§ Order of the Day for the Second Reading read.
§ THE PARLIAMENTARY UNDERSECRETARY OF STATE FOR DOMINION AFFAIRS (THE DUKE OF DEVONSHIRE)My Lords, I am sorry to have to make a speech of considerable length to your Lordships starting at this late hour of the evening, but this is a Bill of some length and complexity, and I feel bound to explain its provisions in some detail to your Lordships. Its main purpose is to establish a cancer service under which there will be available in every part of the country modern facilities for the diagnosis and treatment of the disease. At the present moment such facilities exist in some voluntary hospitals and some municipal hospitals, but there are wide areas of the country where they are far from adequate.
I want to stress the point that the Bill is primarily one for the diagnosis and treatment of the disease, because some criticism, both in another place and outside, has been directed to the point that the Bill contains no provision for further research into the nature, the causes and the cure of the disease. My noble friend behind me, Lord Balfour of Burleigh, has an Amendment on the Paper directed to this particular point. With all respect to the noble Lord and to those who agree 189 with him, I would point out that the provision of machinery for the diagnosis and treatment of disease throughout the length and breadth of the land and the provision of funds for highly specialised research work are two entirely separate and distinct things. The Lord President of the Council, and not my right honourable friend the Minister of Health, is the Minister responsible for the allocation of funds for medical research, and even if he were of the opinion that at the present moment it was desirable for him to find more money for research work into cancer, this Bill, which is an administrative Bill, dealing with the machinery of local government, would not be the appropriate method of his doing so. In point of fact the Lord President of the Council can increase his grant to the Medical Research Council without any legislation whatever. Legislation is not required for that purpose.
Besides that it is a fact that a very great deal of admirable research is being carried on by the two great bodies which are engaged on cancer research, the Imperial Cancer Research Fund and the British Empire Cancer Campaign. Between them these two bodies are to-day spending over £90,000 a year on research and both have given my right honourable friend formal assurances that there shall be no relaxation of their efforts. A Clinical Cancer Research Committee has been formed which is composed of representatives of the London teaching hospitals, the London County Council, the Middlesex County Council Hospitals, and a proportion of the specialised hospitals in London. This committee hopes to investigate the whole of the 17,000 new cases of cancer which are estimated to be admitted to London hospitals each year. It has appointed cancer registrars at the hospitals which are co-operating in the scheme and those registrars will record by means of a system of uniform registration particulars of all cancer patients who attend at the hospitals. The committee will thus be able to investigate and compare the results obtained by different methods of treatment and to advise on what form of treatment is best under any given condition.
Arrangements are being made to secure that adequate records are kept of all cases treated under the Bill. Moreover, the Minister has arranged for the appointment 190 of a special sub-committee of the existing Medical Advisory Committee which will advise him in the exercise of his functions under this Bill, and will, in particular, be consulted as to the records required, the methods of analysis and the publication of results. I have already referred to the Medical Research Council, which anticipates that the increased number of cases which will be treated under this Bill will add to its responsibility, and, to quote its report for last year, the Medical Research Council is prepared to assume responsibility for the greater efforts in this direction which have now plainly become a matter of urgency in relation to the development foreshadowed in the Cancer Bill. It may well be that the greater number of cases which will be treated under this Bill and the increase of medical knowledge which that treatment may lead to, may open up new lines of research which may be profitably pursued. If that proves to be the case I have very little doubt that the Lord President of the Council will lend his ear to representations which may be made to him by the Medical Research Council, and that the Chancellor of the Exchequer in his turn may be willing to listen to representations made to him. I hope that I have said enough to indicate to your Lordships that research, although not specially provided for in this Bill, is not being neglected and that the possibilities of further grants for research have not been ignored.
Cancer, my Lords, is not only one of the most deadly, and I think quite the most dreaded, of all diseases which afflict mankind, but is one of the most baffling to medical science. Great progress has been made in the prevention of other diseases which used formerly to be dreaded scourges. Cholera, malaria, typhus and plague, all of which at one time were dreaded afflictions in England, have been for all practical purposes eliminated altogether. It is not a very long time ago that normal parents expected to lose a considerable proportion of their numerous families from smallpox, and that any woman who was not irretrievably scarred by smallpox was considered a great beauty. Last year there were only three cases of smallpox in Great Britain and not one was fatal. Great progress has been made with the treatment of tuberculosis and the death-rate from that disease is going down. No one now regards it as incurable, as it 191 was universally regarded until a relatively short time ago. The position with regard to cancer is otherwise. The death-rate is rising and it is now the second on the list of fatal diseases. Deaths in 1937, the last year for which complete records are available, were 74,000. Of the total deaths from all causes during the working period of life, that is fifteen to sixty-five years of age, no less than 17 per cent. are due to cancer, and it seems probable that even that does not represent the full mortality, for medical men, I understand, for the sake of avoiding distress to relatives, do not certify death to be due to cancer if they can fairly and reasonably avoid doing so.
