Lords Sitting of 9 June 1913

MANCHESTER ROYAL EXCHANGE BILL.
The CHAIRMAN OF COMMITTEES informed the House that the opposition to the Bill was withdrawn: The Orders made on Tuesday last discharged, and Bill committed.
The LORD CHANCELLOR acquainted the House, That the Clerk of the Parliaments had laid upon the Table the Certificates from the Examiners that the further Standing Orders applicable to the following Bills have been complied with:

Mid-Kent and East Kent District Water.

Dundee Boundaries.

Hull and Barnsley Railway.

Humber Commercial Railway and Dock.

Kent Electric Power. [H.L.]

Lymm Urban District Council.

And also the Certificate that the Standing Orders have not been complied with in the case of the Petition for additional Provision in the following Bill:

London County Council (General Powers).

The same were ordered to lie on the Table.

ELECTRIC LIGHTING PROVISIONAL ORDERS (No. 2) BILL. [H.L.]
The CHAIRMAN OF COMMITTEES informed the House that the opposition to the Leatherhead and District (Extension) Order was withdrawn: The Orders made on Tuesday last respecting the commitment of the Bill to a Select Committee in regard to the said Order, discharged.
RICHMOND (SURREY) ELECTRICITY SUPPLY BILL. [H.L.]
Reported, with Amendments.

TYNEMOUTH GAS BILL. [H.L.]
Reported from the Select Committee, with Amendments.
EDUCATION BOARD PROVISIONAL ORDER CONFIRMATION (LONDON No. 4) BILL. [H.L.]
EDUCATION BOARD PROVISIONAL ORDERS CONFIRMATION (CARDIGAN, &c.) BILL. [H.L.]
MANCHESTER SHIP CANAL BILL. [H.L.]
Committee to meet To-morrow.

DUNDEE CORPORATION (IMPROVEMENTS AND TRAMWAYS) BILL.
Read 3a, with the Amendments: A further Amendment made: Bill passed, and returned to the Commons.
ROCHFORD RURAL DISTRICT COUNCIL BILL. [H.L.]
Read 3a, and passed, and sent to the Commons.

GREAT EASTERN RAILWAY BILL. [H.L.]
Read 3a: An Amendment made: Bill passed, and sent to the Commons.
UNITED DISTRICT GAS BILL. [H.L.]
LEEDS CORPORATION BILL. [H.L.]
Read 3a, and passed, and sent to the Commons.

EXTENSION OF POLLING HOURS BILL.
Brought from the Commons.
LOCAL GOVERNMENT PROVISIONAL ORDER (GAS) BILL. (No. 56.)
LOCAL GOVERNMENT PROVISIONAL ORDERS (No. 4) BILL. (No. 57.)
LOCAL GOVERNMENT PROVISIONAL ORDERS (No. 7) BILL. (No. 58.)
Brought from the Commons; read 1a; to be printed; and referred to the Examiners.

YORK CORPORATION BILL.
Brought from the Commons; read 1a; and referred to the Examiners.
LOTHIAN RAILWAYS BILL. [H.L.]
Report from the Select Committee that it is not expedient to proceed further with the Bill; read, and ordered to lie on the Table.
LEITH HARBOUR AND DOCKS BILL. [H.L.]
Report from the Select Committee, That the Committee had not proceeded with the consideration of the Bill the opposition thereto having been withdrawn; read, and ordered to lie on the Table: The Orders made on the 17th of March and the 5th of May last discharged, and Bill committed.
NATIONAL INSURANCE ACT, 1911.
Regulations of the Welsh Insurance Commissioners as to the decision of questions arising under Section 66 of the Act: Laid before the House (pursuant to Act) and to be printed. (No. 59.)

PIER AND HARBOUR PROVISIONAL ORDERS (No. 3) BILL. [H.L.]
A Bill to confine certain Provisional Orders made by the Board of Trade under the General Pier and Harbour Act, 1861, relating to Buckie and Findochty—Was presented by the Lord Granard (E. Granard): Then it was moved, That the Order made on the 22nd day of April last, "That no Provisional Order Confirmation Bill originating in this House shall be read a first time after Tuesday the 29th instant," be dispensed with in respect of the said Bill and that the Bill be now read 1a; agreed to: Bill read 1a accordingly; to be printed; and referred to the Examiners. (No. 60.)
LOCAL GOVERNMENT PROVISIONAL ORDERS (No. 1) BILL.
LOCAL GOVERNMENT PROVISIONAL ORDER (No. 2) BILL.
LOCAL GOVERNMENT PROVISIONAL ORDERS (No. 3) BILL.
House in Committee (according to Order): Bills reported without amendment, and to be read 3a To-morrow.

LAND DRAINAGE PROVISIONAL ORDER, BILL.
Read 2a (according to Order), and committed.

SANITARY ADMINISTRATION IN INDIA.
VISCOUNT MIDLETON*VISCOUNT MIDLETON rose to call attention to the Resolution of the Government of India (Sanitary), dated August 19, 1912, and to the subordination of the Sanitary Commissioner with the Government of India to the Director-General, Indian Medical Service; and to move for Papers.
The noble Viscount said: My Lords, I do not apologise for bringing before your Lordships' House the question of Indian sanitation, because I believe that all who have been concerned in the Government of India, either in this country or in India,
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are well aware of the immense importance and complexity of the problem. I do not suppose that many members of this House have grappled with the voluminous Bluebook that was published in August last, but if they have they will probably agree with me that it is more voluminous than illuminating. The Papers laid before us have not been drawn out with a view of giving the country the opportunity of studying the problem to the best advantage, but rather of massing together a number of somewhat confused details from which it is difficult to extract the real heart of the matter, and still more difficult to realise why the Resolution of the Government of India which has settled this question for the moment and which was published in August last should have been arrived at.
I hope that, although it is necessary in any review of this matter to criticise in some respects what has been done by Governments of India in the past, I shall not be supposed to be making a general attack on the Government of India in respect of a matter which, although it is, of course, enormously important, is not, or has not been considered in the past to be, of the same practical effect as the absorbing questions which take the whole time of the Indian Government and make that Government and the Local Governments among the hardest worked men in the service of the King. And although, in regard to the particulars to which I desire to call the attention of the House this afternoon, there has been, I will not say a laxity, but at all events an inequality of effort and a great incompleteness, I quite recognise that in those parts of the subject which relate to establishments directly under the control of the Government of India there have been results which do great honour to their administration and to the British name in the East. But if we look to the standard of progress in regard to the civil population, I am bound to say that the figures fill us with concern.
I do not think anybody speaking from the Front Government Bench can express satisfaction if he compares what has been accomplished in those establishments which are directly under the control of the Government with what has been done in regard to the mass of the people of India in the 600,000 villages of under 1,000 inhabitants which it is said are spread over the whole face of

