§ Motion made, and Question proposed, "That the Bill be now read a second time."
§ The PARLIAMENTARY SECRETARY to the LOCAL GOVERNMENT BOARD (Mr. Hayes Fisher)
This Bill to which I ask the House to give a Second Reading to-day was introduced in another place by my Noble Friend the President of the Local Government Board (Lord Rhondda), who ever since he has presided over the Department has lost no opportunity of emphasising the need of dealing with all that concerns the mortality among children and the health and welfare of the community. This subject was inquired into by a Royal Commission, to which the country owes much for its laborious investigations into very painful and difficult problems, and for its very practical and fertile recommendations. This Bill had an uneventful passage through the other House, but I cannot hope that it will have a similarly uneventful passage in this House, for I see that the hon. Member for North Somerset (Mr. King) has put down a 2072 Motion, the object of which is apparently to defeat the Bill: and I much regret that he is opposing a policy which has at its back the Association of County Councils, the Association of Municipal Corporations, the London County Council, the Royal College of Physicians, the Royal College of Surgeons, and last and not least, the National Council for Combating Venereal Diseases. This Bill is the outcome of a very important Royal Commission.
§ Mr. HAYES FISHER
It is a matter of opinion, and my opinion is that it was a very important Royal Commission, dealing with a very important subject, and making very important recommendations. This is not a war measure; it is not war legislation, but it has a connection with the War, and the aftermath of the War, in regard to which the Royal Commission reported:All experience shows that after a War an excessive incidence of disease is certain to occur, even in districts previously free. In order to meet present and future conditions, it is essential to make provision, and no lime should be lost.The Royal Commission was appointed by my right hon. Friend the Member for North Monmouthshire (Mr. McKenna), who was then Home Secretary. After two years' work, they made their report, which contains unanimous and practical recommendations. The subject with which the Bill deals is very much in view at the present time, and it is a matter of conversation in many quarters where it was never before discussed. But I think it is right that neither the House nor the country should jump to the conclusion that there is any increase in this very formidable disease. Except in regard to the Army and Navy and the Police Force, there are no accurate statistics which enable us to arrive at safe conclusions in regard to the prevalence of this disease. But if we take the deaths recorded from syphilis, I think that, on the whole, the evidence leads us rather to the conclusion that the disease is stationary, or at all events not increasing. As regards the Army and Navy, the Commission reported:The statistics available for the Navy and Army, dealing with large bodies of men under close and constant supervision, are accurate and complete to an extent which is, at present, impossible in the case of the civil population. They indicate a very satisfactory decline of venereal diseases.Of course, that was before the War. So far as we are able to obtain particulars, 2073 there is really nothing to show that the ratio per thousand of men in the Army and Navy is in any way increased. Of course, there is more venereal disease in the Army, because the Army has so enormously increased in numbers. So far as the Royal Commission was able to obtain evidence, it reported that the percentage of infected recruits in the German Army is more than five times as high as in Great Britain, and Professor Blaschko considers that the prevalence of venereal disease in Germany is higher in the civil population than in her army. Take another form of statistics, that relating to venereal disease in the Metropolitan Police. There it is reported that it is very small indeed. We often hear criticism and complaint of the way in which police handle traffic in the streets, we often hear criticism and complaint of the kind of evidence they give in Court, but I do not think there is any real ground for that criticism and complaint. Every now and then, of course, the police make mistakes like other people, but at all events they give us a very good example in their own life of cleanly and orderly conduct. It is not necessary, really, to try to prove any increase in this disease. The statistics are clearly quite sufficient to make it well worth while to try to deal with the problem, without there being any increase at all, or even if the disease is stationary. After all, on the evidence which it took the Royal Commission reported that no less than ten per cent. of the population in our great towns are infected with syphilis, and a still greater percentage of the population are infected with gonorrhoea. One figure in London alone shows that the disease has got to be attacked in a very earnest and thorough manner. In the Lock Hospital in London alone, in the year 1916, there were 36,500 cases treated, as compared with the figure for 1913 of 23,974. Then we have the Royal Commission on the Poor Law, which took evidence on venereal disease, and reported:We have received evidence to the effect that these diseases work terrible havoc with the physique and stamina of the community, and that much of the infant mortality and bad health of children is due to their after consequence,In the Report of the Minority of that Commission it is stated:A grave problem, which in our judgment cannot be ignored, is that presented by the widespread suffering of the poor from venereald sense 'These,' testified a medical expert,'constitute be of the greatest evils of 2074 the age. I am nut sure that they do not give rise directly and indirectly, to more suffering and more injury to us as a nation than even tuberculosis.'4.0 p.m.
The Royal Commission was appointed in 1913, before the War, and unanimously made recommendations. They came to-the conclusion that if early and efficient treatment of the most scientific type were afforded to that portion of the people who suffered from these diseases, those diseases would be held in check, greatly controlled, and could be narrowed down to a comparatively small compass or degree; and that new scientific methods had now come to the knowledge. of the medical body, and that by means of those methods diseases which had hitherto-refused at all events to be cured, can now be cured if only the victims would apply at once and be treated at once on a sound scientific system by men qualified to administer that system. They came to the conclusion that everywhere there ought to be centres set up for scientific diagnosis and for free treatment, and that it was not likely those centres would ever be set up unless they were set up by the State and largely at the expense of the State, and they recommended that national finances should bear 75 per cent. of the burden of setting those up. They went on to say that if those treatment centres were set up and properly, equipped, and if they were made free to everybody, that men would be persuaded to go to them rather than as they go now to quack doctors; but that no questions should be asked of anyone, and that the whole system should be secret and confidential, with no records of names and no-attempt in any way to identify the patient. We all know what happens in many eases with the Reports of Royal Commissions, but this Commission met with a very different fate. The Secretary of State for the Colonies (Mr. Long), who was then President of the Local Government Board, warmly welcomed the proposals. He issued circulars to the local authorities requiring them to set up, in conjunction and cooperation with the hospitals, those centres for scientific diagnosis and full and free treatment. In a recently issued White Paper, Cd. No. 8509, particulars-were given of the number of schemes that have, up to the present, been submitted by the local authorities. Schemes for the diagnosis and treatment of these diseases: have now been submitted to the Local 2075 Govemment Board by ninety-nine out of 145 councils charged with the execution of the recommendations. Sixty-one schemes, serving a population of over 3,000,000, have been approved. A good many schemes submitted have not yet been approved. When we contemplate the extraordinary difficulties under which our hospitals are at present working with depleted staffs and the need for doctors and nurses everywhere, I think the House may fairly say that we owe a great debt of gratitude to those hospitals which have, on the whole, very freely come forward to co-operate with the local authorities to undertake a new task under new circumstances.
§ Mr. HAYES FISHER
That is a very unfair suggestion. In London alone, in six hospitals out of twenty-two which are dealing with these diseases, from the first three months of this year 1,195 males have been treated, and 350 females, making a total of 1,545 new patients treated under this scheme. In the Newcastle district 309 males and 154 females have been treated in the first three months of this year. The Report was only issued last year, and the circulars could only go out some months ago, and having regard to all the difficulties through which we are passing, it is really wonderful that over those great areas practical schemes should already have been brought into operation. I have the very greatest hope that these schemes will rapidly mature, and that the results from them will be, I will not say all we can possibly expect, but very substantial indeed towards the cure and gradual diminution of those diseases. The policy being adopted is one of the maximum of persuasion with the minimum of penalty, and it is the complement of administrative action, and is calculated to secure a speedier and larger scope for that action. There is a positive and negative policy. There is the policy of persuading those who are victims of these diseases 2076 to abandon quack methods and go to centres where they will meet with early and scientific treatment by men who are well qualified to give that treatment. There is also a negative policy, which is to deal with specious, fallacious, and pernicious remedies, and which is of a prohibitive character. What the Bill does is to prohibit all persons except qualified medical practitioners from treating venereal disease, or prescribing or advising in connection with it. The Bill makes it illegal to dispense any drug or other preparation as a remedy for venereal disease unless on the written prescription of a qualified doctor. The Bill will not apply to the sale of those substances to doctors or to wholesale supply. Offences are punishable on summary conviction to a fine of £100 or six months' imprisonment, or on indictment to imprisonment for two years. The Bill will only operate in areas to which it is applied by Order of the Local Government Board, and the Board will have to be satisfied that free centres for the treatment of the diseases have been set up before they apply a Bill of this prohibitive character to any area.
The person, man or woman, who contracts a disease of this kind is injured vitally, but it injures still more innocent people and arrests the whole growth and efficiency of the community. Men and women will, unfortunately, conceal these diseases after they have contracted them, and will resort to quacks and will not go to the family doctor but somebody else, while if they would only resort to the proper remedies which now exist an early cure might be effected, The Royal Commission said let us set up these treatment centres and persuade the people to go there, and let us also do something to prohibit those who are not really qualified for treating them and whose remedies have been very often, I will not say worse, but almost as bad as the disease. What are the arguments for this measure of prohibition? It may be said, "You have something more at the back of your mind; you are trying to drive out all those who are not qualified medical practitioners." I want to disclaim that. That is not the intention of the Department. We have no desire to drive out generally the non-qualified medical practitioners. It may be said, "Why do you apply it (prohibition) in venereal diseases?" This is a very exceptional case, and I think very exceptional treatment can be made out for this case. After all 2077 in the case of an ordinary man who suffers from an ordinary complaint it does not matter so much to the community to whom he goes to be treated for that complaint. If he prefers a herbalist or a quack of some sort, it is his concern. His liver or his lungs may be affected, and? while it is of importance to the man himself it is not of such vital importance to the community to whom he goes. In the case of venereal diseases it does matter; it is of importance. The whole of the evidence goes to show that the great point about this disease is to prevent its infectivity to the person. By the treatment of salvarsen or something of the kind infectivity can be stopped at an early stage. We have evidence to show that infectivity, instead of lasting for several months, can be reduced to a period of several weeks Here is another reason for this prohibition: A man who suffers from this disease is not really a free man, but is under arrest the whole time of fear and shame. He grasps only too greedily at the remedy that is held out by these quacks who have advertised so extensively. We had evidence given by a body themselves composed of non-certified and unqualified practitioners, who said there were at least 5,000 men calling themselves herbalists offering remedies of sorts for this disease, and tempting young men by the very fact of secrecy to come to them. Secrecy is the great agent of these men. The man who suffers from this disease is really in a very different position from the man who suffers from any other disease, and the community has a right to say, "You are a danger to innocent people, you are a danger not only to this generation, but to the third and fourth generations from now, and if we provide an efficient remedy for you and treatment of a most scientific character, entirely free, without any inquiries or registration of any kind, we have a right to say that you shall not go to someone who will drive the disease into you and very likely prevent your being cured, but that you shall go to somebody who will cure you, and therefore relieve the community of infectivity."
