation for that object, because, though under the Notification of Infectious Diseases Act twelve diseases are specified which shall be notified, local authorities are given power to add other diseases to that number 929 if they consider it desirable to do so, always with the consent of the Local Government Board; and, as I have already said, it is believed that the harshness and inelasticity of these provisions constitute one of the principal factors in preventing this from being done. A very interesting circular was issued last March by the Scottish Local Government Board to local authorities, calling attention to the duties of those authorities to take steps to prevent the spread of consumption. That circular shows how the patients themselves and their friends may be educated, both as to the precautions against the spreading of the disease and also as to the curative value of such simple things as fresh air and open windows. It goes on to show how small open-air sanatoria may be erected at very trifling cost, and it concludes by stating that notification by itself is useless and that the Board will not sanction its being applied unless it is at the same time accompanied by some measures of a curative nature. As to the actual amendments of the Public Health Act contained in this Bill, it may be broadly said that they consist in substituting for absolute prohibition such words as— Provided that adequate precautions have been taken against spreading such disease or infection, thus leaving to the medical officer of health a certain discretion as to what those adequate precautions shall be. For instance, a child living in a house where there had recently been a case of small-pox or scarlet fever would, of course, not be allowed to return to school any more than it is at present, but that prohibition would not be necessary in the case of a child living in a house where there was a case of consumption, at all events except in a very acute stage of that disease. I hope I have said sufficient to indicate the character and the objects of this Bill. It is a very modest measure, but it is hoped that it may have a very far-reaching effect in stopping the spread of the most deadly and most prevalent disease in Scotland.

*LORD BALFOUR OF BURLEIGH

My Lords, I rise to give a very cordial welcome to the provisions contained in this Bill, and I do not think, after the 930 really lucid explanation which the noble Lord opposite has given, it is necessary for me to say very much. But the case is even stronger in one respect than the noble Lord stated. As he told your Lordships, the object of this Bill is to bring three clauses of the Public Health Act, 1897, into harmony with other sections and with what really is the existing practice. Take Section 57 of that Act, which is known as the School Attendance Clause. In practice it is quite clear to me that, as interpreted, the section is much too stringent, and is far more stringent than was really intended when Parliament passed it. It provides that no child from an infected house shall do certain things—amongst others, go to school. It takes no account whatever of whether the child has been exposed to any infection. The child may have been isolated; the house may have been a large one, and it may have been even a workhouse. In Scotland we have the sensible practice, if there are children in the workhouse, which is not often, of sending them to the ordinary public school. If there had been a case of infectious disease —it might only be measles or whooping cough—at one end of the building, the child being at the other end and never having been in contact, the clause has been held to preclude that child from attending school. It is obviously of advantage that discretion should be given to the local authority and the medical officer, and if the medical officer certifies that there is no danger in the child's attending school it is better that it should go to school. Take another case. No child from an infected house shall pick fruit, and so on. It is perfectly right, if the operation which is prohibited is the milking of a cow, that nobody from a house in which there is an infectious disease should deal with milk, milk being known to be one of the most prevalent means by which infectious diseases of certain kinds can be carried. But it is absurd, if there is a case of whooping cough in a house, that a child from that house is not to be allowed for example, to pick fruit for sale: and the effect of the extreme stringency of these three clauses of the Public Heath Act of 1897 is, that they act as a restraint upon local authorities adding certain diseases to the list of those that are notifiable. It is obviously of importance that diseases 931 like measles and whooping cough, which are not, I think, on the compulsory list, and consumption, or phthisis as it is more scientifically called, should be made notifiable; but if, by making them notifiable, you by necessity carry with it all these restraints which I have indicated, you put a very great handicap and difficulty in the way of an intelligent local authority and medical officer working the Acts in a sensible and reasonable spirit. I am able to say, from a knowledge of what has been going on in Scotland, that public opinion is really ripe for this change. Certain of the principal local authorities have already taken considerable steps in the direction desired by setting apart hospitals and beds in hospitals for such dieases as consumption. The city of Edinburgh has done so, Glasgow is contemplating doing so, and the large county of Lanark has already taken action in the same direction. I believe local authorities all over Scotland would have gone further but for these clauses, and I believe the passing of this Bill will remove a difficulty out of their way. It is because of the extremely stringent nature of these three clauses, as interpreted, that matters have not gone further than they have. I believe that by the sensible and moderate relaxation which is proposed in this Bill a valuable power will be put into the hands of local authorities, and so far as I am concerned I venture respectfully to give the Bill my very cordial support.