HL Deb 29 January 1952 vol 174 cc900-15

3.12 p.m.

LORD DOUGLAS OF BARLOCH rose to call attention to the high incidence of illness and disability among the people, the national loss thereby occasioned, and the need for preventive measures, such as building up greater resistance to disease by better nourishment, and to move for Papers. The noble Lord said: My Lords, judged by objective standards, such as the increase in the expectation of life, during the last hundred years the health of the population of this country appears to have improved greatly. Not so many are dying in the first weeks and years of life, and people are living to a greater age. But the question remains: Do they enjoy good health during their longer life, or is their activity and happiness impaired by disability and disease? The first comprehensive investigation of this problem with which I am familiar was made at the Pioneer Health Centre in Peckham in the years preceding the outbreak of war. Examination of 1,000 families, containing over 3,000 persons—men, women and children—revealed that only 10 per cent. showed no sign of bodily disorder. Not more than one in ten could be regarded as completely healthy. Of the others, 20 to 30 per cent. were aware that something was wrong with them; but 60 to 70 per cent. did not recognise that their health was affected and, indeed, considered themselves to be quite well. This last fact indicates that a National Health Service, which proceeds upon the principle of treating disease in those who feel themselves to be ill and seek medical attention, can do little to prevent disease and will never raise the health of the people to a reasonably high and attainable level.

The findings of the Peckham experiment were so surprising and so disagreeable that many to whose attention they were drawn brushed them aside or said they were not credible. When it was pointed out that the facts were scientifically obtained, being based on clinical examination, it was stated that the sample of the population tested could not be typical. Those who are acquainted with the work of the Peckham Health Centre will be inclined to think that the sample might have been rather better than the average. However, there are now data available which provide a partial check upon the Peckham results and afford some corroboration of them. Since 1944 an official survey of sickness has been carried out month by month, the results obtained being tabulated and published by His Majesty's Registrar-General. This survey is conducted by interview of persons chosen at random from national registration records or from electoral registers. The number interviewed is about 4,000 a month, scattered over England and Wales, and a different sample is taken every month. The accuracy of the investigation is attested by the consistency of the figures year after year. This official survey differs from the Peckham one in two respects: it does not include those under sixteen years of age, and latterly it includes only those of twenty-one years and over. It is not, of course, based upon clinical examination, but upon the testimony of the person interviewed, that he or she had during the previous month suffered from some disability; in other words, it depends upon the person's statement that he was aware of something disturbing to his health. The sickness survey, therefore, automatically excludes all those—and in the Peckham experience they were the majority—in whom some disorder could have been detected by clinical examination, but where the person affected considered himself to be in good health.

The facts disclosed are serious and significant. During the four years from July 1, 1946, to June 30, 1950, nearly 70 per cent. of those interviewed had suffered from some sickness during the course of a month. A closer examination of the statistics reveals various points of interest. Of those aged sixteen to sixty-four years the figures were 60 per cent. for men and 70 per cent. for women. Of those aged sixty-five years and over, the figures were 77 per cent. for men and 86 per cent. for women. The conclusion that women suffer more sickness than men, and the higher age groups more than the lower, is not unexpected. It is the absolute magnitude of the figures which is so astonishing and alarming. I will refer to only two more facts from this survey. The number of days of incapacity averages about 100 per month for every 100 persons interviewed, but is lower in the younger age groups and much higher in these of sixty-five years and over. Only about two-thirds of those who suffered from some sickness consulted a doctor, but again the number of medical consultations was much lower in the younger age groups and much higher in the older ones.


Will the noble Lord make it quite clear whether sickness includes the common cold or not?


As I understand the Registrar-General's Report upon this matter, it includes everything which one would regard as to some extent disabling the person concerned. The figures of incapacity show that there was sufficient disablement to prevent the person concerned from either going to his work, in the case of those who were employed in some occupation, or, in the case of those who were not, sufficiently severe to prevent them from being able to leave their homes. That is how incapacity is defined for this purpose, and it gives an indication of what is meant by "sickness." In addition, I may say that there is a classification according to internationally recognised categories of the various afflictions from which people suffer, but I do not want to go into the detail of that matter.