§ Mr. HAYES FISHER
I quite agree, but the policy will have to be largely one of persuasion, and, personally, I hope that 2078 there will be more or less of a State Publicity Department attached to this, and that we shall spread the news far and wide where these centres are, and that we shall give, as far as we can, the same information about what we think are the right and proper scientific methods of treatments as the quack gives of his own little centre of treatment, which we think neither right nor proper. But, although we must rest on persuasion, that policy is retarded and hindered unless we do something to prevent these five thousand and more gentlemen who hold out these so-called remedies from carrying on their trade and luring into their nets those who we think would be far better dealt with, in their own interests and in the interests of the community, by the schemes which are now being set up. I have now summed up the arguments for the Bill, but there are a few arguments against it used by the hon. Member for North Somerset (Mr. King). He first of all says it interferes with the liberty of the subject. Yes, it does, and I think we hear sometimes a good deal too much about the liberty of the individual and too little about the safety of the State; for my part I think the liberty of the individual has got to give way quite constantly to the safety of the State, and I think it has got to give way in this case. After all, all our Act a of Parliament which provide for compulsory notification of diseases, such as small-pox, measles, and so on, interfere with the liberty of the subject, and every time you isolate a man with smallpox or measles you interfere with his liberty, and you often take his clothes away and burn them. I admit also that it interferes with chemists. I have no desire to do any harm whatever to chemists, who are a most splendid body of men doing a particularly great service at the present time, but all Acts to prevent the adulteration of food and to secure the provision of pure milk interfere with the liberty of somebody or other, and the liberty of the individual must give way, as I have said, to the safety of the State. But it is an infringement of the liberty of the subject with a view to preserving the greater liberty of the community. Another argument is that the Royal Commission did not advise the prohibition of unqualified practice. The Commission hesitated at that point, it is quite true, but I would like to read the paragraphs dealing with unqualified 2079 practitioners in the Report of the Royal Commission. The Royal Commissioners said:We have no hesitation in stating that the effects of unqualified practice in regard to venereal diseases are disastrous, and that in our opinion the continued existence of unqualified practice constitutes one of the principal hindrances to the eradication of those diseases. cannot be too strongly emphasised that the essential point in the control of venereal diseases is to secure for the patient the best treatment at the earliest possible moment. By the intervention of the unqualified person the stage at which the permanent eradication of the disease is possible is lost, and the many and terrible after-effects which we have described may supervene, for although the disease is difficult to cure. symptoms are readily made to disappear. In any case the treatment is rendered more difficult, protracted, and expensive, and the risk of the disease being communicated to others is very largely increased.And they add a paragraph on which I think the hon. Member for North Somerset relies, namely:We should have advocated legal provisions making the treatment of venereal disease by unqualified persons a penal-offence, but we recognise the practical difficulty in securing the effective operation of such a law in present circumstances.Yes; they did not contemplate that so soon as their Report was issued these treatment centres would spring up in such numbers as they have sprung up, otherwise they would have made a very different report to that which they made in the last paragraph, and on that point I may quote the opinion of the Noble Lord who presided over this Royal Commission (Lord Sydenham) when this Bill was introduced, and this is what he said:My Commission were so strongly impressed with the evils arising from this cause, that we unanimously reported in the very strong terms which the Noble Lord has quoted. But, as he has said, we did not like at that stage to recommend legislation for the suppression of quacks; we felt that we could not say to people, You shall have no treatment whatever, while the State was doing nothing to provide treatment; and we were also aware that among the working classes especially there was really no means of treatment on reasonable terms. Therefore, we did not make a specific recommendation, feeling that it ought to come at a time when free treatment and ample treatment was made available for all classes in this country.We do not propose to apply this Bill to any area until we have made that treatment free and complete for all classes of the community, but when we have done that, I believe this House will support us in our full policy and will say that, considering the interest which the community has in stamping out this disease, if the State goes to the enormous expense and trouble and labour of setting up all these treatment centres and making them free and thoroughly well known to the population, in addition to persuading those who are victims of the disease to go there for treatment, it is only fair that power should be given to prevent others 2080 from hindering and retarding this policy of treatment by offering remedies which are no remedies but which, as I have said, are specious, fallacious, and often pernicious. There is only one other argument that the hon. Member for North Somerset uses in the Amendment which he has put upon the Paper. He says that these remedies are not adequate to meet the state of things existing at the present time. Nobody is more conscious of that than I am. I am perfectly conscious of the limitation, not only of this particular measure, which, indeed, only touches; the very fringe of the question, but also of the whole policy of remedies. I would, in concluding my speech, say that we have-to bring to bear upon this disease all forces—educational, moral and spiritual, and there is a very powerful passage which ended the Report and recommendations of this Royal Commission on this point. I will read it:If venereal diseases are to be stamped out it will be necessary not. only to provide the medical means of combating them, but to raise the moral standards and practice of the community as a whole. Such an improvement can only be brought about by closer co-operation between religions bodies. the teaching and medical professions, and the education authorities. Though we are not unmindful of much excellent work that is being carried on, we are strongly of opinion' that there is urgent need for more careful instruction in regard to self-control generally, and to moral conduct as bearing upon sexual relations throughout all types and grades of education. Such instructions should be based upon moral principles and spiritual considerations and should by no means be concentrated on the physical consequences of immoral conduct. But the fact that we recommend that free treatment should be provided for all sufferers makes it, in our opinion, all the more necessary that the young should be taught that to lead a chaste life is the only certain way to-avoid infection.I fully endorse these recommendations, and I hope that every head of every college and school, and that every parent may take heed to these admirable words-of advice and recommendation, and that by those means, as well as by these means, we may be able at least to stay the ravages of a disease which causes many men and many women a painful and miserable life and a death too often full of mental and moral remorse. If this Bill is carried a second time, I propose that it should be sent upstairs to the same Grand Committee that dealt with the Criminal Law (Amendment) Bill, and I hope that when we get upstairs and deal with it we shall provide this House and the country with legislation which will at least be ancillary to the policy of persuasion.
§ Mr. KING
We have listened to a very interesting statement on a very grave 2081 subject, and I for one wish at once to say that it is because of my great interest in the subject and not from any lack of appreciation whatsoever of the efforts and the work which the Local Government Board already have in hand to deal with it that I am taking the line which I propose to take this afternoon. I wish at the outset to say that Lord Rhondda's efforts and the efforts of the right hon. Gentleman (Mr. Hayes Fisher) to take up this question as soon as the Royal Commission Report was out, instead of pondering it over for two or three years, which is usually the practice of Government Departments after a Royal Commission has reported, and at once to get schemes submitted to and approved by local authorities in the midst of this War, meet with my highest approval and sympathy, and I am sure therefore that in one way the activity and energy of the Local Government Board in this connection are bound to be generally approved. I therefore consider this a very curious thing. It takes a course of action which might be advisable later, but in my opinion is quite wrong now, and will be quite futile if really put into operation. A few weeks ago there were statements in the public Press about the new Bill which Lord Rhondda was to introduce in another place. We were told that this Bill was to establish yet another Ministry, the Ministry of Public Health. We were told that this Ministry of Public Health was to concentrate in the hands of one set of men all the organisations and opportunities there are for seeing that our nation is as healthy and virile as possible. The Bill was to add certain new powers to those existing. We have not had that Bill introduced. There has been no attempt yet to set up a Ministry of Public Health. -I am here to say that after a year or two even of the Ministry of Public Health, if this Bill had been thought advisable, there might have been some reason for it. You are putting the cart before the horse. You are not taking things in the right order. Moreover it is quite obvious that the Royal Commission did actually consider this proposal to make the treatment of venereal disease by unqualified practitioners a penal offence and definitely, for the Commissioners came to the conclusion that it was undesirable. The right hon. Gentleman has quoted certain extracts or paragraphs dealing with this which occupy a page and a half. He quoted 2082 about six lines. If I were to read the whole page and a half of sixty or seventy lines I am sure the House would realise that there is a very much better case for deferring legislation like this than for proposing it. I will only quote the few lines necessary To show the other point of view:The wide provision of free treatment will tend to diminish unqualified practice.Undoubtedly:Until you get wide treatment provided by the State you will have unqualified practice.You will not be able to stop it. It is that argument which prevailed with the Royal Commission. In their Report they point out the experience of other countries, and quote both Denmark and Italy. From each country they had witnesses. Both the Danish and the Italian witnesses pointed out that as there was a widespread system of treatment of this disease gratuitously, treatment by quack doctors or unqualified men of no reputation or standing had been diminished. Therefore the whole gist and point of the Report of the Royal Commission was: Do not make unqualified practitioners liable to any penalty for treating this disease until you have got the widespread operation of gratuitous treatment by every country, and have had that in operation for some time.
§ Mr. KING
Yes, it does. Has my hon. Friend read this Report? If not, I wish that he would do so. I am really trying to argue the matter not on party lines or in a spirit of antagonism. I am trying to take the real gist of the Report, which was considered for years by very able men, and I am trying to give the real conclusions. I say that at present the Government have not done anything like providing free treatment for this disease for the whole of the United Kingdom. The right hon. Gentleman pointed with pride—and I congratulate him on the record, for it is a very remarkable achievement—to the fact that he has already got ninety-nine councils who have submitted approved schemes of treatment. Out of how many of the 45,000,000 of people of this country are there already living in the areas for which these schemes have been approved? Only 19,000,000. Not half of the great population of this country are already provided for. Even when in a 2083 few weeks schemes which have been submitted acre approved; there will only be 25,000,000 of our population provided out of 15,000,000, leaving 20,000,000 for whom schemes have not been submitted.
§ Mr. HAYES FISHER
The Bill refers only to England and Wales, not to 45,000,000 but to 37,000,000 people.
§ Mr. KING
The right hon. Gentleman is quite right. His purview is limited to that. Apart, however, from that, my argument is good to this extent: Before you legislate in such a way as proposed—because Scotland, I suppose, will subsequently be brought in—as to make unqualified practitioners liable to a penalty for prescribing for this disease you ought to give gratuitous treatment a fair chance for some time over the whole of the United Kingdom. That is my argument. I do not think anything that the right hon. Gentleman has said or can say has touched that point of view, which is the point of view of the Royal Commission. That is why I think that this Bill at the present time is quite unnecessary and undesirable. I go further, and say that the form in which the Bill is drafted is altogether wrong. For this reason: It makes it an offence for a man who is not a duly qualified practitioner to treat any person for reward, cither directly or indirectly, for venereal disease, or prescribe any remedy or give any advice. The Bill is drawn in the widest possible terms. Suppose, for instance, a medical student is suffering, or has suffered from this disease, and he finds his brother or fellow-student suffering in like manner. If that medical student says to his fellow, "Use this ointment, or take this drug," or gives any advice of any kind, that man is liable to two years hard labour.
§ Mr. HAYES FISHER
Does the hon. Gentleman suppose that the Local Government Board would take action of that sort?
§ Mr. KING
I think the principles on which our Government Departments are now being run tend to tread down all liberty, and what I suggest is, I think, 2084 likely to be the case. The question is not one as to whether our laws are going to be put into force in a tyrannical spirit or in the proper spirit. It is whether the law is good or not. I say that the intention of this Bill, when it becomes an Act, is to make it practically impossible for anybody not a duly qualified practitioner to give any advice whatever in connection with this disease. That leads to the question whether or not it is desirable and possible to put down all unqualified practitioners. Here I wish to say at once that I am in favour of liberty—-liberty even for the unqualified man to pursue his calling. Though I favour trade unions in connection with law and medicine, yet I do not favour trade unions in the learned professions to such an extent as to crash out all independent men. What is a quack? A quack is a man like Mr. Barker. What have we seen in this House? Mr. Barker though not a medical man and with no qualifications in surgery, undoubtedly has a marvellous gift in certain applications of the healing art. Certain Members in this House would prevent him carrying on his business and profession as he does. The feeling generally in the House is against it. There may be and there have been Mr. Barker's in the sphere of medicine. I need only point to the case of the great Pasteur himself, and to the much advertised and very hopeful remedy Salvarsan. When Pasteur's great discovery of the methods of diagnosis, pathology, and treatment based upon his inquiries and investigations were first brought before the world, eminent physicians in this country discouraged them and threw cold water upon them. They pointed out that Pasteur was not a medical man.
Men of the very highest medical standing threw a slight upon Pasteur and his work, simply because he was not a medical man. Everybody knows that in the medical profession there is a tendency to regard the fashionable remedy, and particularly the style treatment at the time, as final. There must be men here who remember-—T am just old enough to remember -when the late Lord Lister introduced his new methods of surgery. We owe it today to Lord Lister that we have the enormous number of recoveries in all great surgical operations. We owe it perhaps to Lord Lister beyond anybody else that many of the 2085 recoveries of our wounded men are effective, because surgery by his advocacy was entirely revolutionised. But Lord Lister when he first introduced these ideas and practices was entirely out of the fashion. He was combated and disregarded by the great majority of the medical profession, and if he had not been a man of the very highest determination and character, and a man, too, of independent private means who was able to get one medical faculty to give him the opportunity which he could not get anywhere also, the great revolution in surgery, initiated and developed by the great genius of Lord Lister, would possibly have been delayed for years.