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India. I desire to guard myself in any degree from being supposed to couple what has been done in the great municipalities and in the great towns of India with what has been neglected with regard to the rural community. The great municipal corporations, the towns immediately under the control of the Local Governments, have made enormous strides. They have faced this most intricate problem with courage and certainly with no undue parsimony in regard to expenditure; and we shall all be glad to welcome to this House this afternoon my noble friend Lord Sydenham, who has so recently returned, and who took a considerable part in what was done in regard to this business in Bombay.
That there is something left to be desired is shown perhaps best from the figures. The first real attempt to tackle sanitation in India was the outcome of the researches and the Report of the Army Sanitary Commission of 1859–63, and the results of the efforts of that Commission have been that whereas in about the year 1860 the loss of British soldiers was at the rate of 69 per 1,000, or, put in another way, was in the course of two years the loss of one whole company out of every battalion, the loss has now been reduced to 4 and a fraction per 1,000. In the Indian Army the death rate used to be 44 per 1,000; it is now 4·89 per 1,000. In the native gaols the death-rate used to be 96 per 1,000; it is now 17 per 1,000. When we come to the civil population statistics are not absolutely reliable as regards the past, but fifty years ago it was estimated that the mortality ranged at between 37 and 80 per 1,000; it is now about 33 per 1,000. This is some reduction, but is still double the loss by death in this country and in some other European countries; and it is shown not to be due merely to race or climatic disease, seeing that, in regard to those forces which are actually under the control of the Government, results akin to those in this country are readily produced.
The Commission of 1859–63 urged that the measures which they proposed should not be restricted to the Army and the convicted population. They proposed measures which, if they had been taken, would have advanced us very rapidly from our present position. They asked that there should be a permanent health committee and also a trained medical officer of health in each district. The
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Government of India welcomed these proposals with open hands, but the changes were not of long duration. After two years they abolished the committees. A short time afterwards they abolished the secretary. They finally left the president alone, and then, having got him alone, they reduced his status so that practically the whole affair went by the board. In another respect that noted Commission made a proposal which will come home to the noble Marquess the Secretary of State for India and to the noble Viscount beside him who for some time held that office. They proposed that there should be an advisory committee of trained sanitary experts from India who should advise the Secretary of State in Whitehall; and during the short time it was allowed to exist that committee made suggestions which caused the Secretary of State to raise the very question which I am venturing to bring, fifty years later, before your Lordships' House to-night. But, as I have said, this committee also had a short life. For economic reasons or on other grounds their powers were cut clown. Then the committee was extinguished, and now the unique position of sanitation in the India Office is this, that it is the only subject on which the Secretary of State has no technical advice whatever. If he desires to send out stores to India, to take any steps with regard to the Indian Army, with regard to education or to any single question which may arise in regard to India, he has technical advisers; but with regard to matters affecting sanitation he is left entirely and severely alone. Bearing in mind the fact that the great advance which has taken place in the medical service of the Army at home began by the institution of a committee of sanitary advisers, including civil doctors, at the War Office ten or twelve years ago, I cannot help thinking that this is a point in regard to which some alteration should be made.
These changes have not been without protest from all sorts of bodies well qualified to advise. In 1864 the Sanitary Commissioners of Madras and Bombay called upon the Government of India to establish an Executive Sanitary Service in the rural districts. The Army Sanitary Committee did the same. The Secretary of State himself at that time, under the influence of his Committee, did the same. In 1894, the matter having slept to some extent for thirty years, the first Indian Medical