The survey of sickness provides a valuable index of the state of health of the population, and it ought to be continued and receive wider publicity. The general picture which is to be drawn from it is clear: that lack of knowledge and neglect of health in early life paves the way for chronic and incurable illness in later years. The loss to the national economy is enormous, and there is also the loss and suffering sustained by the individual. The survey, however, does not answer the question: What is the cause of so high an incidence of sickness, and can anything be done about it? The Peckham experiment, which was much more than a medical inquiry—it was, indeed, the most profound sociological research of our times—indicates some of the reasons, although it does not attempt to evaluate their relative importance. We all know that health may be impaired by bad housing, by unsuitable clothing, by lack of fresh air, exercise and sunshine, by unhealthy working conditions, by domestic and social tensions, and by insufficient or ill-balanced diet.

I do not believe that unhealthy houses and work places or inadequate clothing are now the principal factors in rendering people susceptible to illness. I think that an unsuitable and deficient diet is the main cause. Perhaps the most conclusive demonstration of this is afforded by the work of Sir Robert McCarrison when he was Director of Nutrition Research in India. He showed that the principal cause of the great discrepancies in the health and physique of the peoples of the various parts of India was their diet. He verified, by experiments upon animals addicted to the same diets as men, the truth that McCay had deduced from observation: As we pass from the North West region of the Punjab down the Gangetic Plain to the coast of Bengal, there is a gradual fall in the stature, bodyweight, stamina and efficiency of the people. In accordance with this decline in manly characteristics, it is of the utmost significance that there is an accompanying fall in the nutritive value of the dietaries. The people of the North West, as we know, eat cakes made of whole wheat meal, milk and milk products, pulses, vegetables and fruit. Some eat meat sparingly, others eat it in considerable quantities. On the other hand, the staple food of the peoples of Southern India is rice which has been milled, polished and parboiled, so that all the most valuable constituents have been extracted. We are on the way to reducing our white wheaten flour to a similar condition. McCarrison demonstrated that malnutrition not only caused gastric and intestinal diseases but conduced to many others, including a high incidence of respiratory diseases. There is also good reason for thinking that some of the chronic and intractable ailments of middle and old age are the ultimate effects of the same cause.

Now what are the facts about diet in this country? I am not going to repeat what I said in this House on July 4 about chemical adulteration, contamination and substitution in foodstuffs. The position in this respect remains the same, so far as I am aware, and I shall be interested to hear what measures the Government may have in contemplation to deal with this evil. A start might at least be made by requiring, as is done in other countries, manufacturers and vendors of foodstuffs to disclose to the consumer clearly and completely all the ingredients in compounded or fabricated articles. Neither do I propose to do more than mention the dirt and contamination of food in the course of handling and preparation. This matter has excited a good deal of attention recently, and is brought to notice from time to time by the more serious cases of food poisoning reported in the Press.

Apart from all these things there is the great fact of poor quality and lack of balance in the diet available to the mass of the people—those deficiencies, in fact, to which McCarrison drew attention. Most of our fellow-countrymen live under urban conditions and are unable to grow their own food. It is now difficult for them to obtain food which is perfectly fresh or which has not been robbed of part of its nutriment, or which has not been processed or tampered with in some way or other. Milk is frequently two days old, and sometimes older, before it reaches the consumer. It is a food of very great value, but it should be consumed with the least possible delay after milking. Meat is often chilled or frozen, and the small ration is often eked out by tinned meats. No wonder that the noble Lord whose duty it is to co-ordinate food and agriculture voiced in his Election broadcast a longing for "red meat"! Green vegetables deteriorate rapidly after they are cut, and if they do not reach the consumer quickly will have lost part of their nutritive value. The quality of potatoes, which should, if stored properly, keep for a long time, is often deplorable. Frequently they have large blemishes or green spots, or turn black on being cooked. A large part of what the housewife buys with hard-earned money has to be discarded and thrown away. It is now impossible to buy new-laid eggs; they take so long to reach the consumer. In many cases they are putrid and uneatable.

Lastly, I must refer to the impoverishment of bread. A relatively white flour (but not bleached) was known to the Greeks and Romans, but their athletes ate whole wheat flour, and Hippocrates, the father of medicine, recommended it. In fact, so long as wheat was ground in stone mills it was not possible to sift out all the germ and bran. It was the Invention of the roller mill in the 1880's which made this easy, and it is only since then that our flour has become progressively denuded of so much of its vital elements. These are sold to farmers for feeding pigs, or to manufacturers of vitamin extracts, to be resold to the public in the hope that they will remedy dietary deficiencies. The more impoverished is the bread, the more necessary it is to eat large quantities of meat to compensate for its deficiency. Up till a decade or so ago, meat was relatively cheap and abundant in this country, but that is no longer so.