At this stage to make the treatment by Salvarsan a State monopoly, and to make that the only method of treatment is altogether wrong scientifically. I believe, from the point of view of the the State and the public interest, this scheme of the Local Government Board, which is nothing less than to give this Salvarsan treatment the monopoly of treatment in the country, is altogether a wrong policy. I say that for two reasons. First of all, Salvarsan is a patent medicine, a proprietory medicine not available in the ordinary way. It is very undesirable, I think, that we should pin our faith in a great movement in public health to one particular medicine, and that a German medicine, which has now passed from a German manufacturing firm into the hands of a private firm, or possibly two or three private firms. To make the treatment of these terrible venereal diseases depend solely upon a patent medicine is altogether wrong, especially at this stage, because great as are the effects already achieved by Salvarsan, no doubt in many cases the remedy fails. For myself, I very much doubt whether the Royal Commission frankly faced the facts in connection with this. I believe that anybody who reads the evidence of the Royal Commission will see that a not very fair account of that evidence is given in the conclusions of the Report. For instance, Ehrlich, the great German inventor of Salvarsan, himself admitted that he had seen 164 deaths under Salvarsan. That there is no reference in the Report to the fact that 164 deaths under Salvarsan had been chronicled by the man who invented it, and brought it out to the world, is a very remarkable fact. Why is it suppressed 2086 in the Report of the Royal Commission? It is bad policy, it is unscientific, and it is not in the highest and best interests of the profession, at this stage, to give a Government monopoly in Salvarsan for the treatment of these diseases.
There is another point in connection with this. It is that the Royal Commission's Report admits the fact that the average qualified medical man is in many cases extremely ignorant of the treatment of this disease. Now a quack may be, and very often is, a man who has definitely studied this disease, and is an honest, a straightforward, and an honourable man. There are such men. I can assert myself that I have met such men, and know such men. There are decent quacks, but there are at the same time very ignorant doctors indeed, and if my right hon. Friend will turn to page 42 of the Royal Commission's Report, he will see that the Report speaks there of "the existing lack of full appreciation by practitioners of the importance of pathological aids to diagnosis," and then it says that "partly because of the expense involved in the examination, the assistance of pathologists is not utilised to the extent which is essential." Lower down it says that "the training of medical students with regard to venereal diseases has not in the past been sufficiently thorough." The whole of that page might be quoted, but I have quoted enough fairly to show what is perfectly true, that many doctors do not understand the real nature of these diseases, and are not able to diagnose them or treat them successfully from the start. Therefore, it does seem to me that it is altogether wrong to penalise one man who may know, and has perhaps given a great deal of time and ability to the study of a case, when you allow another man to be perfectly free to treat this case, although you admit all the time he very likely does not understand it. I am very glad we shall have this Bill in Grand Committee upstairs, and I intend to put down some Amendments. I can assure my right hon. Friend I do not do so in any cantankerous spirit, but in the effort which I shall exercise to make this a practical measure, the hardships and the injustices of which must be modified, because otherwise the Bill will not work. But I hope he will be a little more reasonable than he has been in the speech just now in meeting my point of view.
2087 I am going to call attention to one fact more. I have already referred to the difficulty under the Bill of saying when a man is giving advice "for reward either direct or indirect." I will give another case which is very likely to occur which, I say, will be an anomaly under the Bill. Suppose two men in a workshop together find that they are suffering from a certain disease, and the nearest place of treatment is twenty miles away, and one goes and gets some medicine, and the other pays half his fare and something else for his expenses. Now an offence has been committed under this Bill in a case like that, and it is quite obvious that such practices might become not uncommon, and, I think, not morally wrong. There will be cases also of this nature: A man will go, we will say, to a quack who will treat him for one disease, not knowing that he has got a venereal disease, and may treat him for what appears to be another disease, when he is really treating him for one of the consequences of venereal disease. To get a conviction in a case like that will be very difficult. But, on the other hand, it may be very possible to have serious injustice done to a perfectly qualified man, and a perfectly honest man, who does not wish to contravene the conditions of this Bill in the case of a man suffering from a disease which may not be, or cannot be at the moment, diagnosed as a venereal disease.
I will only point out in conclusion one more aspect of this Bill, which, I think, ought not to be forgotten—the difficulty of getting convictions. Men go, it is said, to quacks or unqualified men who practise in these diseases, and have been in the habit of issuing advertisements for the sake of secrecy. Now, if a man goes to a stranger for the sake of secrecy, is it likely he will be willing to go into Court and give public evidence in order to get a conviction against that man? Why, there will be the very greatest difficulty in getting evidence, and it will be a very cruel thing, when you are holding out this opportunity of gratuitous treatment of a private character which is not to be published, to make men who have been in this way subject to the treatment of unqualified persons bring evidence in a public Court. I think I have said enough to show that there are points of view in this Bill which are open to grave objection. I hope they will be fairly con- 2088 sidered not only by the right hon. Gentleman representing the Local Government Board but by the Grand Committee upstairs. Of course, I am well aware that it is useless at the present time to get such a Bill dropped. I should prefer that this Bill were dropped until a later time. I am sure it would be desirable not to bring in legislation like this for another year or two, when we had a complete system of gratuitous treatment in operation all over the country. I am afraid what the Government proposes and determines to put through they can put through at the present time. In the interests of public liberty and scientific and professional progress, as well as the real interest of the nation in grappling with this great evil of venereal descuse, I believe this Bill to be ill-conceived, unnecessary, and altogether ill-timed.
§ 5.0 p.m.
§ Captain FREDERICK GUEST
My only reason for intervening in this Debate is due to the fact that a subject such as this very rarely conies before the House of Commons, and I think this opportunity is too good a one to lose, and that we should fairly face the magnitude of the evil, and the smallness of the effort made to deal with it, and see whether we cannot out of this opportunity obtain something of which the House of Commons may be proud. So far as the Bill is concerned, I find no fault with it. Possibly in detail it may not meet with the approval of everyone in the House, but I most certainly support the general principle that quack medicines nearly always, if not always, do more harm than good, and, to put it in plain language, usually effect, or attempt to effect, an impossibly rapid cure, the result of which usually is to drive the disease in instead of bringing it out, in which case no doubt the constitution suffers at a later date. But before being prepared to go so far as to support the Bill, if necessary, in the Lobby, I would have liked to hear a good deal more about the free institutions which, we are informed, are being set on foot to handle the. difficulty. I am convinced that the spirit is willing in all the corporations and in all the various councils that have applied their minds to this, but I am afraid I am one of those who believe that the machinery, even if it is ever obtained, will be too slow- adequately to tackle the disease in time to secure a remedy, anyhow for the purposes of this War. The statistics given 2089 to us this afternoon by the Parliamentary Secretary to the Local Government Board seemed to me to make so terrific a case for a larger treatment of the measure, that I feel more encouraged than when I first came this afternoon to ask the House to give its mind for a little to the magnitude of the evil. I had myself presumed that the introduction of this Bill, or the Second Reading of this Bill, in the House of Commons to-day was merely an indication that the Government were prepared to consider the details of a serious measure, as the House of Commons had been invited to collaborate with a view to grappling with the problem. As I have said, I am surprised at so poor an effort; in fact, I go further and say that it seems to me that this Bill might quite easily have been possibly a Sub-section of a real Bill for grappling with the evil, but that it is not worthy of the position of a Bill by itself. I go to the extent of saying that if this measure is to be a war measure we must make it effective, and effective in a very short space of time. Later I shall ask the House to allow me to give them my view of the magnitude of the case so far as the Army is concerned. I understand that the introduction of this Bill in the other House was due to the presssre of public opinion regarding the effect and inroads that this disease has made upon our fighting troops rather than actually to its effect on the civil population. If that is so, and if this is to be a war measure—and that is largely the reason why I welcome it and intervene in the Debate—it seems to me a pity not to face the issue once and for all, and go for it properly. There are in my opinion only two ways in which good can be done. The first, is to remove temptation from the soldier, and the second, is to subject the civil population to compulsory treatment and detention until cured. I know that is asking a good deal of the House, composed as it is of sixty or seventy members of the Grand Committee which has been sitting on the other Bill which comes up for discussion here on Wednesday. This seems to be a subject on which they have already made up their minds that such stringent treatment is not likely to be successfully carried out, and that public opinion is not ready for it. [An HON. MEMBER: "No."] I am only too glad to hear that 2090 there is someone who is disinclined to believe that to be the state of public opinion.
I think I may say again that this Bill evades entirely the real problem. Dealing with quack doctors and the advertisement of quack medicine is, as I think the right hon. Gentleman said, merely the fringe of the matter. I wonder if the House has had time, with the immense amount of business it transacts, really to grasp what inroads this disease and similar diseases have made into the fighting ranks of the Army. We were given a figure a few days ago by the Under-Secretary of State for War who told us, with some nervousness, that the figure was not a very serious one, and that it only amounted to 43 per 1,000. Forty-three per 1,000, in these days when you are combing out industries, when you are hunting among funk-holes in different parts of the City to get men in hundreds, seems to me to be a very large figure indeed. Forty-three per 1,000, If you take it over an Army such as we may possibly imagine we had last year, without giving any figures away to anybody, a very fair average calculation gives something like 107,000 cases. I know that a 107,000 men are very sorely needed at the present minute, and that the weight of those men, if we could keep them fit, would be very valuable indeed at this minute. This is the War Office figure. I do not know whether that covers all the cases which have accrued in France as well as in England. It is impossible for those of us who are outside to criticise with any chance of success figures put forward by the Government, but I have a certain number of figures, very few, which make me rather suspicious. The most noticeable fact seems to me to be the following: that the admissions into hospitals in England since the War began go very nearly all the way to fill up the 43 per 1,000. My figures are these. They are open to challenge, and I submit them purposely to challenge from the Department who can verify them. During the two and a half, or two and three-quarter, years of war we have had admitted into-the hospitals of England over 70,000 cases of gonorrhoea, over 20,000 cases of syphilis, and over 6,000 cases of another disease somewhat similar to syphilis which goes by the name of soft chancre. Those diseases have the effect in different proportional strengths of incapacitating the men from further activity or further par- 2091 ticipation in the war. I am quite openly prepared to state that of these 20,000 cases of syphilis you do not get much work out of them under two and a half years. I know from what I have seen of the modern conditions of this War that you may absolutely wipe them out, except for a few handfuls, for any practical use they will be. So far as the other disease which has produced the smallest number of cases is concerned, the effects for a considerable period of time are very debilitating.
When you come to the great mass of casualties under this head you are dealing with a disease of which—and doctors will support me—unless you do give time, trouble, and care to its complete eradication and cure, the only effect is to drive it into the system and to turn out a man who is neither fit nor absolutely unfit, but who will succumb immediately the conditions of service becomes severe. These figures mean that you have a Division constantly out of action, due to one cause or another. I consider, and I think any man who knows the pressure that exists at the present time will agree, that at present to have a Division, or very nearly a Division, month by month permanently out of action is a very serious loss. If you have anything like 70,000 men enfeebled—and I think "enfeebled" is a very generous word to use—you find that you suffer to that extent also. It is not only that you lose the men, and not only the men who are partially cured and are suffering for many months to come, but I have considerable experience from a hospital with which I am intimately connected, and their chances of recovery from wounds are not nearly so good as those of men who have escaped the disease. That is only in England. What has happened in France? What the figures are I admit I am not in a position to say, because very wisely they are kept wrapped up and from us. I do know of a hospital which was instituted for the purpose of handling venereal cases, and which it was found necessary to expand from its normal accommodation for 500 or 600 up to 2,000 cases, and they are continually full. It is a British hospital in France. A figure I should like to submit to challenge, and I should be only too delighted if the Government would say that these figures are wrong and that my case has been grossly exaggerated, is that during the course of the War it is no exaggeration to say that 2092 between 40,000 and 50,000 cases of syphilis have passed through our hospitals in France. I admit that some of these reappear in the figure of cases which are regarded as admissions into England, but I do not believe there are many. When you come to the figure for gonorrhoea, which is probably a case which is kept until it is cured, I doubt whether those figures do appear again in those I have given. The figure given me which covers that is between 150,000 and 200,000 cases. I submit those figures in the hope that the Government will be able to challenge them and to satisfy the House that I am inaccurate, and I shall be only too glad to accept their answer. I think, however, they will find it very difficult. For the past five minutes all I have been trying to do is, as inoffensively as possible, to build up a case to show the magnitude of the problem with which we are faced, and largely to show how meagre and small is the effort put forward by the Government as, I imagine, a measure to overcome the difficulty. Those are the figures which deal with those who have passed through the hospitals in England, and, so far as I can make out, in France. There are, however, one or two rather striking things, which are public property, which narrow this down to a more personal issue—personal in the sense that they bring it down more to some concrete section of the community. I take the Canadians. They come three or four thousand miles to assist us in this great War, and are men who in most cases are entirely lost when they arrive in this new country. Certainly they are lost in London, and very often in the camps in which they are placed. They are much more liable to the temptation which is thrown in their way, but when you give a figure such as this—that is, in one camp during last year, and two months of the previous year, namely, fourteen months, there were 7,000 cases—it seems to me that it is about time we realised definitely the size and magnitude of the evil. I do not know what has happened to them, except that I imagine a large number have gone back to Canada, and have, not been able to play the part in this great War which they had hoped to play when they set out.
