THE HEALTH OF THE PEOPLE.

HL Deb 05 May 1943 vol 127 cc365-95

LORD GEDDES had the following Notice on the Paper: To recall the shock to public opinion in the reception areas caused in September, 1939, by the condition and conduct of many of the evacuees from our cities; to refer to the "achievement of positive health" apparently accepted by the Government as one of its social aspirations; and to move for Papers. The noble Lord said: My Lords, I think your Lordships who were concerned with the evacuation from the great cities in 1939 will not have forgotten that experience. Since I put this Motion on the Order Paper I have read with extraordinary interest a book called Our Towns—A Close Up, recently published by the Oxford University Press, which records in the form practically of a report a condition that was found among many of the children and the women who were evacuated. That relieves me of any responsibility of recalling matters to you in detail, because I feel sure the vast majority of your Lordships will either have already read that book or will read it. It displays a state of affairs which is enormously to be regretted. I am well aware that at the time there was a great deal of exaggeration. Many of the people who were receiving these evacuees were not in fact at all prepared by knowledge or experience to take in people from the towns, and many little things created friction between the evacuees and their hosts and hostesses. There was an enormous amount of difficulty at the time with the children and with the women.

It so happens that I have been rather familiar with slum conditions not only in this country but in other countries as well for a period now of fifty years. I think it was in 1893 that I was first introduced in Edinburgh to its slums and to the problems of the slums of that, at that time, very slummy city. I also saw a good deal of the slums of Glasgow and then of those in the East End of London, where I was at one time actually driven out by vermin. Later I got to know fairly well the slums of Liverpool and Manchester, and also, subsequently, those of New York, Chicago, Boston and various places in Europe. I was not perhaps so surprised as some of the people were in the country who were receiving these evacuees at the condition of those who came from the cities. As a matter of fact the impression I got at the time, when those trains were unloading their children, was that there was an enormous improvement in physique and in general bodily health, and also that there was a great improvement in clothing, although there was still much room for improvement. Practically so sign of rickets was visible and many of the diseases which used to be so obvious in the slums were not present to any extent among the children.

What really impressed me most was the extraordinary difference that had come about in the period since I gained my first knowledge of the young people and the adults in the crowded areas of our great cities. Although their physical condition was better and the signs of rickets and so on were absent, there was a strange listlessness about these people. A great deal of the independence which characterized the dwellers of the densely-crowded parts of the cities when I was a medical student and a young doctor in slum cities seemed to have vanished. It was a strange experience in 1939. The mothers who came from the cities seemed quite unable to do very much for themselves. They were quite obviously without any effective social traditions. They did not know how to cook. I remember one little boy telling me he had never seen a meal cooked in his own home. Their idea was that food was supplied from a shop already cooked—generally it was fish and chips for one meal and bread and jam, if they were lucky, for the others.

The impression they created on me at that time was that they were cultural orphans. Some how or another the old tradition of home-making seemed to have vanished from the lives of the parents of these children. One knew, of course, the the dreadful condition of the houses in which many of them lived. One knew perfectly well that in many cases these children were being brought up and mothers were trying to bring them up in houses badly converted from being single private dwellings to tenement buildings, without any provision for cooking on an adequate scale in each tenement, without any real provision for cleanliness and washing, and with the most deplorably inefficient and insufficient provision of latrine accommodation. The children just did not know at all how to keep a house clean. They were like untrained puppies or untrained kittens; they messed in the corner of any room. That did not apply, of course, to the whole lot. As one gradually sorted out the people in one's mind the proportion came down in actual fact to perhaps about 10 per cent. of those who came from the cities who were in this deplorable state of absolute cultural orphanage. The other thing that struck me, as I talked to the women and the older children, was that although we were just at the beginning of this great war they had no knowledge at all of their own country. They seemed to know something about the Spanish civil war, which was at that time not very long over, and they seemed to know, in a quite extraordinary way, a lot about Russia; but about England, about the Empire, about their own kith and kin they were extraordinarily blank, just as they were about their own traditions or about the traditions they should have had concerning our manner of life.

A great many of the worst cases went back to the cities—they could not stand this change to the rural areas—and after they had gone we began to get billeted in the hundreds of villages with which I was familiar at that time, the young conscripts, men largely from the cities who were taken up by the Army or in one or two areas by the Air Force. I made it my business to get in contact with as many of them as I could and to get impressions from other people, because I was alarmed, not so much by their physical condition, which was much better than I expected, and very much better than half a century ago, but by their mental state. As we got to know these young conscripts we found an extraordinarily sharp contrast existing between them and the men who had been in a comparable position at the beginning of the war in 1914 or among the men whom I remember so well, because I was among them, at the beginning of the Boer War. We had in both those wars men taken up by the Army who were keen and full of enthusiasm and who knew something about what the war was for and why. But in 1939 there was an enormous number of these young fellows who said to me, almost in these actual words: "Well, they have got us here, what are they going to do with us?" It was this strange listlessness that came out into the rural districts among these young men, among the parents of the children and among the children themselves, that I think really provided a great part of the shock to the rural districts when these people appeared among them.

It is quite true—you can read about it in this book to which I have referred—that there were some infected with lice, with scabies between the fingers, with skin diseases, children sewn into their clothing, children without proper boots. That is all true, and is stated in the book without exaggeration, I think. But it was the listlessness of these people, and their ignorance of their own country, matters not referred to in the book, which really shocked me much more than the other thing, because I have some familiarity with slum conditions. Now in order that that state of mind should exist, in order that that condition of listlessness should have developed, there must surely have been something very wrong; not on the medical side, because that was not too bad, but on the teaching side and on the disciplinary side. It is true of course, and one has to recognize it, that at that time we had emerged not many years from the worst economic depression any of us has ever known. It is true that during that time there had been a great deal, a horrible amount, of unemployment, a great deal of misery and unhappiness, not only in the crowded districts of our cities, but throughout the whole country, especially in certain parts. But, when you have made all allowances for that, it seems to me that that condition which undoubtedly existed in 1939 showed that there was failure, not only in connexion with such material things as housing, but in connexion with the whole cultural tradition of the country; failure to pass it on, to pass it on to the young people. And that failure must have been continuing for years, for the parents were the same.