§ VISCOUNT SAMUELDo those figures relate to England and Wales?
§ THE DUKE OF DEVONSHIREI think England and Wales. Nearly half the deaths from cancer occur when the victim is under sixty-five and about 10,000 under the age of fifty, when working or business capacity is still at its best and the head of a family is most necessary to his dependants. Moreover, as I have said, the death-rate is rising. In 1901 it was 835 per million. To-day it is over 1,600 per million, so that it has nearly doubled in the course of one generation. The problem is not one which is confined to our own country. Other countries which have a registration system show a high and increasing figure. There is some doubt whether the figures are strictly comparable, and I give them to your Lordships with all reserve. It may be that the method of keeping figures on the Continent does not afford an exact comparison with our own, but, for what they are worth, it seems that in the five years from 1926 to 1930 the incidence of cancer increased 9.5 per cent. in Holland, 3.9 per cent. in France and 3.7 per cent. in Switzerland, while in this country it increased by 14 per cent. It is sometimes suggested that cancer is a disease of civilisation and that the increasing artificiality of our lives has something to do with its increase. In fact, it is by no means confined to civilisation. No comparable figures of mortality are available, of course, but the disease is by no means unknown among quite primitive native races, and among some very primitive peoples there are forms of it which are actually more common than they are among ourselves. So much for the 192 seriousness and magnitude of the problem which confronts us.
There are brighter aspects of the situation which it is permissible to consider, anxiously and carefully, and not without hope. One of these is that there are very good grounds for believing that the increased incidence of cancer is due in no small measure to the increasing average duration of life. Medical science has in the last two generations enormously extended the average person's duration of life. The result is that many more millions of persons are living on until the age at which cancer normally becomes prevalent. It is a mistake, as I said just now, to regard cancer as a disease only of old age. It attacks many people in the prime of life. But it is, generally speaking, not a disease of youth. In the eighteenth century nearly half the people born in a great city died without reaching the age of 21, and the incidence of cancer was necessarily very low. There can be no doubt that the fact that many people's lives are prolonged into the late sixties—many more than was the case in the past—has had a good deal to do with the increased death-rate from cancer, and we can fairly claim that the figures, formidable and serious as they are, are not quite so formidable as at first sight they may appear.
Another ground for optimism is that the mortality from cancer of certain of the more accessible organs is declining at almost every age of life, notably cancer of the lip, jaw and skin. There seems to be no doubt that this decline is due, in part at any rate, to the increased knowledge of the appropriate treatment and to the effects of that treatment, though it may be partly due to the lesser incidence of the disease in those particular organs. Again, some forms of cancer seem to be disappearing altogether. Some forms of skin cancer, due to exposure to certain irritants, such as tar, some forms of mineral oils, and some forms of industrial processes, are preventible, partly by avoidance of exposure to the particular forms of irritation and partly by preventive treatment of those conditions of the skin which may give rise to the disease. It seems certain, and I think credit should be given to my right honourable friend the Minister of Health and his Department, that some of the health services which are now available are definitely bearing fruit in reducing the 193 incidence of the disease. Dental services, venereal disease services, and maternity care services are all contributing to the prevention of conditions which might otherwise have become ultimately cancerous conditions.
But above all other ground for hope is that we can claim—only tentatively as yet—that our knowledge of the treatment of the disease is increasing. The records of the surgeons show that by surgery, by radium treatment and by X-ray treatment patients can be not only relieved but, especially in the earlier stages of the disease, definitely cured and freed from their disease. Little progress has been made in our knowledge of the causation and real nature of the disease. We know that certain forms of irritation may produce it, but we do not know how or why. We do not know whether it is caused by a bacillus or by a virus. We know very little about the extent to which it is contagious. There are many things we do not know, but we do know beyond possibility of doubt, that treatment both by radium and by X-rays—and in some ways, I understand, X-ray treatment has held out most encouraging hopes, in some forms at least, of late—does produce some definite action on the cancer cells which leads either to their destruction or to some change which facilitates their removal by the normal regenerative processes of the body. In that knowledge there is ground for hope.