I begin by suggesting that the Government might, if they cared to tackle the subject, confine their desires and determination to two proposals, the first to remove temptation from the soldier, and 2093 the other compulsory treatment of civilians and detention until cured. The remedy, so far as the soldier is concerned, and the punishment for the offence, should, I think, be appreciated, because during the passage of the Criminal Law Amendment Bill through the Grand Committee a great deal of opposition was raised, sometimes, perhaps largely, by women's societies, on the ground that legislation was being rather levelled at their sex, and that discrimination was made in favour of the men. I think that so far as the Army is concerned, it is only fair that the public should understand that it is a military offence to contract this disease. It is, first of all, a military offence not to admit it by those who have grounds for thinking that they have it, that is, by submitting themselves to the doctor at the daily inspection. Apart from that, a penalty is inflicted on a man when he has it. His proficiency pay is cut off. I do not know what the exact effect of this may be under war conditions, but so far as peace time is concerned, it is a very serious penalty. His proficiency pay is cut off until he is able to rejoin the ranks and do duty. Another punishment was confinement to barracks, and being debarred from such recreation rooms as were available, including the canteens. I only mention this to show that we are prepared to apply the King's Regulations certains pains and penalties to the soldier who has contracted the disease, that pressure is put upon him to get cured as rapidly as possible, but that we are afraid to apply it to the civil population. That seems to me quite illogical.
Passing from that for a minute to more war considerations, I must ask the War Office, if it will, to pay closer attention to the care of the soldier when he comes home on leave. It is only a few months ago that the following scene might be witnessed. Hundreds of them may be seen on the arrival platforms, and they are exhausted men. Soon after arrival they are paid, and as soon as they pass through the barrier often there is someone waiting to lure them off Surely, if the War Office do not look after the soldiers in this respect, it is asking a good deal from the Local Government Board to deal with the matter in other directions. I think it could be dealt with, in the first place, in the camps, and, secondly, when the soldier comes home on leave. With regard to my views as to the treatment of the civil population, I do not think anyone need be 2094 afraid of the re-entry into British legislation of the Contagious Diseases Acts. Many of the suggestions which have been made, none of which are incorporated in the Bill which will be brought forward on Wednesday next, have no relation to the Contagious Diseases Acts of the old days and are as different as chalk and cheese. One of the essential conditions of the Contagious Diseases Acts is that there should be State brothels, but that has been made impossible and legislated against in the measures which have been adopted.
The suggestion I put forward is one which I think was frightened out of court at the commencement of the discussions during the weeks that have gone by. My suggestion is that it should be a criminal offence not to report yourself to a doctor when you have grounds for suspecting that you have this disease. This condition is imposed upon the soldier, and penalties are attached for non-compliance, and under these circumstances I do not see why the same rules should not apply to a civilian, whether to a man or to a woman. I know the word "notification" is something at which many people jib. I do not see why anybody should be afraid of the word "notification," and I suggest that there should be compulsory powers for a man or a woman to notify the disease to a medical practitioner, and, if they fail to take the treatment ordered, then it should be the duty of the medical practitioner to pass that name on to some other authority. I do not think that is imposing too great a burden on the public, in view of the magnitude of this evil. If persons, after the disease has been notified, refuse to attend treatment, they thereby make themselves into a walking menace to society and a danger to the public, and they ought to be treated in a very drastic manner. It is only at. that stage that the word "notification" becomes serious. If a patient refuses to continue treatment after notification, the local medical authority should have power, either from a magistrate or from a Court, to apprehend the person and detain that person—I suggest for not more than four weeks—until cured.
The Under - Secretary to the Local Government Board (Mr. Hayes Fisher) said that people would not resign their liberty, but we have to remember that we have got to fight our battles abroad, and under these circumstances it is just as well to make up our minds to resign 2095 our individual liberty and hand it over to the Government to increase our chance of success. At the present time in the War we are giving all we possess, and we are prepared to give up more, and if the public refuse to give up their liberty in order to enable the Government to handle drastically a plague which is ravaging not only our soldiers, but the men and the women in the civil population and the children who follow after, I call that a miserable form of false pride. I admit that the women's view on this subject is very important, but I do not think that it has been properly cultivated or ascertained, and that if the full weight of women's opinion could be properly ascertained, I feel sure it would lie in the direction of drastic legislation. I think the want of agreement on this subject amongst women is due to the fact that they believe that we desire to legislate against them as a sex, and it is the duty of the Government to show that we have no intention of doing that, and to convince them that what is fair for the men is also fair for the women.
I said something just now about the Canadians who had suffered in this War, but I would like to ask what will the Canadian mothers say upon this subject? What a pity it is that we do not throw off some of the hypocrisy and the sham with regard to this subject! The women of Canada have given of their best in the men, and they have sent them to the War; in fact, in Canada the women have made the men go, and it was largely the women there who made it impossible for any man of able-bodied age to stay behind. If the women do this, are they not entitled to demand that we should do for the soldiers what I am asking the House to do? I would go further on this point. We have have now entering into the War another partner, who has very strong views on this subject, and the Americans look things very directly in the face. I have had some considerable experience of them in the East and in the West, and I can assure hon. Members that they will not tolerate or forgive this country if we play with an evil of this magnitude, and do not do our utmost to cure it and save their people from becoming sufferers. I believe if we do not do our best to satisfy them of our intentions and by our performances in checking this evil, it will do a good deal to undermine the loyalty and the harmony which exists at the present time. I gather that the Government 2096 attitude on this measure is largely one of leaving the question to solve itself. I do not say that in any offensive sense, but it amounts to that. They are prepared to set up free institutions and machinery, but the general attitude they adopt towards the question is one of letting people work out their own salvation with a little bit of assistance. I do not think that is a rapid enough way of dealing with this question, and I think that if the method I have suggested, or a similar one were adopted, we might get good results before the summer is over, instead of waiting for these free institutions, because by the time they are established the summer will have gone before they can come into active operation.
It may be true that you cannot make-a nation either moral or sober entirely by legislation, but you can do a great deal; you can remove temptation, and in a case of this kind where a person becomes a public nuisance and danger, you can punish the offenders after you have given them reasonable notice. This has been honestly described as a. plague, and I ask the House, before it is too late, to take great care that this plague does not get out of control. You come to a condition in society where everything is a little bit loose and disconnected, your doctors are getting tired of this subject, their numbers are getting short, and only within the last few days there has been an additional call of 1,400 or 1,500 doctors to do further work in France. With a shortage of men to handle it, and with less officials in different parts of England to control the department, I think there is a danger that this plague may get out of control. We are in the middle of the third year of the War, and probably as most people admit we are arriving at the climax of intensity, and you are getting many people with their nerves in an overwrought and strained condition, and such men are inclined to say, "I will have a short life and a merry one, because what does it matter what I do before my turn comes?" In this way you get everything disorganised, and under these conditions you will find evil and plague raise their heads higher than they otherwise would do. I hope it is not too late for the Government to reconsider the inadvisability of putting forward so small a measure to deal with so big a case. I ask on behalf of the Army and on behalf of a large section of the public who are prepared to face this question 4hat what I have asked should 2097 be done. I ask the Government to look this question fairly in the face and to reconsider the inadvisability of bringing forward such a small measure to deal with so dreadful a plague.
§ Sir WILLIAM COLLINS
The hon. Member who has just spoken has emphasised the magnitude and importance of this question, and he seems to think that there was a tendency on the part of previous speakers to minimise the seriousness of this social evil. He has also incidentally raised the question whether other principles ought not to be considered in approaching anything like a satisfactory solution of the problem of how to deal with this serious matter of venereal diseases. I agree with the speaker who moved the rejection of this measure in complimenting the former President and the Noble Lord (Lord Rhondda) upon the activity they have shown in taking advantage of the Report of the Royal Commission and in making provision for subsidies by the State to the extent of 75 per cent. of the cost of the diagnosis and treatment of venereal diseases. I cannot help thinking, however, that the legislative efforts of the Government have not been quite so fortunate as their administrative efforts. It is our duty to inquire what are the principles which should underlie the policy in dealing with these questions of contagious diseases, and what is the relation between the administrative efforts which have been made and the two legislative projects which have been brought before this House.
Two courses were open to the Local Government Board—either to endeavour to see how far legislation in regard to infectious diseases was capable of extension to these contagious diseases or to follow the Report of the Royal Commission. The Government has not seen fit to do either. The other Bill, which has been through Grand Committee, and which is coming back again to this House, made it a crime for a person suffering from a venereal disease to perform certain acts or to solicit to the performance of those acts, and this Bill now introduced invites the suppression of unqualified practise or the prescription of remedies by unqualified persons for these particular diseases, and these alone. The first proposal embodied in the Criminal Law (Amendment) Bill was not recommended by the Royal Commission. It was silent on the subject, and when that particular question was inquired into in 2098 1870 a Royal Commission then condemned it, because it thought that anything like an enactment of that kind would be likely to produce a great deal of blackmailing. With regard to the second proposal in this. new. Bill, the Royal Commission did not recommend the suppression of unqualified practice. It might very well be asked whether the two things are not somewhat contradictory. Administratively, under legislative powers which I think were never intended to deal with cases of contagious diseases—they were originally introduced in connection with epidemic and infectious diseases, notably cholera—centres for diagnosis and treatment have been established over a large part of the country under secrecy and confidence, and the very fact that you are providing free efficacious diagnosis and treatment under secrecy and confidence one would have thought might have been sufficient to attract those who desire to be treated in that way to these publicly provided centres. At the same time, to introduce a proposal to suppress unqualified practice seems to imply a certain mistrust of the administrative provision you have made, free and confidentially, for those who desire to avail themselves of it. It seems that the Local Government Board desire to exercise vis a tergo as well as vis a fronte, and that they are not content to rely upon the efficacy of the provision they have made.
A great deal has been said about quacks. It is not a term easily capable of definition. It belong to that class of question begging epithets which imply their own condemnation, but I am not quite certain that it would be possible in regard to a profession, which after all is experimental, to draw up a definition of an empiric which would include all those unqualified practitioners, and not at the same time apply to some of those who are qualified. I do ask the House seriously to consider what are the principles which ought to underlie the policy of the legislature with regard to unqualified practice. Allusion has already been made to the case of the bone-setter: I have only returned to this House within the last couple of months or so, but at Question Time I have often heard the case of the manipulative practitioner spoken of in the highest terms, and endeavours have been; made to see that he receives recognition at the hands of Government Departments. In the case of the Insurance Act special provision was made under a particular 2099 Regulation whereby a man might contract for treatment by an unqualified practitioner, and a good deal was said at that time with regard to the free choice of a doctor. Quite recently I have seen a Report of a Departmental Committee on the subject of the use of cocaine in dentistry in which it is recommended that a whole body of unqualified and unregistered persons should receive recognition by the Home Secretary for certain purposes.