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Congress addressed the Government of India and asked that a Bacteriological College should be established. The only answer they received, shortly after my noble friend Lord Lansdowne had left India, was that money could only be found by cutting down a Sanitary Commissioner in the Punjab, the place of all others where a Sanitary Commissioner is most needed. Two years later the Government of Madras, subsequently seconded by the Governments of the Punjab, of Bengal, of Bombay, and of Eastern Bengal, memorialised the Government of India that Professor Ross, whose services with regard to malaria are of more than European fame, should be asked to go out and advise with regard to the measures to be taken against malaria. The Government of India replied that on the ground of expense it would be impossible to detail a special officer for that service; and it was not until my noble friend Lord Curzon became Viceroy, in 1898, that the Government of India—the Government of an Empire which loses annually 2,000,000 lives from preventable causes, in that the diseases winch Cause these losses can be considerably restricted—were able to find the funds to provide for one special officer to at all events advise them and discuss whether it was possible in India to effect the same reformation which had been carried out in Egypt and elsewhere. I think we owe to a certain want of action—not want of scientific appreciation by the Government of India, but of practical action—the fact that when the great plague outbreak of 1896 took place we were still without any Executive Sanitary Service throughout the rural districts.
The action on the part of the noble Marquess the Secretary of State for India which I now impeach is this, that after a step forward had been taken in 1904 in appointing a Chief Sanitary Commissioner to the Government of India who was to be free from the trammels of the Senior Medical Officer, an official eminent in curative but unskilled in preventive medicine, the noble Marquess sanctioned a backward step last year in replacing this most needed official under exactly the same control under which the question had slumbered during so long a period. In doing this the Government of India justified themselves in the Papers laid before Parliament by talking of the impossibility of divorcing the two services. My Lords, throughout India in the Local
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Governments the two services have been divorced by the Government of India's orders for a great many years. In 1886 the Government of India laid down that in all Provinces for which a separate Sanitary Commissioner was sanctioned the Sanitary Department should remain distinct from, and not subordinate to, the Medical Department. In the Punjab the Sanitary Commissioner, the head of his Department, reports direct. It was the same in Bombay and Madras, and up to 1895 it was the same in Bengal. A change was made for a time, but when the new Province of Eastern Bengal and Assam was created the old and more salutary practice was reverted to, and the Sanitary Commissioner was given a direct statue and direct responsibility to the Local Government. And here we are in this absurd position at this moment, that what the Government of India has laid down for all the Local Governments now for twenty-seven years it has nullified with regard to itself, and having established certain trained qualifications in sanitation for every municipal health officer in towns of over 50,000, it puts at the head of the profession a man who may have none of those qualities and who has never been trained to the business he has to look after.
This has not been done without a very serious protest from authorities in India. The Sanitary Commissioner in the Punjab writes a letter which tears to threads all the fictions on which the Government of India founded this very retrograde action. He points out that with regard to cholera and plague the efforts of the Government are "not merely of importance to India but are of importance to the whole world," and that to handicap them in any respect is to "put us back from the position which we have a right to occupy in the forefront of nations having Eastern possessions." He points out also that the plea of the Government of India that the Sanitary Department is unpopular is based on a fallacy, the fact being that if it is unpopular it is because the appointments have been starved and because they have both insufficient means of bacteriological study and insufficient subordinates to carry out the work.
THE LORD PRESIDENT OF THE COUNCIL (VISCOUNT MORLEY): Will the noble Viscount tell us the date of that letter?
VISCOUNT MIDLETON: I have the letter here, but as it will take time to find it perhaps the noble Viscount will allow me to give it to him as soon as I sit down. The third point which is made is that laboratories which have been arranged have not been placed at the most convenient spots; and, finally, it is most clearly laid down in the letter—and on this I base my plea this afternoon—that it is absurd to say that there is no division between the work of the clinician and the work of the sanitarian. The clinician is engaged with the personal health of the individual, while the sanitarian is engaged with the general health of communities.
The points which I make with regard to the whole of this are that there has been a step backward when a step forward ought to have been taken; that the recent history has been a most unfortunate one; that failing in their attempt when Colonel Leslie, the head of the Sanitary Department, died in 1911, to abolish the appointment, the Government of India put it back under the Medical Officer; and, finally, after the Secretary of State had agreed to the second and refused the first, they proceeded to appoint, as the head assistant to the Senior Medical Officer, a very junior officer who could not possibly have proper weight and authority, and who is to be the editor of the Sanitary Magazine and secretary at Congresses, but who is altogether deprived of the status and power to suggest any great schemes or to advise on the larger and more important issues. The position is a serious one with regard to expenditure and also with regard to the results.
I know that the noble Marquess opposite will probably call attention to large grants which have been made recently, but those are non-recurring grants. It is impossible to deal with this great question by merely voting a million when there happens to be a surplus and leaving the medical work to continue on very insufficient financial support. What we have to remember is that the expectation of life of every boy child in India is twenty-one years, or from that to twenty-two years. The expectation of life of every boy child in this country is forty-two years. A financial computation has been made which is really worth consideration by the Government. They have made enormous grants to education. If you deduct from those grants the sum
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spent on children who do not reach the age of twenty-one years you find that you lose £1,000,000 every year. If you compute at the lowest rate of coolie labour the losses from preventable disease, your loss in productive labour is £20,000,000 every year. Those figures, I think, justify us, not in asking for prodigious and panic grants, but at all events for some steady progress which we have not got at the present time.
Since 1896 India has lost 8,000,000 persons from plague, 2,000,000 in the Punjab alone. The population of the Punjab, instead of increasing as normally by 7 per cent., has gone back by 1·6 per cent.; and in Bengal the population has gone back in certain areas by 8 per cent. The District Boards of Bengal in 1910–11 had, out of a population of 52,000,000, a death-rate of 38 per 1,000. These District Boards had an income of £440,000. I am informed that they expended £96,000 on education and £21,000 on medical relief, but on sanitation they expended only £1,700. The whole expenditure of these District Boards out of these funds on new water supplies in aid of the twenty-five districts was less than £330, and on drainage about £453. I think I am justified in saying that here are cases where the Government of India should either press for further progress or themselves be willing to supply the initiative.
What does the scheme detailed in these Papers do? While it lowers the status of the head of the Department it adds eight Deputy Sanitary Commissioners, making in all twenty-nine for the whole of India. By population that would be equivalent to having five Sanitary Commissioners for the whole of Great Britain; by area it is equivalent to having three Sanitary Commissioners for Great Britain. And those twenty-nine officials compare with 1,700 Medical Officers of Health whom we have scattered about this country. I dare say it may be said that the officers of the Indian Medical Service also give such support as they can. I think their number—223—shows that they have their hands pretty full already, and I do not believe that an Indian medical officer has any more time for research and for bacteriological study than a panel doctor in this country would have. You must go beyond them if you desire to get anything done in that direction.