The object of this Bill is to make available, where they are not available to-day, the benefits of this advance in knowledge. For treatment to be successful it must be given in the early stages of the disease, and to enable it to be given there must be adequate facilities both for early diagnosis and for proper treatment. In some parts of the country these facilities are not unsatisfactory to-day. In London, for example, it is computed that there are at any given time some 11,000 sufferers from the disease, and that about 10,000 of them are receiving some form of treatment. Progress nearly as great is being made in some other areas. There are, however, extensive areas where no adequate or accessible facilities are obtainable. These are, notably, a belt of country extending from the Tyne to the West Riding; very nearly the whole of North and Central Wales, and a broad belt of country running across England from the Wash to Devonshire. There are, of 194 course, other minor areas as well. My right honourable friend, after making a most exhaustive survey of the situation, estimates that in order to carry out the objects of the Bill and to make such provision that the sufferer from cancer in any part of the country shall have available adequate facilities for the early diagnosis and early treatment which are necessary, approximately 300 to 350 new consultation centres and twelve new treatment centres in addition to the existing twenty-two will have to be established. This will necessarily take time. I need not remind your Lordships of the danger of entrusting to an inadequately-trained staff so formidable a weapon as a deep X-ray apparatus. He further estimates that about 1,000 additional beds will have to be provided at existing hospitals.
We lay stress on the provision of the Bill that the new beds will be attached to existing and established hospitals, because we wish to avoid the stigma which might adhere to the word "cancer." Many of your Lordships will be aware that there still existed until lately in many parts of the country a deep-rooted fear and suspicion of all hospitals. Many people believed that admission to a hospital was probably a death sentence, and almost certainly a sentence to be ruthlessly experimented upon by unskilled and unprincipled medical students. That belief has died, or is dying fast, and the hospitals to-day enjoy the confidence of the people of the country. The management and the medical and nursing staffs have deserved the confidence of the people, and there is a great measure of confidence in the hospitals to-day. I think, however, that your Lordships will agree that there might well exist, both on the part of patients and on the part of their relatives, especially in the remoter parts of the country which it is the special object of this Bill to assist, a real dread of visiting any hospital which is called a cancer clinic, cancer hospital or whatever you like to call it, and that this dread might go far to defeat the object of the Bill. We have therefore considered it important to attach the new facilities for cancer treatment to existing hospitals which enjoy the confidence of the population. The Bill also includes provision for financing the purchase by the National Radium Trust of additional quantities of radium and of other radio-active substances, and of apparatus and appliances 195 for radiotherapeutic treatment. This financing will be done by means of loans through the Trust, and the loans will be repayable to the Minister. The Bill also includes provision for the prohibition of certain classes of advertisements.
So much for the Bill and what it sets out to do. I propose to take your Lordships very briefly through the various clauses and to explain how the Government intend to do it. Clause 1 lays upon the local authorities the duty of making arrangements to facilitate the diagnosis and treatment of cancer, and for the payment where necessary of travelling expenses both for patients and for a friend or a relative to accompany them. I think your Lordships will agree that that is both a humane and a necessary provision. Clause 1 further lays upon the local authorities the duty of reporting from time to time to the Minister what arrangements they have made, and of consulting certain expert bodies upon these arrangements. Certain sections of the Public Health Act, 1936, and of the corresponding Acts applying to Scotland are made applicable to the new service, so that in suitable cases the local authority will be able to recover expenses. The net cost of the new service is estimated at approximately £700,000 a year, Scotland included, of which half will be found by my right honourable friend and half by the local authorities.
Clause 2 deals with the method of allocating the Exchequer grant to local authorities. The broad principle is that Parliament provides half the money and the local authorities the rest, but, as I think your Lordships will agree is fair and reasonable, the half provided by Parliament is not to be divided on a flat rate but according to the needs of the locality. Under the ingenious and, I think, very fair and reasonable system of weighting the percentage grant, so that it may accord with the needs of the locality, it will vary from as low as 21 per cent. in a comparatively well-to-do area such as Bournemouth to as high as 85 per cent. in Merthyr Tydfil, Denbigh, Pembroke, Glamorgan and a number of other relatively poor areas in Wales and elsewhere. I need scarcely say that, while the general principles of the Bill have not been seriously challenged in another place, this scheme which deals with a share-out on a cash basis has been 196 the subject of severe criticism. There was no lack of members who were prepared to declare upon their conscience that, while on the whole the system was fair, the needs of the particular locality which it so happened that they represented had been grossly under-estimated. Your Lordships are immune from the necessities which begin to weigh upon the members of another assembly with increasing severity towards the end of the third year of the life of a Parliament, and I trust that you will agree that, while no system is perfect, the system of weighting the percentage grants which my right honourable friend has worked out is on the whole a fair and a just one.