These things may be right or they may be wrong, but I confess that I am a little perturbed at the suggestion that unqualified practice with regard to these particular diseases which the State has largely undertaken to treat should be suppressed and that in all other directions it should be permitted. It seems to me that this Bill and the other Bill might be more suitably sent to a Select Committee than be subjected to the mauling which the other Bill has received at the hands of a Grand Committee upstairs. I submit that the present law with regard to unqualified practice is not illiberal, and I like to say that because I notice in the literature which has been circulated among Members that the profession of medicine is sometimes represented as claiming a greedy monopoly in the practice of medicine and surgery. The present law in regard to that subject is by no means illiberal. It was in 1858 that the legislature passed a medical Act whereof the Preamble said,Whereas it is expedient that persons requiring medical aid should be enabled to distinguish qualified from unqualified practitioners.It did not forbid the practice of unqualified practitioners. It did not say, "It shall not be open to anybody to give advice or to sell advice or to offer to undertake any medical or surgical treatment." It forbad the giving of death certificates and precluded persons except those qualified from giving treatment in the Army or Navy, but it did not set up any rigid or close monopoly. I cannot help thinking, therefore, that this new departure in the case of these particular diseases is exceptional and anomalous. I entirely agree with the right hon. Gentleman that practice by the quack in the case of these particular diseases is most pernicious and objectionable, and from every medical and surgical point of view to be condemned—and when in addition to trading on the 2100 ignorance of the person the quack trades on the sense of shame, I feel it is a very despicable act. I do not desire adventitious protection for the profession against that kind of practice which ought to carry its own condemnation. There is also the case of the tuberculosis quack and the cancer quack The recent Departmental Committee on Patent Medicines said:Amongst fradulent secret remedies the alleged cure for tuberculosis are perhaps the worst of all.I am not at all sure that the tuberculosis quack is not more shameful, and that the cancer quack is not worse than either. If you are going to put down unqualified practice at all it would be better to put it down altogether rather than deal with this particular corner of it alone. At the same time I wish to recognise that the practice of medicine, though a science, is not an exact science but a progressive science, and a science that should look for new light from any quarter from which it may proceed. The science or the individual which would silence all criticism would claim infallibility, and infallibility in medicine is the monopoly only of the charlatan or the exceedingly young practitioner. Personally. I should be prepared to see the practice of scientific medicine and surgery, which needs no justification, stand upon its own merits without these illegitimate rivals being suppressed under penalty of hard labour or fine. The profession suffers rather than gains by association with the policemen and the gaoler in enforcing its prescriptions, and I would rather see it rest upon its own merits and upon the force which attaches to moral suasion.
§ Mr. GLYN-JONES
The statement which the right hon. Gentleman has made as to the progress of the Department during the last few months in setting up institutions for the treatment of the diseases which are the subject of this Bill will be well received in this House; but I am inclined to think that those who have taken any special interest in public health matters will regard the Bill itself with mixed feelings. I think they thought that it would have been said that the reason for bringing in this Bill in this particular narrow form was in order to meet a special war difficulty, but I understood from the right hon. Gentleman that it was not put forward as a war measure. We have had some figures given by the hon. and gallant Member (Captain Guest), who spoke from the Front Opposition Bench as to these diseases in the Army; but I think 2101 I am right in saying that it is almost impossible to get really satisfactory and reliable data which will enable anyone to say what is the degree of mischief which has to be met. It is common knowledge that the mischief is one of long standing. and I would have preferred that the House were dealing with this matter in normal times, when we could go into the whole question in a way which I am afraid is quite impossible under the circumstances. It is right to say that the present day provision for the prevention—and I lay a good deal of stress on prevention—cure, and relief of those diseases is unsatisfactory; but I have every sympathy with the hon. Member for Somerset (Mr. King) when he said that he would have preferred this matter to have been dealt with as part of the great problem of public health and of the practice of medicine in this country. It is a matter of common knowledge that the right hon. Gentleman's Department and the Government as a whole are seriously contemplating setting up a Ministry of Public Health, and there is a great deal to be said for not touching this matter at the moment. If yon do seriously intend setting up a Ministry of Public Health, you would be more likely to get a satisfactory provision dealing with this particular difficulty if it were dealt with by such a Department with the special knowledge of that Department and in connection with all the other problems appertaining to medicine.
I. believe, however, that it may be argued that the excuse for dealing with this subject in this way at this time is due to the desire to take advantage of the quickened humanitarian interest from which such speeches as that we heard from the hon. and gallant Gentleman opposite arise. The hon. Gentleman who just sat down (Sir W. Collins), whose views upon this subject are entitled to the greatest respect owing to the special knowledge he possesses, referred to the first Statute which deals with the practice of medicine, namely, the Apothecaries Act. I mention it. for reasons which will appear in. a moment. There the Legislature made it a penal offence for anyone to act or practise as an apothecary who was not a certified apothecary. That to-day is still the law of the land. It is still illegal for any person to act as an apothecary if he is not in fact a certified apothecary. I am satisfied that a good many of the practices of quacks, with which this Bill is intended to deal, could be dealt with 2102 effectively under the Apothecaries Act if that Act in fact were enforced. It is a mistake to keep putting on the Statute Book Acts of Parliament which, for some reason or other, are found to be unworkable and which are not enforced. When you come to deal with the subject again, instead of admitting that the old Act was a mistake and scrapping or amending it, you go off on another line entirely and bring in a new measure. One ought, perhaps, to define as nearly as one can what acting as an apothecary really means. The Courts have decided that. Years ago case after case occurred in which people were summoned by the Society of Apothecaries, the only people who could enforce that Act for penalties. The Courts said that acting as an apothecary was to diagnose a disease and prescribe a remedy for it. If the provisions of the Apothecaries Act were enforced against unqualified people who are to-day dealing with this disease, I have no hesitation in saying that nine-tenths of the evil which this Bill is intended to but would be removed. We do not enforce them, but we leave the Act on the Statute Book, and now start off on this new line.
There is another aspect of the question which I feel bound to put to the Mouse. In this Bill you are giving—I think rightly—to the medical profession the sole right to treat these diseases. The whole question of the treatment of disease and who is to carry it out ought to be dealt with at one and the same time. If that were done, we should then, perhaps, examine what we have done under the Insurance Act, in which we have provided for the medical treatment of about 14,000,000 of the insured population of this country. Under that Act every insured person is entitled to receive at the hands of a qualified medical man treatment for this disease. The country has not apparently gone so far as the hon. and gallant Gentleman desires, for, if I understood him aright, he would go so far as to say that not only shall a person consult a doctor, but that he shall consent to be treated by that doctor, whatever treatment that doctor chooses to give him, or otherwise be guilty of an offence, be taken into custody, and kept in confinement. It is more or less natural that a soldier comes to think that you have the right to do anything by compulsion, but it is a very long step from compulsory military service to compulsory medical treatment. I do not think the country would be ready for compulsory 2103 medical treatment. When you gave the 14,000,000 of people the right to treatment by qualified practitioners, you recognised the different functions of the doctor and the pharmacist. You said in regard to these 14,000,000 that the doctor should prescribe and treat, and that the pharmacist could dispense, except in emergency cases and in rural areas.
This Bill confers privileges upon the medical practitioner which are not already possessed by him. The Bill confines itself to venereal diseases, and it provides that the treatment should, for the first time by law, be limited to the medical profession, whilst allowing doctors when treating other than insured persons, to buy and sell for profit to their patients any drugs or appliances they might require. That is contrary to the fundamental principles which have always been recognised between the leaders of these two professions. It is contrary to the practice of every European country, and certainly contrary to the practice the country has set up in regard to the 14,000,000 of insured population. The pharmacists have every desire to see the treatment for these diseases as well as all other diseases in the hands of those who possess such a hallmark as the State will give them of their qualification, but they do find it difficult--I say this quite seriously--to understand how the medical profession does not realise the illogical and inconsistent position they occupy in supporting this movement, while at the same time insisting that they shall have the right not only to an income which they derive from the fees for their own professional work, but also to turn into customers patients whom the law compels to consult the doctors or go without treatment, out of whom they make a profit for selling the remedies which they supply. The pharmacists are not claiming too much when they say that if you give the medical profession the sole right to prescribe for patients who cannot get treatment anywhere else, you first of all drive the patients to them, and that sole right carries. with it the ability to usurp the functions of another profession, and to make a profit out of buying and selling the remedies which are supplied to those patients.
So much for the general objection to the Bill. There is a serious flaw in the first Clause. The House will notice that the prohibition against treating this disease by unqualified practitioners is confined to 2104 areas. The right hon. Gentleman has explained why that is so. He says that they are not prepared to impose the provisions of this Bill except in areas where they have institutions for treatment. It has been said that the result of this Bill will be to drive patients into those institutions. We might as well know exactly, as far as we can ascertain it, what will happen. What will happen is this: Of course, everyone will be compelled to consult a doctor. If the patient is in a position to pay the doctor his fees, unless it is a case requiring treatment by Salvarsan or one of the substitutes for Salvarsan, the doctor will treat that patient. The patient who can afford to pay will not be sent to an institution. Indeed, if he can afford to pay, he will secure Salvarsan treatment and will not be sent to an institute. He will be sent to Harley Street, to another man in the profession, who will act as a consultant, and between them, rightly enough—I am not complaining in the least, but let us understand what is going to happen—they will charge the fees to which they are justly entitled for treating these diseases. The institution is only set up for the special treatment of syphilis, which is only one of these diseases. I do not think that the Local Government Board would argue that the ordinary general medical practitioner is unfitted to do work, such as the treating of ordinary gonorrhoea, without sending the patient to an institution. The setting up of the institution is due to the fact that during the last ten or twelve years a special system of treatment for these diseases has come into vogue which was as new to the profession ten years ago as it is to the quack to-day. It has established itself on evidence which is regarded to-day as satisfactory, and it is a form of treatment which cannot be given by the ordinary general practitioner. What will happen when this Bill goes through is that the people who to-day go to quacks or who buy remedies from chemists will go to the doctors, and that in the case of those who are too poor to pay and who will require Salvarsan treatment they will be sent by the doctor to an institution. If they are suffering from the minor forms of these diseases-one is thankful to say they are by far the majority of cases which come within the term "venereal diseases"—they will be better treated by doctors than by quacks, but they will not be treated in institutions. 6.0 p.m.
According to the right hon. Gentleman, however, it is only in ninety-five 2105 out of 145 areas where these provisions will be enforced. One heard in this House recently a suggestion that you might enforce an Act of Parliament in one part of the country which liked it, but not in another part which did not like it. In a question of this sort it is no attraction to say that you are only going to enforce the Bill in districts which are constituted as areas. You have to ask the local authority whether it is to become an area, because you cannot cumpulsorily sot up an institution there. You have to go to the local authority and get them to set up an institution. it you deal with this question piecemeal, you are running a serious risk. Everyone in the area who objects to this Bill and wants to continue the present arrangements will be against institutions being set up and will use all the influence they possess to block the local authority in setting up the institution, because they will say that once the institution is there you bring in the scheme which is enforced under the Bill. Suppose, for instance, there is an institute in Manchester. What is the use of raying to the people in Manchester, "You shall not go to a quack in Manchester, but you can in Salford"? There are now, according to the right hon. Gentleman, about fifty areas in this country where any quack could treat these diseases, and anyone can go to him without being amenable to the law. That objection is very much worse when we come to the second sub-Clause of the Bill prohibiting the sale of certain articles. This, again, is only in areas. What is the good of saying to people in London, "You shall not sell or buy these articles," if people in Bristol or Cardiff or Brighton can sell them and send them on by post or in any other way? The provision will not work in that way. In the view of the pharmacists it is absolutely unworkable. It is made an offence to offer to supply or dispense any drug or medicine or other preparation as a remedy for venereal disease. What constitutes the sale of anything as a remedy? The offence for which a person is to be liable to two years imprisonment is to sell a thing as a remedy for these diseases. In what circumstance is the sale of an article a sale as a remedy for these diseases?
