§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Batsford.]
§ 2.44 p.m.
§ Mr. Richard Marsh (Greenwich)
It was on 3rd July last year that I raised in this House the problem of what I believe is the terrifying growth of the incidence of venereal disease in this country. As a result, and as often happens following debates of this type, I was bombarded with an enormous volume of correspondence. Much of it, as usual, was from cranks of one type and another, but a great deal was from ordinary people equally disturbed by the problem.
A number of people also queried, I suppose understandably, why I was interested in this matter. I will merely say that I spent some years in the Army working for Command Headquarters and concerned solely with the administration of Defence Regulation 33B. I became interested in the subject professionally then and have been interested ever since.
I make no apology for bringing the subject to this House, because I think that, though it is generally regarded as an unpleasant topic, it has none the less reached proportions which make it a matter of national concern. That is the proposition I shall attempt to put forward. Last year, I tried to introduce a Bill under the Ten Minute Rule in order to deal with the problem, and I gave some figures for new cases of V.D.
Those figures, for 1960, showed 139,506 new cases in that year compared with 94,698 in 1955.The percentages showed that the 1960 figure of new cases was 8 per cent, higher than the figure for 1959, which was in turn 12 per cent, higher than the 1958 figure. The latest figures I have—I gather that later ones are now available to the Minister—show that in 1961 new cases of V.D. reported to the special clinics totalled 141,361.
I do not think that there would be any dispute between any of us that this is a most serious problem and that it has become a national issue. In fairness, it should be said that this is not just a British problem. But this makes 1921 the thing all the more dangerous because of the speed with which people move about the world, as we discovered when there was an epidemic of a different complaint a year or two ago. Such easy movement renders the dangers of any world increase of any particular disease that much more severe to this country.
Out of 105 countries which made returns to the World Health Organisation last year, 76 recorded a significant increase in the figures for V.D. Again the point should be made that this is not just a problem of the coloured sections of the world. I know that the Joint Parliamentary Secretary would not claim that it was, but some people would say that it was a problem purely of coloured people. There are immigrant problems but that is not the issue.
The European figures in general are deplorable. In Denmark, for example, there was a tenfold increase between 1957 and 1961. We are faced with the position where this group of diseases, very serious in nature, is growing very rapidly throughout the world, including Europe and this country. But because it is happening in other countries we have no cause for complacency. The latest figures show that complications of syphilis alone killed 600 people in 1961. More people were killed by syphilis than by tuberculosis, poliomyelitis, scarlet fever and diphtheria together. We are therefore faced with a disease that is killing a large number of people.
That is not the sole point. A very much more serious facet of this problem, and the one with which I want primarily to deal, is the increasing number of children from 11 years upwards who have venereal disease. One of the great difficulties is the widespread lack of knowledge about the disease and the myth that exists among ordinary respectable parents that it involves only the rather dark, murky underworld of professional prostitutes—places and people with whom their children could not have any contact at all—and therefore does not concern them or their families. The result of that attitude is that the ignorance continues, not only among the children but among their parents. Children do not ask their parents about this subject, but, even if they do, in the overwhelming 1922 majority of cases the parents have no more knowledge than their children.
The latest figures show that a quarter of all infected females were between 15 and 19 years of age, and of the total increase among females between 1957 and 1961 one-third were teen-agers. It is time that it was quite brutally said that thousands of our teen-agers and a not inconsiderable number of school children have venereal disease. That is the hard, brutal fact. This group of diseases will render some of the sufferers blind, crippled or insane, will kill a few of them, and cause suffering to numbers of children who have not yet even been conceived.
There is no need to labour the horrors of some of this group of diseases. Nor is there much point in moralising. Morality is an entirely separate issue, and one of the things that this House cannot do, and never has been able to do, is to legislate very successfully about sex. On the other hand, the position is now sufficiently serious for the House to take cognisance of it and see if there is anything that can be done about it.
We can put up more posters, but the figures of the last ten years show that very little will be achieved by that. We can say that younger people should not have casual sexual relationships, but I do not think that anybody has the slightest hope that that would have very much effect. We therefore have to accept this as a major, serious and growing problem, that none of the present methods appear to have altered the very serious and steady increase in the incidence of the disease, and decide whether there is anything further that the House can do.