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The attachment of sanitation to education is rather a doubtful measure. Nobody can doubt that education will play a considerable part in the improvement of India in regard to sanitation; but when we come to the list of grants which are made for, and the amount which goes to, sanitation we find that in the last seven years education has had £13,000,000, and sanitation, in all its bearings, £2,000,000. The nonrecurring grants are equally divergent. I would ask the Secretary of State whether the large sums respectively spent on sanitation and education over a series of years might not be presented to Parliament in order that we may see clearly what has been done in one direction and in the other, because I notice that the Under-Secretary in the House of Commons is constantly mixing up education and sanitation, and also medical relief and sanitation, in the same figure, whereas the contention of those for whom I speak, and who feel strongly on the matter, is that you have to treat prevention entirely separate from cure. The tendency to belittle this question was shown in his Budget speech last year by the Finance Member of the Viceroy's Council, in which he classed the organisation of the Sanitary Service in India, over which he made a reserve of £15,000, as one of two small matters, the other being the abolition of a village cess in the Madras Presidency.
I invite the Government to take a forward step and to recast the whole of the decisions of the last two years with regard to this question. I do not ask them to pledge themselves to a vast expenditure. I do not desire, nor do I suggest, that they should undertake anything which is likely to interfere with the habits of the people or cause prejudice, but I do submit that it is possible to overstate the extent to which native opinion is adverse to an advance in sanitary improvements. It has been well pointed out that the main sanitary improvements at the present day are in reality merely an adaptation of old Hindu laws and customs. In the old Hindu laws will be found all the injunctions against the use of water from impure sources; all the injunctions against the defilement of water before use which has come from pure sources; all we desire at present in keeping food from the influence of microbes and in regard to the boiling of water, the removal of filth—all are part of the old Hindu laws which have been
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forgotten; but to this day there are, I believe, only about 1 per cent. of the villages in which the water collected into tanks is not allowed to be so placed and the tanks to be so arranged that everyone who dips a bucket or a jar into them walks straight in with the filth of the road upon his feet. Yet in cases where that has brought about a large amount of cholera, no difficulty whatever has been found in walling up the tank and in placing taps which have been readily used by the people. In the same way the old Hindu laws specially enjoin the use of running water; but I do not think it would be difficult as a matter of education to teach the people that water which has been defiled by latrines and by constant washing of clothes, even though running, must unquestionably be unfit for human consumption.
In the Madras Presidency 52 per cent. of the sanitary inspectors are themselves high-class Brahmins who risk a temporary defilement knowing that they can be purified, and who hold that in so doing they are carrying out one of the greatest instincts of their creed in the preservation of human life. The greatest authorities have borne testimony to the improvement of native opinion in this respect. The Punjab Plague Committee of 1910 reported—
"It has also been brought home to the Committee, particularly by the evidence of Indian witnesses, that the measures which have been adopted with the object of suppressing plague have introduced a desire for sanitary reform on the part of all classes of the population."
What I ask is that the Secretary of State should endeavour to establish a comprehensive Executive Sanitary Staff which shall be of the same caste and the same race as the people to be dealt with; and, of course, the administrative European staff should be of such experience and such sympathy with caste and race prejudices as would prevent what might have been on several occasions a serious danger. Dr. Greig, who made a survey for the Calcutta Improvement Trust, had occasion to enter 14,332 buildings, through himself and his staff, and he reported that—
"The survey had been carried out with remarkable smoothness. He doubted whether house-to-house visitation on such a wholesale scale could have been made in any other city in the world with such ease and safety."

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And the Hindu newspaper some years ago wrote these remarkable words—
"A little courage is all that is wanted on the part of the Government. The Hindu population is not what it was fifty or sixty years ago. It is now more disposed to be influenced by reason."
These experiences are encouraging. I do not for a moment suggest that it will not be long before this will be universal, and longer still before anything we can do will bring complete sanitation on a European scale to Asiatics.
I ask the Government this afternoon to consider four points. In the first place, that they should put the Head Sanitary Officer in the position which I claim for him, and which is claimed by every sanitarian throughout the world—that is, an autonomous position subject only to the Government which he serves. If you look to the number of lives and to the amount of money involved, you will find that he has a better claim to sit on the Viceroy's Council than probably several of those who are sitting there to represent other interests. I take it that such a proposal would be regarded as beyond the pale. But at all events let him have a sufficient status, one which will enable him to be called in early in the day to advise—not, after the event, to spend large sums of money in providing quinine for those who are struck with malaria, but to see that in the irrigation schemes which are brought forward some regard is had to the prevention of further danger. Again, in the large movements of corn at the time of plague it is only reasonable, before the Government acts, that the advice of the senior sanitarian should be taken. As to the grants to municipalities, I suggest, not that he should interfere with the Local Government, but that he should be there from an advisory standpoint, as, at all events, a reinforcement of the demands of the Local Government upon the Government of India.
The next point is in regard to education. I recognise to the full the value of education as being perhaps the only means of bringing sanitation into the households, but I ask, not that the education authority should be the arbiter of what sanitation should be taught, but that the sanitary authority should be the arbiter of what education should be given as far as sanitation is concerned, and that they should be more listened to as regards the establish-
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ment of scholarships or hostels in connection with laboratories than has been the case up to the present time. I hope it is not too Utopian to express some sympathy with the demand for a further attempt at female education in India in these matters. Between 1907 and 1910 6,450 male graduates were produced. Between 1822 and 1912—that is, in ninety years—our progress with female education was so small that only 1 per 1,000 females are able to read or write in English; and I suppose there is no Indian administrator here who has not realised that it is only if you can by some means educate the female population or some portion of it that you can stop the terrible waste of life in child-birth and in the early stages of the child's life, and also hope for serious improvement in regard to sanitation. I noticed that Sir Murray Hammick, who lately officiated as Governor of Madras, said in his closing speech before leaving—
"If anything is certain as to the future of this country it is the fact that until there has been an enormous development in female education there can be little social or political improvement."
I know all the difficulties, but I imagine it is possible to improve on the rather unfortunate figures which we still have to face in that respect. The third request I make of the Government is that they will organise such a Sanitary Staff as I mentioned just now, remembering that a thousand sanitary inspectors really doing their duty must be able to do in the way of education far more than the extra primary schools are likely to accomplish in a generation. Fourthly, I would ask the Secretary of State to re-establish the sanitary advisers to himself at the India Office. I cannot imagine that on any grounds it can be justified that sanitation should be the one and only subject on which the Secretary of State is to go without expert advice.
The conclusion to which I invite the Government to come is that if India is to make good in the rural districts the immense advantage which has been achieved in the municipalities; if any attempt is to be made to nip in the bud the epidemics that from time to time trammel the commerce and devastate the homes of India; if the new and admirable sources of water supply are to be kept free from pollution, and if the unremoved waste of these communities is no longer to be a fertile source of infection—in short, if India is to be in any respects