But, now take those people: those listless young men who used to say "They have got us here, now what are they going to do with us?" What are they now? They are the men who have been winning great victories for us in North Africa. We, in the past have criticized the War Office for many things, but there is one thing that the War Office know and that the Army know, and that is how to bring the best out of these young men, how to instil into them the great traditions of the Army, of the regiments and of the corps to which they are posted. They lead lives of activity, they develop strength of purpose and they turn into the kind of men who make our Army what we know it to be—the finest body of fighting men to be found anywhere in the world. That is education. It is education of a highly specialized sort. But there was no education along those lines obviously for these people before the war. No one would suggest that they should have had the same teaching as the Army, but after all the traditions of our great regiments, of the Highland regiments, of the Guards, are part of our whole British tradition. They are not being transmitted into the general stream of tradition and all these things we could refer to have not been brought together into the life of the people. The Army has taken these men and made them what they are. The Air Force has taken them and has made them—well, I need not say what we all know the Air Force to be. By educating them in the great traditions of their own people it has built up this magnificent body of men of whom we are all so proud.

Now look into the country where the women still are. Where are those listless, incompetent, rather unpleasant women still are. Where are those list-ally? I know that when they came they were strange and conditions were quite unknown to them. I know that there were great difficulties very often in connexion with the housing and other matters. But these women to-day are in cases which I could mention the backbone of village life. They have been "magicked" by the country, by the open spaces, by the beauty of flowers, by the friendliness of the people; "magicked" out of this strange listlessness, and have been steeped in the tradition of British country life. Just this last week I saw in a village not far from my home women who, I remember, in 1939 were anything but satisfactory. To-day they are grand. Again that is education—education of the people by the people. Through the Women's Institutes, the Women's Voluntary Services and through all sorts of influences that have been brought to bear on their lives, these women have undergone a great change. I can assure your Lordships that within my own experience the change has been wonderful.

And the children, those funny little things that came out of the city: what are they like to-day? Last week, when I had the rare privilege of being at home for Easter I saw, after an interval, some of the little fellows whom I remember coming into the village as miserable little children with no decent clothing, no manners, no knowledge of how to keep clean, no knowledge of good food. Well now, they, too, are grand. I was more than cheered to find while going round this village some of the refugees—now nearly four years older than when they first went there—taking a light cart, harnessing themselves to it and taking part in the local salvage campaign, collecting paper and so forth. Those are children who would do nothing for anybody four years ago. This means that there is nothing wrong with the start which they have now been given. They are fine and they will grow up into just such men as their elder brothers and their fathers and their grandfathers were. As I have indicated, when they came to us they were dreadful in many ways. Many of them had no conception of what was one person's property and what was another's. They stole anything and everything. Now they do not do anything of the kind.

Of course, they were strange when they went to the village and children who are strange are apt to be frightened. Now when I meet them I am hailed as an old friend and we discuss all sorts of things. They are entirely different young people, and that is entirely due to the education that has come to them in the village schools, from the various efforts that have been made to help them in their difficulties, and from the country. The country has "magicked" them, too. They have experienced the beauty of the countryside, the beauty of flowers and trees and shrubs and streams. That means a tremendous lot to them. It shows that within the short space of four years these people, whose lives seemed to be almost derelict and adrift, can be transformed. They are transformed and I have no doubt that the transformation is permanent.

But there is another side to it. These are the healthy ones, and we have to realize that not all are healthy. Many of the children that are born not only in the towns but in the countryside as well are not fit from birth. Some of them—not very many, but too many—are not mentally up to standard. Near 'my own home, we have a group of these children, who have come from one of our great cities, with a number of young nurses who look after them. You could not find a happier lot of children—they were in my garden the other day. If ten years old in life, they were only seven years old in mind; if seven years old in life, they were perhaps only three years old in mind. They are backward, and are never going to be normal, but they are far better than they were before, and they are as happy as they could be. I have seen them chattering together happily, and watching the young goslings and the chickens.

All that has made me realize that we have been failing most miserably somewhere and somehow to make it certain that the people of our towns enter into their rightful heritage. That is what they have not been doing. These people were not in any real sense English; they were born here, of our blood and stock, but they were not conscious of the great history of their country. That seems to me to reflect upon us all—not only on their teachers, not only on the local authorities, not only on the Government, but upon all of us who have had greater privileges. There has been a change; it was not like that in the past, in my experience, to anything like the same extent. There is another thing that I ought to mention. The adults and the older children who came out into the country in 1939, and during the air raids of 1940, were to a surprising extent convinced that they were not well. They wanted "Aspros" and this, that and the other to kill pain. They all seemed to believe that patent medicine was an essential element of diet. Fortunately, in my district there is no chemist's shop, and they could not get it and so recovered without it. But there we have an example of what we have such a lot of in this country to-day in the cities, and even in Government offices—people who are feeling below par, and who think they ought always to be taking medicine of some sort; in other words, they have been infected by the medical profession with the cult of negative health.

The term "positive health," which is used in the report of the British Medical Association on the organization of the medical profession, and which is used in the Beveridge Report, and which has, I understand, been accepted by the Government—whether they understand what it means or not, I am not sure—is a term of art. It was introduced first of all by Alexis Carrel, the great and distinguished biological scientist in New York, a Frenchman by origin, and it has a very special meaning. It does not mean that you have recovered from an illness by medical treatment; it means that you are not going to be ill. All medical treatment, with one or two exceptions to which I shall refer in a moment, is really based on an attack upon illness. If you have diabetes, about which we all know, you take Insulin, and there is a cessation of the diabetic condition as a result, and you seem to be better; but that is not positive health; it is negative health. If someone receives an injection against colds and it happens to work—which it does not always do—and that individual no longer gets colds in the head, that person is negatively protected against colds.