I am not advocating that people should be obliged to eat whole wheat bread; but I must point out that Government action puts pressure upon them to eat white bread, because the State subsidises the production of white flour, made still whiter and more unsafe by being bleached with agene, while whole wheat flour and bread receives no financial assistance. The State also rations meat, and so prevents the population from obtaining from meat compensation for what they lose in the bread. The State should at any rate hold the balance even, and make it as easy to get good flour as impoverished flour. I do not believe in compulsion, but I do believe in education. The people should be told the truth. During the war the Ministry of Food did a valuable service by explaining in their advertisements how to make the best of the diet, how to cook vegetables so as to conserve the salts and vitamins, what foods to eat in order to obtain a proper balance. Educational work of this kind, however, must be persistent and continuous. The generation which is growing up knows nothing about it. Others have forgotten it, or regard it only as of war-time importance and not applicable to the conditions of to-day.

It is difficult to exaggerate the cumulative effect of all the dietary evils to which I have referred: the chemical manipulation of foodstuffs, their contamination in handling, their poor quality because of the way they are grown or the delay in reaching the consumer, the abstraction from food of valuable nutritive elements, and the lack of balance in the diet available to most of the population. The consequences seem to me to be revealed by the statistics of sickness and invalidity to which I have referred. By neglect of these matters we are wasting a large amount of the energy, talent and stamina of our people. It is only by those qualities that, with the natural resources of these Islands, we are able to support 50,000,000 people at a tolerable standard of comfort. These men and women have had to bear a heavy burden since the outbreak of war and in the troubled and uncertain days which have followed. The Government are calling upon them for further efforts and sacrifices, but their endurance is not unlimited. It is unwise, it is improvident, to test it to the breaking point. If more effort is asked for, the means must be supplied for producing that effort. Action is needed, and needed without delay, to improve the quality and, where necessary, the quantity of the food supply, and in every other way to create conditions of living which will reduce the frightful toll of invalidity revealed by the Government's own investigation. I beg to move for Papers.

3.38 p.m.


My Lords, I am glad that my noble friend is continuing with his health campaign. He is, if I may say so, in the succession of Samuel Butler, whose Utopia was a community in whom ill-health was indeed a crime: the individual was not to allow himself to become unhealthy. Although that may seem a rather paradoxical way of looking at it, the more one thinks about the matter the more one must agree that there is a great deal in that point of view. It has always seemed to me a very peculiar thing that one of the few diseases over which man has no control is the only one which is regarded as rather shameful, one to be hidden away—that is, the terrible disease of cancer; whereas all sorts of diseases and sicknesses over which the individual has a great deal of control are not regarded as shameful at all. There is no public opinion against a man with influenza or a serious cough travelling in a crowded tube or, what is worse, for his own pleasure going to a theatre and infecting all his neighbours. That, surely, should be just as much a criminal offence as many of the offences for which people are brought before the magistrates' courts.

I am afraid the noble Lord will have to wait a long time, just as Samuel Butler did, before he finds his ideals put into practice, but in the end I am sure that victory will be his. Indeed, I think your Lordships will agree that we have already travelled a good long way since the time of Samuel Butler, because, while his ideas were subjected to ridicule and contempt, the ideas which the noble Lord has been putting before us this afternoon now receive a great deal of assent, particularly from the more thoughtful section of the community. The difficulty is not that people do not agree that preventive medicine—or, as it is perhaps better called, positive health—is not the right objective, but that so few of us are prepared to take any positive steps to see that it is brought about. We put too little energy into building up positive health because so much of our effort is directed to the curative branch of medicine. The trouble is that we have got ourselves into the grip of one of those great machines which humanity creates for its own advantage and which then, like Rossum's Universal Robots in the play, seem to develop a sort of demoniacal life of their own and dominate their creators.

