diff options
| author | Roger Frank <rfrank@pglaf.org> | 2025-10-15 04:46:33 -0700 |
|---|---|---|
| committer | Roger Frank <rfrank@pglaf.org> | 2025-10-15 04:46:33 -0700 |
| commit | 226b081300cc41787acf28d02ae733481cb8fd9c (patch) | |
| tree | c9d59a1aa2fd26ab8047ed8d2a9f4fab30f816a4 | |
| -rw-r--r-- | .gitattributes | 3 | ||||
| -rw-r--r-- | 15352-0.txt | 3514 | ||||
| -rw-r--r-- | 15352-0.zip | bin | 0 -> 64206 bytes | |||
| -rw-r--r-- | 15352-8.txt | 3511 | ||||
| -rw-r--r-- | 15352-8.zip | bin | 0 -> 64168 bytes | |||
| -rw-r--r-- | 15352-h.zip | bin | 0 -> 121073 bytes | |||
| -rw-r--r-- | 15352-h/15352-h.htm | 4611 | ||||
| -rw-r--r-- | 15352-h/images/img01.jpg | bin | 0 -> 54842 bytes | |||
| -rw-r--r-- | 15352.txt | 3511 | ||||
| -rw-r--r-- | 15352.zip | bin | 0 -> 64139 bytes | |||
| -rw-r--r-- | LICENSE.txt | 11 | ||||
| -rw-r--r-- | README.md | 2 |
12 files changed, 15163 insertions, 0 deletions
diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..6833f05 --- /dev/null +++ b/.gitattributes @@ -0,0 +1,3 @@ +* text=auto +*.txt text +*.md text diff --git a/15352-0.txt b/15352-0.txt new file mode 100644 index 0000000..6e7ecf2 --- /dev/null +++ b/15352-0.txt @@ -0,0 +1,3514 @@ +The Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Venereal Diseases in New Zealand (1922) + Report of the Special Committee of the Board of Health appointed by + the Hon. Minister of Health + + +Author: Committee Of The Board Of Health + +Release Date: March 13, 2005 [EBook #15352] + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES 1922 *** + + + + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + + + + + + + + +1922. + +NEW ZEALAND. + + +VENEREAL DISEASES IN NEW ZEALAND. + + +REPORT OF THE COMMITTEE OF THE BOARD OF HEALTH APPOINTED BY THE HON. +MINISTER OF HEALTH. + + +_Presented to both Houses of the General Assembly by Leave._ + + +CONSTITUTION OF THE COMMITTEE. + +Hon. W.H. TRIGGS, M.L.C., Chairman. +J.S. ELLIOTT, M.D., Member of the Medical Board. +Mr. MURDOCH FRASER (New Plymouth), representing the + Hospital Boards of the Dominion. +J.P. FRENGLEY, M.D., D.P.H., Deputy Director-General of Health. +Lady LUKE, C.B.E. +Sir DONALD McGAVIN, K.C.M.G., C.M.G., D.S.O., Director-General of + Medical Services. + + +CONTENTS. + +PART I.--INTRODUCTORY AND HISTORICAL. Page + +Section 1.--Origin and Scope of Inquiry: Witnesses; Sittings, Date and +Place of; Appreciation of Services rendered 2 + +Section 2.--Venereal Diseases and their Effects: Ignorance, Effect of; +Sex Education for Young; Syphilis and GonorrhÅ“a, Origin and +Description; Treatment after Exposure; Diagnosis, Methods of; Treatment, +Importance of Early and Completed 4 + +Section 3.--Accidental Infection: Sources of Infection; Metchnikoff's +Investigation; Food-conveyance; Lavatories, Towels, Drinking-cups, &c. 5 + +Section 4.--Previous Inquiries and Conferences: Contagious Diseases Act, +England; Royal Commission, 1913, Evidence, View of Compulsory +Notification, Divorce and Venereal Disease, Sex Education, Instruction, +and Propaganda; Australasian Medical Congresses. Committee appointed; +Auckland Congress, 1914, Report presented, Nature of Notification +recommended; Melbourne Conference, 1922, Review of Legislation, Comments +and Recommendations; England, Committee recently appointed to report on +Venereal Diseases 5 + +Section 5.--Legislation in New Zealand, Past and Present: Contagious +Diseases Act, 1869 (A), Reference to; Cases Cited (B) which require New +Legislation to deal with; Hospital and Charitable Institutions Act, 1913 +(C); Detention Provisions; The Prisoners Detention Act, 1915 (D); +Provisions for dealing with Venereal Diseases in Convicted Persons; +Social Hygiene Act, 1917 (E); Provisions of the Act outlined; Subsidy +for Maintenance in Hospitals 7 + + +PART II.--PREVALENCE OF VENEREAL DISEASE IN NEW ZEALAND. + +Section 1.--Medical Statistics (A): Medical Practitioners, Special +Returns from, Cases reported, GonorrhÅ“a and Syphilis: Chancroid; +Prevalence. Clinic Statistics (B): Department of Health Data; Clinic +Distribution; Age Distribution; Marital Condition. Mental Hospital +Statistics (C): Syphilis and Dementia Paralytica; Computations as to +Prevalence of Syphilis based on Fournier's Estimate. Incidence among +Maoris (D): Early Days, Miscarriages; Prevalence at Present, Origin. +Death-certificates (E): Two Certificates, one for Relatives, other for +Registrar; British Empire Statistical Conference, Resolutions passed; +Committee's Conclusion 9 + +Section 2.--Causes of the Prevalence of Venereal Diseases in New +Zealand: Infected Individuals, neglect to undergo or continue Treatment; +Chiropractors; Herbalists: Overseas Introduction; Promiscuous Sexual +Intercourse; Professional Prostitution; Police Evidence; "Amateur" +Prostitution; Social Distribution; Extra-marital Sexual Intercourse, +Result of; Parental Control; Sex Education; Housing and Living +Conditions; Hostels, Advantages of; Moral Imbeciles, Danger from; +Delayed Marriages; Alcohol; Accidental Infections; Dances; Cinema; +Returned Soldiers 11 + + +PART III.--BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASES. + +Section 1.--Education and Moral Control: Chastity, Value of; +Relationship between Sexes; Infected Persons, Responsibility; Church and +Press influence; Parents duty to Children; Pamphlet for Parents; Sex +Hygiene in Schools, Mode of Teaching; School Mothers, Value of, in +Girls' School; Instruction in Sex Hygiene; Adolescents; Moral Standard, +Value of 12 + +Section 2.--Clinics for the Treatment of Venereal Disease: Distribution; +Work performed; Male and Female Attendance; Locality of Clinics; Hours +of Attendance; Lady Doctors; Supply of Apparatus and Drugs for certain +Cases; Advertising Clinics; Extension of Clinics; Training at Clinics +for Nurses, Students, &c.; Cases attending until non-infective; Male and +Female; Lady Patrols; Social Hygiene Society, Work of; Laboratories and +Free Treatment: Complement Fixation Test for GonorrhÅ“a 14 Page +Section 3.--Licensed Brothels: Observations on; Dangers of Infection +from; Statistics; North European Conference's Resolution; Flexner's +Views; American Opinion. 15 + +Section 4.--Exclusion of Venereal Cases from Overseas: Health Act, 1920, +Provisions; Attendances at Clinics; Recommendations; Immigration +Restriction Act and Syphilis. 16 + +Section 5.--Prophylaxis: Packet System; Early Treatment; +Inter-departmental Committee on Infectious Diseases, Conclusions; +Notices in Public Conveniences; Prophylaxis, Efficiency of 16 + +Section 6.--Legislation required: Conditional Notification (A)--National +Council of Women, View on; Number or Symbol Notification; Infectious +Diseases Notification Bill, England (1889), Opposition to, Comparisons +with Control of Infectious Diseases; Present System, Disadvantages of; +West Australia Act; New Zealand Legislation suggested. Compulsory +Examination and Treatment (B).--Department of Health, proposed +Legislation, Contagious Diseases Act compared with; West Australia +Legislation, Effect on Attendances at Clinics 17 + +Section 7.--Marriage Certificate of Health: Royal Commission on Venereal +Diseases; National Birth-rate Commission; Medical Certificate; Statement +before Registrar, Communicable and Mental Disease; Recommendation; +Medical Practitioners' duty 20 + +Section 8.--Treatment of Unqualified Persons: Chemists, Herbalists, +Chiropractors; Effect of such Treatment; Clinic Statistics relating to +same; West Australian 20 + +Section 9.--Mentally Defective Adolescents: Danger and Cost to the +State; Supervision and Control proposed 20 + + +PART IV.--SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS. + +Section 1.--Conclusions 21 + +Section 2.--Recommendations 21 + +Section 3.--Concluding Remarks 22 + +APPENDIX 24 + + * * * * * + +REPORT. + +The Hon. the Minister of Health, Wellington. + +SIR,-- + +The Committee of the Board of Health appointed by you to inquire into +and report upon the subject of venereal diseases in New Zealand have the +honour to submit herewith their report. + + + + +PART I.--INTRODUCTORY AND HISTORICAL. + + +SECTION 1.--ORIGIN AND SCOPE OF INQUIRY. + +A perusal of departmental files reveals that many persons and bodies +have during recent times urged upon the Government the desirability of +setting up a Committee or Commission of Inquiry to go into this subject. +The appointment of the present Committee, however, arose out of a +suggestion forwarded to the Chairman of the Board of Health, under date +of the 20th June, 1922, from the Council of the New Zealand Branch of +the British Medical Association. The Board of Health duly considered the +representations of the Association and passed a resolution recommending +the Minister to set up a committee to gather data and to make +recommendations as to the best means of preventing and combating +venereal diseases. The proposal thereafter took concrete form, following +the receipt by the members of this Committee of the under-quoted letter, +dated 13th July, 1922, sent out under your direction by the Secretary of +the Board of Health:-- + + "I am directed by the Hon. the Minister of Health, Chairman of this + Board, to inform you that, acting upon the recommendation of the + Board, he has decided to appoint a special Committee from among the + members of the Board to conduct an inquiry into the question of + venereal diseases in New Zealand. The following members are being + asked to become members of the Committee, and the Chairman trusts + you will see your way to accept the position: Dr. Valintine, Dr. + Elliott, Lady Luke, Hon. Mr. Triggs, Sir Donald McGavin, Mr. + Fraser. The Hon. the Minister has asked the Hon. Mr. Triggs to + accept the chairmanship of the Committee. + + "I am further directed to state that the function and duty laid + upon the Committee is as follows:-- + + "(1.) To inquire into and report upon the prevalence; of venereal + disease in New Zealand. + + "(2.) To inquire into and report any special reasons or causes for + the existence of venereal disease in New Zealand. + + "(3.) To advise as to the best means of combating and preventing + venereal disease in New Zealand, and especially as to the necessity + or otherwise of fresh legislation in the matter. + + "The Minister of Health is anxious that the Committee should hear + such evidence and representations on the above-mentioned matters as + may be necessary to fully inform the Committee on the items + referred to it, and with respect to which it is asked to report, + and he further suggests to the Committee that the various + organizations and persons likely to be interested should be + notified that the Committee will, at a certain place and date, in + Wellington, hear any evidence they may desire to tender." + +The Committee regrets that owing to ill health Dr. Valintine, +Director-General of Health, was unable to act as one of its members. His +place was taken by Dr. J.P. Frengley, Deputy Director-General of Health. +Unfortunately, illness also overtook Mr. Murdoch Fraser, who has been +unable to attend the sittings of the Committee since the middle of +August. The remaining members have been present at all sittings of the +Committee, details of which are appended in the following table:-- + +--------------------------------+------------------------------------------ + Places and Dates of Sittings. | Witnesses examined or Work done. +--------------------------------+------------------------------------------ +Wellington, 26th July, 1922 | Preliminary meeting. + (forenoon only) | +Wellington, 8th August, 1922 | Dr. M.H. Watt, Director, Division of + (forenoon only) | Public Hygiene. + | Dr. B.F. Aldred, Officer in Charge + | Venereal Diseases Clinic. +Wellington, 9th August, 1922 | Hon. Dr. W.E. Collins, M.L.C. + (forenoon only) | Mr. J. Caughley, M.A., Director of + | Education. +Auckland, 17th August, 1922 | Dr. Falconer Brown, Officer in Charge + | Venereal Diseases Clinic. + | Dr. Hilda Northcroft. + | Dr. Frank Macky. + | Dr. W. Gilmour, Bacteriologist and + | Pathologist, Auckland Hospital. + | Dr. C.E. Maguire, Medical Superintendent, + | Auckland Hospital. + | Dr. W.H. Parkes. + | Dr. J. Hardie Neil. + | Dr. R. Tracy Inglis, Medical Officer, St. + | Helens Hospital. + | Dr. E.W. Sharman, Port Health Officer. + | Dr. W.H. Pettit. +Auckland, 18th August, 1922 | Mrs. De Treeby, representing Women's + | International and Political League. + | Dr. D.N.W. Murray, Medical Officer to + | Prisons Department. + | Mr. R.J. Pudney. + | Mr. Egerton Gill. + | Mrs. Harrison Lee Cowie. + | Mrs. E.B. Miller. + | Dr. Kenneth Mackenzie. + | Dr. E.H. Milsom. + | Dr. E. Carrick Robertson. + | Rev. Jasper Calder. + | Mr. F.L. Armitage, Government + | Bacteriologist. + | Dr. W.A. Fairclough. + | Dr. A.N. McKelvey, Medical Officer, + | Costley Home. +Christchurch, 29th August, 1922 | Dr. A.C. Thomson, Officer in Charge + | Venereal Diseases Clinic. + | Dr. P.C. Fenwick. + | Mrs. E. Roberts, President Women's + | Branch, Social Hygiene Society. + | Mrs. A.E. Herbert. + | Dr. A.B. Pearson, Bacteriologist and + | Pathologist, Christchurch Hospital. + | Nurse E.M. Stringer, Health Patrol. + | Dr. W. Fox, Medical Superintendent, + | Christchurch Hospital. + | Dr. C.H. Upham, Port Health Officer. + | Dr. C.L. Nedwill, Medical Officer to + | Prisons Department. + | Dr. D.E. Currie. + | Dr. J. Guthrie. + | Dr. W. Irving, Medical Officer, St. + | Helens Hospital. + | Dr. A.C. Sandston, President, Men's + | Branch Social Hygiene Society. + | Major R. Barnes, Salvation Army Officer. + | Dr. A.B. Lindsay. +Dunedin, 31st August, 1922 | Dr. A. Marshall, Officer in Charge + | Venereal Diseases Clinic. + | Dr. A.R. Falconer, Medical + | Superintendent, Dunedin Hospital. + | Dr. H.L. Ferguson, Dean Medical Faculty, + | Otago University. + | Dr. Emily H. Seideberg, Medical Officer, + | St. Helens Hospital. + | Dr. J.A. Jenkins. + | Canon E.R. Nevill, representing the + | Dunedin Council of Sex Education. + | Miss Pattrick, Director of Plunket + | Nursing. + | Mr. J.M. Galloway, representing Society + | for Protection of Women and Children. + | Dr. F.R. Riley. +Wellington, 12th September | Dr. W. Young. + (forenoon only) | Mr. T.R. Cresswell, Headmaster, + | Wellington College. + | Mr. W.W. Cook, Registrar-General. + | Mr. Malcolm Fraser, Government + | Statistician. + | Mr. W.D. Hunt. + | Rev. R.S. Gray. +Wellington, 13th September | Dr. Frank Hay, Inspector-General of + (forenoon only) | Mental Defectives. + | Mrs. Henderson, Representative Women + | Prisoners' Welfare Society and + | Wellington Branch National Council of + | Women. + | Rev. Van Staveren, Jewish Rabbi. +Wellington, 14th September | Dr. Agnes Bennett, Medical Officer, St. + | Helens Hospital. + | Mrs. F. McHugh, Health Patrol. + | Mr. F. Castle, President Pharmacy Board, + | and Chairman Wellington Hospital Board. + | Dr. D.M. Wilson, Medical Superintendent, + | Wellington Hospital. + | Mr. A.H. Wright, Commissioner of Police. + | Mr. W. Dinnie, ex-Commissioner of Police, + | representing Bible in Schools + | Propaganda Committee. + | Rev. J.T. Pinfold, D.D., representing + | Wellington Ministers' Association. + | Canon T. Feilden Taylor, appointed by the + | Bishop of Wellington. +Wellington, 15th September | Major Winton, Salvation Army. + | Mr. W. Beck, Officer in Charge Special + | Schools Branch, Education Department. + | Dr. D.E. Platts-Mills, representing Young + | Women's Christian Association. + | Mrs. Morpeth, representing Young Women's + | Christian Association. + | Miss Dunlop, representing Young Women's + | Christian Association. + | Mrs. Glover, Salvation Army. +Wellington, 26th September | Consideration of report. +Wellington, 10th October | Consideration of report. +Wellington, 12th October | Consideration of report. +Wellington, 13th October | Consideration of report. +Wellington, 18th October | Final meeting. + | +--------------------------------+-------------------------------------- + +It will thus be seen that, apart from time spent in travelling, the +Committee have met on seventeen days and have heard seventy-four +witnesses in person. + +The Committee would like to express their thanks to the witnesses, many +of whom had gone to considerable trouble to collect information and +prepare their evidence. Thanks are also due to the British Medical +Association for their willing co-operation and assistance; to the large +number of members of the medical profession throughout the Dominion who +responded to the Committee's request for information; to Dr. J.H.L. +Cumpston, Federal Director-General of Health, Melbourne, for much +Australian information on the subject, particularly in relation to +Commonwealth quarantine provisions; to Dr. Everitt Atkinson, +Commissioner of Public Health, Perth, West Australia, for a most lucid +and informative report on the working of the legislation in force in +that State; and to many other persons who by means of correspondence and +literature have placed at the Committee's disposal a large amount of +information which has been of material assistance in considering various +aspects of the problems involved. + +The Committee desire to acknowledge their indebtedness to their +secretary, Mr. C.J. Drake, whose wide knowledge of public-health matters +has been of material assistance in their investigations and who has +discharged his duties with marked zeal and ability. + + +SECTION 2.--VENEREAL DISEASES AND THEIR EFFECTS. + +One result of the Committee's investigations has been to show that the +public in general are very ignorant regarding the nature of venereal +diseases, and their lamentable effects not only upon the individuals +infected, but upon the health and well-being of the community as a +whole. This ignorance of the nature of the problem and of the grave +issues involved naturally stands in the way of the evil being grappled +with effectually. Furthermore, the policy of reticence which has +prevailed in the past, while it has led to the omission of proper +instruction of the young, either by their parents or as part of our +system of education, has not prevented the dissemination of an +incomplete or perverted knowledge of the facts relating to sex, which, +being derived as a rule from tainted sources of information, has been +productive of a great deal of evil. + +In these circumstances the Committee feel it their duty, before making +known their recommendations, to state in as plain terms as possible the +medical aspects of the problem they have had to consider. + +There are three forms of venereal diseases namely, syphilis, gonorrhÅ“a, +and chancroid--and of these the first two are the common and most +serious diseases. That sporadic syphilis existed in antiquity and even +in prehistoric times is probable, but there is no doubt that the disease +was a malignant European pandemic in the closing years of the fifteenth +century. The first reference to its origin is in a work written about +the year 1510, wherein it is described as a new affection in Barcelona, +unheard of until brought from Hayti by the sailors of Columbus in 1493. +The army of Charles VIII carried the scourge through Italy, and soon +Europe was aflame. "Its enormous prevalence in modern times," says Dr. +Creighton, "dates, without doubt, from the European libertinism of the +latter part of the fifteenth century." GonorrhÅ“a also has its origin in +the shades of antiquity, but that it became common in Europe about 1520 +is a fact based on the highest authority. + +Syphilization follows civilization, and syphilis is an important factor +in the extermination of aboriginal races. Syphilis was introduced into +Uganda when that country was opened to trade with the coast, and Colonel +Lambkin reported that "In some districts 90 per cent. suffer from it.... +Owing to the presence of syphilis the entire population stands a good +chance of being exterminated in a very few years, or left a degenerate +race fit for nothing." The earliest known account of the introduction of +syphilis into the Maori race is in an old Maori song composed in the far +North. The Maori population in a village on the shores of Tom Bowline's +Bay was employed in a whaling-station on the Three Kings Islands, and +there they became infected and carried the disease to the mainland. +Venereal disease is not common now among the Maoris, but it made great +ravages in the early days of colonization, to which may be attributed +much of the sterility and repeated miscarriages in the transitional +period of Maori history. + +Through the ages great confusion existed as to the origin and nature of +venereal disease, but in 1905 a micro-organism, the _Spironema +pallidum_, was demonstrated as the infective agent in syphilis, and the +gonococcus as the infecting organism of gonorrhÅ“a had been discovered in +1879. As regards modes of infection, syphilis is contracted usually by +sexual congress; occasionally the mode of infection is accidental and +innocent, and congenital transmission is not uncommon. GonorrhÅ“a is +contracted by sexual congress as a rule, but occasionally from innocent +contact with discharges, as in lavatories. + +Syphilis, therefore, is a markedly contagious and inoculable disease. It +gains entrance, and usually in three weeks (although this period may be +much shorter) a slight sore appears at the site of infection. It may be +so slight as to pass unnoticed. This is the primary stage of syphilis. +Later, often after two months, the secondary stage begins, and if not +properly treated may last for two years. The patient is not too ill +usually to attend to his avocation, and has severe headache, skin +rashes, loss of hair, inflammation of the eyes, or other varied +symptoms. The tertiary stage may be early or delayed, and its effects +are serious. Masses of cells of low vitality, known as "gummata," with a +tendency to break down or ulcerate, may form in almost any part of the +body, and the damage that occurs is considerable indeed. Various +diseases result which the lay mind would not associate with syphilis, +but it would be difficult to overestimate the resultant diseases that +may occur in any organ of the body:-- + + This racks the joints; this fires the veins: + That every labouring sinew strains; + Those in the deeper vitals rage. + + +Many deaths ascribed to other causes are the direct consequence of +syphilis. It cuts off life at its source, being a frequent cause of +abortion and early death of infants. It slays those who otherwise would +be strong and vigorous, sometimes striking down with palsy men in their +prime, or extinguishing the light of reason. It is an important factor +in the production of blindness, deafness, throat affections, +heart-disease and degeneration of the arteries, stomach and bowel +disease, kidney-disease, and affections of the bones. Congenital +syphilis often leads to epilepsy or to idiocy, and most of the victims +who survive are a charge on the State. This indictment against syphilis +is by no means complete. The economic loss resulting from this disease +is enormous as regards young, old, middle-aged. It respects not sex, +social rank, or years. + +GonorrhÅ“a is characterized in its commonest form by a discharge of pus +from the urethra, and causes acute pain at its onset in the male, but in +the female it commonly causes little or no discomfort. Unless carefully +treated, and treated early, it gives rise to many complications, such as +inflammation of the bladder, gleet, stricture, inflammation of joints, +abscesses, and rheumatism. It is a common cause of sterility and of +miscarriages, and, in the female, of many internal inflammations and +disablement, and in its later effects requires often surgical operations +on women. It is a very common disease, and the public know little of the +evil consequences which may follow what they have persisted in regarding +as a simple complaint. From its prevalence and its complications it is +one of the most serious diseases that affect mankind. + +As regards treatment of venereal disease of all kinds, it should be +clearly understood that the causative germs are well known and can +readily be destroyed immediately after exposure to infection by thorough +cleansing with antiseptic lotion or ointment. The use of soap and water +only would lessen the incidence of infection. On the first suspicious +sign of venereal disease the patient should apply at once for medical +advice. There are methods of diagnosis, such as microscopic examination +and the Wassermann test, the result of recent discovery, which make +diagnosis simple and certain; and if treatment is begun early according +to modern methods, which are much more effective than the remedies +formerly applied, the germs of infection are easily vanquished. When +sufficient time, however, is lost to enable these germs to become +entrenched in parts of the body not readily accessible to treatment, +cure is difficult, prolonged, and perhaps in some cases uncertain. + +For their own sakes, as well as for the sake of others, patients +suffering from any form of venereal disease should continue treatment, +which may be prolonged in the case of syphilis for two years, until +their medical adviser is satisfied that further treatment is +unnecessary. + +Women suffer less pain than men in these diseases, and consequently are +more apt to neglect securing medical advice and treatment, and more +ready to discontinue treatment before a cure is effected. + + +SECTION 3.--ACCIDENTAL INFECTION. + +Occasionally cases are met with in which syphilis is acquired innocently +by direct or indirect contact with syphilitic material, and then the +primary sore is often located on some other part of the body than the +genitals. Thus the lip may be infected by kissing, or by drinking out of +the same glass, or smoking the same pipe as a syphilitic patient. A +medical witness reported a case to the Committee in which syphilis was +conveyed to two girls "through a young fellow handing them a cigarette +which he was smoking." Metchnikoff has proved that the spironema of +syphilis is a delicate organism and quickly loses its virulence outside +the human body, and it cannot enter the system through unbroken skin or +mucous membrane. It is extremely doubtful if any form of venereal +infection can be conveyed in food. Frequently venereal disease is +deceitfully attributed by patients to innocent infection, and no doubt +some genuine cases do occur, but how seldom is illustrated by the +statement of the Officer in Charge of the V.D. Clinic at Christchurch, +who said, "I cannot remember a case where I was absolutely certain that +infection was acquired innocently or extragenitally." + +GonorrhÅ“a may be conveyed innocently from infective discharge on a +closet-seat, or from an infected towel, &c., and undoubtedly gonorrhÅ“al +discharge if brought into contact with the eye sets up a violent +suppuration. + +The Committee are of opinion that the extent of accidental infection is +greatly exaggerated in the public mind, but a few cases occasionally +occur, and the Committee recommend that there should be better provision +of public conveniences, especially for women, and the U-shaped +closet-seat should be adopted. The use of common towels and +drinking-cups in railway-trains, schools, factories, and elsewhere is +condemned not only for the reasons stated above, but on general sanitary +grounds. + + +SECTION 4.