SCROTAL CANCER

HL Deb 13 March 1969 vol 300 cc649-78

6.1 p.m.

LORD CROOK rose to ask Her Majesty's Government what steps they are taking, in the light of the latest information, to supplement the excellent efforts of the Factory Inspectorate as to scrotal cancer. The noble Lord said: My Lords, I rise to ask the Question standing in my name on the Order Paper, a Question which has been deliberately phrased on this occasion. When I have raised this issue in the past I have related it mainly to the Factory Inspectorate. On this occasion the Question has been widened, because I am clear that a number of Government Departments are involved, and it is useless just looking to the Factory Inspectorate in this matter.

The truth of the position at the moment, of course, is that some employers have been forced into facing their responsibilities after nearly a hundred years. They have done so because a learned judge has given £10,000 agreed damages to a widow, and in giving judgment the learned judge indicated that it was wrong that the factory doctor had failed to institute six monthly inspections of men at risk, despite weighty medical opinions making such a recommendation. And still there are some employers who want to run away from their responsibilities for the lives of their workers; still some who are doing nothing.

I am asking to-day not only for a reappraisal by the medical section of the Factory Inspectorate for short-term action, but also that this field of consideration and investigation should be widened. Doctors are predicting an increase in scrotal cancer during the next few years, an increase which it may be could have been avoided if notice had been taken of the warnings of over 90 years ago. The medical profession is unanimous that the male scrotal sac is the part of the skin most susceptible to cancer in the human body.

It was in 1922, in Scotland, that 65 cases were first clearly diagnosed in the Scottish shale oil industry. Four years later, in 1926, arising out of that, a Home Office inquiry found: conclusive information that certain mineral oils, including such refined mixtures as lubricating oils, are capable of inducing cancer". The cause of the present increase—and, as I shall try to show, the forecast of a greater increase—is that most of the oils used to lubricate and to cool machines contain cancer-producing agents. The faster the modern machine, the greater the need for special oils, the more the splashing and the saturation of the clothing of the workers. Ten million workers in this country come into contact in some way or other with mineral oil in their daily work. Those most at risk are the tool setters, who lean over machines to adjust them; and the next at risk are the machinists. The stomach, thighs and groin area of their clothing comes into contact with the oil. But the really worrying thing about this type of cancer is the known long incubation period. Dr. Francis Roe, of the Chester Beatty Institution for Cancer Research, says that the average period of incubation is very long—in fact, up to 50 years.

At present, most cases are occurring to men in their late fifties. Dr. Roe was among others who commented recently on the forthcoming likelihood of an increase in cases. He said—and I quote: Bar automatic machines came into wide use in the 1920s, and if one allows 40 to 50 years from this time one would expect the main wave of cases to begin about now. The evidence that the number of cases is on the increase is confirmed by Dr. C. N. D. Cruickshank, the world authority on the disease, who is head of the Medical Research Council Unit for Research on the Experimental Pathology of the Skin. He agrees that it is inevitable that the notifications to the Factory Inspectorate are fewer than the actual cases that occur. This he says—and I agree with him—is due mainly to two causes. The first is lack of notification through ignorance. The second, and more important, is because the cancer may occur years after the patient has left the work where he was exposed to risk from the mineral oil and at the time of his development of the cancer is employed in an occupation where there is no obvious hazard. I am quite satisfied that the Factory Inspectorate figures are not inaccurate, as was alleged in a newspaper: they are completely accurate, and record what is notified to the Factory Inspectorate—which is no guide to us at all, and of no use. And this is one of the reasons why I want to develop my plea for going outside just a reliance on the Department of Employment and Productivity.

The Minister of that Department indicated in another place on January 27 that the number of deaths was negligible. This produced a Press statement from Dr. J. A. H. Waterhouse, the Director of the Regional Cancer Registry at Birmingham, and Reader in Medical Statistics at the University of Birmingham, that it was: absolutely astounding and completely out of touch. It was an understandable reaction for a newspaper to try to get from a man of that distinction. The two sets of figures are not completely comparable. What is true and is comparable is that in the Birmingham area there are greater figures each year than the Factory Inspectorate figures given for the whole of the country.

In the Birmingham area, which I think is probably the worst in the country, it is reckoned that one in every 1,000 tool-setters contracts scrotal cancer. There are, on average, 14 new cases a year. Between 1950 and 1966 the number of deaths in the area recorded by the Birmingham Cancer Registry was 65 among tool-setters and machinists, 7 gas workers, 5 garage hands and 3 chimney sweeps. That is a total of 80 in the 17 years. There were another 95 deaths from scrotal cancer in that period, but they were not investigated, solely because as Dr. Waterhouse has said, his unit does not have the resources. But he added: I feel sure that if we did, we would find a history of contact with mineral oil among many of them. So you see, my Lords, that in the Birmingham area alone it is known officially that there was an average of five proven cases a year. And if note is taken of those cases that were not followed up the figure could reach probably 10 a year. Yet the Minister's figures of notification to the Factory Inspectorate given in another place gave the average number of deaths notified to the Factory Inspectorate as two a year. So much for establishing the facts. What is being done about them is part of what is involved in my Question.

Coming back to what I said in opening, obviously concerned in this question are not only the Factory Inspectorate but, I think, a total of seven groups. They are the workers; the employers; the Medical Research Council; the Ministry of Social Security in its Health Department, and the Factory Inspectorate, which fits in there; the Ministry of Technology, and the great oil companies. I ask that each of these shall be looked at, and shall themselves be asked to look at their responsibilities and their problem.

I start with the workers quite deliberately, because it must clearly be true that the workers who are at risk must make their own contribution to their own good health. Washing after going to the toilet is something recommended to all of us. Washing before going to the toilet is clearly advisable for those at risk, and notices should indicate that. They should not keep their oily wiping rags in their trouser pockets. They should drop the practice, which some of us, in fact many of us, have seen, of cycling home in clothing oil-soaked in their middle parts in order to get home just that little bit sooner.