Over the last 200 years, we have built up a most magnificent and beneficent science of medicine aimed at the curing of people who are ill and diseased; and so much of our energy, so much of our skill and so much of our wealth is put into keeping that machine going and building it up still further that it has almost become a sort of vested interest. It would be unfair to use that term in its ordinary expression, although it is undoubtedly true in respect of certain aspects of health, such as the patent medicine trade. But what I am trying to indicate is that so much of our skill, intelligence and wealth has gone into this machine, which in effect exists for the purpose of curing sick people, that we have no wealth, energy and intelligence left to put into the far more important problem, the problem of seeing that people never become sick and diseased at all. Is it not true that something over £400,000,000 a year of taxpayers' money is spent on the curative aspects of medicine, whereas we could not even afford the cost of one bomber per annum to keep alive the great Peckham Health Centre, to which the noble Lord referred in his speech? In some ways that was the most valuable of all the research work done, at any time and in any country, into this problem of positive health in the community. It was an experiment for the study of which people came from all over the world, and yet it has been allowed to die away in this positively scandalous manner. I think we ought to be ashamed of ourselves that we could not keep alive that piece of fundamental research into this problem of positive health.

The coping-stone of this intense concentration, so to speak, on the curative aspects of medicine comes with our magnificent National Health Service, of which we are all so rightly proud, but which has, nevertheless, developed a definite bent towards curative medicine as opposed to positive health. It may turn out, if we do not give this Service a new orientation, and do so soon, that in a sense it will become a curse in disguise rather than a blessing. The policy should not be so much one of curing the sick as of seeing that there are no sick to be cured. I remember, when the National Health Service Act was before your Lordships' House, discussing the matter with an eminent member of this House who himself had a distinguished career in his earlier life in the medical service—Lord Geddes. He advanced the view that the National Health Bill conception had gone wrong for this very reason; that there was no drive towards building up positive health by preventive medicines. It was concentrated entirely, as he said, upon the curative side. The more one looks at it the more one realises that that is true.

It is not an unnatural sort of thing; it is in what one might call the natural evolution of events that we should concern ourselves with the curing of people who are sick. It is a very natural thing that medicine should have evolved on lines of that sort. The trouble is that it has become so concentrated on those aspects that it has not time for energy and thought along the other side, which is really fundamental to the whole problem. I should not like your Lordships to think that I have not the greatest admiration for the work which has been done over these last years by the great medical scientists and by the doctors. When history comes to be written in the remote future, it may well be thought that medical science was the greatest contribution which Western Europe had to make to the civilisation of the world. But we must see to it that that evolution now takes on a new slant. I quite appreciate that in working towards such a new ideal the medical profession does not get a great deal of help from the general public, because the ordinary man in the street becomes conscious of his health only when, unfortunately, he begins to lose it— The devil was sick; the devil a monk would be. The devil grew well; the devil a monk was he! If I might take one illustration from what is now going on in the National Health Service, I should like to emphasise a point which was made by my noble friend in his opening speech. I imagine that one of the greatest contributions, if not the greatest contribution, which has been made to positive health over the last years was the discovery of the vitamins—a discovery made by one of the greatest of our English scientists—one of the outstanding contributions which this country has made to the knowledge of the world. Of course, vitamins are not drugs or medicines; they are essential matter in the food we eat. Their presence is essential to the full nutritive value of those foodstuffs, but unfortunately in the business of processing food, subjecting it to the action of all sorts of chemicals (a matter to which the noble Lord has referred), these vital elements are destroyed and the health of the community suffers. It is fortunate that the vitamins themselves can be manufactured and that the deficiencies can be made good by people taking vitamin tablets. But is it not an unfortunate thing that in the natural foodstuffs which we consume we should first destroy the vitamins and then, by an expensive process, manufacture them again? It is an expensive process and only people who can afford these vitamins are able to replace the deficiencies.

The National Health Service is constantly fighting financial difficulties, and I understand that doctors who prescribe vitamin tablets and who take what might he called a positive attitude towards this problem, are told by visiting inspectors that vitamins are too expensive and that something cheaper must be prescribed. I understand that doctors have actually been warned that they will get into trouble if they prescribe vitamin tablets in this way. My Lords, could there be a better example of the old-fashioned practice of giving out-of-date medicines because they are cheaper, instead of essential vitamins, which are not drugs at all but which are quite necessary to the positive health of the patient? And all this because it is an expensive matter to prescribe vitamins for these people. Yet in a recent publication of the British Medical Journal there is a most interesting article on the subject of the ordinary bottle of medicine. Everybody, except the least educated patient, knows that it has no real curative value at all, but it is given because it is the practice to send the patient away with a bottle of medicine. It is calculated that we spend no less than £5,500,000 a year on bottles of medicine which are really of no value to anybody, except here and there where they may have a psychological effect: If this £5,500,000 were spelt effectively on vitamin tablets, it would probably make a great deal of difference to the health of the community as a whole.