--PREVIOUS INQUIRIES AND CONFERENCES. + +After the repeal of the Contagious Diseases Act in England in 1886, +various Committees and Royal Commissions, such as the Inter-departmental +Committee on Physical Deterioration in 1904, the Royal Commission on the +Poor-laws in 1909, and the Royal Commission on Divorce in 1912, drew +attention to the frightful havoc wrought by venereal disease, and urged +that further action should be taken to deal with the evil. In 1913 the +British Government appointed a Royal Commission to inquire into the +prevalence of venereal diseases in the United Kingdom, their effects +upon the health of the community, and the means by which these effects +could be alleviated or prevented, it being understood that no return to +the policy or provisions of the Contagious Diseases Acts was to be +regarded as falling within the scope of the inquiry. + +The Commission took a great deal of most valuable evidence, and did not +present their final report until 1916. They recommended improved +facilities for diagnosis and treatment, including free clinics. They +came to the conclusion that at that time any system of compulsory +personal notification would fail to secure the advantages claimed. The +Commission added, however, "it is possible that the situation may be +modified when these facilities for diagnosis and treatment [recommended +by the Commission] have been in operation for some time, and the +question of notification should then be further considered. It is also +possible that when the general public become alive to the grave dangers +arising from venereal disease, notification in some form will be +demanded." The Commission supported the adoption of a recommendation by +the Royal Commission on Divorce to the effect that where one of the +parties at the time of marriage is suffering from venereal disease in a +communicable form and the fact is not disclosed by the party, the other +party shall be entitled to obtain a decree annulling the marriage, +provided that the suit is instituted within a year of the celebration of +the marriage, and there has been no marital intercourse after the +discovery of the infection. The Commission urged that more careful +instruction should be provided in regard to moral conduct as bearing +upon sexual relations throughout all types and grades of education. Such +instruction, they urged, should be based upon moral principles and +spiritual considerations, and should not be based only on the physical +consequences of immoral conduct. They also favoured general propaganda +work, and urged that the National Council for Combating Venereal +Diseases should be recognized by Government as an authoritative body for +the purpose of spreading knowledge and giving advice. + +Another important Commission, sitting almost simultaneously with that +just referred to, was the National Birth-rate Commission, which began +its labours on the 24th October, 1913, and presented its first Report on +the 28th June, 1916. The Commission was reconstituted, with the Bishop +of Birmingham as Chairman, in 1918, to further consider the question, +and especially in view of the effects of the Great War upon vital +problems of population. Among the terms of reference the Commission were +requested to inquire into "the present spread of venereal disease, the +chief causes of sterility and degeneracy, and the further menace of +these diseases during demobilization." The Commission in their report, +presented in 1920, stated that they realized the difficulties involved +in the introduction of any efficient scheme of compulsory notification +and treatment of venereal diseases, but, they added, they "feel that it +has now passed the experimental stage both in our colonies and in forty +of the forty-eight of the United States of America, and think it is +advisable for the State to make a trial of compulsory notification and +treatment in this country, provided that there should be no return to +the principles or practice of the Contagious Diseases Act." Referring to +the finding of the Royal Commission on Venereal Disease that it would +not be possible at present to organize a satisfactory method of +certification of fitness for marriage, the National Birth-rate +Commission thought this question should now be reconsidered with a view +to legislation. "If," says the report, "a certificate of health was to +become a legal obligation for persons contemplating marriage, many of +the legal, ethical, and professional difficulties surrounding this +question would be removed." + +In Sweden, where a Venereal Diseases Law was passed in 1918, stress was +laid on the importance of general enlightenment with regard to venereal +disease and germane subjects, such as sex hygiene. A committee was +appointed, consisting of experts in medicine and pedagogy, to inquire +into the best means of providing such education. Their report, which has +just been issued, is described by the _British Medical Journal_ as a +document of considerable value, promising to become the charter of a new +and complete system of sex education and hygiene in schools throughout +Sweden. Further reference will be made to this document in the section +of this report dealing with education. + +The subject of venereal disease has also been considered by more than +one important Medical Conference in Australia and New Zealand. + +At a general meeting of the Australasian Medical Congress held in +Melbourne in October, 1908, it was resolved that the executive be +recommended to appoint a committee to investigate and report on the +facts in regard to syphilis. Such a committee was appointed, and +reported to the Congress in Sydney in 1911. In 1914 the Congress was +held in Auckland, and a special committee which had been appointed, with +the Hon. Dr. W.E. Collins, M.L.C., as chairman, presented a valuable +report giving some interesting information in regard to the prevalence +of venereal disease, in New Zealand. The committee recommended that +syphilis be declared a notifiable disease; that notification be +encouraged and discretionary, but not compulsory; and that the Chief +Medical Officer of Health be the only person to whom the notification be +made. They also recommended the provision of laboratories for the +diagnosis of syphilis, and that free treatment for syphilis be provided +in the public hospitals and dispensaries. These recommendations were +embodied in the report adopted by the Congress. + +In February of the present year an important Conference, convened by the +Prime Minister of Australia, was held in Parliament House, Melbourne. It +was attended by official representatives of the Health Departments of +all the States, together with representatives from the British Medical +Association, the Women's Medical Staff at the Queen Victoria Hospital +Diseases Clinic in Melbourne, and other scientific and medical +authorities. The Commonwealth subsidizes the work of the States in +combating venereal disease, and the object of the Prime Minister in +calling the Conference was in order that it might inquire into the +effectiveness of the present system of legislation, of administrative +measures, and of clinical methods, with a view of determining whether +the best results were being obtained for the expenditure of the money. + +Western Australia has an Act, which came into operation in June, 1916, +providing for what is known as conditional notification of patients, +together with other provisions for the control of venereal disease which +are on a more comprehensive scale than has been attempted anywhere with +the possible exception of Denmark. In December, 1916, Victoria passed a +similar Act, and this example was followed by Queensland, Tasmania, and +New South Wales. + +The Conference, answering the several questions put to it, found that a +greater proportion of persons infected with venereal disease were +receiving more effective treatment than before the passing of the +Venereal Diseases Act. In the opinion of the Conference this was due +partly to the passing of legislation and partly to the opening of +clinics affording greater opportunities for free treatment. They +considered the operations of the Act had been more successful in +bringing men under treatment than it had been in the case of women. +Among the opinions expressed by the committee were the following: The +Act was not equally successful in respect of private and hospital +patients in regard to notification, but was equally successful in +respect of securing to both more effective treatment. There has been an +apparent reduction in the prevalence of venereal diseases, and the +Conference were strongly of opinion that the results so far justify the +continuance of these Acts in operation. + +The Conference found that venereal diseases are the most potent of all +causes of sterility and of infant and fÅ“tal morbidity and mortality. It +recommended, among other remedial measures, that prophylactic depots, +both for males and females, should be established as widely in the +community as possible. Referring to the educational aspect, the +Conference urged that children should be instructed in general +biological facts up to the age of puberty, when more explicit +information concerning facts of sexual life should be given. They urged +on all parents and educational, philanthropic, and religious +organizations the pressing necessity for a sustained campaign, in +co-operation with the medical profession, in order to inculcate in the +community higher ideals of personal hygiene and health. + +Lastly, it may be mentioned that, at the instance of Lord Dawson of +Penn, a highly qualified and representative committee of medical men, +with Lord Trevethin as chairman, has been appointed in England to report +to the Minister of Health upon "the best medical measures for preventing +venereal disease in the civil community, having regard to administrative +practicability, including cost." The appointment of such a committee was +requested by Lord Dawson chiefly with a view to obtaining an +authoritative pronouncement on the subject of medical preventive +measures, and the committee's report will be awaited with much interest. + + +SECTION 5.--LEGISLATION IN NEW ZEALAND, PAST AND PRESENT. + +(A) _Contagious Diseases Act (repealed)._ + +The Contagious Diseases Act was passed in 1869, and repealed in 1910. +Briefly, its aim was to secure periodical examinations of prostitutes, +and to detain for treatment those prostitutes found infected with +venereal disease. + +There appears to be, in some quarters, an apprehension that hidden +beneath the movement to combat venereal diseases is an implied desire or +intention to reinstate the antiquated and detested provisions of that +Act. The Committee deem it necessary to say that they have not found +grounds for this suspicion; that no legislation can be effective unless +it deals equally and adequately with all men, women, and children +sufferers from venereal diseases of all kinds; that it finds little +evidence of a definite prostitute class in New Zealand, and, even if +there were such, the Contagious Diseases Acts have been proved to be +useless as measures towards the prevention of venereal infections; and +it is the Committee's individual and collective opinion that anything +involving a return to the administrative procedure of the Contagious +Diseases Act should have no part whatever in any new legislation in this +Dominion. + +(B.) _Examples of Difficulties--Concrete Cases._ + +Before proceeding to refer to present and suggested legislation, a few +incidents and cases taken from the evidence may help, as concrete +examples, to indicate the difficulties to be contended with:-- + +_Case 1._--A man--young and married, a municipal employee in a +city--associated sexually with a female employee in an eating-house +frequented by himself and co-employees. In due time he sought the advice +of the Medical Officer of Health for (what he suspected) severe +syphilis. Steps were taken to obtain his speedy admission to the local +hospital. The woman continued in her employment. + +_Case 2._--A social-hygiene worker in her evidence said: "I think the +majority of cases I deal with (girls attending a hospital clinic) are +caused through mental depravity, and in some instances you cannot +convince them--they continue to carry on. I have tried all I know how to +show them the dangers, but they just laugh at me. I think it is really +in many cases just a mental condition--mental degeneration, possibly." +This officer explained that even while actually attending the clinic +some of these girls (affected with gonorrhÅ“a), without any semblance of +reserve or decency, would discuss arrangements for further intercourse +with men, and on leaving the clinic (still in an infectious state) were +even seen to go off with young men waiting for them. + +_Case 3._--Asked if he knew of any cases where the disease had been +contracted innocently, a medical practitioner stated in evidence: "I +know of a case where two girls in ---- were infected (syphilis) on the +lip through a young fellow handing them a cigarette which he was +smoking." + +_Case 4._--A medical man in private practice, and Medical Superintendent +of the hospital in a small country town, states: "Although, judging from +an experience of over fifteen years, this district would appear to be +peculiarly free from any variety of venereal disease, I think it may be +of interest to your Committee to know what happened here in the early +part of 1918. At that time there came to reside with her father in ----, +a township about nine miles south of ----, a woman, ----, who, shortly +after her arrival consulted the late Dr. ----, and was found to be the +subject of secondary syphilis.... In all, three cases of gonorrhÅ“a, four +of soft chancre (three of whom suffered from phagadÅ“mic ulceration which +laid them up for weeks), and six cases of purely syphilitic infection +came under my care, all traceable to this same woman. As every case of +gonorrhÅ“a and soft chancre afterwards developed syphilis, ultimately I +had thirteen cases of syphilis under my treatment alone. Others, I have +good reason to believe, went to other towns, and doubtless some failed +to seek any kind of help.... Having prevailed upon the woman to come to +my surgery ... I told her that she was suffering from three varieties of +venereal disease, which she was freely disseminating. I then read to her +that part of the Act which deals with those who "knowingly and wilfully +disseminate venereal infection." That same afternoon she left for ----, +where she continued to ply her calling unhindered. Who can estimate the +sum of the damage done by one such person? Not one of those men infected +was properly treated, although I did all I possibly could to convince +them of their own danger and of the risk of spreading infection to +others. Gradually, as the obvious signs of active disease abated, they +drifted away. I may say the Wassermann reaction proved strongly positive +in every case.... One of these men passed on his infection (syphilis) to +a young girl in this town, and she in turn infected other men, one of +whom came to me, while others went to my colleagues. Another man of the +first group, about middle age, and previously a very healthy, sober, +hard-working fellow, has developed thrombosis of his middle cerebral +artery as the result of a syphilitic endarteritis. He is totally +incapacitated, and in the Old Men's Home at ----. He remains a permanent +charge on the community." + +(C.) _Hospital and Charitable Institutions Act, 1913, Section 19._ + +In 1913 the need for detention provisions, to cover any infectious or +contagious disease, received the attention of Parliament, and these are +embodied in section 19 of the Hospitals and Charitable Institutions Act, +1913, thus: + + "19. (1.) The Governor may from time to time, by Order in Council + gazetted, make regulations for the reception into any institution + under the principal Act of persons suffering from any contagious or + infectious disease, and for the detention of such persons in such + institution until they may be discharged without danger to the + public health. + + "(2.) Any person in respect of whom an order under this section is + made may at any time while such order remains in force appeal + therefrom to a Magistrate exercising jurisdiction in the locality, + and the Magistrate shall have jurisdiction to hear such appeal and + to make such order in the matter as he thinks fit. An order of a + Magistrate under this subsection shall be final and conclusive. + + "(3.) Regulations under this section may be made to apply generally + or to any specified institution or institutions." + +The Committee are advised that this section was not aimed solely at +venereal diseases. In that year, and prior thereto, was prominent the +difficulty of detaining consumptives who refused to take precautions to +prevent the spread of their disease to others; and, again, much +attention was being centred on the chronic typhoid and diphtheria +"carrier." It seemed rational to compel isolation of such persons in +hospital until there was some assurance that they would no longer be a +danger to the community if allowed their liberty. Regulations under the +Act were not issued, owing to opposition manifested at the time, and +consequently the section never became operative. + +(D.) _The Prisoners Detention Act, 1915._ + +This Act secures that individuals of one class of the community--viz., +convicted persons--can be held until freed from venereal disease with +which they were known or found to be infected. The measure is of value, +but logically seems unsound, because the venereal diseases from which +such persons suffer are in no way a greater danger to the public than +the same diseases in the law-abiding subject of any class, and, +furthermore, the Committee have no reason to conclude from the evidence +that convicted persons, as a whole, show a higher percentage of venereal +cases than those who never enter a prison. The Controller-General of +Prisons submitted a schedule showing that the number of prisoners +detained under the Prisoners Detention Act from its commencement in 1916 +to 1922 was twenty-eight, consisting of nineteen males and nine females. + +(E.) _Social Hygiene Act, 1917._ + +In the words of the Commissioner for Public Health of West Australia, +who prepared the first comprehensive legislation on venereal diseases in +1915, this Act "can hardly be classed with recent Australian +legislation, for the reason that it provides for no notification of the +disease and no compulsory examination." By this Act infected persons are +required to consult a medical practitioner and go under treatment by +him, or at a hospital; but no penalty is provided, and there is nothing +to compel such persons to do either of these things. + +Reference to case 1 in the concrete examples cited above will show the +weakness of the Act. The waitress continued in employment, handling cups +and spoons and cakes, &c. The Medical Officer of Health had every reason +to believe she was infected with syphilis, but, not having the power to +insist on her obtaining medical advice, he could do nothing to enforce +the provisions of section 6 of the Act. + +Section 7, making it an offence for any person not being a registered +medical practitioner to undertake for payment or other reward the +treatment of any venereal disease, has, in the opinion of the +Commissioner of Police, proved beneficial in restricting the operation +of quacks, but he suggests that it should be amended by deleting the +words "for payment or reward," as it is sometimes easy to prove the +treatment and difficult to prove the payment, and it is the treatment by +unqualified persons that is aimed at. + +Section 8, which makes it an offence knowingly to infect any person with +venereal disease, is practically inoperative, as will be shown later in +this report, owing to the extreme difficulty, in the absence of any +system of notification and compulsory treatment, of proving that the +offence was committed knowingly. + +The Committee desire to draw attention to section 13. Herein is provided +towards hospital maintenance a higher subsidy for venereal patients than +is receivable for the maintenance of patients suffering from other +infectious diseases. They think that it is inadvisable to particularize +venereal sufferers, or, indeed, to draw any distinction between +different classes of diseases in a hospital, and that the ordinary +subsidy should be paid in all cases. + +In this Act also is power to make regulations for the "classification, +treatment, control, and discipline of persons _detained_ in such +hospitals," but apparently, owing to the opposition to the almost +analagous provision in the Hospitals and Charitable Institutions Act, +1913, no such regulations have as yet been made. + + + + +PART II--PREVALENCE OF VENEREAL DISEASES IN NEW ZEALAND. + + +SECTION 1.--STATISTICAL. + +(A.) _Medical Statistics._ + +The first item on the Committee's order of reference is "To inquire and +report, as to prevalence of venereal diseases in New Zealand." + +One of the first matters which engaged the attention of the Committee +was the question how reliable information could be gathered which would +indicate the present prevalence of these diseases in this country. +Recognizing that it would be impossible to obtain trustworthy figures +without securing the widespread co-operation of the medical profession, +the Committee at an early stage sought and was readily given the help of +the British Medical Association in the matter. Representatives of the +Association gave their assistance in the preparation of a form to be +sent to and filled in by all practising members of the profession, and +in the current number of the _New Zealand Medical Journal_ an appeal to +members for their collaboration was made. Suitable circular letters were +also prepared by the Committee asking medical practitioners for their +co-operation, and the Committee are pleased to be able to report that +out of about 750 in actual practice, no fewer than 635 medical +practitioners sent in completed returns. A copy of the form used for +these returns will be found as an appendix to this report, as also a +tabulated return of the replies received and compilations therefrom. + +It will be seen that the total number of cases of all forms of venereal +diseases and of diseases attributable to venereal disease under the +personal care of the doctors reporting is 3,031; and, taking the +population of New Zealand as 1,296,986 (estimated population 31st March, +1922), this means that about one person in every 428 of our population +is at present being treated for venereal infection or for the results +thereof. Acute and chronic gonorrhÅ“al infections give a total of 1,598, +being about one person in every 812 of the population. This is most +likely a very low estimate, for the Committee have had it very +definitely in evidence that many persons suffering, at least from acute +gonorrhÅ“a, seek treatment at the hands of persons other than registered +medical practitioners. For syphilitic infections in all forms the total +is 1,419, about one person in every 914 of the population. The return +bears out other evidence showing that the chancroid or soft-sore type of +infection is rare in this Dominion. + +The Committee regard the result obtained as furnishing some indication +of the amount of active venereal disease existing in the Dominion. The +Committee consider, however, that these figures must be considerably on +the low side, for these reasons: (_a_) that a number of medical +practitioners have not replied: (_b_) that some diseases attributable to +venereal disease may not have been conclusively diagnosed as such, and, +therefore, not included in the return. The return necessarily does not +include cases, probably numerous, which have not been under medical care +for some time, if at all; (_c_) to secure a complete return would have +involved the keeping by each doctor of full records of all cases and a +careful and laborious collation of figures. + +With respect to the expression of opinion asked of medical practitioners +upon the question "If venereal disease in this Dominion has or has not +increased in a greater proportion than the population during the last +five years," it will be seen that of 322 who replied, 199 answered "Yes" +and 203 "No." This is necessarily purely a matter of impression, and it +must also be borne in mind that the evidence shows that patients are now +using the clinics in large numbers, while others who formerly went to +general practitioners now consult specialists who have recently started +in practice. On the other hand, it is possible there is a compensating +influence in the fact that the public are being educated to the +importance of seeking skilled medical treatment for these diseases. + +(B.) _Clinic Statistics._ + +A second source of information as to the prevalence of venereal diseases +was provided by the statistics which have been compiled by the +Department of Health as the result of the establishment of the +venereal-diseases clinics. Among the appendices to this report will be +found a return showing the number of persons attending at each of these +clinics for the years 1920, 1921, and part of 1922, and recorded under +the headings "Sexes" and "Diseases." These statistics are valuable +insomuch as they record facts, but with respect to the total prevalence +they are but an indication, since they relate only to a small proportion +of the population who have become infected and sought treatment. From +this table (B) it will be found that the males attending for the first +time represent 83.60 per cent. of the total, and females 16.40 per +cent., or, roughly, a ratio of six males to every female. + +_Clinic Distribution._--In the figures for syphilis the following points +are worthy of note: Auckland: A distinctly higher number of cases than +the other centres. A marked drop in 1921 for males, but the return for +this year indicates a rise; female cases show a rise for this year. +Wellington: Returns appear fairly uniform, with a slight falling +tendency, most marked in the females. Christchurch: A drop in male +cases, with a fairly uniform rate of females. Dunedin: Here the rates +appear uniform, with exception of a fall for males in 1922. + +As to gonorrhÅ“a, these points may be noted: Auckland: A marked rise. +Wellington: Steady rise with exception of females. Christchurch: Slight +rise since 1920: females uniform rate. Dunedin: Slight rise, with +indication of male increase in 1922. + +_Age Distribution._--The age-period of persons attending the clinics is +mainly eighteen to thirty. + +_Marital Condition._--From the evidence of the clinics it is very +apparent that venereal disease is especially a problem associated with +the unmarried. + +(C.) _Mental Hospital Statistics._ + +A third source of estimation of prevalence was opened to the Committee +by the Inspector-General of Mental Hospitals. The method of +investigation adopted by Dr. Hay is based on Fournier's estimate that 3 +per cent. of the cases of syphilis existing at any one time will +ultimately develop dementia paralytica. + +The introduction of the Wassermann test and treatment by salvarsan or +other arsenical preparations will vitiate this index in future, for the +reasons that by the Wassermann test more cases will be diagnosed, and by +the use of recent remedies the complete cure of many more cases will be +effected, and consequently fewer will develop dementia paralytica. This +disability does not develop until about ten to fifteen years after +infection. The Wassermann test and the modern arsenical preparations +have not yet been in use for that period, therefore these figures, as an +estimate of the prevalence of syphilis in 1921, would not be materially +affected by these developments. An estimate based on these data may +therefore be regarded in the meantime as approximately correct. + +During the past ten years 4,763 males and 3,747 females have been +admitted into New Zealand mental hospitals. The percentage of syphilitic +admissions of all types was 4.74, while the percentage of cases of +dementia paralytica was 3.89. In other words, of the admission of +syphilitics 82 out of every 100 cases were dementia paralytica. The +average yearly number of deaths from dementia paralytica according to +the Government Statistician's returns between 1908 and 1921 was just +under 40. + +If Fournier's estimate that 3 per cent. of syphilitics ultimately +develop dementia paralytica be accepted, one would arrive at the annual +infection by multiplying 40 by 33, which gives 1,320. Assuming the +average duration of life, after infection, to be twenty-five years, this +means that at any given time there are twenty-five years' infections on +hand. Dr. Hay computed from this the number of persons in New Zealand +now who have, or have had, syphilis to be 1,320 x 25, equalling 33,000, +or 1 to every 38 of the population. If the average duration of life +after infection were assumed to be thirty years, the figures would be 1 +to every 32 of the population. + +Taking the figure for syphilitic infections over a period of years at +1,320 per annum, this would mean for the population of New Zealand +(exclusive of Maoris) 1 fresh infection annually in about every 850 +persons. + +(D.) _Incidence among Maoris._ + +It is even more difficult than in the case of the European population to +say what is the prevalence of venereal diseases amongst Maoris. The +Director of the Division of Maori Hygiene (Dr. Te Rangi Hiroa) in a +statement to the Committee says:-- + +"Venereal disease made great ravages amongst the Maori population in the +early days of colonization. To this may be attributed much of the +sterility, with histories of repeated miscarriages, that existed in the +transitional period of Maori history. Most of the old men--hemiplegias, +and paraplegias, and subsequent general paralysis of the insane--gave an +old history of syphilis. These cases that I saw twenty years ago have +now disappeared. + +"In my experience of eighteen years' constant work amongst the Maoris +venereal disease has been comparatively rare. It disappeared amongst the +people, only to recrudesce in some localities as fresh infection was +introduced by the white man, or brought back to the settlements by +visits to the white towns. I see very little of it at present, but now +and again hear reports from medical officers that it has cropped up in +the settlements near them ... In all these cases I am convinced that the +origin is from a white source, and the problem amongst the Maoris is not +nearly so serious as amongst Europeans. It seems to me unjust that the +idea should be circulated that the Maoris are a source of danger to the +European community--the reverse is much more likely. + +"It is impossible for me to supply accurate data as to the incidence of +the disease amongst the Maori race at present, but I am confident that +reports have a natural tendency to become exaggerated. I do not consider +that returned Maori soldiers, owing to the treatment they received +before being discharged from the service, have been a factor in the +introduction of the disease amongst the settlements. If they have in +some areas, it has been from fresh infection, which their experience of +prostitution in Egypt and Europe has made them more liable to acquire +from professional and amateur prostitutes in towns. At the same time, +the experience of returned soldiers as to the value of treatment makes +them more likely to seek such aid." + +(E.) _Death-certificates._ + +There are no trustworthy statistics in any part of the British Empire of +the deaths due to venereal disease. Many persons die from illnesses +which result from an initial syphilis contracted perhaps many years +prior to death. It is well known that medical practitioners, from a +laudable desire to spare the feelings of relatives, refrain from stating +the primary cause of death in such cases, and merely enter the secondary +or proximate cause. For the same reason, the statistics regarding deaths +due to alcoholism, and perhaps in a less degree some other factors in +the mortality returns, are incomplete and consequently useless. + +Both the Royal Commission on Venereal Diseases and the Birth-rate +Commission recommended that the medical attendant should issue two +certificates--one, which would be a simple certificate of death, to be +handed to the relatives, and the other, a confidential certificate +giving the primary cause of death, which would be transmitted to the +Registrar. + +The Registrar-General for New Zealand, Mr. W.W. Cook, in his evidence in +chief, stated that he did not favour these suggestions. A certificate of +death, he said, cannot be regarded as confidential, as the information +contained therein is recorded in the death entry, which may be inspected +by the public, and of which a copy may be obtained by any applicant. In +reply to questions, however, he stated that the law could no doubt be +altered so as to make the death-certificate confidential, the +information to be given up only on an order from a Court of justice. +Apart from the fact that the insurance companies might object, he did +not see any objection from the public point of view. + +Mr. Malcolm Fraser, the Government Statistician, said that there was +considerable division of opinion on this question at the British Empire +Statistical Conference held in London in 1920, when statisticians from +all parts of the Empire were present. It was generally agreed that the +system was good theoretically, but some doubt was expressed whether in +practice there would be as much improvement as was expected, since the +system would depend entirely on the medical attendant strictly complying +therewith and disclosing the true cause of death in every case. Any +system of confidential information always had that failing. The witness +thought the register must be open for persons having a right to call for +copies of entries. In dealing with insurance claims at death the truth +or otherwise of the statement in the proposal form was important, and +might require verification by inspection of the death entry. At the +Conference Dr. Stevenson, the Statistician to the Registrar-General of +the United Kingdom, was very pronounced in his advocacy of the +confidential form of certificate. The Conference passed the following +resolutions: "(1.) That the present system of open certification tends +to prevent candid statements of the causes of death, and thus introduces +a systematic error into death statistics. (2.) That the error would be +eliminated by a system of confidential certification." + +The Committee, while agreeing that such a system of registration of +deaths would undoubtedly afford better means of approximating to correct +returns of mortality not only from venereal diseases but also from +alcoholism and some other diseases, would point out that, if New Zealand +were to adopt the reform while the rest of the Empire retained the +present system, the result would be to place the Dominion in an +apparently unfavourable light in comparison with other parts of the +Empire in regard to the mortality from these diseases. + + +SECTION 2.