There are dozens of common, well-known drugs which are used for all sorts of diseases, and, therefore, a person going into a pharmacist's shop may say, "I want a little weak solution of sulphate of 2106 znic," and it may be for an eyewash or it may be used as an injection. Or he may ask for half a dozen grey powders. It may be that he is in a tertiary stage of syphilis, and is taking powders for them, or that he has got some noisy twins, and is taking them home for the babies—for they are one of the most common remedies given to children. How can you make an offence by an Act of Parliament by saying, "you shall not sell as a remedy," unless you define what are the circumstances which constitute the selling of the article as a remedy?' Then it is provided that it shall not be sold unless it is dispensed under and in accordance with the written prescription of a duly qualified medical practitioner. The onus is upon the seller to prove that what he did was to sell something upon the prescription of a medical practitioner. Twenty-five years ago I saw a good deal of what purported to be prescriptions of medical practitioners, brought into my own shop. What is a prescription? Something written in dog Latin. A person comes in—a stranger; he brings what is called a prescription, with a name upon it that can seldom be read, and some stuff called Latin on it. Any schoolboy could write the signs after a little instruction. As a rule there are only initials underneath which nobody can read. How is the man behind the counter to know, first of all, that it is a prescription, and then that it is the prescription of a duly qualified medical man? How can you throw upon him the onus, having satisfied himself that it is a prescription, and that a medical man wrote it, of then satisfying himself that it is supplied for the use of the person for whom the remedy has been prescribed? How can he say, when an article is sold across the counter, for whose use or for what use the article sold is going to be employed?
Sub-Clause 2 of the Bill is absolutely unworkable. The way to deal with the matter is by means of an Amendment, which I hope the Home Office will consent to include in the Bill, dealing with the advertising of remedies for these diseases. If you provide that nobody shall by advertisement or label hold out anything for the prevention, cure or relief of these diseases, that is as far as you can possibly go, or as far as it is practicable, and then you had better drop Clause 2 of the Bill. It is a great pity to have two Government Departments dealing with the same sub- 2107 ject in two Bills, one of which has gone up to the Grand Committee, and will be down in this House on Report stage on Wednesday. They overlap in this particular. It would be very much better if the Home Office and the Local Government Board between them decide, between now and Wednesday, whether they will deal with this particular side of the subject in the Home Office Bill by means of that Amendment, or whether they are going to substitute that Amendment for Clause 2 of this Bill. The pharmacists for whom I am speaking desire me to say that the last thing which they would desire to do is to prevent in any way the treatment of any disease, and they agree that there is a case, not stronger than in reference to tuberculosis or other diseases, that the ignorant public should be protected from the charlatan and the quack; but they think that this is the wrong way of doing it, and that it would be much better to deal with the question as a whole. They would be sorry to be the means of preventing this Bill going through, but I assure the right hon. Gentleman that so far as sub-Clause 2 and the provision limiting application to areas are concerned, they will meet with the most strenuous opposition. I shall be glad to hear from the right hon. Gentleman that he is prepared to consider the suggestions which I have made.
§ Sir J. D. REES
The hon. Member for Derby, in his speech, which as usual was weighty and well informed, said that the hon. Member for Somerset (Mr. King) had moved the rejection of this Bill. I think, however, that he merely put down the Motion and that he spoke upon and criticised the Bill, and I thought that there was a great deal in his criticisms. He did not, like the hon. and gallant Gentleman on the Front Bench, deal with another Bill which is before the Committee upstairs. My knowledge of this matter is not like that of the hon Member for Somerset, whose knowledge of diseases and medicines ranges from shingles to syphilis and from soothing syrup to Salvarsan, but I know something about it because at one time as cantonment magistrate I have seen the ravages of these diseases upon our soldiers. But that does not make me think that any remedy that is put forward is likely to be efficacious. Venereal disease just now is in the air—I wish it were nowhere else—and the Government are being pressed to legislate, and it seems to 2108 me that you are in great danger in legislating without remembering the saying of the most philosophical, perhaps the greatest, of historians that the more corrupt the republic the more numerous the laws. What we have to consider is whether this particular Bill is likely to have any effect in generally arresting the ravages of syphilis. It seems to me to be worse than useless, and I confess that though I appreciate very much the speech of my hon, and gallant Friend, as showing how serious this matter is to our troops, yet he did not deal with this Bill and show how it was in any way going to remedy the ravages of this disease in France.
The Report of the Royal Commission has been referred to many times. I will not attempt to criticise it, but I am sure that they have exaggerated the matter most enormously. I have had the advantage of discussing the question with a great many practitioners, who have assured me that the ravages of venereal diseases are exaggerated in that Report. That is likely to be the effect of any Report on the subject coming at a time when there is general attention naturally directed to it on account of the necessity, which is greater than ever now, of having our troops fit to fight in the field. But surely the only question before the House now is this particular Bill. It is most inconvenient that two Bills should be before the House. Whether this Bill is due to the efforts of the House of Lords to assert that concurrent jurisdiction which has been so often condemned in this quarter I really do not know. But the result is that we have one Bill upstairs before the Committee, and another Bill down in this House which is going before the Committee, where I prophesy that it will be pounded into pieces like its predecessor. How is it possible to provide that a person shall not treat a case, unless he is a duly qualified practitioner, and so on, according to the Section?
Take the case of the administration of Salvarsan. That has been described here as a patent medicine. I suppose that it practically is that, but it results from that that any person with any surgical knowledge, or any person merely instructed ad hoc, could perfectly well administer this drug as well as the most capable surgeon or the most capable doctor in the three Kingdoms. Why, then, should it be made an offence for a person to study the administration of this particular drug, which 2109 by common consent is the most likely to amend this most serious of diseases? Yet that would be the result of that Bill. A manipulative surgeon might be able to administer it far better than anybody else. I suppose that a man like Mr. Barker would probably administer Salvarsan far better because of his manipulative skill than any ordinary practitioner, but not only would he be ruled out by this Bill, but he would be made subject to serious penalty. My right hon. Friend declared at one period of his speech how far more serious are the ravages of venereal diseases among the civil and military elements in Germany than in this country. What was the inference from that as to the necessity of introducing this Bill? I should have thought, if any deduction were to be drawn, that the argument was the other way about. The right hon. Gentleman has now an opportunity of explaining what he meant, if he cares to avail himself of it. The Section goes on to say, that any person who is not a duly qualified medical practitioner is not to give any advice to the person who is to be treated or to any other person. It seems to me that if any one man said to another, "Tell A B C he had better try Salvarsan," he would be subject to this penalty, unless some words are added "to another person duly authorised on his behalf to receive such advice." This Section, it seems to me, might expose to these penalties anybody in the world who indulged rashly in conversation. Then, again, it is a matter of the most common knowledge that mercury is, in a way, I believe, a specific; at any rate, a treatment. Is anybody who advises another person to take a mercury pill to be subjected to these penalties, and is anybody who provides it to be a criminal? I remember seeing chalked upon the walls of a hospital, occupied by people of no very great intelligence or education, who were suffering from this disease, a pseudo-classical representation, entitled "The advent of Mercury and the flight of Syphilis," something in the style of the Elgin marbles. The whole population knows that mercury is a specific; is it really to be supposed that nobody can re-cominend a supply of it who is not a qualified practitioner? The hon. Member for Stepney who spoke seemed to me to riddle this part of the Bill with his criticisms, and therefore I shall not venture to trouble the House with saying any more about it.
2110 Then, we have another Sub-section which, says that a person shall not sell, offer or dispense any drug or other preparation as a remedy for the disease. Surely you must, therefore, insert the words "other than remedies which are universally acknowledged by the medical profession to be efficacious in that behalf"; otherwise one trembles to think what might be the effect upon persons who mean well and are really doing good, but who have unfortunately offended against this drastic and, as I think, hardly well-considered legislation. The hon. and gallant Member who spoke from these benches was carried away, I think, by his. desire—a very natural and proper desire—to save the soldiers, but he made a general plea for equality of treatment. How can there be any equality of treatment upon this subject as between the sexes so long as the profession of prostitution is recruited, and must be recruited, from one sex? It seems to me that his speech, however well-intended, neither went to the root of the subject nor dealt with the Bill before the House. My right hon. Friend, in speaking, was very anxious to explain that this Bill dealt with exceptional cases; that this was an exceptional matter; and that therefore it was permissible to create a law applicable to these cases which would not be applicable to others. I can only say that if hard cases make bad law, exceptional cases make worse law. This particular Bill, it seems to me, is hardly needed; and if it is needed and is really to be considered and is likely to be in any degree efficacious, it should, at least, be most drastically amended and filled with safeguards. Otherwise, perfectly well-meaning people, meaning well in their limited sphere of doing good, may be subject to exceedingly severe penalties without any good accruing to the public.
The right hon. Gentleman said nothing about the cost, which would result from the general application of this Bill. The hon. Member for Stepney showed that a partial application of a Bill would simply lead to a transference of the place in which the offences were committeed from one area to another, and therefore, if the Government began to enforce it they would have to do so generally. I think the right hon. Gentleman contemplates that. The right hon. Gentleman did not favour the House with even the roughest calculation of what would be the expense of the operation of the Bill. That would be a material consideration, especially at a 2111 time like this, when in all directions expense of every sort and kind is on the increase.
§ Mr. DILLON
In my opinion, having sat in committee upstairs on a Criminal LAW (Amendment) Bill, this Bill and the criminal LAW (Amendment) Bill are rattier bad specimens of panic legislation, and of all legislation that is the worst. one particular subject with which this Bill deals is one of the very worst subjects which we can select for panic legislation, because it is one of the most difficult things to legislate for that can possibly be presented to any assembly of workers; it is full of pitfalls and subtleties, and requires an almost lifelong acquaintance with the technical and medical aspects of the case. Now, I was delighted to hear the hon. Member for Derby, and the view which he put forward on behalf of the profession to which I was proud to belong. That profession has never gained, but, on the contrary, has lost ground whenever an attempt has been made, as it frequently has been made, in its past history, to obtain a monopoly and to enact severe penalties against any people encroaching upon its privileges. That is a sign not of strength but of weakness. The profession of medicine and surgery is one of the greatest and most blessed that it is the privilege of a human being to enter, but. like all other professions—like the Churches, which have often suffered from the same disease—like all other professions open to human beings, there grows up a spirit of monopoly and hatred of any attempt, on the part of "poachers," if I may call them so, to intrude on the domain which they consider to be sacred to their particular cause. The inevitable result of that has always been to lower the tone of the profession, and to limit and check its desire to obtain knowledge and information from every source, no matter from what quarter it may come. The Government were driven into this, and, as has been so frequently the case, as in many other matters since the War commenced, they are really under the lash of an ignorant and unlearned Press, which, without understanding these matters at all, has called out that something must be done to check this great and terrible evil. It is great and terrible, but the gentlemen who wrote these articles are not at all acquainted with the history of the various efforts and attempts that have been made to deal with this great and terrible evil; 2112 their idea is this—we saw it in the Committee upstairs—"put into your Bill stringent Clauses inflicting severe punishments," and that has been done. That is the last way we should proceed; if we pass these drastic Bills with severe penalties, and apply them, either the Bill becomes entirely inoperative and is proved to be useless in that way, or else you raise a tremendous body of public opinion against you, and its operation is impeded in that way. Now, why should the Government undertake to raise this vast question of the legal protection of the profession of medicine on this one particular issue and in respect of this one particular disease? I think that is one of the most difficult and drastic questions which the Government could possibly raise, and this is a most drastic example of the danger. The hon. Gentleman who spoke from the Front Bench made a long and efficient speech, but he never referred to this Bill at all. He was talking about the Criminal Law (Amendment) Bill, which is not before the House at all. His speech only shows the temper of mind in which, at the present moment, the public, some Members of the House and the Press approach this subject. Now, this proposal has for its object to force everybody who has the misfortune to contract one of these diseases to place himself under the care of a qualified medical man. I want to say, first of all, that it is a long time since I studied medicine, but I am sorry to say that in those days—J hope it has improved since then—to imagine that because you placed yourself under the care of a qualified medical man who had a degree that you had therefore placed yourself under the care of a man who had had any experience in the treatment of this disease or was fitted to deal with it. was one of the greatest delusions that could possibly be held.