One thing we could do would be to introduce legislation on the lines of Defence Regulation 33B, brought in during the war. That had two effects. It enabled medical practitioners to inform persons that they were believed to require treatment for examination, and absolved them from any danger of libel action. It also enabled the authorities, on the first notification, to inform the alleged contact that he had been so nominated and, on the second notification concerning the same person, to insist upon that person receiving examination and treatment.
Is the tracing of contacts important? I quote as typical the case of a young business man who reported to a London clinic. He arranged that a woman whose 1923 name he gave should attend for treatment. Incidentally, asking patients themselves to ensure that someone else should attend for treatment is not a very efficient method. I can imagine a number of people who, even if they had the names, would not feel enthusiastic about going to their former girl friend and telling her they thought that they might have caught syphilis from her.
This young man arranged for his woman contact to attend for treatment. He subsequently revealed the names of nine other contacts who reported for examination, and six were discovered also to be suffering from gonorrhoea. The check continued, and four of those six were subsequently discovered to have infected one other person. From the one original case reporting for treatment no less than twelve infected cases were traced. That is the key problem, and I submit that the present methods of tracing contacts are inadequate.
The only argument I have heard against Defence Regulation 33B is that it is a breach of the traditional defence of individual liberty; that it is an infringement of the rights of the individual to insist that he or she should go for examination and treatment, and is contained in no other legislation. I regard that as pure, woolly, doctrinaire liberalism. I appreciate and will defend the freedom of individuals to preserve their liberties to the maximum extent in an organised society, but, in the light of the figures and the rate at which they are increasing, it is not sensible to suggest that a person's liberty possibly to infect other people with syphilis is something with which we should not be concerned and, since other methods have not worked, some such step as this should be carefully considered.
I hope that the Minister will tell us whether there are any other arguments than that against this proposition. I know that after the last speech I made on the subject, I was approached by a number of very respectable large organisations which said that forced treatment and inspection of this type was a monstrous infringement of the built-in rights of the individual. I am not prepared to support those rights in this respect, and if a majority of people knew 1924 what the figures were, and the speed at which they are increasing all over the world they, too, would have some doubts about whether, in the interests of their children, they should support those rights either.
My second point is not an original one, but was raised recently at a conference at Copenhagen where were read a number of papers of considerable interest on this subject. If the dangers of venereal disease are increasing in this country and in others, is it not time that the Ministry provided facilities not only for the treatment of V.D., but for the immunisation of persons against the contraction of the disease?
I know that this suggestion will raise a storm of protest, but one of the advantages of having a good safe Parliamentary seat is that one is not so worried about a storm of protest or an issue such as this. Disregarding whether it is right or wrong, Christian or un-Christian, I think we have to accept the fact that, on the evidence, there is likely to be an increase in casual sexual relationships rather than a decrease, and in present circumstances that leads one to suppose that there will be an increase in the number of persons contracting V.D. I think we have to face that fact and provide the facilities for people who are going to take these risks—and they are a much larger proportion of the population than we are honest enough to accept—to be immunised to see whether there is something we can do to slow down the rate of increase of this complaint.
I do not want to take up any further time on this subject except to say that this one series of figures about the extent to which this is affecting children all over the country—and the figures for the London area are about the worst in the country—shows that this is becoming a bigger problem among children who, if they were the children of hon. Members, would still be at school. Indeed, some of the children concerned could be the children of hon. Members because those affected are not confined to any particular social group. I gather that a survey is now being carried out, but as far as I can establish there is no social pattern for this. There is no particular social or regional group concerned other than where there are ports and things of that sort.
1925 If this disease is becoming as widespread and as dangerous as I think it is, the House ought to regard it as something which we must face to see whether there is a new move that we can make to alleviate what could be a dangerous threat to a large number of children who, in the overwhelming majority of cases, are not particularly wicked. They are certainly not evil children—children never are. They may be stupid and a little silly, but they run the risk of jeopardising their future and that of their unborn children. Those who object to the proposition which I have put forward as a possible method of combating this will, I hope, have some alternative proposal to make.