Clause 3 provides for the financing of the purchase of additional quantities of radium which the provision of increased facilities for the treatment of cancer will necessitate. It has been thought desirable, for reasons which your Lordships will appreciate, that the Government shall not themselves directly enter the radium market. It is proposed that the purchase of the radium and other radio-active substances required shall be carried out by the National Radium Trust. The clause provides that for this purpose the Minister may lend to the Trust sums not exceeding£500,000. This is not new money over and above the £700,000 per annum which it is estimated the Bill will cost, for the clause also provides that the radium purchased by the Trust shall be distributed by it to hospitals, and the hospitals will have to make charges sufficient to cover the service of the loans made to the Trust. The amount of these charges is included in the estimate of £700,000.
Clause 4 deals with advertisements. Your Lordships will remember that we had a most interesting debate, initiated by the noble Lord, Lord Horder, to whose views on this Bill we shall look forward to hearing, on this subject last year. The noble Lord called attention to the enormous growth in the quack medicine trade, and to the incongruity of exercising no control over the deleterious effects of such trade upon health at a time when a serious effort is being made to improve national fitness. After an interesting debate my noble friend Lord Gage expressed the sympathy of the Government with the Motion, but could not promise the early introduction of general 197 legislation dealing with the quack medicine trade. In view of what he said, however, your Lordships will not be surprised that in introducing a measure providing for the effective treatment of cancer the Government should deal with this trade so far as it applies to this disease.
In the course of that debate Lord Horder referred to the fact that the public is slowly becoming aware that some diseases, like cancer, are not cured by drugs, and that the advertiser is quick to realise this, so that in fact cures for cancer have gone out of fashion. There is, nevertheless, a real danger that with the increased publicity given to this disease, and to the undoubted fact that it is curable, by the campaign which the Government are launching in this Bill, there might be a recrudescence of these advertisements, and a valuable opportunity might be missed if advantage were not taken of it to deal with the matter. There is no doubt that the advertisement of these quack remedies is a great evil. In many cases they produce no effect at all, good or bad, and in that case the sufferer is merely wasting money on them which he would do far better to spend on nourishment or something else. That is bad. In other cases they are actually harmful to health, which is worse. In cases where they may produce some temporary alleviation, fancied or real, they may induce the sufferer to postpone taking proper treatment, and in that event they are, positively and literally, a deadly menace to human life. The Government are gratified by the fact, which your Lordships will be glad to learn, that this clause has been welcomed by the two great newspaper organisations, the Newspaper Proprietors' Association and the Newspaper Society, and it was indeed somewhat strengthened in the House of Commons at the instance of a member of one of these organisations.
Some fears have been expressed about the clause, and apprehension has been felt that it may operate to hinder the beneficent work of faith healers and others, who have, it is claimed, sometimes produced the most remarkable results. I do not think that your Lordships need have any fears on that point. There is a saving for advertisements sent to members of the medical, nursing and pharmaceutical professions, and certain businesses, or published in journals of a technical character, or sent to certain 198 classes of persons who may reasonably need to be informed on such matters, such as members of either House of Parliament, or members of local authorities, so that I do not think that there need be any fear that the clause will operate to hinder the proper dissemination of any genuine information about the disease.
The clause, moreover, applies equally to qualified and unqualified practitioners. It does not prohibit an unqualified person from treating cancer, so long as he does not advertise, and it does not prohibit an academic statement for the information of the public of the results obtained by any particular method of treatment. Further, as a safeguard against vexatious prosecutions, it is provided that no prosecution may be initiated without the consent of the Attorney-General or of the Solicitor-General. I have had some inquiries as to the application of this clause to Christian Science treatment. It will be obvious to your Lordships that the clause does not prohibit the treatment of the disease by Christian Science practitioners. But the question has been raised whether the Directory of Practitioners published in the Christian Science Journal will not be an infringement of the provisions of this clause. My right honourable friend the Minister of Health has considered this question with his legal advisers, and he has asked me to say that he is now satisfied that this clause will not prohibit the continued publication of this directory.
Of the remaining clauses, Clause 5 is the Interpretation Clause, Clause 6 deals with the application of the Bill to London, Clause 7 with its application to Scotland, and Clause 8 is the short title. I am afraid that I have kept your Lordships a very long time, but we are dealing with a very big and a very serious subject. I commend this Bill to your Lordships as a serious, carefully-planned, and well-thought-out attack upon one of the most terrible scourges of humanity. At the present time cancer is responsible for over 70,000 deaths a year, and the death-rate is rising. It is reckoned that not more than one case of cancer out of every four in an accessible site, and fewer still where it is deep seated, is to-day given the chance of cure or substantial alleviation offered by the prompt application of methods based on the knowledge now at our disposal, so that a very large number of cancer sufferers, who could be cured, 199 are not being cured, and others whose sufferings could be greatly alleviated are not receiving treatment.