The whole tendency of the medical profession—and it must be so under present conditions of medical practice, and it will be worse, I may tell you, if we have a State medical service, because then only people who are ill will go to the doctor—so far as the general practitioner is concerned—I am not talking of the great leaders of the profession, who are in contact only indirectly with the bulk of the people, through their position as teachers—is to deal with people by giving them either tablets out of a bottle or fluid in a bottle. The old tradition of the bottle still remains, and that seems to have infected our people. I imagine that very many people whom one meets in London—the typists, and the men too, and a good many people whom one meets in Government offices—are all looking for something to escape from pain, something to take to be well; they do not expect to be well without taking anything. To be well without taking anything is what positive health means, that people shall be well without medication, that they shall resist the attack of disease. There is at present no organization on a large scale dealing with positive health. There is a certain amount done by a certain section of the medical profession for positive health, and a good deal of it comes under the Department of the noble Lord, the Minister of Food—diet—but you have only to look at it to see how vague our ideas are.

To begin with the infants, you will see from advertisement that "Glaxo builds bonny babies," and there is a picture of a baby—a fat baby—to show you that it dos. But is it true that it is a good thing for a baby to be encased in rolls of fat? A good deal of importance seems to be attached at the present moment to the gross outward appearance, and to such easily measurable things as height and weight. In the same way, you will hear people recommending the consumption of large quantities of milk—I hope it will be pure!—in order that we may grow larger. That is a movement in the direction of positive health, but nobody knows whether the people who recommend this are talking sense or not. As a matter of fact, we all know that large size is by no means necessary to high efficiency and to making a great stir in the world. I have only to mention Hitler, and, if it will not be putting him into unpleasant company, our own Prime Minister is not a very tall man; General Montgomery is not very large, and one can think of thousands of others. Health propaganda, however, has given us the idea that size is in some way associated with real health.

This question of what is health and what is real health is one of those about which there is a vast body of opinion. There is as yet no science of positive health. There is no knowledge of whether a child is benefited by being given large quantities of milk between the ages of eleven and thirteen years. It grows larger, but there is a great deal of evidence to suggest that that increase of growth, which so many of us of this generation and of the generation behind ours show, is not good. There is a good deal of evidence to show that men of the larger sizes and of the larger bulk are dying younger. The death-rate is rising in the 50 to 65 period, and that shows that something is wrong somewhere in the general life of the individual. I cannot say in the least what it is. It may be that people are drinking too much whisky; it may be the cocktails; it may be that they were grown too large as children; it may be the strain of the last war; it may be wireless and telephones and all the things we call modern conveniences. Nobody knows. There is no science of positive health, but there is one thing that is quite certain and that is that positive health is not material only: it involves also the intellectual and the spiritual sides of man. There is a real truth in spiritual healing. If a man or woman who is ill in the soul recovers, his or her body recovers. It is a real truth that an absorbed and interested mind makes for health. We have all seen that. There is a real truth in the fact that will makes for health. And there is a huge and unexplored field in connexion with positive health, and my mind has been turned to it and turned to it in the last few months as a result of what I have seen.

We must realize that when we are dealing with housing, when we are dealing with feeding, when we are dealing with all the Social Services we are interfering with the life of a very complex creature—man: animal and more than animal. A something that is at the present moment beyond our comprehension governs his health. You know, really when one speaks of a disease like typhoid fever one is speaking of a thing that does not exist. There is no entity typhoid fever. That is a generalization; typhoid fever is simply the organism which is associated with it—Bacillus Typhosis. It is rather like a gang of Nazis trying to find for themselves a Lebensraum in the body of the individual. And the fever does not occur at all if the individual has power to resist, and it occurs in quite a mild form if he has almost enough power to resist, and so the disease itself is a generalization. Each case is an individual battle between an organism that is attacking in millions and a human body that may or may not have the power to resist, and each case is therefore different from all others.

Now what positive health means is that the body of each man, each woman and each child should, so far as possible, have power to resist the assaults of the myriads of the evil ones of the microscopic world—the pathogenic bacteria. And those resistances should be natural. Now science, in medicine and in the veterinary group subjects, is at the present moment, as it seems to me, laying an undue emphasis on the side of the attackers, and too little on the side of the defence of the human body. But we do not know very much about the human body in its ultimate structure and its ultimate being. And this same problem has been going round for consideration, and solution if possible, in many, many minds that have been concerned for a period of years with biological subjects, and Alexis Carrel made a suggestion—I heard it personally, I think, about ten or fifteen years ago—that there should be in each of the great countries—he was speaking for America at the time—a General Staff of Health that would not carry out directly research work itself. That Staff would be recruited of men of the synthesizing type of mind, because so many of the ordinary men in research—in biological research: I am not talking of physical research—are so overwhelmed by their own problems, say in bacteriology, that they really never become expert outside their own profession. And much of the research that is generally published is good and some of it is not so good, but nobody knows which bit is good and nobody knows which bit is not so good. In fact, there is nobody probably who really knows all the results of all the researches being carried out in biological subjects throughout the world, published in many languages.

And so Alexis Carrel suggested that something of the nature of a General Staff of Health should be created in the United States, and that the individuals on that Staff—you would have the doctors, I think, to start with, most of them—should, over a long term of years, be given opportunities of studying biological subjects in their own departments and should watch over the research that was done. Where there was doubt as to its validity, have it repeated; where there was obvious incompleteness, have it completed. And they should be the advisers of the governing machine of the country on measures of social legislation affecting health. It would take a long time. For instance just consider this. I happen to have a case in my own family where over a long period of years I have been able to see the effects of feeding. That individual was supposed to have tuberculosis and was fed on milk and milk and milk, and grew too large—over-stimulated, quite away from the family size, and has never been able to weather all the storms of life with the same vigour as others. That may be a coincidence, but I have known one case after another where such things seem to have happened.

A General Staff of Health over a period of fifty years, perhaps over a period of a century, may be able to tell us, or tell our successors, what real health means. Such a General Staff of Health perhaps would not be in a Government Department, but one reporting to the Government through the Lord President of the Council. It would not be a research council, but a body of individuals to collect results of research, to see what was going on in the country, and to know what the state of the health of the people was in different parts; to be quite certain that we were not developing a lot of cultural orphans again because cultural orphanage obviously is bad for health; to see that we enjoyed all the fruits of all the research in all the countries of the world, examined and brought into such a relation to life that it could be made use of. In the past there was no knowledge of health at all. Within the last century there has been a great development of that knowledge. The next century will see still more. If the different peoples of the world can organize in some way to get that information that is accumulating brought together, made into usable form, checked and tested—because a great deal of checking and testing is necessary in connexion with research—checked and tested before an irretrievable step is taken, then we may look forward to a future where positive health will be really enjoyed, not by us, perhaps not even by our grandchildren, but by our great-grandchildren. If, some time, as a result of this great upheaval of the war and all the lessons we learnt when the towns were turned inside out, some such advance were made, I feel we might have done something to help the world of the future. I beg to move for Papers.