--CAUSES OF THE PREVALENCE OF VENEREAL DISEASES IN NEW +ZEALAND. + +In discussing this order of reference the Committee desire it clearly +understood that these causes are not peculiar to New Zealand, and do not +operate more extensively in New Zealand than elsewhere. The Committee +are concerned, however, in discussing this question only as it affects +New Zealand. + +The causes of the spread of venereal disease may be classified under two +main headings: (1) The presence of infected individuals acting as foci +of infection; (2) the occurrence of promiscuous sexual intercourse, by +which in the great majority of cases the disease is actually transmitted +from one individual to another. + +(1.) _The Presence of Infected Individuals._ + +These sources of infection arise and persist for the following +reasons:-- + + (1.) Neglect by infected persons to undergo treatment. (2.) Neglect + to continue treatment till no longer infective. (3.) The treatment + of infected individuals by unqualified persons, such as chemists, + herbalists, chiropractors, &c. In these cases the disease becomes + chronic, and the best opportunity for its treatment and cure has + passed before the case is seen by a medical man. (4.) By the + introduction of venereal disease to this country from overseas. + +(2.) _The Occurrence of Promiscuous Sexual Intercourse._ + +A striking portion of the evidence placed before the Committee was that +which showed the very small amount of professional prostitution in New +Zealand. This was supported by the valuable evidence of Mr. W. Dinnie, +ex-Commissioner of Police, and Mr. A.H. Wright, Commissioner of Police. +The latter witness stated that there were only 104 professional +prostitutes in the Dominion. + +It would appear also that the professional prostitute, as a result of +her knowledge and experience, is less likely to transmit venereal +disease than the "amateur." It is therefore principally to clandestine +or amateur prostitution that one must look for the dissemination of the +disease, and inquiry into the conditions which tend to the production of +the amateur prostitute is a direct inquiry into the causes of the +prevalence of venereal disease. + +The evidence before the Committee shows that this promiscuity is very +prevalent, and that it is not confined to any particular social strata. +The fact is also strikingly demonstrated by Table A in the appendix. +From this table it will be seen that during the period 1913-21 there +were 10,841 illegitimate births and 33,738 legitimate first births +within one year after marriage. If to the illegitimate births we add the +total number of live births occurring within the first seven months of +marriage viz., 12,235--which may be safely considered to have been +conceived before marriage, we get a total of 23,076 births in which +conception took place extra-maritally. In other words, more than 50 per +cent. of total first births occurring within twelve months of marriage +result from sexual contact prior to marriage. + +Some factors which contribute in a greater or less degree to the moral +laxity which leads to promiscuous sexual intercourse are:-- + + (1.) The relaxation of parental control, which was emphasized by + many witnesses. Girls stay less at home and assist less in the work + of the home, preferring whenever opportunity offers, to go to the + pictures or some other form of entertainment. + + (2.) Lack of education of the young in the facts pertaining to sex. + Especially the Committee would call attention to the unfounded + belief of many that continence in young men is injurious to health. + + (3.) Bad housing and general conditions of living. When members of + both sexes are crowded together in restricted accommodation in + which often insufficient conveniences are supplied, it is easy to + conceive of a relaxation of the proprieties of life which might + lead to acts of immorality. + + In this connection the Committee desire to call attention to the + excellent work done by the Y.W.C.A. and other bodies in the + provision of hostels in which girls are provided with board and + lodging at very reasonable cost. The Committee were surprised to + learn that full advantage was not taken of these provisions, and + that the accommodation at these hostels was not fully occupied. It + would appear that many girls resent the very slight amount of + supervision and restraint exercised over them, precisely as they do + parental control. + + (4.) The presence in the community of individuals, especially + girls, who are to some degree mentally defective or morally + imbecile. The Committee were given several individual instances in + which such girls had acted as foci of infection; they are easily + approached, and facile victims for men. In spite of a degree of + mental or moral defect they may be physically attractive. + + (5.) Economic conditions which delay marriage may reasonably be + regarded as a factor in conducing to an increased frequency of + extra-marital sexual relationship. Graph A in the appendix shows + clearly that the age of marriage in both sexes has, with slight + fluctuations, steadily increased from 1900 to 1921. + + (6.) Alcohol tends to the dissemination and persistence of venereal + disease: it increases sexual desire, lessens control, causes the + individual to be less careful as regards cleanliness, &c., after + exposure to infection, and militates against effective treatment. + It is to be pointed out, however, that the lower control possessed + by some individuals may be the actual predisposing cause, both of + laxity in sexual matters and of the excessive ingestion of alcohol. + There appears no doubt that alcohol is an important factor in the + prevalence of venereal disease, although probably not so potent as + represented by some witnesses. + + (7.) Accidental infections are undoubtedly rare. They may arise + from contact with W.C. seats, dirty towels, and eating and drinking + utensils in public places. + + (8.) Other factors of minor importance which were mentioned in + evidence were the modern dress of women, which was stated to be in + certain cases sexually suggestive, and certain modern forms of + dancing. There appears some grounds to suppose that dances + conducted under undesirable conditions contribute to sexual + immorality, but the Committee see no reason to condemn dancing + generally because the coincident conditions under which it has been + or is conducted in some cases have contributed to impropriety. The + cinema was stated by some witnesses to have an immoral tendency + both in the nature of the pictures presented and in the conditions + under which they are viewed by the audience. The Committee suggest + that a stricter censorship might with advantage be exercised, and + should include the posters advertising the films. + +It has been stated that venereal disease has increased in New Zealand +with the return of the Expeditionary Force from overseas. Ample +evidence, however, was given to the Committee that there has been no +increase of the disease due to returned soldiers. These men were treated +prior to their discharge until non-infective. + + + + +PART III.--BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASE. + + +SECTION 1.--EDUCATION AND MORAL CONTROL. + +There is no question that the most effective way of avoiding venereal +disease is to refrain from promiscuous sexual intercourse. The problem +which the Committee have been asked to consider has very important +medical aspects, but, while these must not be neglected, it is essential +to the health and well-being of the nation that the enemy should be +attacked with every moral and spiritual weapon:-- + + Self reverence, self-knowledge, self-control,-- + These three alone lead life to sovereign power. + +The absence of proper training and instruction of the young is +undoubtedly responsible for a great deal of the evil which has been +shown to exist. Children are led into bad habits through ignorance, and +young men and young women grow up with utterly false ideals of life, and +in many cases fall into deplorable laxity of conduct. + +There is an impression among many young men that chastity is either +impossible or at least is inconsistent with physical health. There is +the highest medical authority for stating that this notion is absolutely +wrong, while there is no difference of opinion whatever as to the +serious risks of contracting diseases of a very loathsome character +incurred by those who do not restrain their passions. Apart from this +aspect of the question, it must be obvious to every thinking person that +looseness of conduct between the sexes such as is shown to exist in New +Zealand is destructive to the high ideals of family life associated with +the finest types of British manhood and womanhood, and if not checked +must lead to the decadence of the nation. + +A sounder state of public opinion needs to be cultivated. The moral +stigma at present attached to sufferers from venereal disease should +rest upon all who sacrifice to their own selfish passions the +chivalrous relations which should subsist between the sexes. Those who +are unfortunate enough to contract disease incur a punishment so +terrible that they deserve our pity and our succour, always provided +that they seek skilled treatment and refrain from any conduct likely to +communicate the disease to others. The man or woman who negligently or +wilfully does anything likely to lead to the infection of any other +person is a criminal, and should be treated as such. + +To bring about this healthier state of public opinion much might be done +by the various Churches, by the Press, and by all who are in a position +to influence the thoughts of others. It is a duty which should be shared +by all--it cannot be left entirely to the Government, to Parliament, or +to the medical profession. If a healthier atmosphere were created for +the proper consideration of this subject, instead of the unwholesome fog +of prudery in which it has been enveloped in the past, a great deal will +have been gained. + +One result of the mistaken policy of reticence which has prevailed is to +be seen in the fact, already mentioned, that children are allowed to +grow up either in ignorance of sex physiology or with perverted ideas +due to the want of proper instruction. Nearly every witness who spoke on +the subject before the Committee agreed that such instruction would come +best from the parents, but there is also practical unanimity among those +who gave evidence that very few parents are capable of giving such +instruction in the right way, and the vast majority are unwilling to +attempt it. In these circumstances our chief hope for the future seems +to lie in an endeavour to educate the children in such a way that they, +the parents of the future, may be enabled to deal justly with their own +children in this vital matter. Nevertheless, the Committee would be +failing in their duty did they not point out that all parents have a +serious responsibility to their children which they cannot evade without +laying themselves open to grave reproach. It is probable, as one of the +witnesses remarked, that "nothing they could do for their children's +happiness in life would be of equal value to the outlook which they +might give to their children upon this matter. Apart from any +possibility of moral ruin or disease, such an outlook would colour the +whole mature life of their children in respect to what is probably the +foundation of the greatest human happiness--namely, home relationship." + +The Committee recommend that the Department of Health be asked to +prepare a suitable pamphlet to assist those parents who desire to +instruct their boys and girls on this subject. It is also suggested that +where parents feel themselves unable to undertake the necessary +instruction, the family doctor should be asked to talk to the boys. +Instruction to the girls should certainly come from the mother, but +failing this a little wise counsel and advice from a woman doctor should +be secured. + +In regard to the teaching of sex hygiene in schools some interesting +evidence was given to the Committee by Mr. Caughley, Director of +Education, Mr. T.R. Cresswell, Principal of the Wellington College +(speaking on behalf of the Secondary Schools Association), and by some +of the women doctors and others who were good enough to attend as +witnesses. + +Mr. Caughley stresses the point that it is not mere knowledge of +physiology that will meet the case. He considers that the most important +thing of all is to establish in the minds of the children noble ideals +with regard to infanthood and motherhood. Lessons in connection with the +care of all birds and animals for their young, with the love and +devotion of parents for their young, with all that is beautiful and +tender connected with the homes of animals and birds, would establish a +kind of reverence about everything that is connected with birth. He +deprecates mechanical, systematic, and consecutive instruction in the +mere facts of sex hygiene, for even the fullest knowledge on this +subject is known to have very little deterrent effect in the temptations +of life. He would rather aim at creating the right atmosphere in a +school, such as would make any coarse or unworthy mention of any of +these matters in the hearing of a child appear more or less repulsive, +and would in general enable him to put in its proper setting any +knowledge that might come to him from various sources. + +Mr. Cresswell gave the Committee an extremely interesting _résumé_ of +the answers to a _questionnaire_ which he addressed to the head of every +secondary school in the Dominion. He suggested--(1) That a determined +public effort should be made to rouse parents to a sense of their +responsibility in regard to this matter by means of broadcasted +pamphlets, and that they should be furnished with simple, specially +written leaflets to assist them in giving instruction to their children; +(2) that sex hygiene be made a compulsory subject in all +training-colleges, the instructors being specially qualified doctors; +(3) that regular courses of public lectures be delivered in suitable +centres; (4) that teachers, and especially physical instructors, be +encouraged to stress the value of physical fitness to pupils +collectively, and, where need is indicated, to have private talks with +individuals; (5) that teachers be advised to take every opportunity +during lessons in hygiene, physiology, botany, &c., to give children a +sane and normal outlook on sex matters. + +Incidentally it was suggested that girls' schools suffer somewhat +through being staffed almost exclusively by celibate teachers. "The +knowledge and sympathy of a real mother would," it was urged, "be +invaluable to many girls in our secondary schools. Does it seem a +trivial suggestion that in every girls' school there should be one +honoured official, the 'school mother,' a sympathetic motherly person +whose duty it should be to get into personal touch not only with +individual girls but also with individual parents?" + +The views expressed by the Swedish Committee of Experts in Medicine and +Pedagogy are well worthy of quotation: "It is illustrative of the broad +view taken by the committee of their task," says the _British Medical +Journal_, "that they deal with the education of the child from the time +it learns to speak and address inquiries as to how it came into the +world. The committee look forward to the time when parents will be so +enlightened that they will not tell their children silly stories about +babies being brought into the home by storks, but will give a simple +account which the child in later years will not discover to be +mendacious. The committee hope that the child, who is gradually taught +more and more about sex hygiene as it passes from one school grade to +another, will eventually become a parent wise enough to instil in the +next generation a frank and healthy attitude towards sex problems. +Parents, it is hoped, will learn to protect their infants from the +undesirable caresses and kisses of strangers ... As for sex teaching in +school, this should be associated with the teaching of biology, +Christianity, sociology, and psychology. The question of venereal +disease should not come into the curriculum until comparatively late, +and until the physiology of fertilization and reproduction has been +fully taught. Advanced sex teaching should preferably be in the hands of +doctors; but they are not always available, in which case other teachers +should give instruction on this subject, male teachers dealing with boys +and female teachers with girls. Teaching of sex hygiene in high schools +for girls should include the subject of venereal disease, and special +emphasis should be laid on the protection of infants from infection. A +further recommendation is that a carefully supervised library of works +on sex hygiene and venereal disease should be compiled at the cost of +the State for the use of teachers and classes." + +The Committee of the Board of Health agree with the suggestion that +teachers should be trained to deal with this question, and that school +medical officers or other qualified practitioners should give occasional +"talks" to the elder boys and girls. A great deal may be done by +physical instructors preaching the gospel of "physical fitness" and +personal cleanliness in thought, word, and deed. Bathing and outdoor +sports and games of all kinds should be encouraged. The Committee would +point out, however, that not all teachers and not all medical men +possess the qualities fitting them to give instruction and advice in +this delicate matter. The task should be entrusted to those who have +shown themselves specially adapted by sympathy and tactfulness for the +work, and preferably those who are parents, otherwise harm instead of +good may result. + +More than one witness spoke with approval of "The Cradleship" and other +books by Miss Edith Howes as suitable for use with young children. + +The Committee are of opinion that addresses on sex questions by lay +persons, except selected teachers, to young people in mass are of +doubtful value. + +Sufficient instruction should be given to adolescents regarding venereal +diseases and their effects to ensure that if they do contract them it +shall not be through ignorance. The Committee cannot too strongly +emphasize their belief, however, that knowledge of the effects of +venereal diseases is in itself by no means a sufficient safeguard; that +in addition to such knowledge the cultivation of a high moral standard +is necessary, and if this is reinforced by religious sanctions it is +likely to be more effective. + +The Committee agree with the view expressed by Dr. E.T.R. Clarkson in a +recent text-book, entitled "The Venereal Clinic," that in many instances +an excessive stress has been placed upon the factor of fear. He says +that a very small proportion of the community are restrained from +indulging in promiscuous sexual intercourse through fear, and it is +irrational to rely so much upon an emotion which at the best is but +slightly inhibitory, and which cannot in itself exercise a direct +energizing influence for good. "We do not," he continues, "wish to deter +the community from living a life of sexual promiscuity by rendering them +fearful of the possibilities of acquiring venereal disease, but we want +rather to instil such an ideal into them, whether it be of a religious, +ethical, or altruistic nature, as will tend to make them regard such a +life as incongruous with those tenets and therefore as undesirable, +however much it may be desired on other grounds." He adds that the +emphatic reiteration of fear possesses another and dangerous +disadvantage. "There is no doubt, as venereologists will testify, that +many individuals are seriously suffering from the effects of fear thus +engendered in their minds. In some instances the resultant damage to +their mentality is more serious than the venereal disease from which +they are suffering: whilst in others an obsession that they are +infected, when there is no foundation for the fear, may develop in such +a manner as to inflict serious and permanent damage." + + +SECTION 2.--CLINICS FOR THE TREATMENT OF VENEREAL DISEASE. + +Early in 1919 clinics for the treatment of venereal disease were +established in each of the four main centres. Arrangements were made by +the Department of Health for the treatment by Hospital Boards throughout +the Dominion of cases of venereal disease, and in the absence of local +institutions arrangements were made with private practitioners. There is +therefore opportunity for all to receive free treatment, wherever they +may be, in New Zealand. + +Table B sets out the work done at the four clinics during the two and a +half years ended 30th June, 1922. From this table it will be seen that +3,038 males and 596 females attended these clinics during the period +named. The total number of attendances was 110,792--101,995 males and +8,797 females. The disproportion between the number of males and females +attending is notable. It is clear from the evidence that this does not +represent a difference in the incidence of these diseases in the sexes, +but that women do not attend so freely when suffering. + +These clinics are attached to the public hospitals in each centre, and +all evidence goes to show that this is most desirable. If the clinics +were apart, the object of the patients' visits would be obvious, whereas +the actual purpose for which they go to a hospital is not so. It is to +be strongly emphasized that the less publicity given to the attendance +of these patients, the greater the number of patients who will be likely +to take advantage of the treatment offered. This applies especially to +the attendance of women. + +The clinics are now open only at certain hours. The Committee suggest +that they might with advantage remain open continuously (except at +certain fixed hours on Sunday). In the absence of the Medical Officer a +sister could take charge of the women's clinic, and a trained orderly of +the men's clinic. It would be necessary in this case to have separate +clinics for male and female patients--the same rooms would not be +available for both sexes. + +The majority of witnesses asked were of opinion that if a lady doctor +were made available for the treatment of women the number of women +attending would increase. + +It is suggested that in certain cases of gonorrhÅ“a, where it is an +advantage that the treatment should be carried out twice or more often +daily, arrangements might he made for the supply of the necessary +apparatus and drugs to patients at cost price, and in indigent cases +free of charge. This is particularly important to women who may have to +continue treatment for several months. + +The clinics should be more widely advertised by notices in public +conveniences and other suitable places. + +The Committee are impressed with the valuable work done at these +clinics, and recommend their extension to other centres as opportunity +offers and necessity is shown to exist. + +The existing clinics are conducted by medical men who have had special +experience and training in the treatment of these diseases. The Dunedin +clinic is attended by medical students for purposes of instruction. In +view of recent advances in the processes of diagnosis and treatment of +these diseases, the Committee consider that opportunity should be given +to medical practitioners to attend these clinics in order to familiarize +themselves with the most recent advances in this field. It would he an +advantage also if nurses in the course of their training attended the +female clinics, so that they might he taught to recognize the commoner +manifestations of these diseases. + +The most disappointing feature in the records of the clinics is the +cessation of treatment by so many patients before they have ceased to be +infective. The following evidence was given in this connection:-- + +_Percentage of Cases attending till Non-infective._ Auckland Clinic: 80 +per cent. cases of syphilis, 50 per cent. cases of gonorrhÅ“a. It was +stated that no woman suffering from gonorrhÅ“a continued treatment till +non-infective. + +Wellington Clinic: 40 per cent. of all cases continued treatment till +non-infective, and very few of these were women. + +Christchurch Clinic: Men with syphilis, 75 per cent.: men with +gonorrhÅ“a, 98 per cent.: women with syphilis, 50 per cent.: women with +gonorrhÅ“a, 14 per cent. + +Dunedin Clinic: In this clinic only thirty-one males suffering from +gonorrhÅ“a were discharged cured: thirty-two absented themselves while +still infective; three female cases remained under treatment till cured, +and six ceased to attend while still infective. Forty male syphilitics +remained till non-infective, and seventy-four ceased treatment before it +was completed. For female syphilitics the figures are four and eighteen. + +It will be noted that in each case the proportion of women who attend +till non-infective is much smaller than of men, especially in cases of +gonorrhÅ“a. The reasons for this are probably that owing to anatomical +considerations women infected with venereal disease suffer less pain and +the disease is less obvious than in men. On cessation of the more urgent +and obvious signs and symptoms they stop treatment. Again, it is +probable that the publicity of attending the clinics is felt more by +women than men. A third reason is the prolonged period of treatment +(often extending over many months) necessary to eradicate gonorrhÅ“a in +women. These difficulties could to some extent be mitigated by the +provision of arrangements for women to carry out treatment in their +homes, which would avoid the publicity and loss of time entailed in +attending clinics. + +The Committee were impressed with the value of the work done by the lady +patrol in Christchurch, and considers that lady patrols would help +greatly in securing the attendance of women at the clinics. It is +recommended that these patrols should be attached to the Hospital Boards +and that they should be trained nurses. They would be available to give +advice to patients as to treatment in their homes. + +The Committee would also draw attention to the very valuable work done +by the Social Hygiene Society in Christchurch, and recommended the +establishment of similar voluntary societies in other centres. + +The Committee recommend that all bacteriological and other examinations +required for the diagnosis and treatment of cases of venereal diseases +should be carried out in laboratories of the Department of Health and +public hospitals free of cost, on the recommendation of medical +practitioners. + +The Committee made inquiries from competent witnesses as to the present +position of the complement fixation test in gonorrhÅ“a. It appears that +this test has not reached yet such a degree of reliability as to render +it of great diagnostic value, but that it is reasonable to hope that it +may be perfected to such an extent to give it a value in the diagnosis +of gonorrhÅ“a comparable to that of the Wassermann test in syphilis. + + +SECTION 3.