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in the rural districts what it has become in the urban, it is absolutely necessary to have a sufficient Sanitary Staff in co-relation between the urban and rural districts. Like the Hindu newspaper, I would ask the Government to have a little courage in this matter. I feel we may well ask ourselves how many more generations are to pass while, as we did between 1908 and 1910, we lose 16,000,000 of people from disease such as malaria, plague, and cholera, which is preventable or which can be reduced.
I know that the difficulties are very great. I fully appreciate the fact that no other Government in any part of the world has attempted to deal with a population of 240,000,000. But I think that if we were to exchange the somewhat halting operations of the past for something like unity of purpose and determined action we might hope to show results which, though they would never approximate to those which we have been able to show in the Army and in the gaols, would at all events redeem us from the stigma that 7 per cent. only of the population are touched, and that in only 1 per cent. of the villages, we will say in the Madras Presidency, is there any sanitary attempt at all. It is for that reason that I would ask the Secretary of State to amplify the Papers which he has laid before us, to give us figures as to the actual sums which have been expended, and are to be expended, over a series of years, and it is for those Papers that I venture to move.
Moved, That an humble Address be presented to His Majesty for Papers relating to the Resolution of the Government of India (Sanitary), dated August 19, 1912, and to the subordination of the Sanitary Commissioner with the Government of India to the Director-General, Indian Medical Service.—(Viscount Midleton.)
LORD BARNARD: My Lords, before the noble Marquess replies to my noble friend Lord Midleton, I venture, with his permission, to ask the attention of the House for a few moments to an illustration of the necessity for some improvement in the system of sanitary administration in India. The town of Tuticorin in Southern India, in the Presidency of Madras, is, I believe, excepting Madras, the largest port on the east coast. It has a population of
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36,000, and the trade which passed through the port last year, I am told, was of the value of some £6,000,000. There is there a water supply of a kind, but it is, alas, open to all the drawbacks and disadvantages to which the noble Viscount has alluded. The water is, I am told, polluted by the time it reaches the consumers in the open wells from which they get their supply.
Not only is the water supply extremely bad in quality, but in quantity the case is almost worse. Those who have given me this information tell me that after the rains there is a fairly adequate supply in quantity, but in two months' time the supply falls short, and if the season happens to be a very dry one it ceases altogether. This question has had the serious attention of the Chamber of Commerce of Tuticorin for a long time past. When the water supply gets to its lowest ebb the only drinking water which Europeans can get which they dare consume at all is brought over by steamer from the Island of Ceylon. Your Lordships can easily imagine the state of matters when the residents have to send down their servants with cans or jugs in order to get water for drinking purposes. I am told that the natives practically have no supply at all under these circumstances, and piteous cases have been known of their begging to be furnished by Europeans with one mouthful of water—and this in a country where an adequate supply of drinking water is absolutely necessary.
I am well aware of the great difficulties, difficulties of expense as well as engineering difficulties, but these surely can and might with vigorous administration be overcome. The present water supply is drawn from tanks five miles off, and the other day a tremendous storm washed down the wall and most of the water ran away. I am told that with a pipe track fifteen miles in length it would be practicable to provide the town with an ample supply of good water. I may mention that all the coolie labour for Ceylon passes through this port. The soreness which the Chamber of Commerce of Tuticorin and the European community feel is at the extraordinary delay in doing anything in this matter. The subject has been drawn to the notice of the Madras Government again and again. The difficulty first arose as far back as 1866, but of late years there have been constant hopes that something would be done, but nothing, I regret to say, has

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ever been done. The Europeans and traders there begin to despair of getting any help at all from the Government of India, and therefore their only hope is to try and call the attention of the people of this country to the matter in the Imperial Parliament.
THE LORD PRIVY SEAL AND SECRETARY OF STATE FOR INDIA (THE MARQUESS OF CREWE): My Lords, I think it will be convenient if I intervene at this stage to answer the various questions which have been put to me, although I hope that some other noble Lords who are interested in Indian matters, and in this question in particular, will not thereby consider themselves precluded from making any further observations on the subject.
I had better first deal with the point which has been raised by the noble Lord opposite, Lord Barnard, with reference to the water supply of Tuticorin. He in no way, I think, overstated the disabilities and indeed privations under which the people of that important seaport have laboured in regard to their water supply. The description is by no means agreeable reading. Some years ago a project was suggested by which the existing supply might be improved and purified, but it was found that owing to leakage and various other reasons connected with irrigation that plan was not practicable. About two or two and a-half years ago a larger scheme was instituted by which a supply for Tuticorin could be brought from the river some five-and-twenty miles away and stored in a reservoir between four and five miles from the town, a supply which would be adequate not merely for the needs of Tuticorin but also for two other important towns, Tinnevelly and Palamkotta. That scheme has apparently somewhat hung fire, but the last intelligence I had on the subject was in August of last year. In reply to a Question in the Legislative Council it was stated that there was every desire to push on that scheme as fast as possible. It is a considerable, and comparatively at any rate a costly, scheme; but I think it is evident that it is one which ought to be proceeded with and if possible pressed on. I will call the attention of the Government of Madras further to the matter, and shall be happy, if the noble Lord desires, to inform him of the result of my inquiry.
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I now pass to the larger question raised by the noble Viscount opposite. The noble Viscount has made a somewhat strongly marked indictment of the policy of the Government of India and of the India Office in reference to this whole question of sanitation. The House will have observed that the main burden of his speech was this—namely, that a complete divorce does exist in fact, and therefore ought to be recognised in legislation and administration, between the two sciences and practices of medicine and of sanitation. This is a view which, as we know, is strongly held by some; but the contrary is not less strongly held by others, and although the noble Viscount could produce, I have no doubt, distinguished names in support of his thesis, yet it would not be difficult to find a great body of opinion which would lament the complete divorce which he is so anxious to see brought about.
In 1904 the Sanitary Commissioner was appointed in express terms as adviser to the Government of India on sanitary matters, and the noble Viscount will, I am sure, remember that at that time a marked difference of opinion existed as to whether or not this officer should be subordinate to the head of the Indian Medical Services. After much discussion that question was decided in the negative, and he was appointed as a purely independent officer; and so things went on until the month of November, 1911, when, as the noble Viscount and the noble Earl opposite will also remember, we had a discussion in this House upon the express desire of the Government of India to do away with—I cannot call to mind the precise number—but a considerable number of the independent Commissioners with the Government of India, and one of those with whose functions they desired at that time to dispense was the Sanitary Commissioner. Again discussion ensued, and the opinion which prevailed was that it would not be advisable to abolish that officer altogether, but that it was wise, for reasons which I stated at the time and which it is not necessary to repeat, but which appeared to us to be conclusive, to return to the system which prevailed before 1904 and for certain purposes to place the Sanitary Officer in subordination to the Director-General of the Medical Service. And in July of last year I stated in reply to the noble Viscount what was proposed—namely, that the Sanitary Officer should