§ 3.2 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
In raising this afternoon the subject of the recent increase in the incidence of venereal disease the hon. Member for Greenwich (Mr. Marsh) has drawn attention to a very serious social problem, one which surely must be of concern to all responsible people. I am glad that the hon. Gentleman has done so, and I think that the House can be assured that the Government share his concern and are not in way complacent about tile present situation.
Perhaps I might first say something about the factual background to this debate. After reaching in 1946 a peak which reflected the exceptional conditions of the later years of the Second World War, the number of new cases treated in hospital clinics of infection by the principal venereal diseases, gonorrhoea and syphilis, fell steadily until 1954. Since then, I regret to say, this welcome trend has been reversed, and the number of such new cases of gonorrhoea in 1961 was more than double that in 1954. It is perhaps a hopeful sign that the figures for 1962, which are not yet published, suggest that the trend has at last been temporarily arrested. Compared with 1961, the total number of new cases of gonorrhoea fell from over 37,000 to 35,438, and of syphilis from over 4,400 to 4,120. However, there was a slight rise in the number of cases of acquired syphilis diagnosed within the first year of infection.
1926 For the record, I should make plain that the figures quoted by the hon. Gentleman are the total number of cases attending V.D. clinics. They include cases of people found to be suffering from conditions which were not venereal disease. In 1961, a total of about 141,000 people attended clinics, but this included 75,000 with other conditions, of which 40,000 required no treatment at all.
Perhaps I could now say something about research into trends. A great deal of valuable information has been obtained by the British Co-operative Clinical Group of Venereologists who have studied cases of gonorrhoea treated each year in an increasing number of representative clinics throughout the country. Undoubtedly, the most disturbing fact emerging from their studies is the increase in gonorrhoea among young people between the ages of 15 and 24 years. Sixty-four per cent, of the female and 37 per cent, of the male cases covered by these studies in 1962 were within this age span.
The high rate of infection among these younger age groups indicated by these studies is particularly worrying, and in future the statistical returns made by all clinics direct to my Department will provide for an age break-down so that an analysis of national figures can be made. We will therefore have in future a clearer picture than we have had up to now. I entirely agree with the remarks of the hon. Member about the seriousness of the position in regard to young people. The Central Council for Health Education is carrying out an investigation into the sexual behaviour of young people, and a specialist committee of the British Medical Association has been considering the more general problems of venereal disease. We are hopeful that the results of both these studies will point to new ways of attacking the problem.
As the hon. Member has raised this question, I want to treat the House with complete frankness. A very important factor in the spread of infection is that girls or women infected with gonorrhoea often show no signs or symptoms of the disease. In fact, they may very well be unaware that they are diseased and therefore do not seek advice or treatment. If such women are promiscuous, their condition is obviously a menace 1927 not only to themselves but to others, because they provide a pool of infection which it is most difficult to detect and treat.
I take this opportunity—and this is why I am most grateful to the hon. Gentleman for raising this matter—strongly to emphasise how important it is for anyone, man or woman, who has been exposed to any possibility of infection to go to a hospital clinic for examination and, if necessary, treatment. Whether a venereal disease has given rise to symptoms or not, its diagnosis and treatment is essential to future health. There is still a great deal of ignorance on this point, and it is dangerous ignorance.
The problem is most acute in the case of women. In past years, thousands of men have presented themselves at clinics for a check-up solely because they have been exposed to infection through promiscuity. Many fewer women have done so. In one clinic recently, out of 124 young women with no symptoms who attended simply for a check-up, 80 were found to have gonorrhoea.
I emphasise that at hospital venereal disease clinics the relationship between doctors and patients is, as would be expected, one of complete confidence. Examination and treatment are painless and the cure rapid and certain. If anyone does not know where a local clinic is, he can quite easily find out in a very simple way by ringing up the health department of the local authority or any large hospital which, if it has no clinic of its own, will know where the nearest one is to be found. I hope that the widest publicity can be given to this information.
The hon. Gentleman mentioned in passing the coloured immigrant aspect of the problem. Studies in clinics covering about 90 per cent, of all cases suggest that over half the males attending clinics are immigrants. But I think I should say that experience indicates that few immigrants bring the infection into this country. The vast majority contract the disease here after arrival. The majority of female patients are British.