LORD LATHAM

My Lords, the noble Lord, Lord Geddes, in calling attention to the condition, both physical and cultural, of a distressingly large number of children and adults who were evacuated from the cities in September, 1939, has put his finger on a running sore in our national life, the causes of which are deeply embedded in our economic and social structure. I could not help reflecting when the noble Lord referred to the listlessness of the children, women, and conscripts, that they are, so far as they come from the industrial centres of the country, probably the second, third, or indeed the fourth generation of slum dwellers. One is not surprised, when one remembers what are the conditions existing in many parts of our great cities, that that listlessness, that lack of adventure, should exist. One is not surprised at the circumstance, which Lord Geddes mentioned, that many of the conscripts were unaware as to why they were in the Army or as to what the Government proposed to do with them, and indeed seemed to be almost wholly ignorant of the causes of the present conflict. We must remember in fairness to them that in the humiliating years of appeasement neither the Government nor the leaders of the people encouraged the people to inquire too deeply into the causes which were leading up to war. I am therefore by no means surprised at that ignorance.

As Lord Geddes said, there is a good deal of exaggeration—not perhaps unnatural—as to the condition of the children and women evacuated into the country districts, but one cannot shut one's eyes to the facts, which were known long prior to evacuation by those engaged in social endeavour, of the conditions prevailing among a large number, although happily a minority, of the children and adults of this country. This should be said, in order that the facts may be seen in proper perspective and proportion, that unhappily evacuation from the towns took place after the children had been away from school on holiday for four or five weeks, and had thus 'been removed from the care of the school medical service and from the restraint and discipline of the teachers. Nevertheless, when all that is taken into account, it cannot be denied that the state of many of the children and many of the women was deplorable.

I suggest that we must look further than the educational system for the real causes. I should be the last to say, and indeed the last entitled to say, that the educational system of this country is not in need of considerable improvement, but I do not believe that even if the most desirable educational facilities had existed they could have offset and countered the destructive influences of the slums and overcrowding in our big cities. It is hardly fair to charge the educational system of this country with the lack of cultural standards among adults. It is no fault of education that a boy or girl, leaving school at fourteen, being thus removed in all too many cases from any further educational influences, and living under unhappy and unhealthy conditions, should forget much of the teaching and instruction and lose much of the discipline inculcated during school life. And it is only fair in this debate to point out that the school medical services, excellent as they may now be in some respects, took nearly 40 years to get established and have been in operation for no more than 25 years. As is the case always with developments in this country, at the time of their initiation these services were of a meagre and inadequate order. It is the case that the classes in our schools are often too large to permit of adequate instruction and to make possible the inculcation of the principles of self-control and discipline. I know with what sorrow the Chairman of the Education Committee of the London County Council has gone repeatedly to the President of the Board of Education to ask for the most meagre reduction in the number of pupils in these classes and to be received with, some-times, cynical disapprobation. The number of children in the classes is quite positively related to the measure of effective education that can be given by the teachers, and, indeed, to that measure of education which can be absorbed and turned to profit by the scholars.

What was the alleged condition of some of the children evacuated from our towns? That they were unclean, that they had bad habits, that they were undisciplined and unruly; and, as regards the women, that many of them were shiftless, ignorant of home-making, unable to cook, frequently lazy, sometimes given to drink, gambling, and picture-going. The real reasons in my submission for that state of affairs are to be found in the slums and overcrowding. The real roots of the problem are the ignorance of parents, poverty, and, as I have said, slums and overcrowding. As regards the children, who are at most not in school for more than 200 days a year five and and a half hours a day, no type of education, no devotion on the part of the school doctors, the school nurses and the teachers, can avail to counter the terrible influences of the slum. We must, therefore, turn to those aspects of our national life when we seek for a remedy for these problems. Teachers face in many cases heart-breaking and heart-rending tasks. Many of them, much as they are glad to be free from work in the schools during the holidays, view with foreboding and misgiving the return of the children after a long summer holiday, knowing in many instances they will have to recommence the work they had formerly done because its influences had been destroyed by the children being away from school. Therefore I submit that improved wider education, necessary as it is, is not enough.

The book to which the noble Lord, Lord Geddes, referred, Our Towns—A Close Up reveals the terrible and indeed terrifying conditions which exist in our towns, and I am myself glad of the shock that certain people in this country got from seeing the condition of some of the evacuated children and the evacuated women. Those engaged in social activity were aware of these things but it is, I think, all to the good that a wider public knows of them now, because it is still the case, unhappily, that there are two nations within the bosom of this one State. A large number of people, at all events up to 1939, were unaware of the sorry and pitiable conditions in which many of the town dwellers have to live. It was a former Minister of Health, now a member of your Lordships' House, Lord Kennet, who said with abundant wisdom that slums and overcrowded houses are radiating centres of disease and death. How can one expect children to be clean when they are part of six or seven families living in a dwelling originally constructed for one family? How can one expect the housewife to be able properly to prepare food or to exhibit any skill in cooking when she is not possessed of any cooking arrangements at all, when the only facility she has is an ability to heat a kettle on an obsolete, inefficient and, from the point of view of fuel consumption, expensive stove? How can one expect children to profit from, and to respect, the teaching of good habits and cleanly manners which they receive at school when they go home and find that they have to share an outside closet with forty other people—not always a water closet and not an effective closet in any sense of the word? How can one expect them to be clean in their bodies when water has to be fetched frequently from two or three floors below and in many cases from outside in the yard? In those circumstances it is not to be wondered at that we see no satisfactory results from, the instruction and training which we seek to give them in their schools.