--LICENSED BROTHELS. + +Inasmuch as one of the many letters addressed to the Committee favoured +the adoption of the Continental system of licensed houses of +prostitution, with medical inspection of the inmates, it seems desirable +to examine the arguments for and against such a proposal. Those who +support it contend that so long as human nature remains as it is +prostitution will continue, therefore it is better that it should be +regulated with a view to controlling the spread of disease. It is also +urged that the system acts as a safeguard against sexual perversion by +providing an outlet for the unrestricted appetites of men; that in its +absence clandestine prostitution increases, and innocent girls are more +likely to be led astray or become the victims of sexual violence. Apart +from the moral aspect of the case, these arguments are entirely +fallacious; and even in the countries where the licensed-house system +prevails enlightened public opinion has come to that conclusion. In the +first place, the idea that the system tends to lessen disease is a +dangerous delusion. Owing to the fact, already referred to, that +venereal disease in the early stages is difficult to detect in women, +even by skilled experts working with the best methods and with +practically unlimited time at their disposal, the routine inspection +given, for example, in the French and German houses is no guarantee of +the inmates being free from communicable disease even at the time of +inspection. + +Flexner, who spent two years in making inquiries and writing his classic +work on "Prostitution in Europe," is most emphatic on this point. The +experience of the American troops in the Great War is further strong +confirmation. The following is an extract from an article published by +the American Red Cross in May, 1918: "During the months of August, +September, October, and the first half of November, the houses of +prostitution flourished and were half-filled with soldiers. On November +15th rigid orders were issued placing these houses out of bounds, and +the immediate result was a great reduction of sexual contacts. As a +result there was a steady decline in venereal infections, and the +monthly rate per 1,000, which in October reached 16.8, dropped in +January to 2.1 among the white troops. During the same period there was +an even more striking drop in the infections among the negro labourers, +the percentage dropping from 108.7 per 1,000 a month to 11 per 1,000. No +statistics could speak more eloquently for the doctrine of closing the +houses of prostitution. Our studies showed numerous infections coming +from houses 'inspected' three times a week." + +In May, 1921, a conference (the North European Conference on Venereal +Diseases), in which England, Finland, Germany, Holland, Norway, Sweden, +and Denmark participated, passed the following resolution: "This +conference, having considered the general measures for the combating of +venereal diseases which have been adopted by the participating +countries, is unanimously of the opinion, so far as the experience of +these countries is concerned, that the legal and official toleration of +professional prostitution has been found to be medically useless as a +check on the spread of venereal diseases, and may even prove positively +harmful, tending as it does to give official sanction to a vicious +trade." + +On the same point Flexner says: "It is a truism that physicians +requiring to equip themselves as specialists in venereal disease resort +to the crowded clinics of Paris, Vienna, and Berlin, all regulated +towns, because there disease is found in greatest abundance and richest +variety--a strange comment on the alleged efficacy of regulation." + +Dr. Clarkson, in "The Venereal Clinic," already quoted, says, in +reference to the fancied security of licensed houses, "It may strengthen +the hands of practitioners to be able to tell interrogators in this +subject that in the opinion of leading venereologists, &c., no +foundation exists for any such feeling of confidence or security. In +other words, the system of licensed houses is a failure, and the 'red +light' of lust shines out as the lurid signal of disease and death." + +It is surely hardly necessary to urge the moral objections to the +proposal. The United States Public Health Service not long ago sent out +a _questionnaire_ to representative citizens in various walks of life +asking for opinion in regard to open houses of prostitution. There was +an overwhelming preponderance of replies against the system on moral as +well as hygienic grounds. One Illinois miner answered: "The life of a +prostitute is short, and her place must be filled when she dies, and, +being the father of two girls, I would not want mine to fill a vacancy, +and I think all parents think the same." A Colorado carpenter replied: +"The woman engaged in such business may not be my wife, mother, sister, +or daughter, but she is somebody's wife, mother, sister, or daughter. It +is a violation of all law." One Chief of Police wrote: "Open houses of +prostitution breed disease, crime, increase the number of prostitutes, +corrupt the morals of the community, and are a menace to the youth of +the country." Another replied: "The only reason I have ever heard +advanced in favour of houses of prostitution is that they protect +innocent girls. I am opposed to sacrificing any woman to benefit +others." + +If statistics could be obtained it would be probably found that the +system tends not only to increase disease, but the volume of sexual +immorality and crime. From the most materialistic point of view the +system is indefensible; while, looking at it from the moral aspect, it +is inconceivable that British people, who spent millions of money to +stop the traffic in black slaves, would ever officially countenance a +system which enslaves the souls as well as the bodies of its victims and +defiles the community in which it exists. + + +SECTION 4.--EXCLUSION OF VENEREAL CASES FROM OVERSEAS. + +The Committee are of the opinion that by the strict exercise of the +provisions of section 111 of the Health Act, 1920, much may be done to +prevent introduction of venereal diseases from overseas. They suggest, +however, that where any person so suffering is required or permitted to +attend a clinic he should be accompanied by some responsible officer of +the ship, or person authorized by the shipping company concerned, and +that the question on the "Report of Master of the Ship" defined by +regulations--"Are you aware of the presence on board of any person +suffering from ... _(b)_ venereal disease?"--might be strengthened by +adopting the Australian quarantine service equivalent viz., "Is there +now or has there been on board during the voyage any person suffering +from demonstrable syphilis in an active condition, or other communicable +disease?" + +The evidence given does not show that the number of venereal-diseases +cases already in the Dominion is greatly added to by the introduction of +cases from overseas. Since 1903 persons suffering from syphilis have +been "prohibited immigrants" within the meaning of the Immigration +Restriction Act. + + +SECTION 5.--PROPHYLAXIS. + +Before discussing this question it is desirable clearly to distinguish +between the procedures which are included under this term. These are-- + + (1.) The supply of drugs and appliances which are made available + for use by the individual before exposure to infection. This may be + described as "anticipatory prophylaxis," and has commonly been + designated the "packet system." + + The Committee condemn this procedure, for these reasons: (i) That + the system suggests a moral sanction to vice; (ii) that the + individual is lulled into a false sense of security, and may + thereby be encouraged repeatedly to expose himself to infection; + (iii) that the individual may be thereby deterred from seeking + early advice or treatment; (iv) that the drugs supplied may be used + for treating disease should it arise, and so delay may result in + seeking skilled treatment in the early stages when it is likely to + be most effective. + + (2.) Treatment applied after exposure to infection. This is called + "early treatment." This term is inapplicable, as a disease cannot + be treated before it exists. It is also likely to be confused with + "abortive treatment," which implies treatment immediately on the + appearance of symptoms. + + The evidence before the Committee shows that this form of + prophylaxis, if applied by skilled persons and within a few hours + of exposure, is effective in preventing disease in a great majority + of the cases in which it is used. + +The Inter-departmental Committee on Infectious Diseases set up by the +Ministry of Health in 1919 in connection with demobilization, in a note +on "Prophylaxis against venereal disease," reported among its +conclusions based on service experience, "That where preventive +treatment is provided by a skilled attendant after exposure to infection +the results are better than when the same measures are taken by the +individual affected, even after the most careful instruction." After +exposure to infection there appears no reason why these diseases should +not be regarded in precisely the same manner as other infectious +diseases, and precautions taken to sterilize the parts which have been +exposed to infection. + +It is to be noted that it is recommended that the prophylactic treatment +is to be carried out by some properly instructed person. This need not +necessarily be a medical man. It is suggested that this form of +prophylaxis might be carried out by an orderly at the venereal-disease +clinics. The notices posted in the public conveniences and other +suitable places indicating the existence of the clinics and the +necessity for treatment might include a guarded reference to their use +for this purpose. + +This form of prophylaxis applies to males. In the case of females the +methods adopted would be also contraceptive, and the Committee do not +recommend that facilities should be provided for this. + +The Committee must not be supposed to advocate prophylaxis as in any way +a substitute for continence and the cultivation of that high moral tone +that repels any suggestion of promiscuous sexual relationships, but they +feel that they could not properly ignore reference to a method of +prevention of these diseases which has proved very efficient in the +services, to which there appears no reasonable ethical objection, and +which brings their prophylaxis into line with that of other infectious +diseases. + + +SECTION 6.--LEGISLATION REQUIRED. + +(A.) _Conditional Notification._ + +The only subjects of importance upon which the witnesses examined +differed materially in opinion were--(1) whether there ought to be any +system of notification of cases of venereal disease, and (2) what steps, +if any, should be taken to deal with persons suffering from such disease +in a communicable form who refused to be treated, and in some cases were +even known to be spreading the disease broadcast. Ladies who attended to +give evidence on behalf of the National Council of Women and one or two +other women's organizations objected to notification and compulsory +treatment. They argued that there was at present a "scare" on the +subject of venereal disease, and deprecated "panic legislation." They +contended that the adoption of notification would deter patients from +seeking treatment for fear of publicity. They were opposed to compulsory +treatment of recalcitrant patients, arguing that any law of the kind +would be used most oppressively against women. They contended that +reliance should be placed on greater facilities for free treatment at +the clinics, the work of women patrols, suppression of liquor, and above +all education and propaganda on moral lines. + +When confronted with typical cases of difficulty already quoted some of +the witnesses admitted that it was not easy to see how such cases could +be dealt with satisfactorily without compulsion of some kind. But they +argued that, even so, it would be a greater evil if the fear of +publicity and the fear of compulsion should have the effect of deterring +sufferers from seeking treatment and so drive the disease underground. + +The National Council of Women, by a substantial majority, at a recent +conference in Christchurch, carried a resolution protesting against a +proposal to introduce compulsory notification and treatment of venereal +diseases, and urging the Government to increase the facilities for free +treatment. The President of the Council, however, informed the Committee +that most of the nineteen societies affiliated to the Auckland Branch of +the National Council are in favour of some form of compulsion, but a +number of the southern branches are opposed to it. Speaking as an +individual, and not as President of the National Council of Women, she +added: + +"Personally, I have no first-hand knowledge as to whether the disease is +so prevalent in the community as to demand urgent measures, but there is +an opinion among women social workers and medical practitioners, whom I +have consulted, that something should be done, and they are in favour of +compulsion under the Act, provided its administration is satisfactory. +There is no doubt that there is a genuine and widespread fear among a +large number of women that, although in the Act itself there is no +discrimination between men and women, in actual practice there will be, +and they fear that the Act will be enforced against women, and +particularly immoral women, while the men concerned will be allowed to +go free. This fear arises partly from the remembrance, particularly +among elderly women, of the old Contagious Diseases Acts, both here and +in England, and partly from the reports of the working of compulsion in +Western Australia and elsewhere. I am of opinion that there is no +serious ground for fear in view of the changed attitude in the public +mind in connection with these diseases, the fuller knowledge that people +generally have, and the high status of women in our country; also the +ready access that all persons have to the protection of the law and the +Courts in the event of false information being given, and the safeguards +embodied in the Bill as I understand it is drafted. My view is that the +objection to the compulsory clauses of the Bill would be removed in the +opinion of many women if women patrols or women police were appointed, +so that the administration of the Act in its compulsory clauses wherever +it treated women could be in the hands of those women officers." + +Among the witnesses questioned on this subject there was an overwhelming +preponderance of opinion that the time had now arrived for the adoption +of notification of all cases of venereal disease by number or symbol, if +only for the purpose of getting more accurate statistics; the +notification by name of those recalcitrant patients who refused to +continue treatment until cured; and compulsory examination of those whom +the Director-General of Health had good grounds for believing to be +suffering from the disease and likely to communicate it to others, and +who refused to produce a medical certificate as to their condition. Only +three medical men expressed themselves as being against these proposals. +On the other hand, the lady doctors examined (two of them members of the +National Council of Women, and the third representing the Young Women's +Christian Association) gave evidence in favour of conditional +notification, and compulsory examination, and compulsory treatment of +recalcitrants. It should be added that all the witnesses who were +engaged in rescue work, or other work bringing them face to face with +the horrors of venereal disease, were most emphatic in their opinion +that compulsory notification and treatment should be adopted. + +It is noteworthy that when the notification of ordinary infectious +disease was first proposed in England almost exactly the same arguments +were brought against the proposal as are now advanced against the +notification of venereal disease. Sir W. Foster, member for Ilkeston, +and a medical man of standing, speaking in the House of Commons in the +debate on the Infectious Diseases Notification Bill, on the 31st July, +1889, said, + +"The Bill calls upon medical men to perform something more than the +ordinary duties of citizenship by requiring them to become informers of +the occurrence of diseases. The relation of a medical men to his patient +ought to be one of complete confidence, and anything that comes to the +knowledge of a medical man in the practice of his profession is +practically an inviolable secret; and I do not like any Bill to +interfere with that relationship. I know myself that one of the results +of this Bill, if passed into law, will be that in scores of cases +medical men will not be called in to attend people suffering from +infectious diseases ... I admit the difficulty of the position, but I am +anxious that no measure should pass into law which will induce the +public to keep these diseases more secret than they have been in the +past, with the risk of adding to the spreading of them. We must be very +cautious not to do anything which will prevent the public from placing +full and implicit confidence in their medical man. I can quite conceive +it to be possible that, if an outbreak of infectious disease occurs in a +populous part of London, the people may, in order to prevent exposure, +refuse to allow a medical man to come in, and in such cases we shall +have tenfold more difficulty than at present. Therefore, while I am +anxious to promote the notification of disease, I do not want the +Government to promote rebellion on the part of the public." + +Needless to say, these gloomy anticipations have not been realized. +Probably the more enlightened generations to succeed us will wonder how +there could ever have been any opposition to the notification of +venereal disease, just as we to-day read Sir W. Foster's words and +marvel that any person of intelligence could have committed himself to +such statements. + +Notification of infectious diseases and isolation of patients suffering +from such diseases have for many years been compulsory. Isolation, when +spoken of by opponents to a similar measure for venereal diseases, is +opprobriously described as "compulsory detention." For twenty years it +has been the law in New Zealand that an authorized medical practitioner +may examine any person suspected to be suffering from any infectious +diseases (save venereal diseases), and the Medical Officer of Health +may, if he deems it expedient in the interests of the public health, +compel the removal to a hospital of any person so suffering. This +long-established procedure as referable to venereal diseases is by +antagonists termed "compulsory examination" and "compulsory removal." + +It is contended by some witnesses that notification will drive these +diseases underground; but syphilis and gonorrhÅ“a for generations past +have been underground. + +Under the present system numbers of unfortunate persons either delay +calling in medical assistance until the case has become almost desperate +so far as the patient is concerned, or they resort to unqualified +persons, with the result that in most cases what was in the first +instance a simple attack, capable of treatment, results in serious +complications most difficult to deal with. In either case the patient +may be communicating diseases to others, and should this come to the +knowledge of the Health Department it has no effective means of checking +him--no power to warn those who are being endangered by his criminal +neglect. + +The Committee think there is some force in the argument that +notification by name, in the first instance, as in the case of ordinary +infectious diseases, would tend to discourage some from coming forward +for medical treatment. They recommend, therefore, the adoption of what +is known as the system of conditional notification embodied in the West +Australia Act. Under this plan the cases are notified by the doctor to +the Health Department by number or symbol only. The name is not sent in +unless the patient discontinues treatment before he is free from +infection and refuses either to go to a clinic or to another doctor. In +cases of those who "play the game," the name of the patient is kept +confidential, and does not pass beyond the medical man attending him. It +is only in cases of those who contumaciously refuse to do what is +necessary for their own safety and the safety of others that the name is +sent to the Health Department, in order that appropriate steps may be +taken in the interests of public health. Even then the name is given +only to officers who are pledged to keep it confidential. + +Following are the clauses in suggestions for a Bill, drawn up by the +Health Department, which in the opinion of the Committee should in +substance be adopted:--- + + "(1.) Every medical practitioner shall forthwith give notice to the + Director-General of Health, in the prescribed form, upon becoming + aware that any person attended or treated by him is suffering from + any venereal disease in a communicable form. The notice shall state + the age and sex and occupation of the patient and the nature of the + disease, but shall omit the patient's name and address. + + "(2.) Every medical practitioner, other than the medical officer in + charge of a public hospital or of a clinic established by direction + of the Minister of Health, shall be paid for each such notification + a fee to be prescribed by regulation. + + "(3.) The provisions of subsection (1) hereof shall apply in the + case of a child under the age of sixteen years who is suffering + from congenital syphilis. + + "(4.) Whenever a patient has changed his medical adviser, in + accordance with subsection (2) hereof, the medical practitioner + under whose care the patient has placed himself shall notify the + Director-General of Health in accordance with subsection (1) + hereof, and shall include in such notice the name and address of + the previous medical adviser." + +Without some such system of preliminary notification no adequate +statistics can be collected as to the prevalence of venereal diseases in +New Zealand, and no conclusion could be arrived at in the future as to +the effect of the whole or any part of the programme for combating these +scourges. Again, without such notification, and the attachment thereto +of some method of ensuring that the patient is made definitely +acquainted with his condition, it is practically impossible to enforce +the provisions of section 8 of the Social Hygiene Act for the crime of +"knowingly" infecting any other person. + +Here the Committee would refer to case 2 quoted above. Of what use is it +to provide free clinics if those who make use of them are permitted, as +soon as the urgent symptoms are relieved, to disseminate disease +broadcast, widening the circle of infection? Again, where is our +humanity if no step is to be taken to try to prevent a syphilitic child +being born to the man in case 1? + +A very valuable result of anonymous notification would be the +possibility afforded of observing any unusual "flare-up" or succession +of cases, especially in country districts and small towns. Study of case +4 will show the great value it would have been to have a record of an +unusual increase of syphilis in that township, giving an opportunity for +prompt investigation by the Medical Officer of Health for the district. + +(B.) _Compulsory Examination and Treatment._ + +This question obviously presents more difficulty than that of +notification, but it is clear that unless some means are provided of +bringing under treatment and, if necessary, isolating persons who are +suffering from highly contagious diseases, and who will not avail +themselves of medical treatment although this is provided free of cost +by the State, and who are knowingly or recklessly communicating the +disease to others, it will be impossible to keep in check this terrible +scourge. Without such provision any abandoned woman, as in case 4, or +any male libertine, may continue to sow disease broadcast without any +power to stop them. Failing some such measure, table articles and food +may continue to be smeared by hands soiled with syphilitic material, as +in case 1; section 6 of the Social Hygiene Act remains mere useless +verbiage, and the infecting of innocents, as in case 3, may continue +unchecked. + +Legislation dealing with this subject needs to be carefully framed with +suitable safeguards, but the Committee think that an amendment of the +Social Hygiene Act on the lines proposed by the Department of Health +should be adopted. These provisions are:-- + + (1.) That whenever the Director-General of Health has reason to + believe that any person is suffering from venereal disease, and has + infected or is liable to infect other persons, he may give notice + in writing to such person directing him to consult a medical + practitioner, and to produce within a time specified in the notice + a certificate from such medical practitioner to the satisfaction of + the Director-General of Health that such person is or is not + suffering from venereal disease. + + (2.) Should the person not comply with this request, the + Director-General of Health may obtain a warrant from a Magistrate + ordering such person to undergo examination to prove the existence, + or non-existence, of venereal disease. + + (3.) Making it possible for a Magistrate, on the application of the + Director-General of Health, to order the detention in a hospital or + other approved place of a person who is likely to be a danger to + other persons until that person is cured of venereal disease. + +These provisions are applicable equally to both sexes, and the Committee +see no reason to fear that the law would not be carefully and +impartially administered. If it should appear that more women than men +came under the operation of the law this result would be due to the fact +that, as disclosed in the evidence, a much larger proportion of women +than men fail to seek treatment, and of those treated a much larger +proportion of women fail to continue treatment until no longer +infectious. + +It is hardly conceivable that a responsible officer, such as the +Director-General of Health, would take action under these provisions +unless he had strong reason to believe that such action was justified. +But, even if he makes a mistake or is misinformed, the worst that can +happen to an innocent person wrongfully suspected is that he or she will +be required to produce a medical certificate, which can be procured free +of cost from any hospital or V.D. clinic. This is wholly different from +the provisions of the Contagious Diseases Act, under which a woman +suspected of prostitution was liable to be arrested by a constable in +the street. + +The Committee recommend that the serving of notices, &c., under these +sections be done by officers of the Health Department and not by the +police. They also recommend that all proceedings taken under any Act +having reference to venereal diseases should be heard in private unless +the defendant applies for a hearing in open Court. + +With regard to the effects of the actual operation of notification, +examination, and isolation, the Commissioner of Public Health for West +Australia, under date 25th August, 1922, advises the Committee that +there is an increase in the number of cases attending public clinics, +and that this is regarded not as evidence of increased incidence, but of +increased interest and appreciation of early treatment by those +suffering from the diseases. + + +SECTION 7.--MARRIAGE CERTIFICATE OF HEALTH. + +The Royal Commission on Venereal Disease reported that there was a vast +amount of ignorance as to the dangers arising from the sexual +intercourse of married persons one of whom had previously to the +marriage contracted syphilis or gonorrhÅ“a. The effect upon the +birth-rate, and the misery caused during married life, and in many cases +to the offspring who survive, as they pointed out, are most serious, and +the fact that the actual cause of the trouble often remains unknown and +unrecognized prevents the calamity from serving the purpose of example +or warning. + +Some of the witnesses heard before the present Committee have urged that +a certificate of good health, or at least a certificate of freedom from +communicable disease, should be required from each party to a proposed +marriage before the Registrar issued a license to marry. The Royal +Commission considered that "it would not be possible at present to +organize a satisfactory method of certification of fitness for +marriage." The National Birth-rate Commission, however, reported that in +their opinion the question should be reconsidered with a view to +legislation. + +There is much to be said in favour of such a proposal from the point of +view of national health. If the system were adopted the certificate +should, in the opinion of the present Committee, include freedom from +mental disease as well as freedom from communicable disease. But there +are manifest difficulties in the way, chiefly in regard to the delicate +and searching examination which would be required in the case of women +before a doctor could certify positively to the absence of communicable +disease. + +The Committee recommend that instead of a medical certificate each party +to a proposed marriage should be required to answer appropriate +questions in regard to the presence or absence of communicable and +mental disease, and to make a sworn statement before the Registrar as to +the truth of the answers. It should be the duty of the Registrar to +communicate the contents of the statements to the other party in the +event of any admission of the presence of communicable disease. + +In addition to the penalty for making a false statement it might be +provided, as in the Queensland Act, that venereal disease shall be a +ground for annulling a marriage contract when one party is suffering at +the time of marriage from such disease in an infectious state, provided +the other party was not informed of the fact prior to marriage. + +The Committee would also recommend the adoption of a further provision +that it should be the duty of a medical practitioner attending a case of +venereal disease which is or is likely to become infective, if he has +reason to believe that the patient intends to marry, to warn him or her +against doing so, and if he or she persists it should be the duty of the +doctor forthwith to notify the case by name to the Director-General of +Health, whose duty it should be to inform the other party. It should +also be provided that _bonâ fide_ communications made in such a case, +either by the Director-General of Health or the doctor, to the other +party to the marriage, or to the parents or guardian of such party, +shall be privileged. + + +SECTION 8.