The great message of hope which this Bill brings is that cancer, especially in its early stages, is curable, and that a new cancer service, designed to bring the most modern methods of treatment and cure within reach of every part of the country, is being set up. The bogey of the incurability of cancer is one which we have got to fight. It has been a powerful ally of this fell disease, and a powerful hindrance to the doctors in their fight against it. So long as people believe, as very many still believe, that cancer is incurable, many will shrink from going to a doctor about it at its first onset. I dare say that there is not one of your Lordships who is not familiar with some such case as that of a person tormented by the fear that he or she has cancer, but deferring any treatment or even a visit to a doctor because of the fear that, at worst, he or she will hear a death sentence or, at best, that nothing much can be done about it.
This fear of diagnosis, which is a very real thing, is one which it is very important to dispel. It is a fact that many forms of the disease are curable, and curable completely and permanently if taken sufficiently early, and that many thousands of curable cases are to-day reaching the incurable stage through lack of sufficiently early diagnosis and treatment. The evil effects of this fear of even naming the disease extends beyond those who are actually suffering from it. There must be many thousands of people who are torturing themselves with the fear that they are afflicted, who have in fact little or nothing the matter with them. Within my own experience I have known a case of suicide from fear of cancer, when in fact the victim was suffering from nothing of the kind. It is our hope that by making facilities both for diagnosis and for treatment available, and by proving to an ever-growing number of people that the disease is curable, and that all is not over when a diagnosis of cancer has been made, a different attitude may in time become prevalent. It is our belief that this Bill holds out a prospect of cure to very many sufferers for whom a cure has not hitherto been available, that for many more it affords a prospect of substantial alleviation of their sufferings, and that it will add, and add appreciably, to the sum 200 of our knowledge of the disease, and so enable us to intensify our attack upon it. I earnestly commend the Bill to your Lordships, and I beg to move.
§ Moved, That the Bill be now read 2a.—(The Duke of Devonshire.)
§ LORD BALFOUR OF BURLEIGH had given Notice that, on the Motion that the Bill be now read 2a, he would move to insert the following words after the word "That"—namely, "this House whilst regretting the Bill does not contain a provision for increased research into the cause and treatment of cancer, resolves that." The noble Lord said: My Lords, my first duty must be to offer my respectful congratulations to the noble Duke for the very admirable speech which he has just delivered. It was full of information and I think we could not have had a better exposition of the Bill and of the many admirable things which it contains. I might add, if I may, as I think this is the first time the noble Duke has been in charge of an important Bill in your Lordships' House, how fortunate we must think the Government to be in having secured so admirable and eloquent a recruit for their Front Bench in your Lordships' House.
§ Admirable as the noble Duke's speech was, I must confess that the part which I liked least was that with which he began, when he made reference to the question of research. The object of my Motion is to stress the need for fundamental research into the cause of this disease and to give the Government an opportunity of making a statement on the point. I hoped to hear that along with this great measure for alleviation, and in some cases cure, we were to have a stimulation of the other side, the driving force of the whole business, the stimulation of research. Instead of that I must admit the statement the noble Duke made was worse than anything which I could possibly have imagined. I can only say that the bad impression which the absence of any reference to research in this Bill has already created in medical and scientific circles in this country, will be intensified by the statement which has been made by the noble Duke. I do not think I am exaggerating when I say that every speaker in another place who had any medical or scientific knowledge referred particularly to the question of research, and indeed it is a matter which 201 has been uppermost in scientific and medical circles ever since the introduction of this Bill.
§ May I remind your Lordships that the cause of this disease remains undiscovered? The noble Duke said, of course quite truly, that machinery was one thing and the provision of funds was another, and I admit that his departmental defence is complete. But that does not meet the charge against the Government that this policy is lop-sided and incomplete. The noble Duke said, quite truly, that the Medical Research Council had at its head the Lord President. He made a slip when he said—I took it down—that the Lord President could quite easily increase his grant. Of course, as the noble Duke knows, the Lord President has no funds at his disposal. All he can do is to apply to the source of all bounty and hope for the best. After the statement which the noble Duke has made to-day, what hope is there of increased grants for research? I must confess I am deeply discouraged by what we have heard.