Take also the question of the preparation of meals. It is well for us to realize that the income of a large section of the people of this country was so inadequate before the war as not to enable them to buy sufficient food to meet their needs. Such observers and research workers as Mr. Rowntree, such authorities as Sir John Orr, have told us that before the war in many cases the incomes of families were below that necessary to provide the minimum nutritional requirements and necessities of men, women and children. But apart from that, one of the greatest factors making against proper cooking and preparation of food in the congested areas of our great cities is the complete absence of any storage accommodation for food, and the need for that in dwellings which are infested with vermin and over- run with rodents will be appreciated. The result is that working people in those conditions not only live from day to day but they live from meal to meal, and much as we may deplore the affection for the fried fish shop, the fried fish shop is in those districts the restaurant of the poor, and but for those fried fish shops those families would never get a cooked meal. We may deplore the dictatorship of the tin-opener, but there is no alternative until these people are provided with dwellings in which there will be adequate cooking arrangements and ad equate storage for food.

I myself am one who is not unacquainted with unsatisfactory housing conditions. I was one, if I may say so with all humility, of a large family which took its water from a tap, twenty yards from the house, which also served twelve other families. You cannot expect a housewife to display any great home-craft, any great and abiding desire to make a home, to prepare and properly cook food in conditions which I have indicated. She carries on ceaselessly a struggle, for the most part a vain struggle, against dirt and disease, and it is not to be wondered at that in many cases she succumbs. She loses heart and I venture to think that many of your Lordships would not be able to do otherwise in such conditions. The defects in housing to which I have referred are by no means limited to the cities. Slum properties exist in the rural districts as well. Perhaps I may be allowed to quote one or two figures to indicate the extent of this problem. It was estimated before the war that there were 100,000 families in this country living in houses which had already been condemned, and it is estimated that there are now 300,000 families living in houses which, but for the war, would have been condemned. In London two out of three families share a house; and when I talk of sharing a house I do not mean that only two families share a house but that three, four, five, six, seven and even eight families in some cases share a house originally built for one family and usually having only one set of conveniences and one water supply. In 1938, notwithstanding three years' operation of the overcrowding provisions of the Housing Acts, which set a standard of overcrowding—not a very high standard but still a standard—there were in the County of London alone, by reference to that standard, not fewer than 43,158 families who were overcrowded.

I therefore suggest to your Lordships and to the Government that desirable as the extension of our educational facilities, necessary as it is to raise the school-leaving age, to provide day continuation schools, to secure smaller classes, to develop school feeding, and to increase the supply of fresh milk—although I say that with some trepidation after the remarks of my noble friend Lord Geddes—it must be recognized that the money spent on these things will not produce its full result unless, at the same time, we tackle housing conditions. A great deal of the money will be spent without any good results because of the destructive counter-influences of the slums. I hope very much that the communal feeding which the noble Lord the Minister of Food instituted in 1940, will be maintained and extended after the war. As a result of that communal feeding through British Restaurants, hundreds and hundreds of families are being able, for the first time in their lives, to have a hot meal once a day, and hundreds of thousands of workmen who leave their houses in the morning and return late at night are getting, for the first time, a hot mid-day meal. If the nutritional needs of the people are not to suffer, communal feeding must become, at all events until housing conditions permit otherwise, a positive feature of our post-war life. The same considerations apply to a comprehensive health service. We are encouraged by the knowledge that the Minister of Health is working assiduously on preparations for this scheme, and we hope that with the co-operation of all the parties concerned it may usher in a new health era; but again the money spent on this health service will be largely wasted if the slums and overcrowding remain.

I therefore ask the Government to hasten with their proposals for enabling the local authorities to replace slums by decent dwellings and to abate overcrowding to the degree that each family shall have its own private dwelling, that each family shall, at all events, have one front door which it can regard as its own and, as an indication, one letter box through which its own letters can be put and not a communal letter box, mostly absent. If peace should come before the plans for dealing with housing and overcrowding are ready, it will not matter very much what has happened as regards the extension of education or the introduction of a comprehensive health service, because bad as is overcrowding now—and it is very bad as the result of the destruction of many dwellings, 50,000, it is estimated, in the County of London alone—it will be worse when the war is over. When the people now living in the provinces and in the country districts return to the big cities, the problem of overcrowding will be appalling—just appalling. Unless we prepare our plans with vigour, imagination and boldness, the outlook for the removal of the "cultural orphans," the outlook for giving our children and their children a happy, healthy, decent place in which to live, will be very remote.

LORD LANG OF LAMBETH

My Lords, I am sure we were all most deeply impressed by the knowledge and the sincerity of the speech with which my noble friend Lord Geddes introduced this subject. He covered an immense range of experience. I am sorely tempted to follow him in some of his journey, but I must steadily resist the temptation and confine myself, in a very few remarks, to only two points which may be worth making. The first is this. He was right in saying that the condition of great numbers of the children evacuated from our cities and towns opened the eyes of the community, as perhaps nothing has done in like measure, to the conditions of life under which multitudes of our people are still compelled to live. I should like, in that respect, to associate myself entirely with all that has been so forcibly and so eloquently said by Lord Latham. Yet there is much evidence—I have some of it myself—that many of these children came from homes where the houses were decent, where the wages were good, and where, apparently, the state of the children was not due to any real defect in the conditions under which they were living but simply to the heedlessness, the shiftlessness, the carelessness and the ignorance of their mothers.

That has always to be remembered and it leads me to the second point, which is this. As Lord Latham has reminded us, in the case of the children evacuated, at least from London, at the beginning of the war, it was urged that their condition, which was most lamentable in many cases, was very largely due to the fact that the schools had been closed for holidays, and that the children were without the usual discipline of the teachers and of medical inspection. If so, it is indeed lamentable that so many mothers should, apparently, have been content to leave the whole matter of the personal habits, the health and the cleanliness of their children to the school authorities, and to allow them to deteriorate so swiftly. All that was revealed is the more lamentable because, as I think the noble Lord, Lord Geddes, said, in other respects the condition of these children was infinitely better than anything that I at any rate can remember in the last fifty years. In point of health and of clothing, and even of manners and of habits while they are at school, the difference is almost unbelievable. I remember that the early part of my ministry was spent in the slums of Leeds. They were infinitely worse than anything I have since seen in East London or elsewhere, and I tremble to think what the effect on the public conscience would have been if children from those slums in Leeds had been sent into our country districts then. I have seen quite recently photographs of schools with which I was once familiar in East London, some taken thirty years ago, and some taken recently. The change in the appearance, the clothing and the expression on the faces of the children during that time is noteworthy. The improvement made in these respects during that time can scarcely be believed, and all that, I think, for the most part, has to be put down to the credit of our schools, above all to their teachers and also to their medical inspectors.