Now I turn to the question which the hon. Gentleman asked me very fairly, the question of compulsion. He suggested that the problem was so serious that compulsory measures are 1928 necessary. I am sure the House would agree that compulsory examination and treatment would be alien to our traditions and could be justified only in the most exceptional circumstances. The hon. Gentleman chose to apply to these traditions the description "pure doctrinaire liberalism".
§ Mr. Braine
"Pure doctrinaire woolly liberalism". Well, I do hot know about that, but there are, of course, considerable practical difficulties to implementing the proposal which he has in mind. After all, we are not operating in a vacuum.
We had experience of such measures under Defence Regulation 33B between 1942 and 1947, and that experience provides no indication that compulsion would be effective. On the contrary, I am advised that it could have unfortunate consequences. Defence Regulation 33B provided for compulsory notification of suspected sources of infection when named by patients. It provided for compulsory examination of any person named as a source of infection by two or more patients and, if necessary, for that person's treatment.
I am bound to say that these powers of compulsion could seldom be applied because sources were seldom identified by more than one patient. While the Regulation was in force, contact tracing in practice continued to be based on informal voluntary action, as it had been before and as it has been since. In other words, we had experience of this during a crucial period and the existence of the Regulation did not help materially to solve the problem. The existence of the Regulation did not increase the number of contacts receiving treatment.
Moreover, and I am bound to say this in the House, the reintroduction of compulsion would impair the confidence which exists at present between doctor and patient. It would be likely, in many cases, to deter patients from attending a clinic at all and might lead to an undesirable increase in attempted self-treatment and unqualified treatment.
May I now turn to the question of immunisation.
§ Mr. Marsh
I am grateful to the hon. Gentleman for giving way. I am particularly disturbed, to give the classic case 1929 of the question of compulsion. On page 62 of the Report of 1961 there is a specific reference to an incident at Holloway Prison. The number of known prostitutes admitted to the prison in 1961 was 537, and of those only 476 submitted to examination. Does not the hon. Gentleman honestly think that there is something a little absurd in a known professional prostitute being in the custody of one of Her Majesty's Prisons, an obvious person to spread venereal disease on a large scale, being permitted to refuse to be examined?
§ Mr. Braine
What the hon. Gentleman is now suggesting is that a specific class of person held in custody in one of Her Majesty's prisons might be subjected to compulsory examination and treatment. That is part of but a separate question from the general proposition that we should introduce compulsory measures, which were found to be ineffective before, to cover the population as a whole. On the other hand, I do not wish to rule completely out of court any suggestion that that problem might be looked at. I do not think that that argument necessarily invalidates what I have said about the broad question of compulsion.
§ Mr. H. Hynd (Accrington)
Is there not another precedent in certain parts of the Commonwealth where there is compulsory notification of leprosy?
§ Mr. Braine
I do not think I can go any further in this connection. Leprosy is not a condition which we have in this country. I am not saying that we cannot draw parallels or anything of that nature. I am merely saying that the general proposition that we should have compulsory powers does not, in the light of past experience, give any promise that we should be able to tackle this serious problem any more effectively than in the way in which we are now doing it.
I turn now to the question of immunisation, a very interesting suggestion made by the hon. Member for Greenwich. He is right. I believe that this suggestion was made at a health conference abroad. The clinics are able to offer an effective cure. I cannot emphasise that too much. If people who fear they may be suffering from this disease will present themselves to the clinics, an effective cure can be provided. How- 1930 ever, on the best advice that I can obtain, the prospect of any effective immunisation seems poor. Many vaccines against gonorrhoea have been tried in the past but none has produced even temporary immunity. Apparently this is a disease which confers no natural immunity and it is possible for patients to be repeatedly infected within a short space of time. In the circumstances, it seems extremely improbable that it will be possible to devise any effective method of artificially induced immunity. The organism which causes syphilis—Treponema pallidum—has never been grown in artificial culture, and until this has been achieved there is, I am advised, no possibility of effective vaccine being prepared.