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for certain purposes be subordinate to the Medical Officer, and be given relief from a burden of office work which would enable him to tour a great deal more than he had been able to do since the appointment had been made; also that the bacteriological work should be treated, as it ought to be, as more distinctly medical, but that in sanitary matters the Sanitary Officer should have the power of direct communication with the Government of India, and, as the noble Viscount very well knows, all independence is marked by the power of direct communication with the supreme Government In that respect and within those limits the Sanitary Commissioner still remains an independent officer.
It is quite true that as the system now exists it falls very far short of the ideal which the noble Viscount described in the closing passages of his speech—namely, that of a great independent Sanitary Department supreme apparently over provincial Governments and forming one of the main Departments of the Government of India altogether distinct from the Government Medical Service. I am able to say that we have no evidence whatever that the kind of co-operation which at present exists between the two services causes in fact any set-back to the further progress of sanitary science and improved sanitary practice. And when the noble Viscount speaks of the head of the Indian Medical Service as being altogether untrained in sanitary science, and as presumably taking no interest in it, he is really speaking with complete injustice of the present head of the Indian Medical Service, because Sir Pardey Lukis, who is the Director-General at present, is a man who is personally most keen upon sanitation, and who is, as I think the noble Viscount will find out if he inquires, generally recognised as a first-rate authority on the subject. And when he speaks of the comparatively subordinate position of Major Robertson, who is now the head of the Sanitary Department, I can only say that he was selected by the Government of India on account of his personal qualifications for the post, and owing to the general recognition there of his knowledge of the subject and of his great capacity in dealing with sanitary matters.
The noble Viscount spoke of the striking inequality of effort of which the Government of India were guilty in dealing with
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preventive medicine. He drew attention to the marked divergence in the mortality percentages of Government services, the Army and others, as compared with the percentages of mortality in the rural communities of India. But surely it is reasonable, in comparing those percentages, to mention the comparative ease of dealing with those over whom you have complete personal control as compared with the endless difficulty of dealing more especially with scattered rural communities over whom you have only a most slender control. The noble Viscount said that he Was not speaking of the vast sums spent and of the improvements effected in the great municipalities such as Calcutta and Bombay, but he fixed his mind upon the rural conditions among the cultivators in the remoter parts of the country. If you are going to make that kind of comparison you ought to look at home. Does the noble Viscount know what the sanitary condition as regards drainage and water supply of a vast number of rural villages in this country is as compared with the conditions of such a town as Birmingham or Liverpool? I think he would find that the discrepancies between the sanitary conditions in some charming rural haunts in the three Kingdoms and the perfection which has been attained in some of the great municipalities are not less striking and not less marked than if he instituted a comparison between Calcutta and Bombay on the one hand and some district in the Central Provinces or the Punjab on the other, and from that point of view his argument, I confess, did not appear to me to be entirely fair.
Although the noble Viscount alluded to them, he passed lightly over the special difficulties of enforcing sanitary improvements in India. I appeal without hesitation to the two noble Lords on either side of him [the Marquess of Lansdowne and Earl Curzon of Kedleston], who have filled the office of Viceroy, as to what the extent of those difficulties are, founded upon the social and religious prejudices of the people of the country. We know what happened in Bombay when the Plague Regulations had first to be put in force, and what happened more recently in the Punjab under somewhat similar conditions. The fact is that if some of the noble Viscount's sanitation friends were allowed loose in India they could produce within a comparatively short time a state of revolution in that country to which what occurred