It follows from that—does it not?—very clearly that two things are urgently necessary. One is that we shall continue with unremitting zeal to carry out a policy of better housing among our people. It is perfectly true that it is idle to speak of a good home unless there is a decent house. And yet is there not equal need of a concurrent policy of endeavouring to awaken in mothers some sense of their own inalienable responsibility? No doubt without that first policy it is almost a mockery to ask mothers to remember their responsibility. But given that policy, we cannot allow ourselves to take no action in face of the necessity of stirring up among many mothers of this country some sense of a responsibility which they cannot possibly delegate to the schools or to anyone else. What I am afraid of is that in this, as in other matters, there is a danger lest the increase of public, social and educational services should lead to a decrease in that sense of personal responsibility, a danger that in rightly endeavouring to uproot the tares of social evils by public action we shall also unwittingly be tearing up the invaluable wheat of that personal responsibility. Therefore I think it is quite plain that granted everything that the noble Lord, Lord Latham, has just been saying, there is great need for endeavouring in every possible way not only to remind mothers of that inalienable responsibility, but also to instruct them and help them to fulfil it.

There is equal need, I think, of training our girls in the functions and responsibility of motherhood. I am afraid that with many of them that is very unpopular. I fear that there is a growing tendency to look upon motherhood as a rather irksome incident of the otherwise agreeable elements of matrimony, and nothing can be more dangerous for the future of our country than the spread of any such feeling as that. It is here that a great deal of good work is being carried on by the aid of such old fashioned and old established institutions as the Mothers' Unions, or, more recently, by the Women's Institutes to which the noble Lord, Lord Geddes, has referred. They may, perhaps, be regarded as very unspectacular. I know the stalwarts of public and social services are apt to look upon them almost with disdain, but they are fulfilling an essential public service, and they are entitled at present to not less but more encouragement and support. I think that without question this war, among other evil effects—for it has had evil effects as well as doing good—has had that of breaking up to some extent the home life of our people. Fathers have been absent from home; mothers have been engaged for the whole or part of the day in munitions or other factories; in many instances their houses have not been available for them; and in all these respects, while there is urgent need of the building of better houses, there is almost equal need of rebuilding the broken family life of the country.

I think we shall all agree—indeed I am almost ashamed to speak of it—that there is no more essential industry than the making and the keeping of a home. In the last resort, no one can carry on that industry except the mothers. For that reason I would plead that we should do everything possible to draw away the minds of the mothers from the idea that everything is to be done for them by nursery schools, by medical inspection in the schools, and so on, and that they can fold their hands and leave these responsibilities to others. On the contrary, it is part of the necessity of the time that they should be reminded of all that rests upon them, and upon them alone. I venture to repeat words that were spoken by King George V, and which have often been quoted since, but which I have reason to think were written by the then Home Secretary, the present Prime Minister: "The foundations of national welfare are set in the homes of the people." If that is true, how inescapable are the conclusions to which the noble Lord, Lord Latham, has just called attention, but also how inescapable is the conclusion that we must do everything possible to awaken in the mothers a sense of that responsibility which is theirs and theirs alone.

THE LORD ARCHBISHOP OF YORK

My Lords, I am very grateful, as I am sure we all are, to the noble Lord for bringing this question of the evacuation before us. We are in a much better position to discuss it now than we were at the time that the evacuation took place. At the time that it took place, as has already been pointed out, there was a good deal of exaggeration. The number of children who were in an unsatisfactory condition was no doubt exaggerated; large numbers of the children who came from the towns were in a condition against which no criticism could fairly be levelled. On the other hand, it is, I think, impossible to exaggerate the condition which some of the children were in; a minority of the children were in a condition which can only be described as a scandal to a civilized country. Those who felt the condition of these children most were not the people who were living in the big houses, but the people who were living in the little country cottages, and who threw them open to welcome the children in the towns in their moment of danger, and who felt intensely the kind of condition in which some of these children arrived.

Of course, as the noble Lord opposite has pointed out, these conditions were perfectly well known to a number of people who were engaged in social work, but they were not known to the country as a whole. I can remember when, shortly before the war, during the Spanish civil war, a large number of children came from Spain and were put into a camp in Hampshire. There were many criticisms, some of them quite justified, about that camp, and one of the facts which caused most consternation was that the children themselves, who had been living under conditions of bombing for several months, were verminous and had a number of unsatisfactory habits. When I happened to point out to the critics, as I did more than once, that the same conditions were to be found in some of our great towns, my statement was simply disbelieved as entirely incredible. The shock came with tremendous force to the people of this country when they realized what these conditions could produce, but I think that along with the sense of indignation and dismay which was felt there was a general recognition that the conditions which the children were in were not due to their own fault. I think that those conditions were very largely due to what the noble Lord opposite has referred to—namely, their environment in the towns, the terrible overcrowding and the insanitary conditions under which so many of them were living.

I should have liked to be in the House yesterday to support the noble Lord opposite when he asked for more houses in rural districts; but your Lordships need not be alarmed; I have no intention of making to-day the speech which I should have liked to make yesterday. The conditions in the towns, however, are, of course, far worse than anything that can be found in the country, for in the country we have at any rate the fresh air, the open spaces, and a silence which is not usually found in the towns. Nearly all the conditions which were found so unsatisfactory in the children can be traced back to the conditions in the towns. I need not labour this point, because the noble Lord opposite has already dwelt upon it in detail; but, when you picture the conditions of overcrowding and the insanitary houses and tenements in which so many of these children have lived, you will agree that it would have been surprising if they had come to the country, straight from their homes, in a condition different from that in which many of them did come. Therefore, although I agree with all that has been said by the noble Lord who moved this Motion about the strengthening of the medical service and about the importance of health, I agree also with what has been said to the effect that any medical service will fail unless we also deal with the environment, and make it possible for these children to live in homes which are less overcrowded and more sanitary.