That brings me to the employers, who for their part must buck up their ideas. The worst standards must be brought up to the best. I have endeavoured to find out what are the present standards at the factory involved in the £10,000 judgment. I find that they seem to be setting standards that others might well copy. I ask that the Factory Inspectorate should see to it that the standards of other firms do at least as well as those of the firm in question. The proper hot water washing facilities which are provided for in the Factory Acts are of course an obvious "must". The provision of shower baths for the men at risk is essential. So is the supply of adequate protective clothing, with a regular laundry service. Barrier and cleansing creams must be available, and clean wipers must be available in the factory without stint. What is more, I ask that these provisions be made mandatory, to be observed by firms large or small.

I like the idea that this firm have introduced, and I ask that the Factory Inspectorate shall look at it. They have provided something for their workers based on the sporran worn by the Scots. This is used for the oily rags to be deposited in as the men move about their jobs. I have no doubt that all employers should be made to provide protective clothing. I have no doubt in my own mind that the trade unions should consider whether their workers should be under terms of service which compel the wearing of that protective clothing and, what is more, compel their submission to medical examinations under properly defined rules.

I realise, of course, the care with which the question of compulsory medical examinations must be faced. The learned Judge, in the judgment to which I have referred, pointed out that the factory doctor had been afraid of frightening the men with talk of cancer. Clearly, the men must be talked to. They must be told that the incidence of the disease is very low and for that reason it is possible to control the situation if care is taken in the right way at the right time. As I have said, the learned Judge based his decision on the fact that the advice that had not been taken was that there should be an examination every six months. To this, my Lords, there is resistance, which is another reason why I put this Question to the Government. One doctor, Dr. Geoffrey Mathew, the medical officer of Rolls-Royce has gone on public record as saying: we are prepared to take the liability. My Lords, what an answer to come from a member of the medical profession on behalf of a great firm! They are to take the responsibility of paying compensation to a widow, and to hell with what happens to the man! That is no answer to people who are at risk. That doctor describes the judgment as "impracticable and unreasonable".

Let us now look at the reaction of another medical man, Doctor Raymond Routledge, chief medical officer of the English Electric Group. He came out at once with the statement: We have always been alert to the dangers but this case has provoked us to do mere. English Electric did not find the, judgment impracticable. They started the six-monthly check-up at once. Put the Medical Defence Union, which might be called on of course to pay for the defence of doctors who are found blameworthy, supported Doctor Mathew's view with this statement: One judge's view has placed industrial medicine in a silly position but we are saddled with the judgment and failure to make six-month checks will make a firm liable. Again the same thing, my Lords—money is the thing that matters; never mind about the lives of men.

There was no bright spark in this matter, in my view, until yesterday. I welcome the fact that yesterday the Parliamentary Under-Secretary of State for the Department of Employment and Productivity, Mr. Ernest Fernyhough, who was accompanied by the Chief Factory Inspector and other factory inspectors, opened the Conference on Safety on Construction Sites. He referred to the employers' estimate that their accidents cost in the order of £500 million, and he went on to say—I quote him with great pleasure: During the next two days"— that is, yesterday and to-day— you will be analysing and considering all these figures more closely. But I would like you also to remember, as I am sure you will, the costs that cannot be counted. I mean, of course, the effect of many of these accidents on the future life and employment of the individual worker. And in the case of the fatal accidents, just think for more than a moment of the effect on the lives of widows and children concerned or left behind. That is the kind of attitude that I am asking the Government to show in reply to this Question.

But I am still worried, even about the Factory Inspectorate whose great standards of work I have admired and respected and supported in this House over the years, for I gather that the Medical Inspector of Factories, Doctor Kipling, has said that the judgment has caused the biggest ever shake-up in industrial medicine. He takes the view, I read, that the examinations are doubtful medically and the task very, very large". That is another reason, perhaps, for increasing the number of inspectors on the medical side. Members of my Party pressed for more factory inspectors when we sat on the other side of the House; there is no reason why we should not still go on pressing for them now that we are sitting on this side, as my noble friend Lady Summerskill and the noble Lord, Lord Amulree, and I have done over the years. Doctor Kipling went on in his statement: The answer is probably in finding and examining only the workers exposed to the neat cutting oils which are the most carcinogenic. All I am suggesting in this Question to the Government is that they should get down to the job and make up their minds; carry out a swift examination and make a pronouncement.

English Electric, who have done this good job as I have said, say that 300 men are exposed to risk in a typical factory of 12,000 men. Doctor Pelmear, who is responsible for the medical affairs of G.K.N., says that in some engineering factories 17 per cent. of the works population can be considered to be at risk of scrotal cancer. But he is in no doubt what to do. He is seeing every setter and every operator exposed to neat oil every six months, and others exposed to neat or soluble oils annually. Is it a practical proposition? Well, my Lords, listen to the figures applicable from the day of the death of the man who died from the scrotal cancer which resulted in the judgment. The annual figures of examinations were as follows. In 1965 they did 75; in 1966 they managed to do 339; in 1967 the figure had risen to 580 and last year it had reached 834. So your Lordships will see that the practice which the Rolls Royce doctor described as "impracticable and unreasonable" is certainly shown to be practicable, which therefore leaves only the fact that someone is unreasonable. The truth is, of course, that the judgment of the court can be said to be in advance of Statute law.

May I put one point to the Government with regard to these regular examinations? They not only permit of an examination of the part of the body for skin warts and cancers, but the medical officer can also look for oil acne and dermatitis. These latter indicate exposure and sensitivity to oil, so that the individuals concerned must take extra care. In asking this question I commend to the Factory Inspectorate a system which has been developed at the factories of G.K.N. When a man leaves a notification is sent to the man's general practitioner, stating that his patient has been in contact with mineral oil and warning the doctor that a watch should be kept for a scrotal cancer condition arising.