It is said that the uneducated patient feels that he is not getting his money's worth unless he is sent away with a bottle. It is interesting to note that one doctor working under the National Health Act, a Dr. Pinsent, has succeeded in persuading his patients that, except in an occasional case, the bottle of medicine is of no real value, and in making them understand what is the matter with them—which, in my experience, very few doctors have ever tried to do. I would suggest that that is a line of development which the medical profession might explore, because over the last generation the education of the ordinary man and woman in this country has improved so much that what was no doubt quite a sensible procedure in Victorian England, when people were comparatively uneducated, is now out of date.

This brings me to the subject of food, to which my noble friend referred more than once to-day and to which he devoted a great deal of the most interesting speech which he made to your Lordships' House, I think in July last. I think he was quite right when he said that fundamentally the health of the community depends more on food than upon anything else. If we could get the right food and get it properly cooked there would seldom be any need for supplementation by vitamins at all. Ever since this planet became populated, for the great mass of humanity the problem of food has been most difficult, pressing and urgent. For a very small section of better-to-do people in Western Europe and America the essential importance of food rather vanished from sight for a short period, but over these last years it has been brought back to all of us in no uncertain way. I have not the time, and I am sure your Lordships would regard it as outside the terms of this Motion, to elaborate upon that, but I should like to say a few words in supplementation of what my noble friend said, both to-day and on the last occasion in respect of the chemical treatment of food. On the last occasion various references were made to an outstanding lecture by Sir Edward Mellanby, who is perhaps the greatest living authority on this problem. At that time the lecture had not been published but now I should like to refer to some of the passages from it as it was published in the British Medical Journal of October 13 of last year.

I should like to refer to two short passages on the subject of chemical manipulation of food. Sir Edward Mellanby says: There are indications that this subject is now an important problem of public health, and unless controlled and wisely guided this practice may have a detrimental effect on the health of the country. A little lower down on the first page he says: At the present time, both in the U.S.A. and in this country, it is possible for chemical substances to be used in food manipulation and production which ultimately prove to be harmful and deleterious. This does not mean that substances known to be harmful can be added to food but only that chemicals are often assumed to be harmless and, after being used for a longer or shorter time, are then proved to have harmful properties. He makes a strong plea that this important matter should not be left to the Ministries of Agriculture and Food, both of which are naturally much concerned with the production of food than with its health properties, but that it should be left to the Ministry of Health, which after all is the Department essentially responsible for the health of the community. I think the noble Lord who moved this motion would agree with that. I certainly do.

Now, my Lords, at the risk of some repetition of what was said on the last occasion, I should like to refer to the problem of bread, and more especially to what is called the agenisation of bread, which I suggest has become nothing less than a public scandal in this country. For the last thirty years our bread has been treated—ironically it is called "improved"—by the addition to it of a rather complicated chemical called agene, and it is thought by many people, including Sir Edward Mellanby, that this is a dangerous chemical addition to the most important of all our foodstuffs. It is said, of course, that there is no clear proof that the agenisation of bread is dangerous to the people who eat it


Will the noble Lord forgive me for interrupting him? He quoted from statements made by Sir Edward Mellanby. I wonder whether he would give the quotation in this connection? The noble Lord said it was plain that Sir Edward Mellanby considered that this drug was dangerous. Would he give us the revelant quotation.


I said it was obvious that Sir Edward Mellanby thought that it was possibly dangerous. I would have to read the whole lecture in order to show that, and it is very long. If the noble Lord will read it, I feel that it will be quite clear to him that Sir Edward Mellanby thinks we are pursuing a dangerous course.

I propose to refer to some further passages from the lecture. To read the whole thing would take up a very great deal of your Lordships' time. What I have just said is the result of the impression conveyed by the whole lecture, rather than from any particular sentences. I am afraid that the noble Lord will have to be satisfied with that.