There is another point which I wish to make. Reference has been made to the quite admirable report entitled Our Towns—A Close Up. That is a most valuable social document of the very first importance, and in this document, which has been drawn up by people who have personal experience of the facts, again and again we come back to the statement that the worst defects in these children begin to appear before they go to school, and that we shall never really deal with this problem satisfactorily until we have nursery schools. Let me read one sentence from this report: Poverty spells overcrowding, with all its evils. The five-year-old enters school suffering from all the complaints which the school doctors and nurses will spend their time in combating during its school life. The under-fives have been found lousier than any other group. Evacuation shows that children of five were already set in bad habits of every kind, and the psychiatrist would not fail to look in the first five years for the roots of delinquency. Criminal statistics show, in fact, that a child may be a thief at seven or eight years of age. The report concludes by saying: We cannot afford not to have the nursery school. It seems to be the only agency capable of cutting the slum mind off at the root, and building the whole child while yet there is time. Very often teachers have told me how impossible their task has been when the child has come to them at the age of five or six, when it has already acquired habits which it is almost impossible to eradicate. Those who have had experience of nursery schools know what wonders can be done by them. I remember, when I was in South London, visiting from time to time one of these schools, run by two very remarkable sisters, who I think were pioneers in this matter, Margaret and Rachel Macmillan. They had houses which were quite small by modern standards, and their garden was nothing more than a back garden, but when you entered these buildings, which were in the midst of the poorest part of South London, you entered into a different atmosphere. You found there a large number of these young children, who were learning habits and entering into a kind of life which otherwise they would have no opportunity of knowing. These nursery schools are also doing something the importance of which has been emphasized by the noble and most reverend Lord who has just spoken. They not only educate the children, but the parents as well. Social workers have told me how the parents, coming backwards and forwards taking their children to and from these schools, come under an influence which helps them in their own homes and in their dealings with their own children. Therefore, supporting as I do the appeal which has been made by the noble Lord for a comprehensive medical service, I would add to it a very strong plea that we should establish a large number of nursery schools which will give the children a chance they do not have at the present time.

LORD SNELL

My Lords, there are few subjects which are more worthy of the attention of your Lordships' House than the one that has been brought before it to-day by the noble Lord, Lord Geddes. It turns a mirror upon ourselves and must cause all of us to reflect upon how far we may be responsible for these things by tolerating the conditions under which they can exist. The noble Lord, Lord Geddes, however, apparently attached blame not merely to the Government but to the defective resisting powers of the human body. Happily I have not to defend the human body to-day, and what the noble Lord has said about the attitude of the Government has not been very severe. But I would suggest that, deplorable as the conditions are which have been mentioned, it is advisable from the standpoint of our national reputation that they should not be magnified beyond what they really are. There is, in fact, no evidence that these conditions were common to any large number of children. That was, I think, admitted by Lord Geddes and by other speakers. Unclean children going into a country village would, of course, create consternation. Countrywomen living in clean, sweet air and the silences of the country, would not understand how children could come to be in such a con- dition. And you may be sure that when they retold the story it would lose nothing in the re-telling. Nevertheless, we should remember that although there were these complaints from almost every area, they referred only to a very small number of people.

Lord Geddes spoke about the listlessness which some of the children showed, a listlessness that is obvious to all of us who have had close social experience. But in spite of that, these things about which we are complaining to-day are not bred in the bone of the people. If we look at what is happening with young people to-day, we can say that there is nothing wrong with the young people as we know them. And then, let us remember that conditions have improved very considerably since September, 1939. There have been fewer complaints. This is to be attributed to the natural influence of the country upon children who are living under conditions under which it may be said they were born again. But it is also due, in a certain way, to the development of welfare services, such as hostels for children not suitable for billeting, hospitals for difficult children and the provision of medical services, clothing for children in need, and social and occupational services for mothers. Many local authorities have established welfare officers to organize this work, to visit billets, to assist householders in their very difficult task, and the whole service is supervised by trained welfare officers attached to all the regional staffs of the Ministry of Health. Therefore I think a modified judgment on this great problem is advisable.

The Shakespeare Committee, which reported early in 1941, said that the experiment as a whole had been successful. One may give illustrations indicating what that success has been. In one town on the Sussex coast there were 154 foster parents who had had children since 1939, and thirty-three of them have still the same children. In another town, in Surrey, eighty-one children are in the same billets as in 1939. In another area in the same county thirty-four foster parents have had evacuees since 1939, and of these twenty-seven have the same children. That is an indication that whatever complaints there may have been at the beginning, the conditions have somewhat improved. But I would join with my noble friend Lord Latham and others who have spoken in not attributing all the blame to deficiencies of individual character. Environment and habit are very closely related. Why do children in these conditions fall below the standard that we regard as being necessary and right? Why do mothers allow children to get into such a condition? Lord Latham has indicated certain difficulties of slum life. There is, above all, the difficulty of distance. If we, members of your Lordships' House, get irritated, or if our nerves get tried, we may possibly find a room where we live to which we can go for peace, but the slum dweller cannot retreat to the wilderness. There is no healing for her, and the thing presses upon the personality until it is subdued to the environment in which it lives.

I think we should remember, too, that in spite of all the difficulties, our London children, whom I know best, are enormously attractive. The London slum boy is the most alert, sharp-witted, gay, and lovable creature it is possible to imagine, and when you realize that these children are always in contact with verminous surroundings in home and street, we can understand what life for such children has been. As Lord Geddes suggested, we may possibly have put emphasis in our educational system on the wrong things. Mothers did not know how to feed and clothe the children they had borne. But whatever changes we may make in our educational system, whatever changes we may make in the environment in which our people live, there will be no lasting cure until there is a deeper sense of parental responsibility towards the children who are born. The greatest responsibility of all is that of handing on life to future generations. Our educational system may have to take that into account and train children and mothers in the really responsible things.