I learn that most of the workers appreciate the health service which is offered them. Unfortunately, however, the natural shyness of men asserts itself. It may be surprising to some of your Lordships that in these modern days this is so, but some of us who have dealt even with the problems of the showers know something of this shyness of men. The truth is that they will resist any examination which involves their private parts unless that examination is made obligatory. I am told that throughout the works the figure who take that line is roughly 4 per cent. They will not even go to their own general practitioners, and in the factory to which I have referred we had the clearest proof of the value of examinations and how tragic it is that men will not take advantage of them. One of the men who would not take advantage of the examination scheme had to consult his general practitioner six months later when he was in pain and his general practitioner had to send him away to the hospital suffering from scrotal cancer.

I have been talking about large factories, but from my discussions over the last twenty years I know the Government do not need me to remind them that the majority of factories in this country are small. These factories are part of the life-blood of the country, and I realise that what is possible in the big factories is not possible in the small ones, and only a national Occupational Health Service could deal with the problem. I urge that this is not just a question for the Factories Inspectorate; the Health Division of the Ministry of Social Security and the Ministry of Technology should come into the picture. I ask the Government to consider this point for a number of reasons. First, there is the question of machine tool design, to ensure that oil is not splashed about as much as it is by some machines to-day. The second is the suggestion made by Dr. Cruickshank, to whom I have already referred, that mineral-oil based cutting fluids should be replaced by other lubricants, or alternatively that the only oils used for this purpose should be further refined to remove the aromatic fraction containing the carcinogenics.

I am sorry that I have taken up so much of your Lordships' time, but the health and lives of workers are involved here, as in the days when the campaign in regard to mule spinners' cancer was proceeding. The intention and the desire is to ask the Government to face the problem, both for some immediate action and also for a long term solution. I will conclude with one final quotation, which is not my suggestion but a suggestion made by a Dr. Roe of the Chester Beatty Institute for Cancer Research, from whom I quoted in opening: I feel that legislation will have to be introduced to enforce frequent medical checks on men at risk, even after they retire or move to another occupation. Even the medical profession has to be alerted, for there have been odd cases where doctors have failed to appreciate the significance of the development of a wart on the scrotum. From our present knowledge and methods, 80 to 90 per cent. of all discovered cases would then have a chance of being effectively treated. My Lords, in the hope that people can be so treated I beg leave to ask the Question standing in my name on the Order Paper.

6.26 p.m.

LORD AMULREE

My Lords, I am extremely grateful to the noble Lord, Lord Crook, for putting down this Unstarred Question because I put down a Starred Question on the same matter in your Lordships' House last October, to which the noble Lord, Lord Hughes, was good enough to reply. I do not want to cover the field which the noble Lord, Lord Crook, has so well covered. There is little more for me to add, except to say that I entirely agree with what he has said and I share his anxiety for the future. For that reason I wish to associate myself with the Question he is asking.

There are certain drawbacks and loopholes in the present system of notification. I think I am right in saying that the legal duty of the doctor is to notify cases of scrotal cancer which have been associated with mineral oils, and to report them to the Factory Inspectorate. That is something which it may be difficult for the doctor to do because quite a number of people who have been associated with mineral oils change their occupations. This was one of the things that was first found out in the year 1925. There is nothing very new about that. In 1925, when a departmental committee of the Home Office reported, it was found that the disease was due to mineral oil and that the mineral oil could be detected in the atmosphere of the factory.

Then the person who was the secretary of that departmental committee, Dr. Henry, of the Home Office, produced a Report in 1946 in which he tracked down with enormous care and labour the particulars from the death certificates of all the people who had died from scrotal cancer from as far back as he could trace—and the period went back quite a long way. By careful and patient research he found that although when they died their occupation might have been any one of a number of things, they had one and all been at one time associated with work connected with mineral oil: and mainly at that time they were mulespinners in Lancashire. Things have changed now. At the present time there are cases of scrotal cancer which appear not to be associated with oil, but when one inquires into them one finds that they all are so associated.

There were three cases reported from a hospital in North London over the last five or six years. Two of them concerned people who were recorded as having worked with mineral oil, and the third was recorded as being a security officer. But when his case was investigated further it was found that at one time he also had worked with mineral oil. As the noble Lord, Lord Crook, has said it may be as long as 30 to 40 years before the cancer appears. The incubation period is exceedingly long.

There was a time, in 1930, when Professor Twort, working at the Cancer Hospital, showed that certain shale oils were potent in producing cancer while certain other oils were not. It was preferable to use these non-carcinogenic oils in factories and places where oil has to be used. One does not know whether that finding has been followed, but the position was known, and just as the work on scrotum was done in 1925, this work was done in 1930. So there is nothing new or modern about it. One does urge the Government to do what the noble Lord, Lord Crook has asked, to encourage the employers and the unions and the factory inspectors to take great care of this problem. One noble Lord, when I put my question to him, said that two officers in his regiment had both developed cancer of the scrotum because they had been working in a motorised unit with a good deal of oil about the place. One died and one did not.

The disease has been notified since 1920; so we have a great deal of information about it. And of course, when one looks at the figures of those who have died one finds that the numbers are not very large. Between 1920 and 1943 1,355 cases were notified. It is a very curable form of cancer. The noble Lord, Lord Hughes, told me on October 23 that there had been 30 deaths among about 300,000 people at risk in the years 1963 to 1967. Although that is not a very big number, it is a number which is preventable; and, as was said on a famous occasion before, if it is preventible why is it not prevented? That is the question I want to put to the noble Lord, Lord Hughes, in support of the noble Lord, Lord Crook. Although the numbers are not very great, he may be interested, as a good start, if I refer him to Luke XV, verse 7.

6.32 p.m.