--TREATMENT BY UNQUALIFIED PERSONS. + +The evidence given before the Committee shows that while reputable +chemists refer to a medical man patients coming to them for treatment +for venereal disease, and while these constitute the great majority of +the profession, there are still far too many cases of venereal disease +treated by chemists, herbalists, chiropractors, and other unqualified +persons. The treatment of venereal disease has become a specialized +branch of medicine, and many general practitioners prefer to refer such +cases to experts. The result of trusting to unqualified persons for the +treatment of such serious and difficult diseases is that the patient +usually drifts on uncured, and serious complications may occur. One +specialist in venereal disease informed the Committee that of 200 of his +cases whose cards showed particulars, 104 consulted chemists in the +first place and received more or less treatment from them. He was able +to give details of twenty-three cases showing the type of treatment +given. In several cases there were severe complications which could have +been avoided by proper treatment. There were also cases in which the +patient, after taking medicine for a time, had communicated the +infection to others. This witness further stated that some chemists +charged consultation fees in addition to charges for drugs applied, and +in certain cases charges for drugs were made which were little short of +blackmail. + +The Committee recommend that, in place of section 7 of the Social +Hygiene Act, a more comprehensive clause from the West Australian Act be +adopted. This is to the following effect: "No person [other than a +registered medical practitioner] should attend or prescribe for any +person for the purpose of curing, alleviating, or treating venereal +disease, whether such person is in fact suffering from such disease or +not." + +The Committee would suggest that if the Pharmaceutical Society were to +do all in its power to discourage its members from treating these +diseases it would have a good effect. + + +SECTION 9.--MENTALLY DEFECTIVE ADOLESCENTS. + +Mr. J. Caughley, Director of Education, stated in evidence: "From a +general inquiry made by the Department a few years ago it was +ascertained that there were at least six hundred or seven hundred mental +defectives in New Zealand under the age of twenty-one. I need scarcely +point out the moral danger to the community of so many of these +defectives being at large. In particular, the girls are a source of +danger to themselves and to the community, since they have little or no +will-power or sense of restraint. I am of opinion that all such cases +should be registered, and that, unless it can be shown that the mental +defective is under thoroughly safe and proper care at home, he should be +taken charge of by the State. I am certain that by this means the +increasing number of mental defectives would be reduced to a minimum, +since mental defectiveness is almost entirely hereditary." + +Mr. Beck, Officer in Charge of the Special Schools under the Education +Department, cited illustrative cases, one of which may be thus stated: +"Two feeble-minded parents in New Zealand have had up to the present +time ten degenerate children, all of whom are a lifelong burden on the +State. Taking the case of these children, and assessing the cost to the +State of maintaining them, the total amount for this family will not be +less than £16,000." + +The Committee are of opinion that supervision of mentally defective +children and adolescents is an important factor in lessening venereal +disease, and urge the Government as soon as possible to adopt a system +of registration and classification of mental defectives, and of +segregation where necessary, either in mental hospitals or in special +institutions where these defectives may be suitably taught, and, where +possible, usefully employed to defray the cost of their maintenance. + + + + +PART IV.--SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS. + + +SECTION 1.--CONCLUSIONS. + +Following are some of the conclusions drawn from the evidence by the +Committee:-- + +There is very general ignorance among the public on the subject of +venereal disease, and this has stood in the way of its being grappled +with effectively. + +Syphilis not only causes loss of life directly, but many deaths ascribed +to other causes in the Registrar-General's returns are due to the +after-effects of this disease. It is responsible for many still-births +and abortions, and its evil effects are seen in such children as +survive. These effects may persist until the third generation. + +GonorrhÅ“a, popularly, but quite erroneously, supposed to be a +comparatively mild complaint, is regarded by medical men as being as +serious a disease as syphilis. It is difficult to cure, especially in +women, unless properly treated at the outset. It is a great cause of +sterility in both sexes. + +Owing to the absence of accurate statistics it is impossible to make +comparisons between New Zealand and other countries as regards the +prevalence of venereal disease, or to say whether it is increasing or +decreasing in this country. + +There are in New Zealand no fewer than 3,031 persons being treated by +registered medical practitioners for venereal disease in some form, or +for the effects thereof--1 person in every 428 of our population. At the +clinics since their establishment 3,634 patients have been +treated--3,038 males, 596 females. + +An interesting calculation as to the prevalence of syphilis in New +Zealand has been made by Dr. Hay, Inspector-General of Mental Hospitals. +Working on what is known as Fournier's Index--the relation of the number +of cases of dementia paralytica existing at any one time to the number +of concurrent syphilitic infectious--he computes the number of persons +in New Zealand now who have or have had syphilis to be 33,000, or 1 to +every 38 of the population. + +The Committee desire to state, however, that in their opinion there can +be no accurate estimate of the prevalence of venereal disease until some +system of obtaining accurate statistics has been adopted. One point +which has come out clearly in their investigations is that venereal +disease is sufficiently prevalent to cause serious concern and to call +for energetic action. + +Evidence was given to the Committee to show that children with mental +and physical defects due to venereal diseases may become a charge on the +State; that a proportion of these on being released become parents of +defective children, who in their turn have to be supported at the public +expense. It was also shown that such defectives have little sexual +control, and are usually very prolific. + +According to the Commissioner of Police there are only 104 professional +prostitutes in New Zealand. + +There is, however, a great deal of "amateur" prostitution, and this is +chiefly responsible for the spread of venereal diseases. + +The evidence points to a good deal of laxity of conduct among young +people of all social conditions, especially in the large towns. This is +generally attributed by the witnesses to the weakening of home influence +and the restlessness of the age. + +Apart from the venereal disease among those who indulge in promiscuous +intercourse, there are many cases in which innocent wives are infected +by their husbands, and other cases (not so frequent) of innocent +husbands being infected by their wives. + +Children suffer innocently from venereal disease, not only by +inheritance from infected parents, but by accidently coming in contact +with the germs on towels, &c., which have been used by a patient. There +are also cases which come before the Courts where disease has been +conveyed directly in crimes of violence by sexual perverts. + +The free clinics in the chief centres are conducted by experts, and are +doing good work. Their influence for good is greatly impaired, however, +by the fact that a proportion of the male patients and the majority of +the female patients leave off treatment before they are cured. As the +law stands there is no power to compel them to continue treatment, and +in many cases they resume promiscuous intercourse and spread the +disease. + +Evidence has been given of other cases, some of them of a very shocking +character, in which persons suffering from venereal disease are not +seeking medical treatment and are communicating the disease to others. +As the law stands at present there is no power to restrain them from +such conduct or to compel them to receive medical treatment. + + +SECTION 2.--RECOMMENDATIONS. + +The Committee stress in the strongest terms the duty of moral +self-control. + +They urge the cultivation of a healthier state of public opinion. The +stigma at present attached to sufferers from venereal disease should be +transferred to those who indulge in promiscuous sexual intercourse. + +Parents have a great responsibility as regards the instruction and +training of their children so as to safeguard them against the dangers +resulting from ignorance of sexual laws. There is too little parental +control generally in New Zealand. The Committee recommend the training +of teachers, and provision for giving appropriate instruction in +schools. + +Classification and, where necessary, segregation of mentally defective +adolescents is recommended. + +The following medical measures for preventing and combating the disease +are recommended:-- + +The clinics should be made more available by being open continuously. +Every effort should be made to secure privacy. A specially trained nurse +should be in attendance at women's clinics, and women doctors should be +secured where possible. + +The Committee recommend that provision be made at the clinics for prompt +preventive treatment of those who have exposed themselves to infection. + +Lady patrols should be appointed in other centres to perform the kind of +work that is being carried on in Christchurch. + +The Committee, having regard to the good work especially of an +educational nature which is being done by the Social Hygiene Society, +Christchurch, consider voluntary effort of the same kind in other +centres would be very helpful. + +The Committee are entirely opposed to the Continental system of licensed +brothels, or a revival of the C.D. Acts in any shape or form. + +They recommend legislation be introduced providing for what is known as +conditional notification of venereal disease. It will be the duty of a +doctor to notify to the Health Department, by number or symbol only, +each case of venereal disease he treats. If a patient, however, refuses +to continue treatment until cured, and will not consult some other +doctor or attend a clinic, it will then be the duty of the doctor last +in attendance to notify the case to the Department by name. + +If the patient continues recalcitrant and refuses to allow himself to be +examined by the medical practitioner appointed by the Director-General +of Health, then the latter should be empowered to apply to a Magistrate +for the arrest of such person and his detention in a public hospital or +other place of treatment until he is non-infective. + +The Committee also recommend further provision to deal with cases in +which persons suffering from venereal disease are not under medical +treatment and are likely to infect others. If the Director-General of +Health has reason to believe that any person is so suffering he may call +on that person to produce a medical certificate, which may be procured +free of charge from any hospital or venereal-disease clinic. If the +person refuses to produce such a certificate he or she may be taken +before a Magistrate, who may order a medical examination. Penalties, +including detention in a prison hospital, should be provided for +recalcitrant cases. The proceedings in all these cases are to be heard +in private unless defendant desires a public hearing. + +The Committee recommend that before a license to marry is issued the +intending parties must sign a paper answering certain questions as to +freedom from communicable disease and from mental disease, and must make +a sworn statement that the answers to such questions are true. + +They recommend the adoption of a provision in the Queensland Act making +venereal disease a ground for annulling a marriage contracted whilst one +party is suffering from such a disease in an infectious stage, provided +the other party was not informed of the fact prior to marriage. Also +that it should be the duty of a medical practitioner attending a case of +venereal disease, if he has reason to believe that the patient intends +to marry, to warn him or her against doing so, and if he or she persists +it should be the duty of the doctor to notify the case by name to the +Director-General of Health, whose duty it should be to inform the other +party, or the parents or guardian of such other party. Such +communications made in good faith either by the doctor or the +Director-General of Health should be absolutely privileged. + +The Committee recommend that the law prohibiting treatment of patients +for venereal disease by unqualified persons shall be strengthened, and +suggest that the Pharmaceutical Society might assist in preventing such +practices. + + +SECTION 3.--CONCLUDING REMARKS. + +The Committee in carrying out their task have been brought into contact +with some uninviting aspects of our social life. Some of the facts +disclosed are of a character to give serious concern to those lovers of +their country who rightly regard it as exceptionally favoured by nature, +and desire to see its people healthy and vigorous, clean in body and +mind, worthy of their heritage. The late war showed that the pick of our +population, physically as well as mentally, were of the finest possible +type, the admiration of all who saw them; but the medical examination of +the recruits disclosed that of 135,282 examined after the introduction +of the Military Service Act--mostly young men in the prime of life--only +57,382, or say, 42½ per cent., could be accepted as fit for training, +unmistakably proving that the nation as a whole was much below the +standard of physical fitness which it ought to exhibit. + +The investigations of the Committee show that already there is far too +large a proportion of mental and physical defectives reproducing their +kind. In the absence of accurate statistics it is impossible to say what +proportion of these defectives are the direct product of venereal +disease, but there is clear evidence that a tendency to lead dissolute +lives is especially noticeable in the females belonging to this +unfortunate class. "A feeble-minded girl," says Mr. Beck, "has not sense +enough to protect herself from the perils to which women are subjected. +Often amiable in disposition and physically attractive, they either +marry and bring forth a new generation of defectives, or they become +irresponsible sources of corruption and debauchery in the communities +where they live." Obviously some method of dealing with mental +defectives--by segregation or otherwise--must be found as part of the +problem of dealing with venereal disease. + +As regards the effect of venereal disease on the general health of the +community, we have the statement of the late Sir William Osler that he +regards syphilis as "third on the list of killing diseases"; while +Neisser, a leading authority, says that "with the exception of measles, +gonorrhÅ“a is the most widely spread of all diseases. It is the most +potent factor in the production of involuntary race suicide, and by +sterilization and abortion does more to depopulate the country than does +any other cause." + +In view of the facts brought out in the course of the inquiry, the +Committee are strongly of opinion that it would be criminal neglect to +allow the evil to go on without taking energetic steps to check its +ravages. They believe that the legislative and other measures which they +recommend for the medical prevention and treatment of venereal disease +will, if given effect to with the loyal co-operation of the medical +profession, have a very beneficial result in reducing the prevalence of +disease, and will save an incalculable amount of sorrow and suffering +which in too many cases falls upon the innocent. In what is proposed in +this report there is nothing approaching a revival of the old Contagious +Diseases Acts. To use the words of Dr. Emily Seideberg, the principle of +the legislation now proposed is "To improve the health of the community, +and not, as in the old Contagious Diseases Acts, to make sexual +immorality safe for men of low morals." + +The Committee are of opinion that, far from conditional notification and +compulsory treatment on the lines proposed being prejudicial to woman in +any way, it is they who will reap the greatest benefit from these +measures. In fact, sufferers from venereal disease, as a whole, have +everything to gain and nothing to lose so long as they will continue +under treatment, and to enable them to do this the best medical skill is +placed at their disposal free of cost. The only persons in the community +who will be penalized by the proposed legislation are those who, having +contracted venereal disease, are so reckless and unprincipled that they +will take no pains to avoid communicating it to others. + +The Committee, it will be seen, regard the legislative and medical +measures which they propose as of great importance, but with all the +earnestness at their command they desire in conclusion to emphasize the +moral and social aspects of the question. With the changing social +conditions, especially in the larger towns, we are losing the home +influence and home training which are the best safeguards to preserve +the young against the temptations and dangers which beset their path in +life. The Committee would impress upon parents the paramount duty they +owe to their children in this matter. There is also a duty cast upon all +leaders of public opinion, and upon the community at large, to do what +is possible to bring about better living-conditions, especially for +girls in the towns, to encourage all forms of healthy sport and +amusement, and to cultivate a higher moral standard. Whatever sanitary +laws may be passed, and whatever success may be attained in dealing with +bodily disease, there can be no true health if the soul of the nation +remains corrupt. If this inquiry should serve to remove some of the +popular ignorance regarding venereal disease, and to quicken the public +conscience so that appropriate steps may be taken to deal with this +dreadful scourge, the Committee feel that their labours will not have +been in vain. + +W.H. TRIGGS, Chairman. +J.S. ELLIOTT, \ +M. FRASER, \ Members +J.P. FRENGLEY, > of +JACOBINA LUKE, / Committee. +D. McGAVIN, / + + + + +APPENDIX. + + +GRAPH A. + +AVERAGE AGES OF BRIDEGROOM AND BRIDE AT MARRIAGE, 1900-1921. + +[Illustration] + + +TABLE A. + +ILLEGITIMATE BIRTHS, AND BIRTHS WITHIN ONE YEAR AFTER MARRIAGE, IN NEW +ZEALAND, 1913-21. + +NOTE.--The figures refer to accouchements, not to children born, +multiple cases being counted once only (Only live births are included.) + +------+------------+-------------------------------------------------+ + |Illegitimate| Duration of Marriage (in Complete Months) | +Year |Births +---+---+-----+-----+-----+-----+-----+-----+-----+ + | | | | | | | | | | | + | | 0.| 1.| 2. | 3. | 4. | 5. | 6. | 7. | 8. | +------+------------+---+---+-----+-----+-----+-----+-----+-----+-----+ +1913 | 1,173| 96|122| 145| 241| 255| 350| 398| 306| 327| +1914 | 1,291| 83|122| 146| 216| 247| 354| 398| 294| 335| +1915 | 1,137| 56| 96| 158| 231| 219| 288| 353| 286| 336| +1916 | 1,139| 63| 95| 135| 170| 212| 269| 326| 266| 343| +1917 | 1,141| 68| 66| 119| 137| 184| 216| 291| 264| 250| +1918 | 1,169| 42| 64| 99| 141| 148| 215| 259| 213| 212| +1919 | 1,132| 52| 98| 101| 125| 161| 202| 258| 222| 238| +1920 | 1,414| 69|125| 167| 220| 295| 347| 445| 377| 407| +1921 | 1,245| 82|140| 177| 228| 253| 341| 456| 370| 382| + +------------+---+---+-----+-----+-----+-----+-----+-----+-----+ +Totals| 10,841|611|928|1,247|1,709|1,974|2,582|3,184|2,598|2,830| +------+------------+---+---+-----+-----+-----+-----+-----+-----+-----+ + +------+--------------------+----------------+----------+ + | |Total Legitimate| | +Year +------+------+------| First Births | Total | + | | | |within One Year |Registered| + | 9. | 10. | 11. | after Marriage | Births | +------+------+------+------+----------------+----------+ +1913 | 831| 669| 462| 4,202| 27,935| +1914 | 720| 642| 487| 4,044| 28,338| +1915 | 769| 621| 457| 3,870| 27,850| +1916 | 793| 694| 512| 3,878| 28,509| +1917 | 575| 505| 449| 3,124| 28,239| +1918 | 443| 298| 279| 2,413| 25,860| +1919 | 469| 397| 314| 2,637| 24,483| +1920 | 859| 802| 575| 4,688| 29,921| +1921 | 979| 804| 670| 4,882| 28,567| + +------+------+------+----------------+----------+ +Totals| 6,438| 5,432| 4,205| 33,738| 249,702| +------+------+------+------+----------------+----------+ + +MALCOLM FRASER, +Government Statistician. + + +TABLE B. + +TABLE SHOWING NUMBER OF CASES TREATED AND ATTENDANCES AT THE +VENEREAL-DISEASE CLINICS DURING THE YEARS 1920-21 AND UP TO JUNE, 1922. + +---------------------------+-----------------------------+ + | Auckland | + |---------+---------+---------| + | 1920 | 1921 | 1922 | +---------------------------+-----+---+-----+---+-----+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 174| 30| 100| 44| 81| 29| + Chancroid | 10| ..| 25| ..| 10| ..| + GonorrhÅ“a | 81| 8| 345| 24| 189| 20| + No V.D. | 59| 10| 73| 25| 21| 8| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis |1,875|462|1,759|474| 830|313| + Chancroid | 100| ..| 72| ..| 37| ..| + GonorrhÅ“a |4,702| 95|9,232|141|3,384|172| + No V.D. | 134| 26| 227| 35| 53| 17| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | ..| ..| ..| ..| ..| ..| + GonorrhÅ“a | ..| ..| ..| ..| ..| ..| +---------------------------+-----+---+-----+---+-----+---+ + + +---------------------------+--------------------------------+ + | Wellington | + |----------+----------+----------| + | 1920 | 1921 | 1922 | +---------------------------+------+---+------+---+------+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 93| 34| 80| 10| 41| 8| + Chancroid | 1| ..| 8| ..| 7| ..| + GonorrhÅ“a | 190| 18| 298| 11| 141| 9| + No V.D. | 40| 10| 52| 25| 33| 17| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 1,388|448| 2,089|616| 1,156|269| + Chancroid | 6| ..| 16| ..| 29| ..| + GonorrhÅ“a |13,436|180|19,369|520|10,853|423| + No V.D. | 40| 10| 89| 35| 68| 35| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 1,624| ..| 1,711| ..| 790| ..| + GonorrhÅ“a | 3,024| 77| 4,098| ..| 1,998| ..| +---------------------------+------+---+------+---+------+---+ + + +---------------------------+------------------------------+ + | Christchurch | + |---------+---------+----------| + | 1920 | 1921 | 1922 | +---------------------------+-----+---+-----+---+-----+----+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 60| 25| 46| 21| 25| 13| + Chancroid | 8| ..| 6| ..| 5| ..| + GonorrhÅ“a | 120| 32| 139| 35| 70| 21| + No V.D. | 20| 10| 62| 31| 31| 16| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 786|450| 903|473| 632| 248| + Chancroid | 110| ..| 45| ..| 37| ..| + GonorrhÅ“a |2,132|245|3,968|902|2,239| 339| + No V.D. | 186| 98| 215|187| 96| 52| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 232| 80| 619| 44| 310| 9| + GonorrhÅ“a | 460|216| 725|161| 221| 157| +---------------------------+-----+---+-----+---+-----+----+ + + +---------------------------+-----------------------+ + | Dunedin | + |-------+-------+-------| + | 1920 | 1921 | 1922 | +---------------------------+---+---+---+---+---+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M.| F.| M.| F.| M.| F.| + Syphilis | 54| 13| 55| 11| 12| 9| + Chancroid | ..| ..| ..| ..| ..| ..| + GonorrhÅ“a | 37| | 55| 9| 46| 6| + No V.D. | 6| 2| 28| 2| 1| ..| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis |816|143|505| 84|432|115| + Chancroid | ..| ..| ..| ..| ..| ..| + GonorrhÅ“a |465| ..|814| 67|638| 63| + No V.D. | 6| 2| 21| 1| 1| | +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 74| 55|169|106| 20| ..| + GonorrhÅ“a | 66| ..|335|166| 28| 59| +---------------------------+---+---+---+---+---+---+ + +---------------------------+--------------------------------------+ + | Total for Years | + |------------+------------+------------| + | 1920 | 1921 | 1922 | +---------------------------+------+-----+------+-----+------+-----+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F. | M. | F. | M. | F. | + Syphilis | 381| 102| 281| 86| 159| 59| + Chancroid | 19| ..| 39| ..| 22| ..| + GonorrhÅ“a | 428| 58| 837| 79| 446| 56| + No V.D. | 125| 32| 215| 83| 86| 41| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 4,865|1,503| 5,256|1,647| 3,050| 948| + Chancroid | 216| ..| 133| ..| 103| ..| + GonorrhÅ“a |20,105| 520|33,583|1,630|17,114|1,017| + No V.D. | 366| 136| 562| 258| 218| 108| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 1,930| 35| 2,499| 150| 1,120| 9| + GonorrhÅ“a | 3,550| 293| 5,168| 327| 2,157| 216| +---------------------------+------+-----+------+-----+------+-----+ + +---------------------------+-------------+-------+ + | Totals |Grand | + | according |Totals | + | to Sex | | +---------------------------+-------+-----+-------+ +Number of persons dealt | | | | + with at or in connection | | | | + with the out-patients' | | | | + clinic for the first time| | | | + and found to be | | | | + suffering from-- | M. | F. | | + Syphilis | 821| 247| 1,068| + Chancroid | 80| | 80| + GonorrhÅ“a | 1,711| 193| 1,904| + No V.D. | 426| 156| 582| +Total attendance of all |-------+-----+-------+ + persons at the | 3,038| 596| 3,634| + out-patients' clinic who |-------+-----+-------+ + were suffering from-- | | | | + Syphilis | 13,171|4,098| 17,269| + Chancroid | 452| ..| 452| + GonorrhÅ“a | 70,802|3,167| 73,969| + No V.D. | 1,146| 502| 1,648| +Aggregate number of | | | | + in-patients' days of | | | | + treatment given to | | | | + persons suffering from-- | | | | + Syphilis | 5,549| 194| 5,743| + GonorrhÅ“a | 10,875| 836| 11,711| +---------------------------+-------+-----+-------+ + + +TABLE C. + +REPLY FORM.--VENEREAL DISEASES. + +(_Confidential_.) + +I, the undersigned registered medical practitioner, desire to advise the +Committee on Venereal Diseases of the Board of Health that I had under +my personal care on Saturday, 16th September, 1922,[A] cases of venereal +disease, and of affections attributable to venereal disease, as under:-- + + NUMBER OF CASES. + Male. Female. Total. +1. Cases of recent infection:-- + (_a._) GonorrhÅ“a (including gonorrhÅ“al ophthalmia) + (_b._) Soft chancre + (_c._) Syphilis, primary and/or secondary +2. Cases of distant infection:-- + (_a._) Chronic gonorrhÅ“al affections or disabilities + directly attributable to gonorrhÅ“a infection--_e.g._, + stricture, gleet, arthritis, abscesses, salpingitis, &c. + (_b._) Congenital syphilis + (_c._) Tertiary syphilitic manifestations or disabilities + directly attributable to syphilis infection:-- + (i.) Affecting nervous system--_e.g._, gumma, + locomotor, G.P.I., &c. + (ii.) Affecting ear, eye, &c. (special + senses)--_e.g._, optic atrophy, &c. + (iii.) Affecting respiratory system--_e.g._, + syphilitic laryngitis, &c. + (iv.) Affecting digestive system--_e.g._, + syphilitic stricture of rectum, &c. + (v.) Affecting circulatory system--_e.g._, + syphilitic angina, aneurism, &c. + (vi.) Affecting spleen + (vii.) Affecting skin, bones, joints, muscles + (viii.) Affecting genito-urinary system, including + abortions, &c. + +NOTE.--No case should be recorded under more than one of these headings. + +Total number of cases under my personal care + +My opinion is that venereal disease in this Dominion has [not] increased +in a greater proportion than the population during the last five years. + + [_Signature of medical practitioner._] +Date of posting: Town where practising or name or } + names of institutions concerned: } + + [A] "Under my personal care on Saturday, 16th September, 1922," + is to be interpreted to include all patients suffering from the + conditions enumerated whom you are attending or have attended, + and who you believe in the event of requiring further + attendance would call you in or consult you, in other words, + _bonâ fide_ patients of your own. It is not intended that you + are to enumerate only the patients actually seen by you on that + date. + + Medical superintendents or medical officers in charge of + institutions will regard all patients in or attending their + institutions as "under my personal care on Saturday, 16th + September, 1922," irrespective of whom the actual medical + attendant may be. + + Please post this Reply Form as soon as possible after 16th + September, 1922, and not later than 20th September, 1922. + + Additional copies of this form are obtainable from the Medical + Officers of Health, or the Secretary of the Board of Health, + P.O. Box 1146, Wellington. + + +TABLE D. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.--NUMBERS IN +HEALTH DISTRICTS. + +---------------+--------------------------------------+ + | Cases of Recent Infection. | +Health |---------+------------+--------+------| +District |GonorrhÅ“a|Soft Chancre|Syphilis|Total | +---------------+---------+------------+--------+------+ +North Auckland | 10| ..| 1| 14| +Auckland | 279| 3| 165| 447| +Hawke's Bay | 35| 3| 17| 55| +Wanganui | 59| 2| 37| 98| +Wellington | 187| 4| 114| 305| +Canterbury | 99| 2| 75| 176| +Otago | 79| ..| 104| 183| +---------------+---------+------------+--------+------+ +Dominion totals| 748| 14| 516| 1,278| +---------------+---------+------------+--------+------+ + +---------------+------------------------------------+------+ + | Cases of Distant Infection |Grand | +Health |---------+----------+--------+------+Total | +District |Chronic |Congenital|Tertiary|Total | | + |GonorrhÅ“a|Syphilis |Syphilis| | | +---------------+---------+----------+--------+------+------+ +North Auckland | 10| 1| 5| 16| 30| +Auckland | 229| 51| 239| 519| 966| +Hawke's Bay | 32| 10| 30| 72| 127| +Wanganui | 97| 10| 42| 149| 247| +Wellington | 279| 56| 220| 555| 860| +Canterbury | 83| 17| 111| 211| 387| +Otago | 120| 23| 88| 231| 414| +---------------+---------+----------+--------+------+------+ +Dominion totals| 850| 168| 735| 1,753| 3,031| +---------------+---------+----------+--------+------+------+ + +---------------+-------------------------+ + | Expression of Opinion | +Health |--------+--------+-------| +District |Increase|Decrease|Not | + | | |stated | +---------------+--------+--------+-------+ +North Auckland | 7| 2| 11| +Auckland | 34| 53| 82| +Hawke's Bay | 6| 19| 24| +Wanganui | 13| 16| 24| +Wellington | 29| 36| 68| +Canterbury | 16| 47| 53| +Otago | 14| 30| 51| +---------------+--------+--------+-------| +Dominion totals| 119| 203| 313| +---------------+--------+--------+-------+ + +Total replies received, 635. + + +TABLE E. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. TOTALS (ALL +FORMS) OF GONORRHÅ’A, SOFT CHANCRE, AND SYPHILIS, AND PERCENTAGE OF +GRAND TOTAL. + +----------------+-------------------------------------+---------+ + | Totals (all Forms) of each Disease | Grand | +Health District |-----------+--------------+----------+ Total | + | GonorrhÅ“a | Soft Chancre | Syphilis | | +----------------+-----------+--------------+----------+---------+ +North Auckland | 20| ..| 10| 30| +Auckland | 508| 3| 455| 966| +Hawke's Bay | 67| 3| 57| 127| +Wanganui | 156| 2| 89| 247| +Wellington | 466| 4| 390| 860| +Canterbury | 182| 2| 203| 387| +Otago | 199| ..| 215| 414| + |-----------+--------------+----------+---------+ +Dominion totals | 1,598| 14| 1,419| 3,031| +----------------+-----------+--------------+----------+---------+ + +-----------------+--------------------------------------+ + |Percentages (all forms) to Grand Total| +Health District +-----------+--------------+-----------+ + | GonorrhÅ“a | Soft Chancre | Syphilis | +-----------------+-----------+--------------+-----------+ +North Auckland | 66.67| ..| 33.33| +Auckland | 52.59| 0.31| 47.10| +Hawke's Bay | 52.76| 2.36| 44.88| +Wanganui | 63.16| 0.81| 36.03| +Wellington | 54.19| 0.46| 15.35| +Canterbury | 47.03| 0.52| 52.45| +Otago | 48.07| ..| 51.93| + +-----------+--------------+-----------+ +Dominion totals | 52.72| 0.46| 46.82| +-----------------+-----------+--------------+-----------+ + + +TABLE F. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.--INCIDENCE +IN CHIEF CENTRES SHOWING RATE PER 1,000 ESTIMATED POPULATION. + +-----------------+----------+--------------------------------+ + | | Cases of Recent Infection | + | +----------+----------+----------+ + | |GonorrhÅ“a | Syphilis | Total | + | | | | | + |Estimated +----+-----+----+-----+----+-----+ +Urban Area |Population| C |Rate | C |Rate | C |Rate | + |1st | a |per | a |per | a |per | + |April, | s |1,000| s |1,000| s |1,000| + |1922 | e | | e | | e | | + | | s | | s | | s | | +-----------------+----------+----+-----+----+-----+----+-----+ +Auckland | 164,450 | 214| 1.30| 146| 0.89| 360| 2.19| +Wellington | 110,680 | 159| 1.44| 99| 0.89| 258| 2.33| +Christchurch | 110,200 | 79| 0.72| 59| 0.53| 138| 1.25| +Dunedin | 73,470 | 54| 0.74| 102| 1.39| 156| 2.12| +Hamilton | 14,950 | 15| 1.01| 3| 0.20| 18| 1.20| +Cisborne | 14,920 | 7| 0.47| ..| ..| 7| 0.47| +Napier | 17,670 | 17| 0.96| 13| 0.74| 30| 1.70| +Hastings | 13,530 | ..| ..| 2| 0.15| 2| 0.15| +New Plymouth | 13,510 | 3| 0.22| ..| ..| 3| 0.22| +Wanganui | 24,170 | 14| 0.58| 12| 0.50| 26| 1.08| +Palmerston North | 17,510 | 5| 0.29| 13| 0.80| 18| 1.03| +Nelson | 10,880 | 1| 0.09| ..| ..| 1| 0.09| +Timaru | 16,040 | 6| 0.37| 1| 0.06| 7| 0.44| +Invercargill | 19,590 | 1| 0.05| ..| ..| 1| 0.05| +-----------------+----------+----+-----+----+-----+----+-----+ + +--------------+--------------------------------------------+----------+ + | Cases of Distant Infection | Grand | + |----------+-----------+----------+----------+ Total + + |Chronic |Congenital | Tertiary | Total | | + |GonorrhÅ“a |Syphilis | Syphilis | | | + |----------+----+------+----+-----+----+-----+----+-----+ +Urban Area. | C |Rate | C |Rate | C |Rate | C |Rate | C |Rate | + | a |per | a |per | a |per | a |per | a |per | + | s |1,000| s |1,000 | s |1,000| s |1,000| s |1,000| + | e | | e | | e | | e | | e | | + | s | | s | | s | | s | | s | | +--------------+----+-----+----+------+----+-----+----+-----+----+-----+ +Auckland | 147| 0.89| 42| 0.26| 194| 1.18| 383| 2.33| 743| 4.52| +Wellington | 240| 2.17| 42| 0.38| 183| 1.65| 465| 4.20| 723| 6.53| +Christchurch | 63| 0.57| 15| 0.14| 87| 0.79| 165| 1.50| 303| 2.75| +Dunedin | 96| 1.31| 18| 0.25| 59| 0.80| 173| 2.35| 329| 4.48| +Hamilton | 22| 1.47| ..| ..| 10| 0.67| 32| 2.14| 50| 3.34| +Cisborne | 9| 0.60| 2| 0.13| 9| 0.60| 20| 1.34| 27| 1.81| +Napier | 8| 0.45| 3| 0.17| 9| 0.51| 20| 1.13| 50| 2.83| +Hastings | 1| 0.07| 2| 0.15| 2| 0.15| 5| 0.37| 7| 0.52| +New Plymouth | 3| 0.22| ..| ..| ..| ..| 3| 0.22| 6| 0.52| +Wanganui | 29| 1.20| 6| 0.25| 21| 0.87| 56| 2.32| 82| 3.39| +Palmerston N. | 12| 0.69| 5| 0.29| 3| 0.17| 20| 1.14| 38| 2.17| +Nelson | ..| ..| 4| 0.37| 10| 0.92| 14| 1.29| 15| 1.38| +Timaru | 5| 0.31| ..| ..| 8| 0.50| 13| 0.81| 20| 1.25| +Invercargill | 7| 0.36| ..| ..| 10| 0.51| 17| 0.87| 18| 0.92| +--------------+----+-----+----+------+----+-----+----+-----+----+-----+ + + +TABLE G. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. +--PROPORTION OF CASES PER 1,000 OF POPULATION IN EACH HEALTH DISTRICT. + +-----------+----------+-------------------------+-------------------------+ + | | Total Cases Proportion Cases per 1,000| + Health |Estimated | (all Diseases) | Estimated Population | + District |Population+---------+---------+-----+---------+---------+-----+ + |1st April,|Recent |Distant |Grand|Recent |Distant |Grand| + |1922 |Infection|Infection|Total|Infection|Infection|Total| +-----------+----------+---------+---------+-----+---------+---------+-----+ +N. Auckland| 36,930| 14| 16| 30| 0.38| 0.43| 0.81| +Auckland | 323,436| 447| 519| 966| 1.38| 1.60| 2.99| +Hawke's Bay| 80,242| 55| 72| 127| 0.62| 0.81| 1.42| +Wanganui | 110,866| 98| 149| 247| 0.88| 1.34| 2.23| +Wellington | 242,830| 305| 555| 860| 1.26| 2.28| 3.54| +Canterbury | 240,387| 176| 211| 387| 0.73| 0.88| 1.61| +Otago | 200,574| 183| 231| 414| 0.91| 1.15| 2.06| +-----------+----------+---------+---------+-----+---------+---------+-----+ +Dominion | | | | | | | | +Totals | 1,244,265| 1,278| 1,753|3,031| 1.03| 1.41| 2.44| +-----------+----------+---------+---------+-----+---------+---------+-----+ + + +TABLE H. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. +--SEX NUMBERS AND PROPORTIONS IN HEALTH DISTRICTS. + +Key: %% = F. to 100 M. + +------------+--------------------------------------------+ + | Cases of Recent | + | Infection | + Health +--------------+--------------+--------------+ + District | GonorrhÅ“a | Syphilis | Totals | + +----+----+----+----+----+----+----+----+----+ + | M | F | %% | M | F | %% | M | F | %% | +------------+----+----+----+----+----+----+----+----+----+ +N. Auckland | 10| ..| ..| 3| 1| 33| 13| 1| 8| +Auckland | 224| 55| 25| 112| 53| 47| 336| 108| 32| +Hawke's Bay | 28| 7| 25| 12| 5| 42| 40| 12| 30| +Wanganui | 40| 19| 48| 25| 12| 48| 65| 31| 48| +Wellington | 143| 44| 31| 95| 19| 20| 238| 63| 26| +Canterbury | 63| 36| 57| 48| 27| 56| 111| 63| 57| +Otago | 62| 17| 27| 89| 15| 17| 151| 32| 21| +------------+----+----+----+----+----+----+----+----+----+ +Dominion | | | | | | | | | | +Totals | 570| 178| 31| 384| 132| 34 | 954| 310| 32| +------------+----+----+----+----+----+----+----+----+----+ + +------------+-----------------------------------------------------------+ + | Cases of Distant | + | Infection | + Health +--------------+-------------+-------------+----------------+ + District | Chronic | Congenital | Tertiary | | + | GonorrhÅ“a | Syphilis | Syphilis | Totals | + +-----+---+----+----+---+----+----+---+----+-----+-----+----+ + | M | F | %% | M | F | %% | M | F | %% | M | F | %% | +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ +N. Auckland | 8| 2| 25| ..| 1| ..| 4| 1| 25| 12| 4| 33| +Auckland | 156| 73| 47| 33| 18| 55| 168| 71| 42| 357| 162| 45| +Hawke's Bay | 27| 5| 19| 7| 3| 43| 22| 8| 36| 56| 16| 29| +Wanganui | 74| 23| 31| 5| 5| 100| 29| 13| 45| 108| 41| 38| +Wellington | 225| 54| 24| 31| 25| 81| 156| 64| 41| 412| 143| 35| +Canterbury | 65| 18| 29| 7| 10| 143| 81| 30| 37| 153| 58| 38| +Otago | 101| 19| 19| 15| 8| 53| 58| 30| 52| 174| 57| 33| +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ +Dominion | | | | | | | | | | | | | +Totals | 656 |194| 30| 98| 70| 71| 518|217| 42|1,272| 481| 38| +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ + +--------------+------------------+ + Health | Grand Totals | + District +-----+-----+------+ + | M | F | %% | +--------------+-----+-----+------+ +North Auckland| 25| 5| 20| +Auckland | 693| 270| 39| +Hawke's Bay | 96| 28| 29| +Wanganui | 173| 72| 42| +Wellington | 650| 206| 32| +Canterbury | 264| 121| 46| +Otago | 325| 89| 27| +--------------+-----+-----+------+ +Dominion | | | | +Totals |2,226| 791| 36| +--------------+-----+-----+------+ + + * * * * * + +_Approximate Cost of Paper._--Preparation, not given; + printing (1,225 copies), £45. + + * * * * * + +By Authority: W.A.G. SKINNER, Government Printer, Wellington.--1922. + +_Price 9d._ + + + + + + +End of the Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +*** END OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES 1922 *** + +***** This file should be named 15352-0.txt or 15352-0.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/5/3/5/15352/ + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +https://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at https://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +https://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at https://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit https://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including including checks, online payments and credit card +donations. To donate, please visit: https://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart was the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. diff --git a/15352-0.zip b/15352-0.zip Binary files differnew file mode 100644 index 0000000..b3f5d4e --- /dev/null +++ b/15352-0.zip diff --git a/15352-8.txt b/15352-8.txt new file mode 100644 index 0000000..00080ad --- /dev/null +++ b/15352-8.txt @@ -0,0 +1,3511 @@ +The Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Venereal Diseases in New Zealand (1922) + Report of the Special Committee of the Board of Health appointed by + the Hon. Minister of Health + + +Author: Committee Of The Board Of Health + +Release Date: March 13, 2005 [EBook #15352] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES *** + + + + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + + + + + +1922. + +NEW ZEALAND. + + +VENEREAL DISEASES IN NEW ZEALAND. + + +REPORT OF THE COMMITTEE OF THE BOARD OF HEALTH APPOINTED BY THE HON. +MINISTER OF HEALTH. + + +_Presented to both Houses of the General Assembly by Leave._ + + +CONSTITUTION OF THE COMMITTEE. + +Hon. W.H. TRIGGS, M.L.C., Chairman. +J.S. ELLIOTT, M.D., Member of the Medical Board. +Mr. MURDOCH FRASER (New Plymouth), representing the + Hospital Boards of the Dominion. +J.P. FRENGLEY, M.D., D.P.H., Deputy Director-General of Health. +Lady LUKE, C.B.E. +Sir DONALD McGAVIN, K.C.M.G., C.M.G., D.S.O., Director-General of + Medical Services. + + +CONTENTS. + +PART I.--INTRODUCTORY AND HISTORICAL. Page + +Section 1.--Origin and Scope of Inquiry: Witnesses; Sittings, Date and +Place of; Appreciation of Services rendered 2 + +Section 2.--Venereal Diseases and their Effects: Ignorance, Effect of; +Sex Education for Young; Syphilis and Gonorrhoea, Origin and +Description; Treatment after Exposure; Diagnosis, Methods of; Treatment, +Importance of Early and Completed 4 + +Section 3.--Accidental Infection: Sources of Infection; Metchnikoff's +Investigation; Food-conveyance; Lavatories, Towels, Drinking-cups, &c. 5 + +Section 4.--Previous Inquiries and Conferences: Contagious Diseases Act, +England; Royal Commission, 1913, Evidence, View of Compulsory +Notification, Divorce and Venereal Disease, Sex Education, Instruction, +and Propaganda; Australasian Medical Congresses. Committee appointed; +Auckland Congress, 1914, Report presented, Nature of Notification +recommended; Melbourne Conference, 1922, Review of Legislation, Comments +and Recommendations; England, Committee recently appointed to report on +Venereal Diseases 5 + +Section 5.--Legislation in New Zealand, Past and Present: Contagious +Diseases Act, 1869 (A), Reference to; Cases Cited (B) which require New +Legislation to deal with; Hospital and Charitable Institutions Act, 1913 +(C); Detention Provisions; The Prisoners Detention Act, 1915 (D); +Provisions for dealing with Venereal Diseases in Convicted Persons; +Social Hygiene Act, 1917 (E); Provisions of the Act outlined; Subsidy +for Maintenance in Hospitals 7 + + +PART II.--PREVALENCE OF VENEREAL DISEASE IN NEW ZEALAND. + +Section 1.--Medical Statistics (A): Medical Practitioners, Special +Returns from, Cases reported, Gonorrhoea and Syphilis: Chancroid; +Prevalence. Clinic Statistics (B): Department of Health Data; Clinic +Distribution; Age Distribution; Marital Condition. Mental Hospital +Statistics (C): Syphilis and Dementia Paralytica; Computations as to +Prevalence of Syphilis based on Fournier's Estimate. Incidence among +Maoris (D): Early Days, Miscarriages; Prevalence at Present, Origin. +Death-certificates (E): Two Certificates, one for Relatives, other for +Registrar; British Empire Statistical Conference, Resolutions passed; +Committee's Conclusion 9 + +Section 2.--Causes of the Prevalence of Venereal Diseases in New +Zealand: Infected Individuals, neglect to undergo or continue Treatment; +Chiropractors; Herbalists: Overseas Introduction; Promiscuous Sexual +Intercourse; Professional Prostitution; Police Evidence; "Amateur" +Prostitution; Social Distribution; Extra-marital Sexual Intercourse, +Result of; Parental Control; Sex Education; Housing and Living +Conditions; Hostels, Advantages of; Moral Imbeciles, Danger from; +Delayed Marriages; Alcohol; Accidental Infections; Dances; Cinema; +Returned Soldiers 11 + + +PART III.--BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASES. + +Section 1.--Education and Moral Control: Chastity, Value of; +Relationship between Sexes; Infected Persons, Responsibility; Church and +Press influence; Parents duty to Children; Pamphlet for Parents; Sex +Hygiene in Schools, Mode of Teaching; School Mothers, Value of, in +Girls' School; Instruction in Sex Hygiene; Adolescents; Moral Standard, +Value of 12 + +Section 2.--Clinics for the Treatment of Venereal Disease: Distribution; +Work performed; Male and Female Attendance; Locality of Clinics; Hours +of Attendance; Lady Doctors; Supply of Apparatus and Drugs for certain +Cases; Advertising Clinics; Extension of Clinics; Training at Clinics +for Nurses, Students, &c.; Cases attending until non-infective; Male and +Female; Lady Patrols; Social Hygiene Society, Work of; Laboratories and +Free Treatment: Complement Fixation Test for Gonorrhoea 14 Page +Section 3.--Licensed Brothels: Observations on; Dangers of Infection +from; Statistics; North European Conference's Resolution; Flexner's +Views; American Opinion. 15 + +Section 4.--Exclusion of Venereal Cases from Overseas: Health Act, 1920, +Provisions; Attendances at Clinics; Recommendations; Immigration +Restriction Act and Syphilis. 16 + +Section 5.--Prophylaxis: Packet System; Early Treatment; +Inter-departmental Committee on Infectious Diseases, Conclusions; +Notices in Public Conveniences; Prophylaxis, Efficiency of 16 + +Section 6.--Legislation required: Conditional Notification (A)--National +Council of Women, View on; Number or Symbol Notification; Infectious +Diseases Notification Bill, England (1889), Opposition to, Comparisons +with Control of Infectious Diseases; Present System, Disadvantages of; +West Australia Act; New Zealand Legislation suggested. Compulsory +Examination and Treatment (B).--Department of Health, proposed +Legislation, Contagious Diseases Act compared with; West Australia +Legislation, Effect on Attendances at Clinics 17 + +Section 7.--Marriage Certificate of Health: Royal Commission on Venereal +Diseases; National Birth-rate Commission; Medical Certificate; Statement +before Registrar, Communicable and Mental Disease; Recommendation; +Medical Practitioners' duty 20 + +Section 8.--Treatment of Unqualified Persons: Chemists, Herbalists, +Chiropractors; Effect of such Treatment; Clinic Statistics relating to +same; West Australian 20 + +Section 9.--Mentally Defective Adolescents: Danger and Cost to the +State; Supervision and Control proposed 20 + + +PART IV.--SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS. + +Section 1.--Conclusions 21 + +Section 2.--Recommendations 21 + +Section 3.--Concluding Remarks 22 + +APPENDIX 24 + + * * * * * + +REPORT. + +The Hon. the Minister of Health, Wellington. + +SIR,-- + +The Committee of the Board of Health appointed by you to inquire into +and report upon the subject of venereal diseases in New Zealand have the +honour to submit herewith their report. + + + + +PART I.--INTRODUCTORY AND HISTORICAL. + + +SECTION 1.--ORIGIN AND SCOPE OF INQUIRY. + +A perusal of departmental files reveals that many persons and bodies +have during recent times urged upon the Government the desirability of +setting up a Committee or Commission of Inquiry to go into this subject. +The appointment of the present Committee, however, arose out of a +suggestion forwarded to the Chairman of the Board of Health, under date +of the 20th June, 1922, from the Council of the New Zealand Branch of +the British Medical Association. The Board of Health duly considered the +representations of the Association and passed a resolution recommending +the Minister to set up a committee to gather data and to make +recommendations as to the best means of preventing and combating +venereal diseases. The proposal thereafter took concrete form, following +the receipt by the members of this Committee of the under-quoted letter, +dated 13th July, 1922, sent out under your direction by the Secretary of +the Board of Health:-- + + "I am directed by the Hon. the Minister of Health, Chairman of this + Board, to inform you that, acting upon the recommendation of the + Board, he has decided to appoint a special Committee from among the + members of the Board to conduct an inquiry into the question of + venereal diseases in New Zealand. The following members are being + asked to become members of the Committee, and the Chairman trusts + you will see your way to accept the position: Dr. Valintine, Dr. + Elliott, Lady Luke, Hon. Mr. Triggs, Sir Donald McGavin, Mr. + Fraser. The Hon. the Minister has asked the Hon. Mr. Triggs to + accept the chairmanship of the Committee. + + "I am further directed to state that the function and duty laid + upon the Committee is as follows:-- + + "(1.) To inquire into and report upon the prevalence; of venereal + disease in New Zealand. + + "(2.) To inquire into and report any special reasons or causes for + the existence of venereal disease in New Zealand. + + "(3.) To advise as to the best means of combating and preventing + venereal disease in New Zealand, and especially as to the necessity + or otherwise of fresh legislation in the matter. + + "The Minister of Health is anxious that the Committee should hear + such evidence and representations on the above-mentioned matters as + may be necessary to fully inform the Committee on the items + referred to it, and with respect to which it is asked to report, + and he further suggests to the Committee that the various + organizations and persons likely to be interested should be + notified that the Committee will, at a certain place and date, in + Wellington, hear any evidence they may desire to tender." + +The Committee regrets that owing to ill health Dr. Valintine, +Director-General of Health, was unable to act as one of its members. His +place was taken by Dr. J.P. Frengley, Deputy Director-General of Health. +Unfortunately, illness also overtook Mr. Murdoch Fraser, who has been +unable to attend the sittings of the Committee since the middle of +August. The remaining members have been present at all sittings of the +Committee, details of which are appended in the following table:-- + +--------------------------------+------------------------------------------ + Places and Dates of Sittings. | Witnesses examined or Work done. +--------------------------------+------------------------------------------ +Wellington, 26th July, 1922 | Preliminary meeting. + (forenoon only) | +Wellington, 8th August, 1922 | Dr. M.H. Watt, Director, Division of + (forenoon only) | Public Hygiene. + | Dr. B.F. Aldred, Officer in Charge + | Venereal Diseases Clinic. +Wellington, 9th August, 1922 | Hon. Dr. W.E. Collins, M.L.C. + (forenoon only) | Mr. J. Caughley, M.A., Director of + | Education. +Auckland, 17th August, 1922 | Dr. Falconer Brown, Officer in Charge + | Venereal Diseases Clinic. + | Dr. Hilda Northcroft. + | Dr. Frank Macky. + | Dr. W. Gilmour, Bacteriologist and + | Pathologist, Auckland Hospital. + | Dr. C.E. Maguire, Medical Superintendent, + | Auckland Hospital. + | Dr. W.H. Parkes. + | Dr. J. Hardie Neil. + | Dr. R. Tracy Inglis, Medical Officer, St. + | Helens Hospital. + | Dr. E.W. Sharman, Port Health Officer. + | Dr. W.H. Pettit. +Auckland, 18th August, 1922 | Mrs. De Treeby, representing Women's + | International and Political League. + | Dr. D.N.W. Murray, Medical Officer to + | Prisons Department. + | Mr. R.J. Pudney. + | Mr. Egerton Gill. + | Mrs. Harrison Lee Cowie. + | Mrs. E.B. Miller. + | Dr. Kenneth Mackenzie. + | Dr. E.H. Milsom. + | Dr. E. Carrick Robertson. + | Rev. Jasper Calder. + | Mr. F.L. Armitage, Government + | Bacteriologist. + | Dr. W.A. Fairclough. + | Dr. A.N. McKelvey, Medical Officer, + | Costley Home. +Christchurch, 29th August, 1922 | Dr. A.C. Thomson, Officer in Charge + | Venereal Diseases Clinic. + | Dr. P.C. Fenwick. + | Mrs. E. Roberts, President Women's + | Branch, Social Hygiene Society. + | Mrs. A.E. Herbert. + | Dr. A.B. Pearson, Bacteriologist and + | Pathologist, Christchurch Hospital. + | Nurse E.M. Stringer, Health Patrol. + | Dr. W. Fox, Medical Superintendent, + | Christchurch Hospital. + | Dr. C.H. Upham, Port Health Officer. + | Dr. C.L. Nedwill, Medical Officer to + | Prisons Department. + | Dr. D.E. Currie. + | Dr. J. Guthrie. + | Dr. W. Irving, Medical Officer, St. + | Helens Hospital. + | Dr. A.C. Sandston, President, Men's + | Branch Social Hygiene Society. + | Major R. Barnes, Salvation Army Officer. + | Dr. A.B. Lindsay. +Dunedin, 31st August, 1922 | Dr. A. Marshall, Officer in Charge + | Venereal Diseases Clinic. + | Dr. A.R. Falconer, Medical + | Superintendent, Dunedin Hospital. + | Dr. H.L. Ferguson, Dean Medical Faculty, + | Otago University. + | Dr. Emily H. Seideberg, Medical Officer, + | St. Helens Hospital. + | Dr. J.A. Jenkins. + | Canon E.R. Nevill, representing the + | Dunedin Council of Sex Education. + | Miss Pattrick, Director of Plunket + | Nursing. + | Mr. J.M. Galloway, representing Society + | for Protection of Women and Children. + | Dr. F.R. Riley. +Wellington, 12th September | Dr. W. Young. + (forenoon only) | Mr. T.R. Cresswell, Headmaster, + | Wellington College. + | Mr. W.W. Cook, Registrar-General. + | Mr. Malcolm Fraser, Government + | Statistician. + | Mr. W.D. Hunt. + | Rev. R.S. Gray. +Wellington, 13th September | Dr. Frank Hay, Inspector-General of + (forenoon only) | Mental Defectives. + | Mrs. Henderson, Representative Women + | Prisoners' Welfare Society and + | Wellington Branch National Council of + | Women. + | Rev. Van Staveren, Jewish Rabbi. +Wellington, 14th September | Dr. Agnes Bennett, Medical Officer, St. + | Helens Hospital. + | Mrs. F. McHugh, Health Patrol. + | Mr. F. Castle, President Pharmacy Board, + | and Chairman Wellington Hospital Board. + | Dr. D.M. Wilson, Medical Superintendent, + | Wellington Hospital. + | Mr. A.H. Wright, Commissioner of Police. + | Mr. W. Dinnie, ex-Commissioner of Police, + | representing Bible in Schools + | Propaganda Committee. + | Rev. J.T. Pinfold, D.D., representing + | Wellington Ministers' Association. + | Canon T. Feilden Taylor, appointed by the + | Bishop of Wellington. +Wellington, 15th September | Major Winton, Salvation Army. + | Mr. W. Beck, Officer in Charge Special + | Schools Branch, Education Department. + | Dr. D.E. Platts-Mills, representing Young + | Women's Christian Association. + | Mrs. Morpeth, representing Young Women's + | Christian Association. + | Miss Dunlop, representing Young Women's + | Christian Association. + | Mrs. Glover, Salvation Army. +Wellington, 26th September | Consideration of report. +Wellington, 10th October | Consideration of report. +Wellington, 12th October | Consideration of report. +Wellington, 13th October | Consideration of report. +Wellington, 18th October | Final meeting. + | +--------------------------------+-------------------------------------- + +It will thus be seen that, apart from time spent in travelling, the +Committee have met on seventeen days and have heard seventy-four +witnesses in person. + +The Committee would like to express their thanks to the witnesses, many +of whom had gone to considerable trouble to collect information and +prepare their evidence. Thanks are also due to the British Medical +Association for their willing co-operation and assistance; to the large +number of members of the medical profession throughout the Dominion who +responded to the Committee's request for information; to Dr. J.H.L. +Cumpston, Federal Director-General of Health, Melbourne, for much +Australian information on the subject, particularly in relation to +Commonwealth quarantine provisions; to Dr. Everitt Atkinson, +Commissioner of Public Health, Perth, West Australia, for a most lucid +and informative report on the working of the legislation in force in +that State; and to many other persons who by means of correspondence and +literature have placed at the Committee's disposal a large amount of +information which has been of material assistance in considering various +aspects of the problems involved. + +The Committee desire to acknowledge their indebtedness to their +secretary, Mr. C.J. Drake, whose wide knowledge of public-health matters +has been of material assistance in their investigations and who has +discharged his duties with marked zeal and ability. + + +SECTION 2.--VENEREAL DISEASES AND THEIR EFFECTS. + +One result of the Committee's investigations has been to show that the +public in general are very ignorant regarding the nature of venereal +diseases, and their lamentable effects not only upon the individuals +infected, but upon the health and well-being of the community as a +whole. This ignorance of the nature of the problem and of the grave +issues involved naturally stands in the way of the evil being grappled +with effectually. Furthermore, the policy of reticence which has +prevailed in the past, while it has led to the omission of proper +instruction of the young, either by their parents or as part of our +system of education, has not prevented the dissemination of an +incomplete or perverted knowledge of the facts relating to sex, which, +being derived as a rule from tainted sources of information, has been +productive of a great deal of evil. + +In these circumstances the Committee feel it their duty, before making +known their recommendations, to state in as plain terms as possible the +medical aspects of the problem they have had to consider. + +There are three forms of venereal diseases namely, syphilis, gonorrhoea, +and chancroid--and of these the first two are the common and most +serious diseases. That sporadic syphilis existed in antiquity and even +in prehistoric times is probable, but there is no doubt that the disease +was a malignant European pandemic in the closing years of the fifteenth +century. The first reference to its origin is in a work written about +the year 1510, wherein it is described as a new affection in Barcelona, +unheard of until brought from Hayti by the sailors of Columbus in 1493. +The army of Charles VIII carried the scourge through Italy, and soon +Europe was aflame. "Its enormous prevalence in modern times," says Dr. +Creighton, "dates, without doubt, from the European libertinism of the +latter part of the fifteenth century." Gonorrhoea also has its origin in +the shades of antiquity, but that it became common in Europe about 1520 +is a fact based on the highest authority. + +Syphilization follows civilization, and syphilis is an important factor +in the extermination of aboriginal races. Syphilis was introduced into +Uganda when that country was opened to trade with the coast, and Colonel +Lambkin reported that "In some districts 90 per cent. suffer from it.... +Owing to the presence of syphilis the entire population stands a good +chance of being exterminated in a very few years, or left a degenerate +race fit for nothing." The earliest known account of the introduction of +syphilis into the Maori race is in an old Maori song composed in the far +North. The Maori population in a village on the shores of Tom Bowline's +Bay was employed in a whaling-station on the Three Kings Islands, and +there they became infected and carried the disease to the mainland. +Venereal disease is not common now among the Maoris, but it made great +ravages in the early days of colonization, to which may be attributed +much of the sterility and repeated miscarriages in the transitional +period of Maori history. + +Through the ages great confusion existed as to the origin and nature of +venereal disease, but in 1905 a micro-organism, the _Spironema +pallidum_, was demonstrated as the infective agent in syphilis, and the +gonococcus as the infecting organism of gonorrhoea had been discovered in +1879. As regards modes of infection, syphilis is contracted usually by +sexual congress; occasionally the mode of infection is accidental and +innocent, and congenital transmission is not uncommon. Gonorrhoea is +contracted by sexual congress as a rule, but occasionally from innocent +contact with discharges, as in lavatories. + +Syphilis, therefore, is a markedly contagious and inoculable disease. It +gains entrance, and usually in three weeks (although this period may be +much shorter) a slight sore appears at the site of infection. It may be +so slight as to pass unnoticed. This is the primary stage of syphilis. +Later, often after two months, the secondary stage begins, and if not +properly treated may last for two years. The patient is not too ill +usually to attend to his avocation, and has severe headache, skin +rashes, loss of hair, inflammation of the eyes, or other varied +symptoms. The tertiary stage may be early or delayed, and its effects +are serious. Masses of cells of low vitality, known as "gummata," with a +tendency to break down or ulcerate, may form in almost any part of the +body, and the damage that occurs is considerable indeed. Various +diseases result which the lay mind would not associate with syphilis, +but it would be difficult to overestimate the resultant diseases that +may occur in any organ of the body:-- + + This racks the joints; this fires the veins: + That every labouring sinew strains; + Those in the deeper vitals rage. + + +Many deaths ascribed to other causes are the direct consequence of +syphilis. It cuts off life at its source, being a frequent cause of +abortion and early death of infants. It slays those who otherwise would +be strong and vigorous, sometimes striking down with palsy men in their +prime, or extinguishing the light of reason. It is an important factor +in the production of blindness, deafness, throat affections, +heart-disease and degeneration of the arteries, stomach and bowel +disease, kidney-disease, and affections of the bones. Congenital +syphilis often leads to epilepsy or to idiocy, and most of the victims +who survive are a charge on the State. This indictment against syphilis +is by no means complete. The economic loss resulting from this disease +is enormous as regards young, old, middle-aged. It respects not sex, +social rank, or years. + +Gonorrhoea is characterized in its commonest form by a discharge of pus +from the urethra, and causes acute pain at its onset in the male, but in +the female it commonly causes little or no discomfort. Unless carefully +treated, and treated early, it gives rise to many complications, such as +inflammation of the bladder, gleet, stricture, inflammation of joints, +abscesses, and rheumatism. It is a common cause of sterility and of +miscarriages, and, in the female, of many internal inflammations and +disablement, and in its later effects requires often surgical operations +on women. It is a very common disease, and the public know little of the +evil consequences which may follow what they have persisted in regarding +as a simple complaint. From its prevalence and its complications it is +one of the most serious diseases that affect mankind. + +As regards treatment of venereal disease of all kinds, it should be +clearly understood that the causative germs are well known and can +readily be destroyed immediately after exposure to infection by thorough +cleansing with antiseptic lotion or ointment. The use of soap and water +only would lessen the incidence of infection. On the first suspicious +sign of venereal disease the patient should apply at once for medical +advice. There are methods of diagnosis, such as microscopic examination +and the Wassermann test, the result of recent discovery, which make +diagnosis simple and certain; and if treatment is begun early according +to modern methods, which are much more effective than the remedies +formerly applied, the germs of infection are easily vanquished. When +sufficient time, however, is lost to enable these germs to become +entrenched in parts of the body not readily accessible to treatment, +cure is difficult, prolonged, and perhaps in some cases uncertain. + +For their own sakes, as well as for the sake of others, patients +suffering from any form of venereal disease should continue treatment, +which may be prolonged in the case of syphilis for two years, until +their medical adviser is satisfied that further treatment is +unnecessary. + +Women suffer less pain than men in these diseases, and consequently are +more apt to neglect securing medical advice and treatment, and more +ready to discontinue treatment before a cure is effected. + + +SECTION 3.