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in 1857 would be mere child's play. To talk, therefore, as though it were simple or easy to enforce in the more backward parts of India all the canons held by sanitary enthusiasts in this country is really to be altogether beside the mark. I confess that when the noble Viscount talks of the Government of India losing two million lives a year from preventable causes, I can only say that I should sooner have expected to find that sentiment stated in those terms in one of the more extreme vernacular papers, of which I read the translations once a week, rather than in the speech of a former Secretary of State for India.
The noble Viscount seemed to speak to some extent with two voices on the subject of education. He complained of the vast expenditure of sack, so to speak, for education with the mere halfpennyworth of bread which was supplied for sanitary purposes. But later in his speech he went on to point out what I believe is the true path to follow in this matter. He said that it is through the road of education that the best hope exists of arriving at an improved sentiment in India in favour of sounder sanitary conditions. There I found myself in complete agreement with the noble Viscount, but I think he must admit that there is a certain contradiction between that sentiment and the complaint on the amount spent on education.
To pass for a moment to the local conditions, it is true, of course, that there exist at this moment no distinct cadres for the local sanitary service, and there is not, generally speaking, a distinct local administration divorced from medical treatment. But it is permissible, I think, to look forward to a time when there will be a definite local sanitary service all over India, and at the same time to point out that when only a certain amount of money is available—when it is necessary to spend largely, or at any rate as we think to spend largely, on education, and also, as the noble Viscount would surely agree, to spend largely on the defence of India—when only a comparatively limited amount of money is forthcoming for sanitary expenditure, it is wiser, in our opinion, not to spend too much of that money in mere machinery and the payment of officers, but rather to devote a considerable part of it to actual expenditure on works for the improvement of the public health.
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I said something when I spoke last year about the proposed improvement in the sanitary staffs, and I think I stated then that I hoped at no very distant time this would lead up to the establishment of a regular sanitary service. I say this with particular pleasure because I am again in agreement with the noble Viscount in thinking that such a local service can be and ought to be very largely staffed by Indians. They are, for reasons which the noble Viscount mentioned, and also by reason both of character and of knowledge of the country, peculiarly well fitted, as I venture to think, for such a service as this, and I should like to see a great multiplication of them in the not distant future. The noble Viscount reminded us that we were appointing eight new Deputy Sanitary Commissioners, not necessarily members of the Indian Medical Service, and he complained, as he was of course entitled to do, of the paucity of their number. We are going to add four more now to that number, and also some additional health officers.
It was pointed out by the noble Viscount that a considerable part of our recent expenditure was non-recurrent. That, of course, is true, because that expenditure to some considerable extent represented sums which we were able to set aside out of our large balances partly due to windfalls which will not recur. Since January, 1911, the total of non-recurring expenditure has been £1,880,000. That is not counting about £90,000 spent on the Provinces immediately under the Government of India, and not counting £667,000 which have been provided from Imperial funds for the Calcutta and the Bombay Improvement Trusts between them. That, as the noble Viscount will agree, is a considerable sum. During the same period the recurring expenditure reaches the figure of £243,000 a year to the Provinces generally, £24,000 a year to the minor Provinces, and £10,000 a year to the Calcutta Improvement Trust. It is, of course, open to anybody to wish that these figures were larger, but I do not think, even in relation to our expenditure on other matters such as education or defence, that they can be regarded as contemptible figures.
The noble Viscount asks whether I can supply him with any more Papers. There are some Papers largely concerned with

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matters of detail, perhaps too much so to be of general interest, but which I have no doubt the noble Viscount and some others would find interesting. I will consider carefully what Papers can be presented as quickly as possible and in what form. I see no present difficulty in at the same time furnishing a Return, for which the noble Viscount asked, of the comparative expenditure upon some of the other services in India during the period, say, of five or ten years. I cannot think that there would be any special advantage in selecting the expenditure on education for the purpose of comparison, for reasons which I have explained in the course of my remarks; but there will be no difficulty in also publishing those figures and possibly others at the same time for purposes of the comparison which the noble Viscount desires to make. I think I have traversed all the ground which the noble Viscount covered, and though I have found it necessary to make some little complaint of the manner in which he approached part of his subject, yet I am grateful to hint for raising the discussion and am glad it has taken place.
LORD SYDENHAM: My Lords, it is with much diffidence that I venture to take part in this discussion, and I do so only because I have lately come back from India where I have striven as much as a layman may to understand the medical and sanitary needs of the country and to find the necessary remedies. All who have read this Blue-book will, I think, feel that the noble Viscount's strictures are most of them well deserved. The Bluebook does not tell us all we want to know, and it is not in any sense an illuminating document. However, it does tell us that there are a large number of able and enthusiastic workers now engaged in the wide field of Indian sanitation, and it brings out the fact that a great deal more investigation has to be done before we can fix our minds upon certain facts which will guide our policy in the future.
The work that has been carried on by the Plague Commission is altogether admirable, and has already been successful in saving a large number of lives; but more investigation still needs to be undertaken before we can say that we know all that we ought to know in regard to Plague preventive measures. Malaria, another terrible scourge of India, is being attacked
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from many sides, and I trust that the conference held in 1909 will help to focus opinion and enable us to decide upon ways and means for reducing the deplorable mortality and economic loss resulting from this distinctly preventable disease. Here, also, there is much still to be learnt, and careful scientific investigation in areas of manageable size is essential. Cholera, which scarcely figures in these Papers at all, may be now said to be fairly well under control. But Tuberculosis is, I am sorry to say, largely on the increase, especially in the great towns; and I am thankful to have been able to start a campaign against this insidious disease in Bombay with the support of the Indian medical profession, of public-spirited Indians, and of the Government.
One naturally turns to that part of the Blue-book dealing with the practical measures proposed to be taken, which are contained in correspondence between the Government of India and the Secretary of State and between the former and the Local Governments. Very briefly, the proposed scheme is directed to the building up of a special expert Sanitary Service by increasing the existing number of deputy sanitary commissioners in Government employ, and by giving assistance to municipalities in providing health officers possessing expert training. The Government of India lay down one important principle in their letter to the Secretary of State, dated January 4, 1912. They say—
"We consider that the agency to be employed for the future development of the sanitary administration in this country should as far as possible be Indian, the direction only being European and of the best class procurable."
I believe, my Lords, that that principle, is absolutely sound. We must do all we can to associate Indians with the Medical and Sanitary Services of their country. But I need hardly say that we must obtain Indians who not merely pass examinations and obtain diplomas, but are men of active habits with scientific initiative, men who will not fear to say and do what may not always be popular amongst their countrymen. I hope that better opportunities of instruction and wise selection will in time enable Indians to play a part also in the higher direction of the Sanitary Services.
The difficulties of sanitary reform in India were to my mind underrated by the noble Viscount in his speech this