LORD COLLISON

My Lords, I too, am deeply grateful to the noble Lord, Lord Crook, for putting down this Question. I must declare an interest, because on Monday some colleagues of mine from the T.U.C. and myself will be meeting representatives of the Confederation of Shipbuilding and Engineering Unions to discuss this very subject. That it is a matter of some urgency I have no doubt at all. I have with me an extract from the Sunday Times of October 13, 1968, an article by Derek Humphrey, which starts by saying that the doctors are predicting an increase in scrotal cancer cases in the engineering industry during the next few years, that the disease has reached worrying proportions, and pointing out that the tragedy is that the suffering—and it is real suffering—and the deaths from scrotal cancer caused by contact with industrial oil could largely have been avoided if warning signals during the last 90 years had been heeded. In the same article it is pointed out that roughly one in every 1,000 tool setters in the Birmingham area contracts cancer of the scrotum, and every year there are 14 new cases in that area.

I entirely agree with the noble Lord, Lord Crook, when he says that we do not know the full extent of the cases that are caused by the use of these oils. The noble Lord mentioned Dr. Cruikshank, and he has recorded that in one town there were 30 cases developed from the use of cutting oils at a time when the incidence for Scotland, England and Wales was reported officially as only 18. So it is quite clear that the number of reported cases is very small in relation to the actual number of cases which must be occurring. Dr. Robert Mallory, the Medical Adviser of the T.U.C., who was previously with the International Labour Organisation as their medical officer, reports that, in his experience, out of 250 cases which he knew only three were notified.

The fact that exposure to tar, soot and shale oil can lead to cancer has been known for a long time, in fact since the beginning of the century. Indeed, it was first described by Percival Pott as a hazard for chimney sweeps in 1776. and investigations into the reasons of scrotal cancer among cotton spinners in Lancashire began as far back as 1928. A conclusion reached by various committees, including a Medical Research Council Committee in 1948, was that cutting oils were carcinogenic, and, as we all know, the mule spinning health regulations of 1953 made the use of technical white oil or animal or vegetable oils—that is to say, non-carcinogenic oils—compulsory, It is interesting to remember that in 1851 spindle oil from Scottish shale was introduced into mule spinning, and it was not until 1953 that we got these regulations making the use of technical white oil compulsory. That has been quoted rather cynically as an example of the one hundred years' law—that is to say, that it takes a hundred years from the introduction of a hazard until it is brought under control. This is no doubt an exaggeration in many cases, but in the case of mule spinners it was not.

The development of automatic machines in the engineering industry using cutting oils has taken place relatively recently, from about 1890, and this has happened particularly in the Midlands area. Oils as we know, mainly mineral oils, are used for cooling and lubricating the cutting edge of tools in a wide variety of operations, such as turning, grinding, milling and honing. Evidence of scrotal cancer in the Birmingham area has shown that it does not tend to spread any more quickly than other types of cancer. But the evidence does show that, for the reasons Lord Crook has mentioned, individuals are less likely to report it in its early stages. This is because of the undue modesty which men have—a point that has been mentioned by the noble Lord, Lord Crook—which to us may seem inexplicable, though it is unfortunately a fact. In recent years there has been evidence that the number of notifications of the disease in the area has become more frequent—it may be because people are becoming more educated or aware of the dangers involved.

Records in the Factory Inspector's report show that a very high proportion of those affected by the disease were tool setters, setter operators and machinists, and those are the occupations that are most exposed to the neat cutting oils, rather than to soluble oil emulsions. As the noble Lord mentioned, it is work which involves bending over a machine; men are working at close quarters with the machines; there is a great deal of splashing, and clothes get contaminated. We have a situation in engineering now which is almost identical with that which applied to mule spinners some 30 or 40 years ago. The records of reported scrotal cancer show that 55 persons who contracted the disease worked in occupations which exposed them to oil, and in particular the occupations I have mentioned.

Again, it is I think a fact that since the automatic machine in the engineering industry was developed only some 35 years ago, insufficient time has elapsed to assess the hazard completely. The peak of cancer in mule spinners was reached in 1927, which was some 70 years after the introduction of shale oil for lubrication. So it is quite clear that this hazard, which has been extant for many years, is just beginning to show the evils of it. But the results will multiply, and we shall have a kind of epidemic. As I say, I am meeting the representatives of the industry on Monday to discuss the matter, and no doubt we shall be making suggestions to the appropriate Ministers. I agree that the problem relates to a number of Departments, not just one; though I would add that I believe that the main burden of giving protection, producing regulations and providing the inspectorate must lie with the Factory Department.

However, I want to make some suggestions as to what precautions could be taken. In the first place, as in the mill spinning industry, the type of oil is fundamental. Steps have already been taken in the cotton industry to use non-carcinogenic oils, and we should do the same in the engineering industry. One appreciates that perhaps more research needs to be done to establish the exact type and quality of oil to be used, but as much of the research has already been done there is no reason why the findings of that research should not now be applied.

Measures should be taken to enable workpeople to avoid contact with, or close proximity to, machines to avoid the splashing which we have mentioned. There should be the provision of a regular laundry service for overalls as well as for oil-soaked clothing of all kinds, and there should, of course, be good washing facilities. In this context, it is quite clear that the washing facility provided by supplying a wash-hand basin with hot water is not enough. As in mining, men get quite dirty; indeed, in this sector of the engineering industry they get even more dirty than do miners. I believe it is highly necessary that showers should be provided. It is worth reminding your Lordships in this connection that it has been demonstrated experimentally that the incidence of tumours in mice exposed to carcinogenic oil can be diminished considerably by washing the site of application with soap and water shortly after exposure.

Again, there is need for widespread education. I will accept that it is up to the trade union movement to play their part in this direction. We shall certainly discuss this problem on Monday. The main point is that the worker should get over any feelings of unwillingness to go to his doctor when he finds suspicious nodules appearing. We should encourage him to go to his family doctor, and we should stress that any kind of irritation is a matter of some seriousness which should be reported. Again, there is the question of periodic medical examination. I agree that this may present some difficulties. It is one of the matters which we shall discuss with the representatives of the union on Monday. But I would make the point that a periodical examination may prove to be essential.