I cannot be satisfied. I am sorry to interrupt again, but the fact is that research has recently been carried out on this issue, and it does not bear out what the noble Lord has just been putting before us. This research has been conducted by the Medical Research Council of which Sir Edward Mellanby, as the noble Lord, Lord Chorley, knows, was the secretary. I thought, therefore, that if the noble Lord was using Sir Edward's name in the matter it would be only fair that he should' give the quotation on which he based his remarks.


I shall give several quotations from what Sir Edward Mellanby said. It is true that it cannot be proved 100 per cent. that this agenisation of bread is dangerous. It is said that, since it has been used for thirty years and it cannot be shown that people have died as a result of consuming it, therefore there cannot be anything harmful in it. Sir Edward Mellanby gives two examples of well-known drugs which were used for years and which were thought at one time to be beneficial to the patients to whom they were prescribed. They were complicated drugs, and the names of them would, I imagine, convey little to any noble Lords except Lord Horder.


I was going to repeat Lord Woolton's question and to ask whether we could have a quotation. I think that a short quotation from Sir Edward Mellanby's statement would save a great deal of assumption as to what he intended.


Sir Edward points out that there are two particular drugs which were used for years, and it was thought that they were not only harmless but positively beneficial. Recent research work has proved that both drugs were deleterious. The passage in which Sir Edward deals with this matter reads as follows: Medical science often cannot give adequate answers to questions of toxicological action, not only as regards new compounds but even in the case of substances long in use. Indeed, to the medical man, unpleasant surprises are constantly being revealed, in the case both of drugs and of chemicals used in food preparation. Many instances of such occurrences could be given, but two in relation to drug action, which will be known to many medical men, will be mentioned. A series of cases of agranulocytosis often associated with septic throats (Vincent's angina) carne to light about 1935–39 in which the individuals affected were found to have taken a well-known and extensively advertised patent medicine. The cause of the trouble in these cases was traced to the amidopyrine present in the patent remedy. As soon as the discovery was made and announced, many further instances turned up, and indeed a number of other chemical substances were later discovered to have a similar toxic action. This was a surprising poisonous action of a drug which had been long in use. Another similar unexpected result casually observed quite recently has been the discovery that resorcinol, which has been a long-standing remedy as an antiseptic in skin disease, has the remarkable effect in some people of producing mycoedema and enlarged thyroid. Those are just two examples of drugs which were used for a long time and apparently were thought to be valuable items in the pharmacopœia. Recent research has shown that they are far from harmless.

The trouble in this country is that we have no proper system of research into these problems, and I would suggest that even at a time like this, when economy is so important, some public money should be spent in setting up a proper research council on drugs and dietetics generally. So much of the research which has been done on these and other lines, in connection with medical and dietetic matters, in this country, is done by private concerns which are, very naturally, chiefly concerned to make a profit. That is surely altogether wrong. In the United States a very great deal more is done on both lines. I am not suggesting that these very fruitful private avenues of research into dietetics and other medical matters should be discontinued. By all means let the great companies who discovered M and B and other valuable drugs of that kind go ahead, but I suggest that we ought to have something like our own National Physical Laboratory which, in a different direction, has done work without which this country at the present time might well, as a country, have ceased to exist. I suggest that we have something on similar lines for doing similar research work into these dietetic and medical problems. I think everyone would welcome some effort on those lines if His Majesty's Government can see fit to initiate one.

It would be almost impossible to get what I might call clear proof that the agenisation of bread is deleterious. Even if some self-sacrificing scientist or some other self-sacrificing citizen were prepared to submit himself to direct injections of agene, or were prepared to eat only agenised bread, it would not necessarily be proved just from the results of one or two cases that agene was deleterious. As Lord Horder, I am sure, will tell us, people vary greatly from one to another in the way that they react to drugs. Some are very susceptible to some sorts of drugs whilst others are not; and while one man might react in a certain way, another might not react in that way at all. But I contend that there is a great deal of evidence that the agenisation of bread is dangerous, and I suggest that if the matter were submitted to a jury in a court of law they would have no difficulty in giving a verdict that the defendant was guilty. Experiments in respect of this matter have been carried out on a large number of animals—particularly on dogs. Sir Edward Mellanby's own researches, by accident, showed that dogs develop hysteria after a very short time.

Forward to