It would be appropriate at this stage to say something about what is being done at the moment to counter these diseases. Following a review of the problem of venereal disease by my right hon. Friend's Standing Medical Advisory Committee in 1960–61, an extensive programme of visits to clinics is now being undertaken by my Department. In the course of these visits improved arrangements are being discussed for tracing contacts and patients who did not complete their treatment, and the adequacy of the present clinics is also being considered in every respect. A memorandum describing the venereal disease service and the criteria for establishing a true diagnosis of venereal disease was prepared and distributed to general practitioners throughout the country in July last year.
New posters have been introduced to help local health authorities in their health education campaigns. We have given assistance to the Press in compiling articles and to the production of television programmes. I think it true to say that these have helped to focus public attention on the problem. A film version of one television programme will very soon be available through the Central Film Library. We hope to add a second film based on another recent programme.
In addition to general health education, a great deal of effort is being put into contact tracing. A physician in charge of a clinic asks his patient about possible sources of infection and any 1931 contact who may have been infected. Patients are encouraged to ask contacts to go to the clinic for examination and medical officers of health co-operate with clinic physicians in tracing contacts where the patient cannot assist. Many local authorities employ full- or part-time social workers for this purpose.
To sum up: we rely not on compulsion but on making examination and treatment readily and conveniently available free of charge and in strict confidence. What is more, we are making treatment available which is effective. We are attempting to dispel by health education the widespread ignorance which still exists generally, with particular emphasis on the special problem of teen-agers.
I hope that our debate this afternoon will make some contribution to this end. It is of the utmost importance that those who may have been infected, and who therefore may infect others, should attend a hospital clinic for examination and any necessary treatment, which they will find there readily available. I repeat my thanks to the hon. Member for raising this subject this afternoon.
§ 3.22 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I wish to add my congratulations to my hon. Friend the Member for Greenwich (Mr. Marsh) for having sought your permission, Mr. Speaker, for an Adjournment debate on a very important subject indeed. I think all of us who have followed these figures have been extremely disturbed at the serious trend of increase in these two diseases. Naturally we all very much welcome the news the Parliamentary Secretary gave this afternoon that the figures for 1962 show not perhaps an enormous, but nevertheless a marked, improvement. Of course we profoundly hope that this improvement will continue.
I was a little sorry that the Parliamentary Secretary in his opening remarks said that this is a very serious social problem, because it is by no means only—perhaps not even primarily—a social problem; it is also a medical problem. I doubt very much whether the increase in incidence of these 1932 diseases over the period we have beer discussing is itself a measure of the increase in promiscuity among young persons or among the population generally.
I should like to know, if the Parliamentary Secretary could, with the leave of the House, answer one question, namely, the extent to which the Minister's advisers think that this increase is due to a failing of the antibiotics which have been used, indicating a renewal of strength of the organisms which cause these diseases against the antibiotics which were contributing so much. There was a time when some optimistic clinicians thought these diseases were on the way out, but they clearly seem to have got a new lease of life. One would like to know how much this is due to a weakening of the antibiotics in the struggle against syphilis and gonorrhoea.
Of the two solutions to this problem put forward by my hon. Friend, I admit that I rather prefer the second. I, too, may have a streak of woolly doctrinaire liberalism about me, but I am unenthusiastic about compulsory measures unless the situation becomes so very serious that no other solution is thought to be adequate. But I was very interested in what the Parliamentary Secretary had to say about the very minimal success of Defence Regulation 33B when it was in operation.
Although the prospects for immunisation may not be very encouraging, I very much hope that the search will go on. The doctor who attended the conference in Copenhagen—I do not know whether he was a venereologist—appeared to think that this was something which we could look forward to in the future. There is everything to be said for pressing on with research. We must look upon this as a group of serious diseases. This is how I prefer to look at them, not as some sort of inhibitor of sexual promiscuity. That aspect should be a matter for departments other than the Ministry of Health, I suggest, and, in any case, one would find it difficult to respect a moral code for which the sole basis was fear of the consequence of breaking it.