Time is short. I do not want to say any more, except this. I am anxious to hear what the Minister has to say. Quite recently the T.U.C. took up the question of bladder cancer which developed among workpeople who many years previously had been employed in the cable industry. I wish to give credit to the then Ministry of Labour and to the chief of the Factories Department for the efforts that they made, and for the efforts they are continuing to make, to trace workers who have worked in that industry and may have left or retired. We have had that example of the development of a dreadful disease which could have been prevented. We have had the example of the mill spinners. There is no excuse at all for allowing this to happen once more in the engineering industry. I stress that, and hope that it is recognised by employers in the industry, and indeed by the Government.

Finally, I agree with the noble Lord, Lord Crook, when he says that this kind of happening, and the others I have mentioned—just two of them: bladder cancer, asbestos poisoning and the rest—point quite clearly to the need in this country for something that they have in other countries in Europe, an Occupational Health Service, properly manned, properly financed to do the necessary research and to provide the necessary field officers which such an occupational service would demand. I think it also underlines the demand of the Trade Union Movement that every factory should have a safety committee. We are discussing on Monday the whole of this question. We are going to stress the need for understanding and publicity. The best way to get understanding of the danger and to insist that people take precautions against it is on the factory floor, through the efforts made by a joint consultative committee of the type I have mentioned.

My Lords, it is late and I apologise for having taken a little of your time, but you will understand that as the chairman of the Insurance and Welfare Committee of the T.U.C. and as one who, with the help of the experts behind me in the T.U.C. and elsewhere, has to deal with these matters, I am greatly concerned about the evidence we are getting that the incidence of this disease is building up. We must do something to prevent it running into the future.

6.47 p.m.

BARONESS SUMMERSKILL

My Lords, once more I am glad to have the opportunity of joining with other noble Lords, and particularly with my noble friend Lord Crook who initiated this debate, to help to focus attention on a problem which is of great importance to the industrial worker. With the rapid advance of technology in industry and with the use of new substances in various processes there will undoubtedly be new industrial diseases, associated with symptoms with which we are not familiar. But, of course, that does not apply to the disease which we are discussing to-day, cancer of the scrotum. Many years ago it was almost confined to chimney sweeps. Indeed, when I was a student, and I am sure when my noble friend Lord Amulree was, we used to call it "chimney sweep's cancer To-day, however, the increased number of cases stems from the fact that mineral oil used in various processes has carcinogenic properties. We must remember that.

We are not seeking to-day for a cause of this serious disease. We all know the cause. Too often we discuss symptoms and diseases and we are in the dark as to what is the origin of the disease. We are in a strong position to-day. We can say to the representative of the Government here that we know the origin; we know that it can be prevented; and therefore it is entirely wrong that men should be exposed to this oil and not be given the protection which is their due. There can be no excuse for not protecting them, because, broadly, the protection of the chimney sweep in the last century and the protection of a worker in a modern plant is the same; namely, to ensure personal hygiene. For this reason, those who are responsible for protecting them cannot complain, as sometimes they have done in the past when my noble friend and I have raised the question of industrial disease, that the cost of some protective clothing or apparatus is prohibitive.

Nevertheless, whatever protective clothing may be worn, it will not be effective unless the management has a well-developed social conscience—not like one doctor, I am ashamed to hear, at Rolls-Royce, who was so cynical as to say, "We shall be responsible for the costs, presumably, if a case is brought". The first thing we want is to ensure that the management has a social conscience; that the management exercises vigilance, and is prepared, patiently and persistently, to disseminate information concerning the health hazards involved in the use of mineral oil. The importance of this approach cannot be over-emphasised, because we are told that there are 10 million people at risk.

I am sorry to learn that in the House of Commons an attempt was made by the representative of the Government to minimise the danger. The fact is, of course, that we cannot possibly compile statistics if years have to pass between the exposure of a man and the time when the first symptoms appear. Both my noble friends have mentioned this fact. One excuse given for failing to give protection is that men are shy of any reference to their genital organs. As a woman doctor—and women doctors to-day treat many, many men—I really fail to accept this excuse. I would say that it is more likely that in those factories where men appear to be shy there is a failure of public relations, and that is the reason for any resistance to good advice. We must recognise that in these days small boys who are taken to maternity and child welfare clinics are accustomed to having women doctors, and are brought up with women doctors. I confess that I was qualified in 1925, and I have never yet met a man who, on being told that something might be very seriously wrong, resisted being given advice and treatment because he was too shy to discuss the subject. Of all the excuses given for failing to provide facilities for examining women for cervical cancer, nobody has yet thought of that excuse.

My noble friend has given the House details of the case of Stokes v. G.K.N. Bolts and Nuts, Limited, which was heard in October, 1968. In that case, the judge considered Doctor W. Jeaffreson Lloyd to be negligent on two counts. That is a very serious charge to make against a doctor; indeed, it could jeopardise his whole career. Consequently, I read with some interest a letter written by this doctor to the British Medical Journal on December 28, 1968. He did not complain about the findings of the judge—which incidentally were very serious, and my noble friend has mentioned them—but in view of his 27 years' experience among industrial workers, he thought he should comment on the whole question.

I would remind your Lordships that this letter was in the British Medical Journal, arid it was for the purpose of informing doctors who, I think one might say, are the only people who regularly read the British Medical Journal. He told these medical readers that it is a legal duty for a doctor, seeing a case of epithelioma of the scrotum, if there has been exposure to mineral oil, to report the case to the Chief Inspector of Factories on Form 303 as the disease is notifiable, and that it was the doctor's moral responsibility to tell the man that he could claim under the Industrial Injuries Act. Furthermore, he said that the doctor would be well advised to inform the employer, in writing, of the company's duty to notify the occurrence to the local Inspector of Factories and to the appointed factory doctor.

My Lords, I should like now to ask my noble friend on the Front Bench why these elementary reminders to doctors are necessary unless the appropriate Government Department has failed to provide them? Why should this doctor at this stage feel that the doctors in charge of these industrial workers needed reminding of the elementary facts of the position? The duty of displaying all statutory notices concerning cancer of the scrotum devolves upon the factory occupier, who is also responsible for the distribution of leaflets. Where a factory uses mineral oil it is statutory to display the cautionary notice, Effects of Mineral Oil on the Skin, form S.W.W.397, and the leaflet, Effects on the Skin of Mineral Oil, S.H.W.295, must be distributed to every worker subject to exposure.