--ACCIDENTAL INFECTION. + +Occasionally cases are met with in which syphilis is acquired innocently +by direct or indirect contact with syphilitic material, and then the +primary sore is often located on some other part of the body than the +genitals. Thus the lip may be infected by kissing, or by drinking out of +the same glass, or smoking the same pipe as a syphilitic patient. A +medical witness reported a case to the Committee in which syphilis was +conveyed to two girls "through a young fellow handing them a cigarette +which he was smoking." Metchnikoff has proved that the spironema of +syphilis is a delicate organism and quickly loses its virulence outside +the human body, and it cannot enter the system through unbroken skin or +mucous membrane. It is extremely doubtful if any form of venereal +infection can be conveyed in food. Frequently venereal disease is +deceitfully attributed by patients to innocent infection, and no doubt +some genuine cases do occur, but how seldom is illustrated by the +statement of the Officer in Charge of the V.D. Clinic at Christchurch, +who said, "I cannot remember a case where I was absolutely certain that +infection was acquired innocently or extragenitally." + +Gonorrhoea may be conveyed innocently from infective discharge on a +closet-seat, or from an infected towel, &c., and undoubtedly gonorrhoeal +discharge if brought into contact with the eye sets up a violent +suppuration. + +The Committee are of opinion that the extent of accidental infection is +greatly exaggerated in the public mind, but a few cases occasionally +occur, and the Committee recommend that there should be better provision +of public conveniences, especially for women, and the U-shaped +closet-seat should be adopted. The use of common towels and +drinking-cups in railway-trains, schools, factories, and elsewhere is +condemned not only for the reasons stated above, but on general sanitary +grounds. + + +SECTION 4.--PREVIOUS INQUIRIES AND CONFERENCES. + +After the repeal of the Contagious Diseases Act in England in 1886, +various Committees and Royal Commissions, such as the Inter-departmental +Committee on Physical Deterioration in 1904, the Royal Commission on the +Poor-laws in 1909, and the Royal Commission on Divorce in 1912, drew +attention to the frightful havoc wrought by venereal disease, and urged +that further action should be taken to deal with the evil. In 1913 the +British Government appointed a Royal Commission to inquire into the +prevalence of venereal diseases in the United Kingdom, their effects +upon the health of the community, and the means by which these effects +could be alleviated or prevented, it being understood that no return to +the policy or provisions of the Contagious Diseases Acts was to be +regarded as falling within the scope of the inquiry. + +The Commission took a great deal of most valuable evidence, and did not +present their final report until 1916. They recommended improved +facilities for diagnosis and treatment, including free clinics. They +came to the conclusion that at that time any system of compulsory +personal notification would fail to secure the advantages claimed. The +Commission added, however, "it is possible that the situation may be +modified when these facilities for diagnosis and treatment [recommended +by the Commission] have been in operation for some time, and the +question of notification should then be further considered. It is also +possible that when the general public become alive to the grave dangers +arising from venereal disease, notification in some form will be +demanded." The Commission supported the adoption of a recommendation by +the Royal Commission on Divorce to the effect that where one of the +parties at the time of marriage is suffering from venereal disease in a +communicable form and the fact is not disclosed by the party, the other +party shall be entitled to obtain a decree annulling the marriage, +provided that the suit is instituted within a year of the celebration of +the marriage, and there has been no marital intercourse after the +discovery of the infection. The Commission urged that more careful +instruction should be provided in regard to moral conduct as bearing +upon sexual relations throughout all types and grades of education. Such +instruction, they urged, should be based upon moral principles and +spiritual considerations, and should not be based only on the physical +consequences of immoral conduct. They also favoured general propaganda +work, and urged that the National Council for Combating Venereal +Diseases should be recognized by Government as an authoritative body for +the purpose of spreading knowledge and giving advice. + +Another important Commission, sitting almost simultaneously with that +just referred to, was the National Birth-rate Commission, which began +its labours on the 24th October, 1913, and presented its first Report on +the 28th June, 1916. The Commission was reconstituted, with the Bishop +of Birmingham as Chairman, in 1918, to further consider the question, +and especially in view of the effects of the Great War upon vital +problems of population. Among the terms of reference the Commission were +requested to inquire into "the present spread of venereal disease, the +chief causes of sterility and degeneracy, and the further menace of +these diseases during demobilization." The Commission in their report, +presented in 1920, stated that they realized the difficulties involved +in the introduction of any efficient scheme of compulsory notification +and treatment of venereal diseases, but, they added, they "feel that it +has now passed the experimental stage both in our colonies and in forty +of the forty-eight of the United States of America, and think it is +advisable for the State to make a trial of compulsory notification and +treatment in this country, provided that there should be no return to +the principles or practice of the Contagious Diseases Act." Referring to +the finding of the Royal Commission on Venereal Disease that it would +not be possible at present to organize a satisfactory method of +certification of fitness for marriage, the National Birth-rate +Commission thought this question should now be reconsidered with a view +to legislation. "If," says the report, "a certificate of health was to +become a legal obligation for persons contemplating marriage, many of +the legal, ethical, and professional difficulties surrounding this +question would be removed." + +In Sweden, where a Venereal Diseases Law was passed in 1918, stress was +laid on the importance of general enlightenment with regard to venereal +disease and germane subjects, such as sex hygiene. A committee was +appointed, consisting of experts in medicine and pedagogy, to inquire +into the best means of providing such education. Their report, which has +just been issued, is described by the _British Medical Journal_ as a +document of considerable value, promising to become the charter of a new +and complete system of sex education and hygiene in schools throughout +Sweden. Further reference will be made to this document in the section +of this report dealing with education. + +The subject of venereal disease has also been considered by more than +one important Medical Conference in Australia and New Zealand. + +At a general meeting of the Australasian Medical Congress held in +Melbourne in October, 1908, it was resolved that the executive be +recommended to appoint a committee to investigate and report on the +facts in regard to syphilis. Such a committee was appointed, and +reported to the Congress in Sydney in 1911. In 1914 the Congress was +held in Auckland, and a special committee which had been appointed, with +the Hon. Dr. W.E. Collins, M.L.C., as chairman, presented a valuable +report giving some interesting information in regard to the prevalence +of venereal disease, in New Zealand. The committee recommended that +syphilis be declared a notifiable disease; that notification be +encouraged and discretionary, but not compulsory; and that the Chief +Medical Officer of Health be the only person to whom the notification be +made. They also recommended the provision of laboratories for the +diagnosis of syphilis, and that free treatment for syphilis be provided +in the public hospitals and dispensaries. These recommendations were +embodied in the report adopted by the Congress. + +In February of the present year an important Conference, convened by the +Prime Minister of Australia, was held in Parliament House, Melbourne. It +was attended by official representatives of the Health Departments of +all the States, together with representatives from the British Medical +Association, the Women's Medical Staff at the Queen Victoria Hospital +Diseases Clinic in Melbourne, and other scientific and medical +authorities. The Commonwealth subsidizes the work of the States in +combating venereal disease, and the object of the Prime Minister in +calling the Conference was in order that it might inquire into the +effectiveness of the present system of legislation, of administrative +measures, and of clinical methods, with a view of determining whether +the best results were being obtained for the expenditure of the money. + +Western Australia has an Act, which came into operation in June, 1916, +providing for what is known as conditional notification of patients, +together with other provisions for the control of venereal disease which +are on a more comprehensive scale than has been attempted anywhere with +the possible exception of Denmark. In December, 1916, Victoria passed a +similar Act, and this example was followed by Queensland, Tasmania, and +New South Wales. + +The Conference, answering the several questions put to it, found that a +greater proportion of persons infected with venereal disease were +receiving more effective treatment than before the passing of the +Venereal Diseases Act. In the opinion of the Conference this was due +partly to the passing of legislation and partly to the opening of +clinics affording greater opportunities for free treatment. They +considered the operations of the Act had been more successful in +bringing men under treatment than it had been in the case of women. +Among the opinions expressed by the committee were the following: The +Act was not equally successful in respect of private and hospital +patients in regard to notification, but was equally successful in +respect of securing to both more effective treatment. There has been an +apparent reduction in the prevalence of venereal diseases, and the +Conference were strongly of opinion that the results so far justify the +continuance of these Acts in operation. + +The Conference found that venereal diseases are the most potent of all +causes of sterility and of infant and foetal morbidity and mortality. It +recommended, among other remedial measures, that prophylactic depots, +both for males and females, should be established as widely in the +community as possible. Referring to the educational aspect, the +Conference urged that children should be instructed in general +biological facts up to the age of puberty, when more explicit +information concerning facts of sexual life should be given. They urged +on all parents and educational, philanthropic, and religious +organizations the pressing necessity for a sustained campaign, in +co-operation with the medical profession, in order to inculcate in the +community higher ideals of personal hygiene and health. + +Lastly, it may be mentioned that, at the instance of Lord Dawson of +Penn, a highly qualified and representative committee of medical men, +with Lord Trevethin as chairman, has been appointed in England to report +to the Minister of Health upon "the best medical measures for preventing +venereal disease in the civil community, having regard to administrative +practicability, including cost." The appointment of such a committee was +requested by Lord Dawson chiefly with a view to obtaining an +authoritative pronouncement on the subject of medical preventive +measures, and the committee's report will be awaited with much interest. + + +SECTION 5.--LEGISLATION IN NEW ZEALAND, PAST AND PRESENT. + +(A) _Contagious Diseases Act (repealed)._ + +The Contagious Diseases Act was passed in 1869, and repealed in 1910. +Briefly, its aim was to secure periodical examinations of prostitutes, +and to detain for treatment those prostitutes found infected with +venereal disease. + +There appears to be, in some quarters, an apprehension that hidden +beneath the movement to combat venereal diseases is an implied desire or +intention to reinstate the antiquated and detested provisions of that +Act. The Committee deem it necessary to say that they have not found +grounds for this suspicion; that no legislation can be effective unless +it deals equally and adequately with all men, women, and children +sufferers from venereal diseases of all kinds; that it finds little +evidence of a definite prostitute class in New Zealand, and, even if +there were such, the Contagious Diseases Acts have been proved to be +useless as measures towards the prevention of venereal infections; and +it is the Committee's individual and collective opinion that anything +involving a return to the administrative procedure of the Contagious +Diseases Act should have no part whatever in any new legislation in this +Dominion. + +(B.) _Examples of Difficulties--Concrete Cases._ + +Before proceeding to refer to present and suggested legislation, a few +incidents and cases taken from the evidence may help, as concrete +examples, to indicate the difficulties to be contended with:-- + +_Case 1._--A man--young and married, a municipal employee in a +city--associated sexually with a female employee in an eating-house +frequented by himself and co-employees. In due time he sought the advice +of the Medical Officer of Health for (what he suspected) severe +syphilis. Steps were taken to obtain his speedy admission to the local +hospital. The woman continued in her employment. + +_Case 2._--A social-hygiene worker in her evidence said: "I think the +majority of cases I deal with (girls attending a hospital clinic) are +caused through mental depravity, and in some instances you cannot +convince them--they continue to carry on. I have tried all I know how to +show them the dangers, but they just laugh at me. I think it is really +in many cases just a mental condition--mental degeneration, possibly." +This officer explained that even while actually attending the clinic +some of these girls (affected with gonorrhoea), without any semblance of +reserve or decency, would discuss arrangements for further intercourse +with men, and on leaving the clinic (still in an infectious state) were +even seen to go off with young men waiting for them. + +_Case 3._--Asked if he knew of any cases where the disease had been +contracted innocently, a medical practitioner stated in evidence: "I +know of a case where two girls in ---- were infected (syphilis) on the +lip through a young fellow handing them a cigarette which he was +smoking." + +_Case 4._--A medical man in private practice, and Medical Superintendent +of the hospital in a small country town, states: "Although, judging from +an experience of over fifteen years, this district would appear to be +peculiarly free from any variety of venereal disease, I think it may be +of interest to your Committee to know what happened here in the early +part of 1918. At that time there came to reside with her father in ----, +a township about nine miles south of ----, a woman, ----, who, shortly +after her arrival consulted the late Dr. ----, and was found to be the +subject of secondary syphilis.... In all, three cases of gonorrhoea, four +of soft chancre (three of whom suffered from phagadoemic ulceration which +laid them up for weeks), and six cases of purely syphilitic infection +came under my care, all traceable to this same woman. As every case of +gonorrhoea and soft chancre afterwards developed syphilis, ultimately I +had thirteen cases of syphilis under my treatment alone. Others, I have +good reason to believe, went to other towns, and doubtless some failed +to seek any kind of help.... Having prevailed upon the woman to come to +my surgery ... I told her that she was suffering from three varieties of +venereal disease, which she was freely disseminating. I then read to her +that part of the Act which deals with those who "knowingly and wilfully +disseminate venereal infection." That same afternoon she left for ----, +where she continued to ply her calling unhindered. Who can estimate the +sum of the damage done by one such person? Not one of those men infected +was properly treated, although I did all I possibly could to convince +them of their own danger and of the risk of spreading infection to +others. Gradually, as the obvious signs of active disease abated, they +drifted away. I may say the Wassermann reaction proved strongly positive +in every case.... One of these men passed on his infection (syphilis) to +a young girl in this town, and she in turn infected other men, one of +whom came to me, while others went to my colleagues. Another man of the +first group, about middle age, and previously a very healthy, sober, +hard-working fellow, has developed thrombosis of his middle cerebral +artery as the result of a syphilitic endarteritis. He is totally +incapacitated, and in the Old Men's Home at ----. He remains a permanent +charge on the community." + +(C.) _Hospital and Charitable Institutions Act, 1913, Section 19._ + +In 1913 the need for detention provisions, to cover any infectious or +contagious disease, received the attention of Parliament, and these are +embodied in section 19 of the Hospitals and Charitable Institutions Act, +1913, thus: + + "19. (1.) The Governor may from time to time, by Order in Council + gazetted, make regulations for the reception into any institution + under the principal Act of persons suffering from any contagious or + infectious disease, and for the detention of such persons in such + institution until they may be discharged without danger to the + public health. + + "(2.) Any person in respect of whom an order under this section is + made may at any time while such order remains in force appeal + therefrom to a Magistrate exercising jurisdiction in the locality, + and the Magistrate shall have jurisdiction to hear such appeal and + to make such order in the matter as he thinks fit. An order of a + Magistrate under this subsection shall be final and conclusive. + + "(3.) Regulations under this section may be made to apply generally + or to any specified institution or institutions." + +The Committee are advised that this section was not aimed solely at +venereal diseases. In that year, and prior thereto, was prominent the +difficulty of detaining consumptives who refused to take precautions to +prevent the spread of their disease to others; and, again, much +attention was being centred on the chronic typhoid and diphtheria +"carrier." It seemed rational to compel isolation of such persons in +hospital until there was some assurance that they would no longer be a +danger to the community if allowed their liberty. Regulations under the +Act were not issued, owing to opposition manifested at the time, and +consequently the section never became operative. + +(D.) _The Prisoners Detention Act, 1915._ + +This Act secures that individuals of one class of the community--viz., +convicted persons--can be held until freed from venereal disease with +which they were known or found to be infected. The measure is of value, +but logically seems unsound, because the venereal diseases from which +such persons suffer are in no way a greater danger to the public than +the same diseases in the law-abiding subject of any class, and, +furthermore, the Committee have no reason to conclude from the evidence +that convicted persons, as a whole, show a higher percentage of venereal +cases than those who never enter a prison. The Controller-General of +Prisons submitted a schedule showing that the number of prisoners +detained under the Prisoners Detention Act from its commencement in 1916 +to 1922 was twenty-eight, consisting of nineteen males and nine females. + +(E.) _Social Hygiene Act, 1917._ + +In the words of the Commissioner for Public Health of West Australia, +who prepared the first comprehensive legislation on venereal diseases in +1915, this Act "can hardly be classed with recent Australian +legislation, for the reason that it provides for no notification of the +disease and no compulsory examination." By this Act infected persons are +required to consult a medical practitioner and go under treatment by +him, or at a hospital; but no penalty is provided, and there is nothing +to compel such persons to do either of these things. + +Reference to case 1 in the concrete examples cited above will show the +weakness of the Act. The waitress continued in employment, handling cups +and spoons and cakes, &c. The Medical Officer of Health had every reason +to believe she was infected with syphilis, but, not having the power to +insist on her obtaining medical advice, he could do nothing to enforce +the provisions of section 6 of the Act. + +Section 7, making it an offence for any person not being a registered +medical practitioner to undertake for payment or other reward the +treatment of any venereal disease, has, in the opinion of the +Commissioner of Police, proved beneficial in restricting the operation +of quacks, but he suggests that it should be amended by deleting the +words "for payment or reward," as it is sometimes easy to prove the +treatment and difficult to prove the payment, and it is the treatment by +unqualified persons that is aimed at. + +Section 8, which makes it an offence knowingly to infect any person with +venereal disease, is practically inoperative, as will be shown later in +this report, owing to the extreme difficulty, in the absence of any +system of notification and compulsory treatment, of proving that the +offence was committed knowingly. + +The Committee desire to draw attention to section 13. Herein is provided +towards hospital maintenance a higher subsidy for venereal patients than +is receivable for the maintenance of patients suffering from other +infectious diseases. They think that it is inadvisable to particularize +venereal sufferers, or, indeed, to draw any distinction between +different classes of diseases in a hospital, and that the ordinary +subsidy should be paid in all cases. + +In this Act also is power to make regulations for the "classification, +treatment, control, and discipline of persons _detained_ in such +hospitals," but apparently, owing to the opposition to the almost +analagous provision in the Hospitals and Charitable Institutions Act, +1913, no such regulations have as yet been made. + + + + +PART II--PREVALENCE OF VENEREAL DISEASES IN NEW ZEALAND. + + +SECTION 1.