§ Mr. DILLON
I am very sorry to hear it, because I have been out of the medical world for a long time, but in my day men were turned out of the schools duly qualified who could not have diagnosed this disease, and were wholly incompetent to treat it. I pass that by, however, but it only shows the enormous difficulty of Bills of this kind. Looking at it from a broader point of view, as regards the treatment by alleged quacks, or by nonqualified men—because it does not follow absolutely that a non-qualified man should 2113 be a quack—it is an absolute fact that some very great improvements in medicine and surgery have been the result of the wit and intelligence of a non-qualified man. Now, I myself, travelling in Italy many years ago, met a gentleman who introduced himself to me—we travelled for some days together—as Mr. Ainger, of Boston. He told me the whole history of his discovery of Ainger's Emulsion, which is very well known to medical Members of this House, and which is now prescribed throughout the civilised earth by qualified men as a very efficient remedy for a certain disease of the chest, and many other sorts of diseases. The result of the discovery was that he made a colossal fortune, and this remedy is now prescribed by thousands of qualified men. But when he first started his remedy, as he explained to me—it had arisen in his mind through reading medical books and observing certain difficulties in the administration of one particular drug which was known to be very effective in this way, but which could not be obtained in a digestible and easily stimulated form; and after years of labour he succeeded, with the assistance of some chemists whom he hired, in obtaining this drug in that form—the qualified medical men of Boston declared war on (him, and he had the greatest possible difficulty in getting anybody to take his drug. Now, this Bill would have actually put him in gaol, and would have made it impossible for him to produce this remedy. That would be the case in a great many other things.
There is another aspect which I would recommend to Members of this House. One hon. Gentleman said that everybody knew that mercury was a specific in this unhappy disease. There is a great amount of difference of opinion in the medical profession on that, and I know that when I was in practice in the medical profession anybody who recommended mercury as a specific would have been denounced as a quack. It had passed entirely out of use, and we were taught, in the school of that time, the most appalling stories of the ruin and destruction that had been wrought on tens of thousands of unhappy men who had been placed in the hands of duly qualified practitioners and treated by mercury; how they were slowly ruined, and their constitutions destroyed for life. We were warned against that treatment. But that treatment, I know, had, for forty years before, been accepted in the schools as 2114 the authorised treatment for every person suffering from this disease Now, you must always remember, as the hon. Member for Derby said, that medicine is a progressive science. It has made great mistakes, which have often extended over whole generations of practitioners and inflicted great suffering on the human race. But observe the effect of that principle, which cannot be denied, on this Bill. Salvarsan is now, I believe, the accepted remedy. Who can tell that the time may not come when Salvarsan will meet the fate of mercury and be denounced as one of the greatest curses, as I have heard it denounced, that ever fell on the human race? I believe it has somewhat recovered its name now, but that was the accepted doctrine at the schools when I was at school. Salvarsan may meet the same fate, and yet you propose to force the whole population to accept whatever is the orthodox medicine or treatment of the day and be guilty almost of a criminal offence; in fact, you cut off every resource from them unless they accept the remedy. That is a most dangerous principle, and what is the effect of it? I have watched that very much in the course of the years I have been in the House, and the effect of it is that the moment you commence legislation on these lines you create a set of objectors, conscientious or otherwise, and they increase. You might conceive of such legislation as this in Germany, where the people are more amenable to discipline and are accustomed to obey without calling in question whatever the State lays down, but the instinct of the Englishman is to kick. If you say to him, "You must do this," his instinct is to say, "I am damned if I will"; and if your legislation is on the face of it unreasonable and unjust, you are almost certain to be faced with popular opposition so widespread as to make your Bill impossible to administer. Therefore, I think you ought to be very cautious how you pass it.
Further, I cannot understand on what principle the Government has split these Bills into two. The idea was to pass a measure dealing with the whole evil. Instead of that, the Government sent their Bill upstairs, and the result, which has rather justified the view of those who voted against sending it upstairs, is that we have an extraordinary Bill, which its author and draftsmen will not recognise when it gets through the House, if it ever 2115 does, dealing with a large section of the subject, and now they bring down this Bill from the House of Lords dealing with the same subject—another side of it, but a portion which ought to be in the main measure—and when the two Bills come before the House everyone will say that the common sense of it will be to get the whole scheme together, so that we can understand the whole plan of the Government to meet this evil. I think the Government will realise, before they have done with these two Bills, that they have put the cart before the horse. They have gone at this troublesome, sad, horrible and painful subject in a wrong spirit, that is the spirit of heavy penalties. Many of their penalties have been knocked to pieces in Committee. More will be knocked to pieces when the Bill conies into the House this week. Some of them were grotesque in their severity and in their operation. In my opinion the way to deal with the subject would have been to go at it first from the moral and economical side, because a great deal of the evil of this arises from economical causes—and also to have set up a Ministry of Health, the necessity of which, I rejoice to observe, has at last dawned upon the people of this country. It ought years ago to have occupied one of the foremost positions in the Ministry that is ruling this country.
I have heard eloquent and heart-rending appeals about soldiers in this city wandering about and exposed to the most hideous temptations; It is perfectly true. You have only to go to Victoria, or any of the other great railway stations, and it is a reproach to the people of this country and the Government, and above all the War Office, to see crowds of strangers—soldiers—wandering about the streets, sitting down on the edge of railings and all kinds of places, where there ought to have been, according as this vast agglomeration of soldiers grew up, comfortable and attractive resorts abundantly provided for them. That is the way to keep them off the streets and out of these filthy public houses, all of which ought to have been closed up long ago in the neighbourhood of the big stations, and there ought to have been clubs. There are one or two started lately, but there ought to be abundant clubs where the soldiers could be made welcome and have social entertainment, agreeable amusement, warmth, light and comfort provided for them without wandering about the 2116 streets, as I have often seen them, wet and miserable, and therefore the victims of all kinds of temptation. These are the things which ought to be done, though I do not say that will complete the subject. The attempt to exterminate this disease by penal methods ought to be postponed until all other means have been exhausted and until you have got a Ministry of Health and a great machine, organised with the best intellect of the country, to take it into control. I have talked this matter over with medical men, and there are medical men who are so attracted—I do not quarrel with them—by the idea of trampling under foot all human feelings in the pursuit of an ideal state of health, that they take the view that we could, if we were brave enough, exterminate this disease altogether. So we could. I am convinced we could. We could exterminate it by compelling every human being in this country to submit to medical examination every six months, and seizing all the people infected with the disease and locking them up until they were cured. That would exterminate syphilis and all these diseases from this country within five years. But where is the man who is brave enough to propose it? You could exterminate this as you exterminated rabies by muzzling dogs. There are medical men who boldly advocate that course. I rather admire their ideals, but it is a bold course, and I do not think any statesman for a long time to come will have the courage to propose it. These little, petty remedies which we are now invited to apply ourselves to have most of the evils of a really radical system like that without the benefits, and therefore in my opinion the whole of this legislation is panic legislation. It is not a thought-out scheme, it is not practicable, it is a gross interference with public liberty, and it is legislation against one sex. There is no attempt in either Bill to do justice as between the two sexes, and there are proposals which some of us will fight to the bitter end before we allow them to pass, because they are scandalously unjust to the unhappy women on whom they would fall, and therefore I think the Government would be well advised to withdraw both Bills and reconsider them.
§ Colonel Sir H. GREENWOOD
With certain of the hon. Member's remarks in reference to the difficulties which beset soldiers I am in hearty agreement, and 2117 I should like to emphasise what was said by my hon. and gallant Friend the Member for East Dorsetshire (Captain Guest) in reference to the perverse sort of hospitality that has welcomed Colonial, and especially Canadian, troops to this Mother Country. It is in keeping with what the hon. Member (Mr. Dillon) has just said. Every Canadian soldier who comes to this country comes after months of segregation in a camp in Canada. He is examined before he goes on board the transport. That transport takes two, three, and sometimes four weeks to reach this country. He is examined on landing. He arrives here not only a first-class specimen of a fine soldier, but as cleanlimbed and as clean a man as the Creator Himself could create. The figures given by my hon. and gallant Friend, namely, that in one only of the three Canadian camps in this country 7,000 of these clean Canadian boys went through the hospital for venereal disease in fourteen months, is a record of negligence, largely Governmental, that is not only a great discredit to any Government in this country but has an effect in Canada which I can assure the House does not make for a better feeling with the Home Country, and does not make for what we all desire—Imperial unity. During a recent visit to the Dominion I met many fathers and mothers whose boys had been sent back to Canada debilitated and ruined for life because they had been enmeshed by some of the harpies who are still allowed to go very near the camps, and especially in this great Metropolis, and again and again these parents have said to me, "We do not mind our boys dying on the field of battle for old England, but to think that we sent our sons to England to come back to us ruined in health, and a disgrace to us, to them, and to the country, is something that the Home Country should never ask us to bear." To think that this is still going on is a criticism upon the Front Bench which I hope, by this and other Bills, and by administrative action, will be remedied as soon as possible.
I welcome the Bill only as an instalment. It is a very small Bill, which deals with what I think is an important phase in this great question of venereal disease, and I disagree absolutely with the hon Member (Mr. Dillon) when he says it is the result of the lash of an ignorant and intolerant Press. That is not so. The Bill is supported by every authority which has dealt with the question. It is supported by all 2118 the county councils and municipal associations of this country—the very bodies which must administer, directly or indirectly, every Act of this Parliament which deals with this very serious menace to the health of the community. It is not fair, therefore, to say the Bill is introduced either because of the ignorance or intolerance of anyone. I did not know before that the hon. Member had been a medical man in his youth, which makes his speech all the more effective and interesting. I am sure he regrets as much as we all do that his student days were a long time ago. Happily he is quite independent of the medical profession as far as the vigour of his health is concerned. We need never deplore that he chose the green benches of the House rather than the other profession as his career. For thirty or forty years the medical profession have dealt with these diseases, and are they to be set aside?
§ Mr. DILLON
How do you know that thirty or forty years hence there may not be some other treatment adopted by the medical profession?
§ Sir H. GREENWOOD
All we are dealing with in this Bill are forms of a disease which require personal and immediate diagnosis if they are to be cured at all. We know that the use of a certain drug immediately applied will stop the infectivity of this disease and will result in a permanent cure. That is not disputed. [HON. MEMBERS: "No; it is !"] I have not heard it disputed by anyone who speaks with authority in the medical profession.
§ Sir H. GREENWOOD
It is not disputed by the medical profession, and in these three phases with which the Bill deals, a certain drug, if used in time, will work a permanent and quick cure. I submit, therefore, that this measure is only incorporating the stage of progress in medical science at which we have arrived to-day. If, in the next year or so, or at any time later, another stage is arrived at, then, if necessary, we can have another Bill. The House of Commons is not bound by any tradition or by any feeling of limit to its power; it is all-powerful. The hon. Member for East Mayo (Mr. Dillon) made a comparison between the treatment of lung disease with some emulsion or other 2119 and the opposition offered that remedy by the medical profession, but that is a comparison which, when applied to this disease, will not stand for a moment. The three phases of the disease provided for by this Bill depend upon immediate personal diagnosis, and the very essence of this measure is that the unfortunate people who contract this disease shall be certain of immediate professional and sympathetic treatment, in their own interests and in the interests of the whole community. I congratulate the President of the Local Government Board (Lord Rhondda), and the Parliamentary Secretary to the Local Government Board (Mr. Hayes Fisher), on having introduced this Bill, which is a great advance in the study of health. I know that they are backed up by the great local authorities of the country. It is regrettable to think that only war makes clear the necessity of healthy men, and of dealing with this and other diseases; but, at any rate, we have this opportunity of passing a Bill that I hope will go through the House of Commons, and will be applied as rapidly as the Parliamentary Secretary to the Local Government Board said it is already being applied, to various areas throughout the country. I think it is an earnest effort to deal with a disease which is largely due to lax administration in the past.