These leaflets, I understand, are a free issue, but until recently they were in very short supply. If my noble friend cannot answer me now I shall quite understand, but I should like to have a letter telling me whether these leaflets are now in ample supply in every factory; whether they are being displayed and are being distributed, or whether there are employers in these factories who are disregarding their responsibilities—in fact, disregarding their statutory responsibilities.

There is another point. Many non-English-speaking immigrants are employed in these factories. Are these leaflets translated for their benefit? It seems stupid to me for a Cypriot, or a Pakistani, to be given a leaflet which perhaps contains advice which is a little difficult to understand because it contains some neomedical terminology. It is a little irresponsible to leave these men in ignorance of what the leaflet says.

My noble friend spoke in detail of the case I have already mentioned, that of Stokes. The judge in that case ruled that everybody in contact with mineral oil must have his scrotum examined by a doctor at six-monthly intervals—and presumably this must continue after he leaves employment. Therefore, there must be a very careful follow-up. This of course is easy, because every doctor has records, and even if a worker trans- fers to another area his records would follow him. It would seem that garage hands would also fall into this category. The point is—and I think this is the most important aspect of the whole thing—that there are not statutory regulations about routine inspections. Therefore, although the judge gave these heavy damages of £30,000, although he criticised the doctor, Doctor Lloyd, and said that he should have made these examinations, there are not statutory regulations about these things. I should like to know what action has been taken regarding these rulings.

Of course, there is no doubt about it that a routine medical inspection may create a false sense of security. The man may well say, "Well, I have had my examination. That is all right, I need not worry." But of course that is not enough. Therefore, I should like to know how much research is being conducted in the oil industry on types of guarding and individual protection. We have just heard from my noble friend that a kind of sporran has been manufactured in which the man puts his oily rags, but this seems a rather primitive approach, and I should like to know what developments are taking place. That is really all I can say, except to say that this debate, in a sense, is an anachronism, for we have had to raise questions regarding an industrial disease which should have been settled many years ago unless, my Lords, there has been some failure of responsibility.

6.59 p.m.

LORD AUCKLAND

My Lords, the whole House is grateful to the noble Lord, Lord Crook, for having raised this very important Question. The pity of it is that there are not more noble Lords present to hear of a problem of a very serious social nature. I cannot claim the knowledge of factories and factory life as some of our experts in the medical profession and in the trade union movement who have spoken, but as a Vice-President of the Royal Society for the Prevention of Accidents and as associate director of a firm of business consultants. I from time to time visit factories. I recently paid a visit to a large machine tool factory in the Midlands where a good deal of this oil is used. In this field the most important factor is that of education.

I was surprised to read in the 1967 Report of Her Majesty's Chief Inspector of Factories that this disease occurs in men between the ages of 40 and 50. Have the Government any evidence whether this is a creeping disease, since some of these men clearly must have been working in these factories for 20 years? I should like to know whether this is a condition which has been developing and which has failed to be spotted.

Other speakers have mentioned the necessity for inspections. The inherent shyness of men in relation to this particular part of their body is something which is widely known. In the unit in which I started my Army service we had a woman medical officer, and there was no question that she carried out the routine tests to establish freedom from infection by venereal disease. One was detailed to parade and she carried out the tests. I do not know how many factories which employ predominantly male labour have woman doctors to perform these tasks; I imagine that they are relatively few. But it would appear that regular inspections are necessary in the machine tool and heavy engineering works where these oils are used. Diagnosis of this condition is not always easy. Possibly the doctors who are connected with these factories are not experts on the subject of cancer, and a man may have to be referred to a specialist, so that the examination may take time. In these times when we are moving into the era of automation fewer men may be needed on these machines, and it may be felt that the accent on safety is not quite so vital as it should be. In these times there should be more prominent notices in factories warning of this and other conditions which are invariably fatal, and there should be regulations governing this whole matter.

The noble Lord, Lord Crook, mentioned the importance of hygiene, as did other noble Lords, It is true that in many of our older factories shower baths and ordinary baths are in very short supply. It is clear that unless this situation is remedied it will be very difficult to counteract this distressing condition. I am sure that Members on both sides of the House are most grateful to the noble Lord for having highlighted an important social problem.

7.5 p.m.

LORD HUGHES

My Lords, my noble friend Lord Crook made one statement which was quite unnecessary, and that was when, towards the end of his remarks, he apologised for the time he had taken. I know we shall all agree that not one word he uttered was unnecessary, not one second was time wasted. I consider that the same can be said of the other speeches which have been made on this Unstarred Question. To a certain extent my noble friend Lord Collison went over the same ground as that covered by my noble friend Lord Crook, but it was permissible and necessary that he should do so. When one bears in mind his close and immediate contact with the problem, and the discussions in which he is taking part, it is worth while that it should go on record in your Lordships' House that not only was he aware of the whole background of history to this disease, but he was well aware, like my noble friend Lord Crook, or the possible solutions.

My noble friend Lord Crook began by giving a résumé of the statistics and referred to the apparent discrepancies which exist between notifications and the actual number of cases. He completely cleared away any suspicion that one set of figures was right and another wrong. He made it quite clear that there were two different sets of statistics and that because of the circumstances of the case, became of the long incubation period and the fact that it may be 30, 40 or 50 years before the disease appears, a cause and a result cannot immediately be identified by the doctor who diagnoses the disease.

As my noble friend Lady Summerskill said, it is not one of those diseases in which the real worry is that one does not know the cause. In this case the cause is known. I accept what noble Lords have said, and therefore, I will not spend any time at all on the statistics. I shall go straight to the question of what is going to be done about it. I do not want to appear to be heartless about what has gone on in the past, but the regrettable situation is that a number of cases will occur in the future because the harm has already been done. The important thing is to see that nobody will become notifiable in 20, 30 or 40 years' time if there is any action which we can take now to prevent it.