I suggest, therefore, that there is everything to be said for pressing on with research to find a vaccine or preparation for inoculation which might render 1933 the subject immune from these diseases. I hope that the Medical Research Council will be interested in the matter. The Parliamentary Secretary was not very clear about whether his Department was doing anything to promote research. Perhaps he can tell us whether it is.
§ 3.26 p.m.
§ Mr. T. L. Iremonger (Ilford, North)
Before my hon. Friend the Parliamentary Secretary asks the leave of the House, as I think lie may, to reply to some of the further points which have been made, may I ask him to include in anything he sees fit to add a rather more detailed reply to the point made by the hon. Member for Greenwich (Mr. Marsh) about action taken in prisons to deal with both men and women who may be infected or who may, perhaps, benefit from instruction and advice in this matter?
Also, with similar reference to a point about Government initiative and the responsibility of Departments, my hon. Friend referred to the use by local authorities of social workers employed by the health departments. I think that it might be helpful to the House to know exactly what they do and which authorities are helpful and which are inclined to drag their feet. There is a tendency among even very great local authorities to regard this as a subject worth thinking about and, perhaps, talking about but very difficult to do anything about. Which are the active authorities, and what are they doing?
Is my hon. Friend satisfied that his right hon. Friend the Minister of Education is fully alive to his responsibilities in this matter? The hon. Member for St. Pancras, North (Mr. K. Robinson) said that this was not a social problem so much as a medical problem. It is, of course, fundamentally a social problem, a problem of the attitude of young people to their sexual behaviour and also to the risks which they run. How far are education authorities stimulated by the Minister of Education to promote responsibility among teachers in this connection? How far do parent-teacher associations actually take the bull by the horns and do something to overcome the reticence to which the hon. Member for Greenwich referred by saying to parents, "This is something which does happen to children, to your children", warning them of the need for regular examination in appropriate cases?
1934 If my hon. Friend could tell us something about those matters of Departmental responsibility, the House will, I think, be grateful.
§ 3.29 p.m.
§ Mr. Braine
May I, by leave of the House, reply to the points made by the hon. Member for St. Pancras, North (Mr. K. Robinson) and my hon. Friend the Member for Ilford, North (Mr. Iremonger)?
This is, of course, primarily a medical problem, but it is also a very serious social problem. Neither the hon. Member for Greenwich who raised the matter nor I have sought to moralise about it. It is a problem which concerns not only physical health but the health of our society as a whole, and I was using the term "social problem" in that sense.
The hon. Member for St. Pancras, North asked about possible resistance through the use of antibiotics. I am advised that the treatment at present available at the clinics can overcome any resistance induced by antibiotics. He asked about research, and I am glad to be able to tell him that the Medical Research Council is doing research on this matter at the present time. Regarding the wider question about pressing on with research into other aspects, we may take it for granted that the Council is concerned with the whole field of research into illness. As regards vaccines, this is a matter about which obviously one must ask questions. The House may rest assured that we in the Ministry of Health shall continue to ask them. Whether one will get the answers hoped for is quite another matter. But up to date, at any rate, it has not been possible to find a vaccine which would be effective.
My hon. Friend the Member for Ilford, North took up the point which was made by the hon. Member for Greenwich about prisons. Perhaps I should have said—I take the opportunity of saying it now—that, with the Home Office, we are considering whether anything may be done by voluntary measures to bring the facts about venereal diseases more clearly to the knowledge of women and girls in prisons and Borstals so as to persuade them of the benefits of examination and treatment.
I have no evidence that local health authorities are in any way failing in their 1935 duties. In recent months I have had the opportunity to travel to many parts of the country and to discuss health and welfare problems with local authorities. I have been struck by the efficient way in which their duties are carried out, and I have no reason to believe that local authorities are failing in vigour or enthusiasm. We give them every possible encouragement. My hon. Friend asked also about social workers. We should like to have more social workers doing this sort of work. Those that we have are actively engaged in contacting people and visiting them. Without due warning 1936 I do not think that it is possible to go into this aspect in greater detail.
As in every other sphere of social health there is need for the utmost vigilance. I hope that this short but extremely useful debate will help to focus attention of the local health authorities and members of other organisations on what is a very serious problem and one which, as I said at the outset, must be of grave concern to us all.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-six minutes to Four o'clock