§ Sir G. RADFORD
I congratulate the right hon. Gentleman who introduced this measure on having obtained what I think is the second supporter of the Bill. The hon. and gallant Member on the Front Bench gave it his support, and, I think, promised to vote for it, although, apparently, it is not the measure he wanted, and that he desired to see a very different one. The whale catches a sprat, but wants something more, and the hon. and gallant Member apparently hopes to get something more later on. I agree with my hon. Friend below the Gangway in his observations as to the right hon. Gentleman bringing in two Bills of a similar character, a procedure which will largely increase the difficulty of this House in dealing with the matter. By taking that course he has put the House in a difficult position in deciding with regard to these two measures. We have had great difficulty upstairs in dealing with the Criminal Law (Amendment) Bill, because we did not know what the Bill now before us would contain, and we shall be in a similar difficulty in dealing with this 2120 Bill, because we will have to dovetail it in with the other, so that the two may become one whole. The adoption of such a course places burdens on Members' shoulders which they ought not to be called upon to bear, and alone it is almost a sufficient reason for rejecting this measure. While listening to the speech of the right hon. Gentleman in introducing it, I found that he himself gave some very excellent reasons either for dropping the Bill, or for postponing it, until the effect of the administrative scheme, to which he referred, had been duly ascertained. The right hon. Gentleman has put forward a method which, by securing confidential treatment of venereal disease, will meet most of the difficulties which have to be faced. He told us, in effect, that the measure was not pressing, that it was not a War measure, that the disease was not increasing, yet we are to devote our energies, that ought to be applied to the prosecuting of the War—and in that way they would be better employed—to dealing with a measure which has nothing whatever to do with the business which mainly occupies our minds at the present time. The right hon. Gentleman ingeniously cited the Reports of the Royal Commission, and he hinted at another Report which he did not cite. He did not dare to say, and could not say, that any Royal Commission had ever recommended the measure that he has brought forward to-day. If that is not a reason for rejecting it, certainly it is not a reason for proceeding with it. The medical profession, which has something to do with this matter, and on whom its success largely depends, do not want the Bill, and do not like it.
I accept the statement of my hon. Friend the Member for Derby that the medical profession generally hold liberal views on the subject of compulsion, and do not desire to have any measure of compulsion introduced. The right hon. Gentleman apparently thinks that he is doing a virtuous action, and in my experience a politician is never so dangerous as when he is quite sure that he is virtuous. I wish to speak with great respect of the medical profession, but we know that their opinions differ from time to time, and that a remedy considered infallible in one period, at another is discarded as an altogether impossible one. I can remember the time when there was inoculation, which was very popular indeed; it was spoken of highly by a great many 2121 people who had gone through it, and the medical profession showed the number of deaths of persons who had been inoculated and of persons who had not been inoculated; but now inoculation is a criminal offence, and Salvarsan is the infallible specific for venereal disease. I can remember the time when mercury was recommended. Which of these two poisons is really the better to be applied? I do not know, and must leave it to another age to find out. I think the Bill has not been carefully thought out, and that its being brought forward is the result of a spasm of virtuous indignation. It is not clear that it will be of any good at all, and therefore I think that it might well be delayed. I hope the House will not be carried away by the arguments of my hon. Friend on the Front Bench, who wants this Bill and a great deal more. What he really wants is the reintroduction of the Contagious Diseases Act, and the House would not agree to that. I hope the supporters of the right hon. Gentleman who introduced this Bill will not be many in number, but I am afraid that my hon. Friend will be one of them. If any Member sees fit to move the rejection of the Bill I shall be glad to support him in the Lobby, in order to save this House from what I think would be futile labour in carrying the Bill through Committee, and reducing it to a form in which it might be acceptable to the House, and then, when it has reached that stage, finding that the best thing to do with it would be to chuck it into the dustbin.
§ Mr. BOYTON
I do not think that the diagnosis of the hon. Member opposite in regard to this Bill will turn out to be correct. I think it has a very great deal of support, and it would seem hardly necessary, when one is sure as to its result, to unduly prolong proceedings. I should not have risen in this occasion had it not been for some remarks by the hon. Gentleman who has just spoken and the hon. Member for East Mayo (Mr. Dillon), after the very clear and dignified speech of the hon. Member for Derby, who so well dealt with the whole question. It is quite clear that the medical profession take a dignified position in regard to this as to any other legislation which this House desires to promote. I am not so well qualified as the hon. Member for Derby to speak on behalf of the medical profession, but I represent a constituency which has within its confines, I suppose, more medi- 2122 cal men than are to be found in any other constituency in the United Kingdom. The medical men in my Constituency are very highly placed members of a distinguished profession, and I may tell the hon. Member for East Mayo and the hon. Member who has just spoken that they follow the dignified view of the hon. Member for Derby, and, so far as I am aware, the medical profession in my Constituency—and they are a very large body of men—leave a Bill of this kind to the House of Commons to decide. It is a Bill which is the result of pressure of public opinion: it is not the outcome of a trade union, as is suggested of the medical profession. The medical profession, as represented by the hon. Member for Derby, have a clean slate. It is not their desire, I am sure, to get any close legislation of a trade union character.
§ 7.0 p.m.
§ Mr. BOYTON
I acquit the hon. Member of that, but I have heard it said that this Bill was promoted by the medical profession or largely promoted by them. Representing a very large number of medical men, I can say that is not the case. No direct representations have come to me from any medical man in connection with this Bill I am pleased to say that, so far from desiring to interfere, as a rule, in political matters or anything this House does, they do not attempt to use their very great influence. I am firmly of opinion that this Bill is the outcome of pressure which has at last been brought to bear on the Government, and I welcome it most heartily and the other Bill. I think they are both necessary, and I hope they will pass.
I suppose hon. Members on all sides are in entire sympathy with the objects of the Government. We recognise that although this is a disappearing evil and has been reducing during a long course of years, and that, while it is not so great as it was two years ago, still it is one which does require to be dealt with, and the question is whether this particular measure is likely to enable us the more effectively to deal with it. The first thing it will do is to make almost impossible the conducting of the ordinary chemist and druggist business. It will be dangerous for any chemist to sell any medicine of any kind unless he has a prescrip- 2123 tion, and if a person purchases medicine otherwise it will become his duty, I suppose, to ask whether it is for one of these specific diseases or not. The danger pointed out by the hon. Member for Stepney is a very real one, and this Bill will, I believe, make very much greater the dangers which exist in connection with this business. Another danger is this: Whatever the intention of the medical profession may be with regard to this Bill—and I can quite understand the speech of the last hon. Member—the effect will be to create a close co-operation which alone can deal with this particular disease as none but qualified men are to be allowed to give advice or prescribe or give medicines to persons suffering from these diseases. It is quite right that none but qualified men should be allowed to deal with matters of the kind, but what kind of qualification is the man to have? The ordinary medical man may never have treated this disease and may know nothing about it, except what he has read in text-books, and he may not even have attended lectures on the subject. He may, therefore, be absolutely unqualified, except for the fact that he has passed certain medical examinations. If you can guarantee that each person dealing with patients shall be qualified to deal with this particular disease, then there may be something to be said for a proposal of that kind. The tendency of recent treatment has been to rule out the ordinary attendant to patients, and to transfer the diagnosis from clinical observation to the bacteriological, especially in regard to diseases of this kind. Tests are applied in the laboratory in the absence of any knowledge of the patient, and the tendency will be to make the corporation become closed and to bring the treatment of these diseases within the compass of a very limited number of specialists, who will keep it in their hands as far as practical, and it will make no progress in medicine except along the lines they lay down. Science seeks to know everything about a subject, and to get experience in all kinds of directions. They will rule out all treatment except orthodox treatment, and this will not tend to the discovery of real cures of this disease.
Something has been said about Salvarsan. I am not a medical man, and I know nothing about it, but I have seen the. statement that the introduction of 2124 Salvarsan would be the destruction of this disease. We do know evidence was given before the Commission that in the treatment by the discoverer of Salvarsan a large number of deaths took place. The only thing certain is its uncertainty. You are going by means of this Bill to place it in the power of the qualified men of the medical profession to make impossible to sufferers any kind of cure except their cure. I do not think that that would tend to eliminate the disease from our midst. You make it dangerous for persons to give advice and to tell others of their own experience, and doing so might be so interpreted as to lead to imprisonment for two years for a perfectly innocent and proper thing. I do not believe these measures will tend in the direction in which they are intended. I believe that the cure for this evil in our midst is not a legal cure, but that it is along moral lines we shall eliminate this disease, which has become less widespread than it was a few years ago, because I believe there has been an improvement in the morals of the people. It is along the lines of education rather than repressive legislation I think will be the promising path which we ought to tread if we are to eliminate this disease. As one who has had to travel in Committee through all the nauseous details of the other Bill, I wish to say that I think we ought to have had this Bill alongside the other and not have to go over the matter twice. I think there are very few friends of this Bill in the House; only two hon. Members have spoken in its favour, and I hope the Government will withdraw it.
§ Mr. D. MASON
I think the reason why very many hon. Members have not spoken in support of the Bill is because they believe that the best way to advance the Bill is to keep silent and allow it to get a Second Beading. I think the speech of the hon. Member (Sir G. Rad-ford) was very unconvincing. The hon. Member who has just spoken did not advance any arguments of any substance against the Bill. He said it would stop all experiments.
I did not say that. I said it would prevent any experience' outside the experience of the profession.
§ Mr. MASON
I apprehend this is to put an end to quacks and those not qualified from experimenting on human bodies. I am sure the hon. Member for Derby (Sir W. Collins), who made a most admirable speech, will bear me out that this will not discourage the medical faculty from still further research. The hon. Member (Mr. Chancellor) said this would ruin the chemist's business, but surely this is not such an enormous business that it is going to do so. I think the hon. Member rather exaggerated the dangers and the difficulties. The Bill is a great step upward in trying to meet this terrible menace. The hon. Member told us the evil is decreasing, but owing to the War it has, perhaps, increased in certain quarters. If the Bill leads to a better state of health and is the beginning of the foundation of that Minister of Health which the hon. Member for East Mayo (Mr. Dillon) welcomed, I do think it is worthy of our support.
§ Mr. FRANCE
If this Bill were the means of bringing the medical profession more directly and more interested in connection with these diseases, especially in connection with the schemes to which the right hon. Gentleman has referred, throughout the country, I for one should support it as far as it goes. Reference has been made to this evil as a diminishing evil. That view was put forward by the right hon. Gentleman to-day and by the last speaker. I do not understand on what ground that optimistic view is taken.
§ Mr. HAYES FISHER
I merely said there were no figures to show it was increasing. I did not give any countenance to the idea that it was decreasing.
§ Mr. FRANCE
I cannot enter into a discussion between the right hon. Gentleman and the hon. Gentleman. That view has been expressed. I want to put this view forward, as the matter is one of grave importance when we consider the problem as to whether this Bill is of sufficient magnitude to deal with the seriousness of 2126 the evil. The other day, from the Front Bench, reference was made to the Army, and we were told the figure was 43 per 1,000, or 4 per cent., being less than in previous years in connection with the Army. If 43 per 1,000 was a serious figure, or even higher than that, in the days of a professional Army of something about 250,000 to a maximum of 500,000, it is a very different thing when that figure of 43 per 1,000 has to be considered of an Army which is not a professional Army in the strict sense of the word, and an Army which is a citizen Army, drawn from the Colonies and from country districts, and an Army of men coming from all parts and chosen for their physical fitness. If in the Army it is true, as I believe was said from the Front Bench a few days ago, that there is anything approaching to forty-three per thousand men affected, then the infective effect and the national effect and the Imperial effect of that is of such a magnitude that I agree certainly with the point of view put forward by the hon. and gallant Member that a Bill such as this is doing very little more than touching the fringe of the subject, and that it is almost playing with it. The whole subject is so mixed up with the other Bill that it is not easy to separate the one from the other. But I should like to add something to what has been said by the hon. Member for Sunderland (Colonel Sir Hamar Greenwood) and the hon. Member for East Mayo (Mr. Dillon), that in dealing with an evil which has been aggravated by this great increase of numbers in the Army, I think the Front Bench and the Government, and particularly the War Office, have to shoulder a very heavy responsibility that they have not done more than they have done in the matter. It is only too true to say that if it had not been for the organisation of the work, the splendid work, of the Y.M.C.A. huts, and the provision that they have made—helped, I agree, to some extent by the War Office, but initiated by that outside organisation taking over responsibility which really belongs to the War Office—the situation would have been even worse. The Government must, I think, see that this kind of Bill is not tackling the subject with half enough seriousness. London offers great temptations to men on leave after long segregation, and I wish to add my words to those already spoken here in urging the Government and the War Office to do something more than 2127 they have done to see that practical measures are taken to help the men for whom they are responsible.
§ Question put, and agreed to.
§ Bill read a second time, and committed to a Standing Committee.