§ The noble Duke made a great point that a great deal of research was already being carried on by voluntary bodies. So it is, and so it will be continued. But all the things which he enumerated—the comparison of results, the question of treatment, the keeping of records—have reference to what I may call clinical research. They have no reference whatever to fundamental research into the cause of this disease, which is the thing to which alone we could look for the mastering of this terrible scourge. The methods of treatment on which the Government are founding this great experiment are surgery, radium, X-rays, and of these three the last two methods are still in their infancy. I was glad to hear the noble Duke's reference to present knowledge of this subject; he did not go further than to say that it was tentatively hoped that knowledge was increasing. He also made reference to the fact that in hands other than the most completely skilled, some of these methods may be more of a menace to the sufferer than an alleviation. The noble Duke made reference to the Report of the Medical Research Council, and I have fortified myself with that Report, because I think it is important to let your Lordships understand exactly where we stand with regard to these methods of treatment.
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At this late hour I shall spare your Lordships the infliction of reading many paragraphs. I would have liked to have been able to give your Lordships more extracts than I now can, because this Report, emanating from so high an authority, must carry more conviction with your Lordships than the words of a layman. In a section of the current Report of the Medical Research Council, just issued, there is a passage of three pages dealing with the treatment of cancer by radium which does show how very tentative the advance is, and how very far we are from having any certainty that even in early stages a cure can be effected. There is the tale about the radium—how in 1920 the Treasury handed over 2½ grammes of radium salt from the Disposal Board of the Ministry of Munitions. It was surplus from the War and that was the origin of the radium available for treatment. It has been added to by other bodies, and for sixteen years investigations have been made. The Report says:
Until recently these were the only methods of radium therapy in practical use and they are of proven value in selected cases.
That means early cases, and cases which are easily accessible, nothing more.
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The Report goes on to talk of the newer methods—radium beam therapy or teleradium therapy, and all that can be said is that "the results have been encouraging," and that "in view of the promising results the research will be continued." It speaks of co-operation with certain other bodies, and states that
the co-operation gives evidence of a belief on the part of the scientific leaders of this country that the hope of establishing satisfactory methods of dealing with cancer depends upon carefully controlled research…. What the future of radium beam therapy will be cannot yet be foreseen.
The Report goes on to say:
Meanwhile there is already looming in the distance the need for studying the therapeutic effects of neutrons and of temporarily radio-active substances, such as radio-sodium, now made possible by the discovery and development of the cyclotron by Lawrence in California.
I am not going to try to explain to your Lordships in detail what a neutron or a cyclotron is; I should very soon find myself out of my depth. Briefly the cyclotron is a scientific apparatus which is capable of emitting a new kind of ray which may make not only radium but X-rays
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entirely out of date in the treatment of cancer. It is the invention of a physicist, and while there are two cyclotrons being built in this country they are both being built in physics laboratories and there is none available for medical and biological research. The Report also says:
There is even the possibility that both radium and X-rays will be superseded by the cyclotron in the treatment of cancer by radiations and radio-active substances.
The Medical Research Council, together with the British Empire Cancer Campaign and the National Radium Commission, are agreed that it would be a great advantage to have a cyclotron in this country available for medical and biological research and also for treatment by radiation, but no funds are available with which it can be provided.
§ Research is an investment which may result in great economy. It seems to me perfectly crazy to be going ahead with the expenditure of £600,000 or £700,000 on treatment which is tentative when new methods are constantly coming into view that may supersede the methods to which we are pinning our faith. I am not sure that the noble Duke did not suggest that this research must continue by voluntary subscriptions because if the Government were to contribute that might tend to dry up the sources which are at present subscribing. Nothing could be further from the truth. The fact is that it is only since the foundation of the Medical Research Council that the greatest benefactions in aid of medical research have been forthcoming from private sources. I need only mention the Nuffield benefaction and the Wellcome benefaction.
§ It is true to say that the Medical Research Council with its Government grants has provided the drive which has given rise to most of the useful medical research which has taken place in the last twenty years. Research costs money. You cannot merely go to the stores, however modern and well equipped, and buy research by the pound or by the yard. It takes months of preparation. It takes the establishment of units of research with the best brains and with the most expensive apparatus, and unless the Medical Research Council and other bodies can know that they are assured of proper support, the research which otherwise would immediately be put in hand must wait and possibly never will 204 come to fruition. It would be a fatal mistake if it were to go forth, as it has gone forth, that this great effort towards treatment is not to be accompanied by a parallel effort with further research, not only into radio-therapeutics but into the fundamental causes of the disease. I venture to say that in launching this scheme in this way the Government are not merely spoiling the ship for a ha'p'orth of tar; what they are doing is building a battleship equipped with every modern appliance on the deck, but failing to equip the engine room with motive power.