I should like on behalf of the Government very quickly to describe what the present medical services are. There is the school medical service which originated with meals in 1907. That has developed into a comprehensive scheme, including the supervision of the health of the children, their minor ailments, provision of milk and meals, and the education of children and parents in the principles of health and living. There has been de- veloped a maternity and child welfare service under local welfare officers for expectant mothers and children under five. There has been developed the national health insurance scheme which provides for all under contract of service at less than £250, recently raised to £420, a year, and a general practitioner service during sickness. There is the isolation hospital service in the hands of county boroughs and district councils. There is the tuberculosis service under the control of counties and boroughs, and the venereal diseases service under the same authorities. There is also operating the midwifery service set up in 1936, and the Cancer Act of 1939 provided the basis of a new service which has unhappily been hindered by the war.

In the judgment of the Government the merits of these Social Services will stand comparison with anything that exists in the world. If we compare the first year of the last war with the first year of the present war, we get certain satisfactory results. For instance, in regard to tuberculosis, the death-rate in England and Wales in 1914 was 1,361 per million living persons; in 1939 it had been reduced to 636. In regard to infant mortality—that is, children under one year—in 1914 the rate was 105 for every thousand children born; by 1939 it had fallen to 50. There have been other general improvements. There has been an increase in the average weight of school children. The expectation of life has been lengthened. There has been a disappearance of the incidence of smallpox, and a reduced incidence of venereal disease, even allowing for war-time increases. During the war itself these remedial measures have not stood still. The birth-rate in 1942 was the highest since 1931. The death-rate was 11.6 per thousand, the same as in 1938, which itself was the lowest since 1930. There has been a new attack on tuberculosis, the aim being to secure early diagnosis and early treatment. There has been inaugurated a diphtheria campaign to stamp out that dreadful child disease, and four million children under 15 have been immunized. War-time nurseries have been established; 1,100 have been opened, and 475 have been approved or prepared.

Nevertheless, whilst we may take credit for these things, certain defects remain to which our attention should be directed. The services tend to be piecemeal and to be restricted in their scope. For example, medical care is restricted in two ways. It extends only to insured persons and not to their families. The administration of the services is divided among a number of authorities, and there is faulty co-ordination. Medical benefit under National Health Insurance is the responsibility of insurance committees in each county and county borough, which are independent of any other local government agency. Tuberculosis, venereal diseases, cancer and general hospital services are the responsibility of the county and borough councils, either separately or jointly. These councils also administer the maternity and child welfare, school medical and midwifery services, but in each case the responsibility in the county areas is shared with a different group of minor authorities. Similarly, the responsibility for isolation hospitals is borne by the county borough councils and by the county district councils in county areas, and the county councils play very little part. These administrative divisions have had a disintegrating effect on the health services as a whole, and the general practitioner finds himself more or less divorced from the specialist local government services just as these services are divorced from one another.

The hospital services themselves have developed in an unrelated and therefore inadequate manner. For example, voluntary hospitals have stood apart from municipal hospitals and even from one another, and municipal hospitals are without a proper relationship to voluntary hospital resources. So a period of reorganization and reform is essential. This has been long recognized by a great many people, and many proposals have been made. There has been a general recognition of the fact that these services should be drawn together and developed into a coherent and comprehensive whole. Certain approaches have been made towards that ideal. The King Edward Hospital Fund promoted cooperation in the London area, the Sankey Report of 1937 urged similar co-operation in the provinces and in some areas there is a standing machinery for co-operation set up after 1930. The Nuffield Provincial Hospital Trust of 1939 assumed the task of promoting a fulfilment of the Sankey Report. In regard to post-war policy— and I will trouble your Lordships only very shortly with that—the Minister of Health on the 9th October, 1941, indicated the lines of that policy which embodied the principle of laying upon local authorities a statutory responsibility for comprehensive hospital services by planning on the basis of wide areas and of division of function between hospitals. The post-war policy must include the position of the general practitioner. Thousands of young doctors are away on war service. All of us owe them a very great debt of gratitude and they have the right to expect conditions when they return which will not only recognize the sacrifices they have made but will also give them an honoured and useful place in their profession.

I do not propose to relate this discussion to-day to the Beveridge Report and policy except to say that any scheme of social security such as was outlined in that Report requires a comprehensive health service, and the Government have accepted the principle of a national health service which will met the needs of every citizen and make the fullest use of all existing resources. They have also accepted the principle that this must be based upon the well-tried local government machine and that the well-being of the medical profession should be safeguarded. The next necessary steps have already been taken. The Minister of Health and the Secretary of State for Scotland have discussed these proposals with their Medical Advisory Committees which have begun preliminary discussions with representatives of the medical profession, local authorities and voluntary hospitals. All these have set up committees which are meeting the officers of the Ministry for detailed discussion, and it is hoped—I ask your Lordships to note this—that in the next few months a general statement of Government proposals will be published. There is therefore in my judgment, no need to be unduly depressed about the conditions which have been referred to this afternoon. We have reached the end of a period of sowing and of growth and we are at the beginning of the reaping of a very fruitful harvest. There is presented to us now an opportunity for a social change of great importance. The Government will do their best to grasp that opportunity as, it is believed, will also the medical profession and the voluntary hospitals. The aim must be for all of us to establish a foundation on which a healthier and happier Britain may be built.

LORD GEDDES

My Lords, I am very grateful to the noble Lord who has just sat down for the reply he has given. I must say that I feel it has rather confirmed the impression I had that the reply of the Government would indicate that what is meant by positive health has not perhaps been fully appreciated. The reply given just now is on the subject of medical health which we know a great deal about and it is interesting and most beneficial that we should have our minds refreshed. Might I make a suggestion to the noble Lord, that he should read a book that is called Man the Unknown, written by Alexis Carrel to whom I referred earlier to-day? If he will do so he will see exactly what is said in that book. Some of the things I have said this afternoon have apparently not been quite understood, and if that book were read they might become clear. I think the book is the best short synopsis of that particular view which exists, and I would venture to suggest that perhaps other noble Lords might be very interested to read it because we shall have a great many debates before the new medical service of this country is organized. One of the reasons why I put this Motion on the Paper in the shape it has taken is that there are two quite separate things—positive health, which requires an approach entirely different from that made in regard to the ordinary sort of health, and negative health, which is so-called to distinguish it from the positive type of health which the medical profession does its best to provide for every one who has fallen sick. With the permission of the House, I beg to withdraw the Motion.

Motion for Papers, by leave, withdrawn.