My noble friend Lord Crook mentioned in his speech the people who were involved: the workers, the employers, the Medical Research Council, the Department of Health and Social Security, the Factory Inspectorate, the Ministry of Technology, and the great oil companies. Then he proceeded to make suggestions as to what should be done by each of these groups of people. I cannot completely accept what my noble friend said. I believe he started off by saying that certain measures should be mandatory in all cases, whether the factories were large or small. I may be wrong in that, however, because later in his speech he clearly differentiated between what was possible in a big company and what was possible in a small one. What it is reasonable to expect G.K.N. or Rolls-Royce to do may be a totally unworkable proposition in a garage employing two people. Those two people may well be at risk, but what it is reasonable to expect that garage to do and what is perfectly proper in a big factory can be different propositions. But the men in the garage must still have protection, and my noble friend made the very useful suggestion that the remedy lies with the factory health service, so that responsibility is not placed directly on the small individual employer, and the community is brought in.

The provision of proper washing facilities is mandatory at the present time, but that is not the position with regard to shower baths. My noble friend asked that an adequate supply of protective clothing and barrier and cleansing creams should all be made mandatory. But in dealing with these matters my right honourable friend thinks it is better to get things done with the good will of those concerned, who accept that their social conscience should require them to do something. It certainly is not possible to legislate a social conscience into anybody, but it is possible to make people aware of the fact that they should be doing something. I do not know whether one can acquire a conscience if one does not have one. I suppose that everybody has one, but sometimes it needs stirring up.

My Lords, that is the first approach, but if something is not done in a reasonable time, as a result of the willing co- operation of those concerned, then we will certainly not rule out making mandatory those things which are obviously within the capabilities of firms.

Some of the questions are difficult. The judge in the case referred to laid very great weight on the six-monthly inspection, but here the co-operation of workers is very much needed. Although I should never be so daring as to disagree with any expression of medical opinion by my noble friend Lady Summerskill, I can point to the fact that my noble friend Lord Crook said that in the case in question there were four men who, in spite of everything the firm were doing, refused to have a medical inspection. Unfortunately, one of the four turned out to be a victim. Perhaps all that was wrong with my noble friend's statement was that she slightly exaggerated in order to emphasise the point. It may well be that shyness is not so common as some people think, and that this was just an exception. I hope she is right, because it should be easier for these inspections to take place. It was suggested that a six-monthly inspection might cause complacency. There is a certain amount of risk, but not if the other steps are being taken.

My noble friend Lord Crook went on to talk about what is being done. I was sorry that my noble friend Lady Summerskill thought that the sporran was rather primitive. I wish I could afford to buy her, as a present (not that she would ever have the right to wear it, of course), one of the more elaborate specimens of sporran. She would certainly agree right away that the use of the word "primitive" was completely erroneous.

BARONESS SUMMERSKILL

When was it invented?

LORD HUGHES

It does not need to be of recent development to be not primitive. Men and women were invented a very long time ago, but we are not primitive—at least, not all of us. This is the sort of article which is already used in trades. I have knowledge of the building industry, and joiners use a leather bag with a strap in which to carry their nails. No one would think of comparing it with a sporran as they have it hung over their hip instead of in front of them, because of the conditions under which they work. But although it seems a perfectly reasonable suggestion we could not make such a bag mandatory, because it is only one of a number of satisfactory methods. What is important is that the employer with a social conscience recognises that he has an obligation and undertakes to provide protective clothing or equipment. Whether it is an imitation sporran, a nail bag or some kind of apron matters not, so long as it serves the purpose of giving protection.

As the noble Lord, Lord Auckland, said, the most important question is that of education. If the employers do all we wish them to do we shall still not accomplish our object if the men themselves do not do what they ought to do. This brings me to the question of the leaflet. My noble friend Lady Summerskill was very kind and she gave me an "out" on the question of the leaflets. I regret very much that her generosity was unnecessary, because for once I have the answer. The distribution of these leaflets was taking place at the rate of about 20,000 a year, not because they were in short supply but because they were not always distributed. In one factory, for example, the doctor deliberately did not distribute the leaflets. He said that he did not want to alarm anybody. The situation has changed completely since this case arose, and the number of leaflets distributed since last summer is 250,000—more than ten times as many in nine months as were previously distributed in a whole year.

The Department are in the process of getting out a new leaflet, and I have a copy here. It is in very simple terms, and there is no technical or medical language used in it. It will bring the point home quite well to those who read it. But having said that, I must add that I think it is an exceedingly dull-looking little document, and it will not cause anybody any special interest. People are just as likely to glance at it and throw it aside. The Department are working on something which will be just as informative but more striking, and much more likely to catch the attention of the men, including an illustration of the sort of thing they should look for.

Whether this will take the form of an actual photograph or whether it will be a sketch has not been decided, but it is going to be something much more striking. It will be more in keeping with the notice that goes on the board, which is a much more useful thing than this little document. On the other hand, not everybody reads a notice on a board. If a man has a thing put in his hand which is likely to interest him, which is likely to attract his attention, and he then goes on to read it, there is a greater chance that he will do those things which are going to be his own best safeguard. After all, even if he worked in a place where the firm did none of the things that they ought to do, if he himself did every day the things which were within his own power, the likelihood is that he would never contract the disease. But if this is not firmly impressed upon him he is not going to do it. This is why I come back to Lord Auckland's point—a point which other noble Lords also made: that the important thing is to impress on the men concerned the fact that they are the people at risk and that a very considerable part of the remedy is in their own hands.

May I come now to the other point about the leaflet? The point about the number of people at risk in some of these factories, particularly in the Midlands, who still have little or no knowledge of English had not occurred to me, and I shall certainly draw the attention of the Department to the very useful suggestion that consideration should be given to making this leaflet available in languages which will make it possible for everybody to read and understand it. There is no point in making this a very much better leaflet if it is then put into the hands of men who will be able only to look at the picture and who wonder what it is all about.