In conclusion, I want to leave your Lordships one thought. The noble Duke has told us that 70,000 people died of cancer last year. The length of the incidence of this disease is one which may vary from a few weeks to a few months. I have not been able to secure any accurate information as to the number of people who suffer from cancer, but if, rushing in as a layman where a scientific man would fear to tread, I may take the average duration of the disease as eighteen months, that means that there are at any one time 100,000 people suffering from this disease. They are, as the noble Duke has told us, men and women mainly in the older sections of the population, largely men and women in the prime of life, men and women doing work which is useful in the service of their country, in the full sweep of their powers, intellectually and physically, men and women who, many of them, have children dependent upon them and still urgently needing the cherishment and support of their parents. This great army is, as we sit here, standing literally on the brink of the River of Death. In a year's time 70,000 of them will be gone, but the ranks of that army will not be depleted. This is not an army which needs any recruiting campaign to keep it up to strength. Silently and inexorably, the conscripts will be called to take their place and fill the gaps. If we could see that army with our seeing eyes what money would we not spend and what effort would we not put forth to avert the fate which so imminently awaits them!
Could we but find it, there is a talisman which would work the miracle. That talisman is the knowledge of the cause of this disease. That talisman remains hidden within the secrets of Nature, and what I want to hear from the Government 205 is a statement that no few paltry thousand pounds shall stand in the way of prosecuting the research which, sooner or later, will give the results which alone will enable this disease to be conquered. We want to see a great deal more than mere alleviation of a few cases, the curing perhaps of a few additional cases in the early stages. We want to see this disease conquered as other diseases have been conquered, and another leaf added to the imperishable story of medical research. I do ask for an unequivocal statement that when we go for money for this research which is essential, we shall not be met with the answer that the commitments are already too great or that the present arrangements are satisfactory. I hope that we shall be given a statement which will extract the Government from the position which at the present time they occupy and which is both ambiguous and disconcerting. I beg to move.
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Amendment moved—
After ("That") insert ("this House whilst regretting that the Bill does not contain a provision for increased research into the cause and treatment of cancer, resolves that").—(Lord Balfour of Burleigh.)
§ VISCOUNT DAWSON OF PENNMy Lords, this Bill has been explained with such clarity by the noble Duke and it has received so wide as acceptance that at this hour of the evening I shall detain your Lordships only a few moments. I would like first to state that this Bill is welcomed by the medical profession, but there is in our minds one reserve which has been so eloquently stated by my noble friend Lord Balfour of Burleigh, who, as your Lordships know, is Chairman of the Medical Research Council. Here is a great extended opportunity for combating the scourge of cancer in our midst. This disease differs from a great many others with which various health services have hitherto sought to combat. It is a disease which is not closely associated, in bulk, with bad environment and bad conditions such as want, ill-feeding, and slum conditions. It is a disease which discriminates but little between one class of the community and another. It knows not one condition of man from another. It is true it is more prone to attack those of advancing years, but at the same time, as has been already stated, it may come out of the blue at any moment and strike down men and women in the full tide of their lives of usefulness.
206 We are face to face with certain cheering circumstances—that is, there has been a definite improvement and increase of knowledge in the treatment of this disease. This Bill is justified thereby, because it will bring to all classes and conditions of people the advantages of that knowledge. As regards personnel, there is no difficulty in obtaining good surgery in the staffing of these sectors, for the reason that surgery offers a good career to men of promise, and they will come forward in sufficient numbers to fill these posts. On the other hand, this is not true of radiotherapy. Radiotherapy does not at the present moment offer sufficient scope to encourage younger men to take up its study, and at the present time this country is deficient in skilled radiotherapeutists. The Bill will be able to meet that difficulty, because it provides not only for facilities but it provides for men. It will thus be able to help in the training of men, and enable radiotherapy, or the centres in which it is practised, to be adequately staffed.
This Bill differs from the previous medical or health services in that it seeks to establish the treatment of cancer in a certain number of centres. In fact what it does is to extend and perfect what has been the practice for some years under the Radium Commission of starting something like twenty centres attached to the teaching hospitals of this country. This Bill will extend that number by something like twelve new centres, and it will provide adequate means for the starting of those centres both as regards fabric and personnel. But I would entirely support the contention of my noble friend Lord Balfour of Burleigh. It is almost incomprehensible that a big scheme of this kind for extending the benefits of knowledge to the masses of the people should have been launched without a research scheme at its head instead of allowing such a scheme, in some few years perhaps, to be affixed to its tail.