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afternoon. The noble Marquess the Secretary of State has, I think, taken a truer estimate of those difficulties. It may be said that the success of modern sanitation depends largely upon compulsion. In Western countries complicated systems of prohibitions and injunctions, enforced by penalties and watched by inspection, have been built up with the acquiescence of the people. That is exactly what we cannot do at present in India, where we must continue to exercise extreme caution in dealing with these matters, as the painful experience to which the noble Marquess referred has taught us. We cannot go, and we ought not to go, far in advance of what public opinion will accept. While it is true that sonic progress in the education of India in sanitary matters is going on, I could give many instances of the difficulties met with from quarters where they would be least expected. The masses have not the slightest belief in modern sanitary science, and even the educated classes are only just beginning to trust our scientific methods. Customs of the most insanitary character are deeply engrained and cherished to an extent which it is difficult for us to realise; and, as the noble Marquess has said, strong religious principles are closely bound up with these customs, and in India we cannot be too tender in dealing with matters of religion.
When one arrives in India nothing strikes one more painfully than the large mortality, the larger amount of ill-health, and the physical deterioration arising from preventable disease. But one quickly realises the difficulties of applying effective remedies and the discouragement which may attend one's efforts. The greatest quality needed in an Indian administrator is patience. Nevertheless I do think that India is steadily progressing in sanitary matters, and that we are doing more than is generally known or than this Blue-book would lead one to expect. My principal criticism of the Blue-book is that it does not set forth in the form of a clear statement what is being done in the various branches of sanitary effort in all the Provinces in India. Nor can I discover a sufficiently plain indication of what lines the policy of the Government of India will follow in the future. We have had rather an epidemic of large conferences in late years. We want to know whither these conferences are going to lead us.
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With regard to the specific terms of the noble Viscount's Motion, I do not find fault, as he does, with the subordination of the Sanitary Commissioner with the Government of India to the Director-General of the Indian Medical Service. There are some branches of sanitary administration which should be kept apart and dealt with by specially-trained men; but, on the other hand, the contact between medical and sanitary science is very close at many points, and in regard to a large number of questions it is difficult to say whether they should be on the medical or on the sanitary side. Therefore I feel that there is great force in what the noble Marquess has said—that we should not divorce these things at their head. The Bombay system works well. The Sanitary Commissioner has all the powers which the noble Viscount has attributed to him; but Bombay has a Sanitary Board the head of which is the Surgeon-General of the Province, and so long as the Surgeon-General is selected on account of wide administrative experience and capacity I believe this plan is a sound one. A Sanitary Commissioner with the Government of India can do nothing directly for the sanitation of a country so vast; but, if he is given large powers, he may effectively obstruct and delay progress in the Provinces. On the other hand, he may be able to give direction and co-ordination to scientific investigation, of which, as I have said, very much more is needed, and he may thus prevent overlapping of work and ensure that specific inquiries are carried on by the most suitable men in the most suitable places. That, I understand, is to be his principal function, and I hope he will be confined mainly to it. I strongly dislike the suggestion that he is to go about all over India inspecting works of sanitation in progress and to give his advice upon them. This would inevitably mix him up with engineering and local municipal matters of which he can know nothing, and must bring him into conflict with men whose practical knowledge is far greater than his own.
Will your Lordships now permit me very briefly to say what I think are the general lines which we should follow in India. In the first place, I feel that initiative and the impulse to sanitary measures must come mainly from the Local Governments. They alone know the needs of their several Provinces and how far they can go with

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the acquiescence of the people, which, after all, is a matter of first importance, in meeting those needs. India requires much more nursing power, especially to aid the poor women in their confinements. The mortality of mothers and infants in Sind, where I lately was, is deplorable, and elsewhere the conditions are nearly as bad. This mortality is due wholly to the barbarous methods which are now in general use. We want to encourage Indian women to take up the medical profession because they can do work which is absolutely denied to men. Then we must spread hospitals and dispensaries, so that in time medical aid is within the reach of the whole of the rural population. All these measures will in themselves have an educative effect among the masses which will certainly smooth our path in regard to sanitary progress in the future. At the same time liberal assistance must be given by the Government of India to water supply and drainage schemes wherever the local authorities are willing to help so far as their means permit; and if this assistance could be given in the form of fixed annual grants instead of in the form of demoralising doles it would be a great advantage. Then we must seek, as we are doing in Bombay, to inculcate the first principles of the laws of health in our schools. But I should trust much more to the agency of nurses and. Indian lady doctors for educating the people of India in the direction of sanitation. Lastly—and it is a matter of great importance, though it cannot always count on popular support—it is essential to carry on continuous scientific investigation in India, where the opportunities for such investigation are supremely favourable.
In various directions we are moving already, though, as I have said, the Bluebook does not tell us enough. But I should like to see a quickening of the pace. I hope that I have not detained your Lordships too long, and my excuse must be that my experience has led me to take strong views as to our responsibilities in regard to the mitigation of preventable diseases among the helpless masses of India and the attainment of a higher standard of public health.
VISCOUNT MIDLETON: I am sure we have all listened with great interest to the speech of the noble Lord who has just sat down. I am sorry that the noble Marquess the Secretary of State has not been able to give a more favourable reply to some of the points which I ventured to put before him, and I do not think that he has really added very much to our stock of knowledge with regard to the position of the Senior Officer. With reference to what has just fallen from the late Governor of Bombay, I am bound to say that had my noble friend Lord Minto, who is unfortunately unwell, been able to be present to-day he would have expressed a different opinion. While fully realising that most of the reforms must come from the Local Governments, he is of opinion that the position of the Sanitary Commissioner with the Government of India would have greatly strengthened the Local Governments as well as the general administration. As to the Papers which the noble Marquess has promised, I trust that we may have in them a better account of what has been done, and also a clear statement of the views taken by the Local Governments in regard to the change. In withdrawing my Motion I would express the hope that, although the noble Marquess has found it necessary to refuse so many of these proposals at this moment, he will find as time goes on that there are some of them to which he may be able to give practical effect.
Motion, by leave, withdrawn.

LOCAL GOVERNMENT (ADJUSTMENTS) BILL. [H.L.]
Order for the Second Reading on Wednesday next, discharged.

EXTENSION OF POLLING HOURS BILL.
Read 1a, and to be printed. (No. 61.)
House adjourned at ten minutes past Six o'clock, till To-morrow, half-past Ten o'clock.