My Lords, as to the question of supplementing the work of the Factory inspectorate, as my noble friend Lord Crook said, the Inspectorate are well aware of the harmful effects of mineral oil on the skin. They have been for many years; and a great deal of work has been done in this matter. Nothing new has emerged about the subject in recent years except that there is an increasing awareness of the problem following the publication of the Medical Research Council's Report and the inclusion of a chapter on "Oil and the Skin" in the 1967 Report of the Chief Inspector of Factories, together with Press reports on the £10,000 damages to the widow of a Birmingham tool setter. This has undoubtedly given rise to alarm in the engineering industry, particularly among those workers in some sections of the industry who were not aware that they were at risk. It has also led to a greater awareness on the part of employers of the risk from exposure to mineral oils.

There is no proposal at present to make regulations for the protection of workers from the risk of scrotal cancer from exposure to mineral oil. This cannot yet take the form of a requirement to substitute safe oils for those at present in use because there is still no completely safe oil available—and this takes me on to the question of what is being done about finding safer oils. The position, as I am informed, is that the Factory Inspectorate are in close contact with the Institute of Petroleum, which set up a committee to consider the problem of carcinogenic risks from oils. Cutting oils used in enginering are divided into two broad types, straight oils and soluble oils. The latter are less dangerous when in use than straight oils, because they are mixed with a relatively large quantity of water and are more easily removed from the skin. Solvent-refined cutting oils are available for use in substitution for straight oils, and factory inspectors have been instructed to encourage occupiers to use them. The problem of producing a less hazardous soluble cutting oil is more difficult and, so far, has not been resolved, so that where these oils are used unmixed occupiers are at present being advised to take more than special care to protect their workers.

This is where we come to the value of the statistics which my noble friend Lord Crook gave about the examinations which G.K.N. have taken. Your Lordships will recollect that these examinations are taking place not over the whole range of their employees but primarily with the people who are most at risk. Even if we take the doctor who was so much criticised—and, as I have not read all that has been said about it, I am not going to join in the criticism of the Rolls Royce doctor; neither do I feel myself, in the absence of any knowledge, obliged to rush to his defence—what I would say is that while it may be completely impracticable at this stage to have six-monthly examinations of every one of the workers in a factory of that kind, what has been done, as my noble friend has pointed out, is to show that it is completely practicable at least to have examinations of the men who are most at risk, and that it is equally practicable to get their co-operation. Obviously this is a very necessary first step.

My Lords, time, as more than one noble Lord has said, is against us as far as the clock is concerned. It ought not to be against us as far as finding solutions to this problem is concerned. The noble Lord, Lord Amulree, referred to the loopholes in the existing procedure. When I was informed (because noble Lords will appreciate that I have to be informed of these matters; they are not things within my day-to-day Ministerial responsibility) of the fact that the responsibility was to notify the cases which were of occupational origin, I said, "Why not make it a responsibility to notify every case of scrotal cancer to the factory inspector?" Then I was led into the tremendous ramifications to which the noble Lord, Lord Amulree, referred: that the man goes along to the doctor, he is examined, the doctor says, "What do you work at?", and he finds that the man is selling vacuum cleaners or that he works in a shop and there is no connection between his job and the disease. It would be a piece of nonsense to write to the firm selling the vacuum cleaners, or to the owner of the draper's shop, telling him that his employee was suffering from scrotal cancer; and, without taking up a great deal of the doctor's time and in many cases for wasteful purposes, there is no way in which he can go back, asking the man what all his previous jobs were, until he finds, perhaps, that twenty years previously he worked with mineral oils.

But what I was told was that every case of cancer of any kind has to be notified to the Cancer Research Bureau. My noble friend Lord Crook referred to that, and pointed out that their difficulty was that they did not have the staff to follow up every one of these notifications, going back over the years, to find out whether this was an occupational hazard. Perhaps I could say, in passing, in answer to the noble Lord, Lord Auckland, who asked whether this was a creeping disease, whether it developed over a period of years, that I am sorry, I do not know the answer. A number of speakers have referred to the fact that the so-called incubation period can be very long. It may be that doctors know, but I certainly do not know whether it is something which can be caused by a minimal period of working with mineral oils or whether it is something which develops because of continued, sustained contact with it. What is accepted is the fact that it may occur a very long time after the man has ceased to have any contact with the mineral oil.

I was a little at a loss to know the exact significance of the religious reference made by the noble Lord, Lord Amulree. He did not quote it. I took the opportunity of having it looked up, and Luke, Chapter XV, verse 7, reads as follows: I say unto you. That likewise joy shall be in Heaven over one sinner that repenteth more than over ninety and nine just persons, which need no repentence. The doubt in my mind is whether it is my right honourable friend the First Secretary (who is responsible for the Department of Employment and Productivity) who is being cast in the role of the one sinner or whether it is my unfortunate person temporarily occupying this Box on this subject. I can say, however, that I do not feel a sinner in this matter. I think I would have great difficulty in disagreeing with what has been said. This is not the sort of debate at the end of which your Lordships will expect me to answer every point that has been put forward, and to say that I accept this and reject that.

What I would say is that it will be well worth the while of the Department of Employment and Productivity and of my right honourable friend the First Secretary if, in the midst of all her many preoccupations, she can read, and the Department can read, this debate; because some of the suggestions which have been made are being acted upon, some are capable of being acted upon and some may have to be followed up if voluntary action is unsuccessful.

I undertake to make certain that the whole of this debate is studied, at least departmentally, and I hope that if my noble friend Lord Crook should wish to return to the subject in the not too distant future we may be able to give him further evidence of the fact that the Department, the Factory Inspectorate, and other Government Departments (and I take the point that it ought also to be brought to the notice of other Ministers concerned) are all playing their part in seeking to see not that the statistics of this year or next year are down but that the statistics of the future are going to be as near as possible a "nil" return.