In a subject like this you want a research unit at its head to explore new avenues, settle differences of opinion, give light and leading to those centres which are concentrating upon routine and who are compelled to apply themselves day by day to the patients who come and seek their advice. There is need of a unit which is untrammelled by routine, where difficult questions can be explored and problems resolved. There is yet another 207 advantage. Such a unit would inspire the whole system with a new life; it would be a court of appeal for the workers; and it would make just the difference between a real vitality and mere routine. If one takes the position that is now occupied by opinions in regard to radium and X-ray therapy, there are those who would give to ray therapy time and space, and there are others who would emphasize the value of radium. There are still others, who are probably nearer the mark, who would apply one or other according to the circumstances. The problem can only be resolved by patient research work of units set up for the purpose, and I would urge with all the force at my command that, instead of the Government giving the impression meanwhile that they attach no value to the growth of knowledge, instead of leaving research to the chance benefactions of private individuals, they should from the first let it be known that they mean these centres to be inspired by the results of new knowledge and to put research at the head of this movement.
If one only looks at it from an economic point of view, if one thinks of the large sums of money which are spent on this expensive apparatus, the cost of the research unit would be met many times over before two years had passed. It would produce an economic saving because it would avoid waste, and waste of effort there must be if knowledge is only advanced by trial and failure. Therefore I would content myself at this time of the evening in beseeching His Majesty's Government to change the wrong step they have taken, and start this movement with a research unit at its head and not wait to see how things go. "Wait and see" in a matter like this is a dangerous course to adopt. If, on the other hand, a research unit is started it will show the world that this scheme is animated by growth of knowledge. It will show that the Government appreciate that it is by growth of knowledge that this disease will ultimately be conquered. These units do offer us a great opportunity, and their harvest will be tenfold if all along the line their work is animated and inspired by the spirit of research standing at their head. I beg to support the Motion of the noble Lord opposite.
§ LORD ADDISONMy Lords, like the noble Lord behind me I shall not detain 208 the House many minutes at this time. I should like to congratulate the noble Duke upon his exposition of the Bill, and of course to congratulate the Government upon the scheme of facilities for early diagnosis and treatment which the Bill provides. It would be churlish and unfair if amongst one's criticisms one failed to recognise that important fact. But I would like to express my agreement with the noble Lord, Lord Balfour of Burleigh and my noble friend behind me (Lord Dawson of Penn) that the opportunity has been lost to associate this with an organised scheme of research. The noble Duke said something—I did not quite catch what—about the Minister of Health being advised by Councils associated with the Clinical Institution. Perhaps I shall understand that better when I read his speech, but in any case whatever system of advice there may be for the Minister of Health derivable from the Clinical Committee associated with the management of these institutions, it has no relation whatever to what is really wanted. I think it is almost fair to say that, despite the advances of knowledge on many other previously fatal diseases, we know very little more about the essential nature and genesis and real causes of malignant disease than we did forty years ago.
It is true there have been great improvements in treatment and it is a good thing that they are to be extended to the masses of the people. But I think, if the noble Duke will look at the history of the Medical Research Council, he will see there a very signal example of the immense value that has followed the organised central direction of research by a body of men highly qualified to undertake that duty. We had it during the War. I remember many significant instances of the immense value of research and its application to the treatment of disease. There was the case of Dr. Leiper in regard to bilharzia. For the first time in history a great army spent a long time in Egypt without being afflicted wholesale by that disease which is as old as the Pharoahs. I could give, of course, many other illustrations.
Here we have a glorious opportunity, if I may so put it, for associating organised, well directed and well supported research. It is not enough, as my noble friend said, that we should have 209 to depend upon the successful application of the Lord President of the Council to the Chancellor of the Exchequer. This thing should be organically associated with the Research Council and with those who are linked up in the direction of research. It is particularly important because, as I am sure the noble Duke will agree, research is a slow business. It takes years. The most difficult provision of all is the researcher. He only crops up now and then, and he does not crop up unless we give sustained opportunities for young men and women to develop their abilities. It is the successful production of researchers, which is a long-term business, which must be encouraged. I will not prolong the debate further, but while welcoming this Bill I must support the Motion of the noble Lord.
§ THE FIRST LORD OF THE ADMIRALTY (EARL STANHOPE)My Lords, I think it would be to the general convenience of the House that we should adjourn the debate at this stage. I have been in consultation with several of my noble friends and it is suggested that we 210 should meet to-morrow at three o'clock and debate this Bill for the first hour, and then go on to the Motion of the noble Viscount, Lord Trenchard. It will be necessary that we should agree to this Bill taking precedence, and I should propose to ask your Lordships to do that on the Motion for the adjournment.
§ Moved, That the debate be now adjourned.—(The Earl of Donoughmore.)
§ On Question, Motion agreed to, and debate adjourned accordingly.