--STATISTICAL. + +(A.) _Medical Statistics._ + +The first item on the Committee's order of reference is "To inquire and +report, as to prevalence of venereal diseases in New Zealand." + +One of the first matters which engaged the attention of the Committee +was the question how reliable information could be gathered which would +indicate the present prevalence of these diseases in this country. +Recognizing that it would be impossible to obtain trustworthy figures +without securing the widespread co-operation of the medical profession, +the Committee at an early stage sought and was readily given the help of +the British Medical Association in the matter. Representatives of the +Association gave their assistance in the preparation of a form to be +sent to and filled in by all practising members of the profession, and +in the current number of the _New Zealand Medical Journal_ an appeal to +members for their collaboration was made. Suitable circular letters were +also prepared by the Committee asking medical practitioners for their +co-operation, and the Committee are pleased to be able to report that +out of about 750 in actual practice, no fewer than 635 medical +practitioners sent in completed returns. A copy of the form used for +these returns will be found as an appendix to this report, as also a +tabulated return of the replies received and compilations therefrom. + +It will be seen that the total number of cases of all forms of venereal +diseases and of diseases attributable to venereal disease under the +personal care of the doctors reporting is 3,031; and, taking the +population of New Zealand as 1,296,986 (estimated population 31st March, +1922), this means that about one person in every 428 of our population +is at present being treated for venereal infection or for the results +thereof. Acute and chronic gonorrhoeal infections give a total of 1,598, +being about one person in every 812 of the population. This is most +likely a very low estimate, for the Committee have had it very +definitely in evidence that many persons suffering, at least from acute +gonorrhoea, seek treatment at the hands of persons other than registered +medical practitioners. For syphilitic infections in all forms the total +is 1,419, about one person in every 914 of the population. The return +bears out other evidence showing that the chancroid or soft-sore type of +infection is rare in this Dominion. + +The Committee regard the result obtained as furnishing some indication +of the amount of active venereal disease existing in the Dominion. The +Committee consider, however, that these figures must be considerably on +the low side, for these reasons: (_a_) that a number of medical +practitioners have not replied: (_b_) that some diseases attributable to +venereal disease may not have been conclusively diagnosed as such, and, +therefore, not included in the return. The return necessarily does not +include cases, probably numerous, which have not been under medical care +for some time, if at all; (_c_) to secure a complete return would have +involved the keeping by each doctor of full records of all cases and a +careful and laborious collation of figures. + +With respect to the expression of opinion asked of medical practitioners +upon the question "If venereal disease in this Dominion has or has not +increased in a greater proportion than the population during the last +five years," it will be seen that of 322 who replied, 199 answered "Yes" +and 203 "No." This is necessarily purely a matter of impression, and it +must also be borne in mind that the evidence shows that patients are now +using the clinics in large numbers, while others who formerly went to +general practitioners now consult specialists who have recently started +in practice. On the other hand, it is possible there is a compensating +influence in the fact that the public are being educated to the +importance of seeking skilled medical treatment for these diseases. + +(B.) _Clinic Statistics._ + +A second source of information as to the prevalence of venereal diseases +was provided by the statistics which have been compiled by the +Department of Health as the result of the establishment of the +venereal-diseases clinics. Among the appendices to this report will be +found a return showing the number of persons attending at each of these +clinics for the years 1920, 1921, and part of 1922, and recorded under +the headings "Sexes" and "Diseases." These statistics are valuable +insomuch as they record facts, but with respect to the total prevalence +they are but an indication, since they relate only to a small proportion +of the population who have become infected and sought treatment. From +this table (B) it will be found that the males attending for the first +time represent 83.60 per cent. of the total, and females 16.40 per +cent., or, roughly, a ratio of six males to every female. + +_Clinic Distribution._--In the figures for syphilis the following points +are worthy of note: Auckland: A distinctly higher number of cases than +the other centres. A marked drop in 1921 for males, but the return for +this year indicates a rise; female cases show a rise for this year. +Wellington: Returns appear fairly uniform, with a slight falling +tendency, most marked in the females. Christchurch: A drop in male +cases, with a fairly uniform rate of females. Dunedin: Here the rates +appear uniform, with exception of a fall for males in 1922. + +As to gonorrhoea, these points may be noted: Auckland: A marked rise. +Wellington: Steady rise with exception of females. Christchurch: Slight +rise since 1920: females uniform rate. Dunedin: Slight rise, with +indication of male increase in 1922. + +_Age Distribution._--The age-period of persons attending the clinics is +mainly eighteen to thirty. + +_Marital Condition._--From the evidence of the clinics it is very +apparent that venereal disease is especially a problem associated with +the unmarried. + +(C.) _Mental Hospital Statistics._ + +A third source of estimation of prevalence was opened to the Committee +by the Inspector-General of Mental Hospitals. The method of +investigation adopted by Dr. Hay is based on Fournier's estimate that 3 +per cent. of the cases of syphilis existing at any one time will +ultimately develop dementia paralytica. + +The introduction of the Wassermann test and treatment by salvarsan or +other arsenical preparations will vitiate this index in future, for the +reasons that by the Wassermann test more cases will be diagnosed, and by +the use of recent remedies the complete cure of many more cases will be +effected, and consequently fewer will develop dementia paralytica. This +disability does not develop until about ten to fifteen years after +infection. The Wassermann test and the modern arsenical preparations +have not yet been in use for that period, therefore these figures, as an +estimate of the prevalence of syphilis in 1921, would not be materially +affected by these developments. An estimate based on these data may +therefore be regarded in the meantime as approximately correct. + +During the past ten years 4,763 males and 3,747 females have been +admitted into New Zealand mental hospitals. The percentage of syphilitic +admissions of all types was 4.74, while the percentage of cases of +dementia paralytica was 3.89. In other words, of the admission of +syphilitics 82 out of every 100 cases were dementia paralytica. The +average yearly number of deaths from dementia paralytica according to +the Government Statistician's returns between 1908 and 1921 was just +under 40. + +If Fournier's estimate that 3 per cent. of syphilitics ultimately +develop dementia paralytica be accepted, one would arrive at the annual +infection by multiplying 40 by 33, which gives 1,320. Assuming the +average duration of life, after infection, to be twenty-five years, this +means that at any given time there are twenty-five years' infections on +hand. Dr. Hay computed from this the number of persons in New Zealand +now who have, or have had, syphilis to be 1,320 x 25, equalling 33,000, +or 1 to every 38 of the population. If the average duration of life +after infection were assumed to be thirty years, the figures would be 1 +to every 32 of the population. + +Taking the figure for syphilitic infections over a period of years at +1,320 per annum, this would mean for the population of New Zealand +(exclusive of Maoris) 1 fresh infection annually in about every 850 +persons. + +(D.) _Incidence among Maoris._ + +It is even more difficult than in the case of the European population to +say what is the prevalence of venereal diseases amongst Maoris. The +Director of the Division of Maori Hygiene (Dr. Te Rangi Hiroa) in a +statement to the Committee says:-- + +"Venereal disease made great ravages amongst the Maori population in the +early days of colonization. To this may be attributed much of the +sterility, with histories of repeated miscarriages, that existed in the +transitional period of Maori history. Most of the old men--hemiplegias, +and paraplegias, and subsequent general paralysis of the insane--gave an +old history of syphilis. These cases that I saw twenty years ago have +now disappeared. + +"In my experience of eighteen years' constant work amongst the Maoris +venereal disease has been comparatively rare. It disappeared amongst the +people, only to recrudesce in some localities as fresh infection was +introduced by the white man, or brought back to the settlements by +visits to the white towns. I see very little of it at present, but now +and again hear reports from medical officers that it has cropped up in +the settlements near them ... In all these cases I am convinced that the +origin is from a white source, and the problem amongst the Maoris is not +nearly so serious as amongst Europeans. It seems to me unjust that the +idea should be circulated that the Maoris are a source of danger to the +European community--the reverse is much more likely. + +"It is impossible for me to supply accurate data as to the incidence of +the disease amongst the Maori race at present, but I am confident that +reports have a natural tendency to become exaggerated. I do not consider +that returned Maori soldiers, owing to the treatment they received +before being discharged from the service, have been a factor in the +introduction of the disease amongst the settlements. If they have in +some areas, it has been from fresh infection, which their experience of +prostitution in Egypt and Europe has made them more liable to acquire +from professional and amateur prostitutes in towns. At the same time, +the experience of returned soldiers as to the value of treatment makes +them more likely to seek such aid." + +(E.) _Death-certificates._ + +There are no trustworthy statistics in any part of the British Empire of +the deaths due to venereal disease. Many persons die from illnesses +which result from an initial syphilis contracted perhaps many years +prior to death. It is well known that medical practitioners, from a +laudable desire to spare the feelings of relatives, refrain from stating +the primary cause of death in such cases, and merely enter the secondary +or proximate cause. For the same reason, the statistics regarding deaths +due to alcoholism, and perhaps in a less degree some other factors in +the mortality returns, are incomplete and consequently useless. + +Both the Royal Commission on Venereal Diseases and the Birth-rate +Commission recommended that the medical attendant should issue two +certificates--one, which would be a simple certificate of death, to be +handed to the relatives, and the other, a confidential certificate +giving the primary cause of death, which would be transmitted to the +Registrar. + +The Registrar-General for New Zealand, Mr. W.W. Cook, in his evidence in +chief, stated that he did not favour these suggestions. A certificate of +death, he said, cannot be regarded as confidential, as the information +contained therein is recorded in the death entry, which may be inspected +by the public, and of which a copy may be obtained by any applicant. In +reply to questions, however, he stated that the law could no doubt be +altered so as to make the death-certificate confidential, the +information to be given up only on an order from a Court of justice. +Apart from the fact that the insurance companies might object, he did +not see any objection from the public point of view. + +Mr. Malcolm Fraser, the Government Statistician, said that there was +considerable division of opinion on this question at the British Empire +Statistical Conference held in London in 1920, when statisticians from +all parts of the Empire were present. It was generally agreed that the +system was good theoretically, but some doubt was expressed whether in +practice there would be as much improvement as was expected, since the +system would depend entirely on the medical attendant strictly complying +therewith and disclosing the true cause of death in every case. Any +system of confidential information always had that failing. The witness +thought the register must be open for persons having a right to call for +copies of entries. In dealing with insurance claims at death the truth +or otherwise of the statement in the proposal form was important, and +might require verification by inspection of the death entry. At the +Conference Dr. Stevenson, the Statistician to the Registrar-General of +the United Kingdom, was very pronounced in his advocacy of the +confidential form of certificate. The Conference passed the following +resolutions: "(1.) That the present system of open certification tends +to prevent candid statements of the causes of death, and thus introduces +a systematic error into death statistics. (2.) That the error would be +eliminated by a system of confidential certification." + +The Committee, while agreeing that such a system of registration of +deaths would undoubtedly afford better means of approximating to correct +returns of mortality not only from venereal diseases but also from +alcoholism and some other diseases, would point out that, if New Zealand +were to adopt the reform while the rest of the Empire retained the +present system, the result would be to place the Dominion in an +apparently unfavourable light in comparison with other parts of the +Empire in regard to the mortality from these diseases. + + +SECTION 2.--CAUSES OF THE PREVALENCE OF VENEREAL DISEASES IN NEW +ZEALAND. + +In discussing this order of reference the Committee desire it clearly +understood that these causes are not peculiar to New Zealand, and do not +operate more extensively in New Zealand than elsewhere. The Committee +are concerned, however, in discussing this question only as it affects +New Zealand. + +The causes of the spread of venereal disease may be classified under two +main headings: (1) The presence of infected individuals acting as foci +of infection; (2) the occurrence of promiscuous sexual intercourse, by +which in the great majority of cases the disease is actually transmitted +from one individual to another. + +(1.) _The Presence of Infected Individuals._ + +These sources of infection arise and persist for the following +reasons:-- + + (1.) Neglect by infected persons to undergo treatment. (2.) Neglect + to continue treatment till no longer infective. (3.) The treatment + of infected individuals by unqualified persons, such as chemists, + herbalists, chiropractors, &c. In these cases the disease becomes + chronic, and the best opportunity for its treatment and cure has + passed before the case is seen by a medical man. (4.) By the + introduction of venereal disease to this country from overseas. + +(2.) _The Occurrence of Promiscuous Sexual Intercourse._ + +A striking portion of the evidence placed before the Committee was that +which showed the very small amount of professional prostitution in New +Zealand. This was supported by the valuable evidence of Mr. W. Dinnie, +ex-Commissioner of Police, and Mr. A.H. Wright, Commissioner of Police. +The latter witness stated that there were only 104 professional +prostitutes in the Dominion. + +It would appear also that the professional prostitute, as a result of +her knowledge and experience, is less likely to transmit venereal +disease than the "amateur." It is therefore principally to clandestine +or amateur prostitution that one must look for the dissemination of the +disease, and inquiry into the conditions which tend to the production of +the amateur prostitute is a direct inquiry into the causes of the +prevalence of venereal disease. + +The evidence before the Committee shows that this promiscuity is very +prevalent, and that it is not confined to any particular social strata. +The fact is also strikingly demonstrated by Table A in the appendix. +From this table it will be seen that during the period 1913-21 there +were 10,841 illegitimate births and 33,738 legitimate first births +within one year after marriage. If to the illegitimate births we add the +total number of live births occurring within the first seven months of +marriage viz., 12,235--which may be safely considered to have been +conceived before marriage, we get a total of 23,076 births in which +conception took place extra-maritally. In other words, more than 50 per +cent. of total first births occurring within twelve months of marriage +result from sexual contact prior to marriage. + +Some factors which contribute in a greater or less degree to the moral +laxity which leads to promiscuous sexual intercourse are:-- + + (1.) The relaxation of parental control, which was emphasized by + many witnesses. Girls stay less at home and assist less in the work + of the home, preferring whenever opportunity offers, to go to the + pictures or some other form of entertainment. + + (2.) Lack of education of the young in the facts pertaining to sex. + Especially the Committee would call attention to the unfounded + belief of many that continence in young men is injurious to health. + + (3.) Bad housing and general conditions of living. When members of + both sexes are crowded together in restricted accommodation in + which often insufficient conveniences are supplied, it is easy to + conceive of a relaxation of the proprieties of life which might + lead to acts of immorality. + + In this connection the Committee desire to call attention to the + excellent work done by the Y.W.C.A. and other bodies in the + provision of hostels in which girls are provided with board and + lodging at very reasonable cost. The Committee were surprised to + learn that full advantage was not taken of these provisions, and + that the accommodation at these hostels was not fully occupied. It + would appear that many girls resent the very slight amount of + supervision and restraint exercised over them, precisely as they do + parental control. + + (4.) The presence in the community of individuals, especially + girls, who are to some degree mentally defective or morally + imbecile. The Committee were given several individual instances in + which such girls had acted as foci of infection; they are easily + approached, and facile victims for men. In spite of a degree of + mental or moral defect they may be physically attractive. + + (5.) Economic conditions which delay marriage may reasonably be + regarded as a factor in conducing to an increased frequency of + extra-marital sexual relationship. Graph A in the appendix shows + clearly that the age of marriage in both sexes has, with slight + fluctuations, steadily increased from 1900 to 1921. + + (6.) Alcohol tends to the dissemination and persistence of venereal + disease: it increases sexual desire, lessens control, causes the + individual to be less careful as regards cleanliness, &c., after + exposure to infection, and militates against effective treatment. + It is to be pointed out, however, that the lower control possessed + by some individuals may be the actual predisposing cause, both of + laxity in sexual matters and of the excessive ingestion of alcohol. + There appears no doubt that alcohol is an important factor in the + prevalence of venereal disease, although probably not so potent as + represented by some witnesses. + + (7.) Accidental infections are undoubtedly rare. They may arise + from contact with W.C. seats, dirty towels, and eating and drinking + utensils in public places. + + (8.) Other factors of minor importance which were mentioned in + evidence were the modern dress of women, which was stated to be in + certain cases sexually suggestive, and certain modern forms of + dancing. There appears some grounds to suppose that dances + conducted under undesirable conditions contribute to sexual + immorality, but the Committee see no reason to condemn dancing + generally because the coincident conditions under which it has been + or is conducted in some cases have contributed to impropriety. The + cinema was stated by some witnesses to have an immoral tendency + both in the nature of the pictures presented and in the conditions + under which they are viewed by the audience. The Committee suggest + that a stricter censorship might with advantage be exercised, and + should include the posters advertising the films. + +It has been stated that venereal disease has increased in New Zealand +with the return of the Expeditionary Force from overseas. Ample +evidence, however, was given to the Committee that there has been no +increase of the disease due to returned soldiers. These men were treated +prior to their discharge until non-infective. + + + + +PART III.--BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASE. + + +SECTION 1.--EDUCATION AND MORAL CONTROL. + +There is no question that the most effective way of avoiding venereal +disease is to refrain from promiscuous sexual intercourse. The problem +which the Committee have been asked to consider has very important +medical aspects, but, while these must not be neglected, it is essential +to the health and well-being of the nation that the enemy should be +attacked with every moral and spiritual weapon:-- + + Self reverence, self-knowledge, self-control,-- + These three alone lead life to sovereign power. + +The absence of proper training and instruction of the young is +undoubtedly responsible for a great deal of the evil which has been +shown to exist. Children are led into bad habits through ignorance, and +young men and young women grow up with utterly false ideals of life, and +in many cases fall into deplorable laxity of conduct. + +There is an impression among many young men that chastity is either +impossible or at least is inconsistent with physical health. There is +the highest medical authority for stating that this notion is absolutely +wrong, while there is no difference of opinion whatever as to the +serious risks of contracting diseases of a very loathsome character +incurred by those who do not restrain their passions. Apart from this +aspect of the question, it must be obvious to every thinking person that +looseness of conduct between the sexes such as is shown to exist in New +Zealand is destructive to the high ideals of family life associated with +the finest types of British manhood and womanhood, and if not checked +must lead to the decadence of the nation. + +A sounder state of public opinion needs to be cultivated. The moral +stigma at present attached to sufferers from venereal disease should +rest upon all who sacrifice to their own selfish passions the +chivalrous relations which should subsist between the sexes. Those who +are unfortunate enough to contract disease incur a punishment so +terrible that they deserve our pity and our succour, always provided +that they seek skilled treatment and refrain from any conduct likely to +communicate the disease to others. The man or woman who negligently or +wilfully does anything likely to lead to the infection of any other +person is a criminal, and should be treated as such. + +To bring about this healthier state of public opinion much might be done +by the various Churches, by the Press, and by all who are in a position +to influence the thoughts of others. It is a duty which should be shared +by all--it cannot be left entirely to the Government, to Parliament, or +to the medical profession. If a healthier atmosphere were created for +the proper consideration of this subject, instead of the unwholesome fog +of prudery in which it has been enveloped in the past, a great deal will +have been gained. + +One result of the mistaken policy of reticence which has prevailed is to +be seen in the fact, already mentioned, that children are allowed to +grow up either in ignorance of sex physiology or with perverted ideas +due to the want of proper instruction. Nearly every witness who spoke on +the subject before the Committee agreed that such instruction would come +best from the parents, but there is also practical unanimity among those +who gave evidence that very few parents are capable of giving such +instruction in the right way, and the vast majority are unwilling to +attempt it. In these circumstances our chief hope for the future seems +to lie in an endeavour to educate the children in such a way that they, +the parents of the future, may be enabled to deal justly with their own +children in this vital matter. Nevertheless, the Committee would be +failing in their duty did they not point out that all parents have a +serious responsibility to their children which they cannot evade without +laying themselves open to grave reproach. It is probable, as one of the +witnesses remarked, that "nothing they could do for their children's +happiness in life would be of equal value to the outlook which they +might give to their children upon this matter. Apart from any +possibility of moral ruin or disease, such an outlook would colour the +whole mature life of their children in respect to what is probably the +foundation of the greatest human happiness--namely, home relationship." + +The Committee recommend that the Department of Health be asked to +prepare a suitable pamphlet to assist those parents who desire to +instruct their boys and girls on this subject. It is also suggested that +where parents feel themselves unable to undertake the necessary +instruction, the family doctor should be asked to talk to the boys. +Instruction to the girls should certainly come from the mother, but +failing this a little wise counsel and advice from a woman doctor should +be secured. + +In regard to the teaching of sex hygiene in schools some interesting +evidence was given to the Committee by Mr. Caughley, Director of +Education, Mr. T.R. Cresswell, Principal of the Wellington College +(speaking on behalf of the Secondary Schools Association), and by some +of the women doctors and others who were good enough to attend as +witnesses. + +Mr. Caughley stresses the point that it is not mere knowledge of +physiology that will meet the case. He considers that the most important +thing of all is to establish in the minds of the children noble ideals +with regard to infanthood and motherhood. Lessons in connection with the +care of all birds and animals for their young, with the love and +devotion of parents for their young, with all that is beautiful and +tender connected with the homes of animals and birds, would establish a +kind of reverence about everything that is connected with birth. He +deprecates mechanical, systematic, and consecutive instruction in the +mere facts of sex hygiene, for even the fullest knowledge on this +subject is known to have very little deterrent effect in the temptations +of life. He would rather aim at creating the right atmosphere in a +school, such as would make any coarse or unworthy mention of any of +these matters in the hearing of a child appear more or less repulsive, +and would in general enable him to put in its proper setting any +knowledge that might come to him from various sources. + +Mr. Cresswell gave the Committee an extremely interesting _résumé_ of +the answers to a _questionnaire_ which he addressed to the head of every +secondary school in the Dominion. He suggested--(1) That a determined +public effort should be made to rouse parents to a sense of their +responsibility in regard to this matter by means of broadcasted +pamphlets, and that they should be furnished with simple, specially +written leaflets to assist them in giving instruction to their children; +(2) that sex hygiene be made a compulsory subject in all +training-colleges, the instructors being specially qualified doctors; +(3) that regular courses of public lectures be delivered in suitable +centres; (4) that teachers, and especially physical instructors, be +encouraged to stress the value of physical fitness to pupils +collectively, and, where need is indicated, to have private talks with +individuals; (5) that teachers be advised to take every opportunity +during lessons in hygiene, physiology, botany, &c., to give children a +sane and normal outlook on sex matters. + +Incidentally it was suggested that girls' schools suffer somewhat +through being staffed almost exclusively by celibate teachers. "The +knowledge and sympathy of a real mother would," it was urged, "be +invaluable to many girls in our secondary schools. Does it seem a +trivial suggestion that in every girls' school there should be one +honoured official, the 'school mother,' a sympathetic motherly person +whose duty it should be to get into personal touch not only with +individual girls but also with individual parents?" + +The views expressed by the Swedish Committee of Experts in Medicine and +Pedagogy are well worthy of quotation: "It is illustrative of the broad +view taken by the committee of their task," says the _British Medical +Journal_, "that they deal with the education of the child from the time +it learns to speak and address inquiries as to how it came into the +world. The committee look forward to the time when parents will be so +enlightened that they will not tell their children silly stories about +babies being brought into the home by storks, but will give a simple +account which the child in later years will not discover to be +mendacious. The committee hope that the child, who is gradually taught +more and more about sex hygiene as it passes from one school grade to +another, will eventually become a parent wise enough to instil in the +next generation a frank and healthy attitude towards sex problems. +Parents, it is hoped, will learn to protect their infants from the +undesirable caresses and kisses of strangers ... As for sex teaching in +school, this should be associated with the teaching of biology, +Christianity, sociology, and psychology. The question of venereal +disease should not come into the curriculum until comparatively late, +and until the physiology of fertilization and reproduction has been +fully taught. Advanced sex teaching should preferably be in the hands of +doctors; but they are not always available, in which case other teachers +should give instruction on this subject, male teachers dealing with boys +and female teachers with girls. Teaching of sex hygiene in high schools +for girls should include the subject of venereal disease, and special +emphasis should be laid on the protection of infants from infection. A +further recommendation is that a carefully supervised library of works +on sex hygiene and venereal disease should be compiled at the cost of +the State for the use of teachers and classes." + +The Committee of the Board of Health agree with the suggestion that +teachers should be trained to deal with this question, and that school +medical officers or other qualified practitioners should give occasional +"talks" to the elder boys and girls. A great deal may be done by +physical instructors preaching the gospel of "physical fitness" and +personal cleanliness in thought, word, and deed. Bathing and outdoor +sports and games of all kinds should be encouraged. The Committee would +point out, however, that not all teachers and not all medical men +possess the qualities fitting them to give instruction and advice in +this delicate matter. The task should be entrusted to those who have +shown themselves specially adapted by sympathy and tactfulness for the +work, and preferably those who are parents, otherwise harm instead of +good may result. + +More than one witness spoke with approval of "The Cradleship" and other +books by Miss Edith Howes as suitable for use with young children. + +The Committee are of opinion that addresses on sex questions by lay +persons, except selected teachers, to young people in mass are of +doubtful value. + +Sufficient instruction should be given to adolescents regarding venereal +diseases and their effects to ensure that if they do contract them it +shall not be through ignorance. The Committee cannot too strongly +emphasize their belief, however, that knowledge of the effects of +venereal diseases is in itself by no means a sufficient safeguard; that +in addition to such knowledge the cultivation of a high moral standard +is necessary, and if this is reinforced by religious sanctions it is +likely to be more effective. + +The Committee agree with the view expressed by Dr. E.T.R. Clarkson in a +recent text-book, entitled "The Venereal Clinic," that in many instances +an excessive stress has been placed upon the factor of fear. He says +that a very small proportion of the community are restrained from +indulging in promiscuous sexual intercourse through fear, and it is +irrational to rely so much upon an emotion which at the best is but +slightly inhibitory, and which cannot in itself exercise a direct +energizing influence for good. "We do not," he continues, "wish to deter +the community from living a life of sexual promiscuity by rendering them +fearful of the possibilities of acquiring venereal disease, but we want +rather to instil such an ideal into them, whether it be of a religious, +ethical, or altruistic nature, as will tend to make them regard such a +life as incongruous with those tenets and therefore as undesirable, +however much it may be desired on other grounds." He adds that the +emphatic reiteration of fear possesses another and dangerous +disadvantage. "There is no doubt, as venereologists will testify, that +many individuals are seriously suffering from the effects of fear thus +engendered in their minds. In some instances the resultant damage to +their mentality is more serious than the venereal disease from which +they are suffering: whilst in others an obsession that they are +infected, when there is no foundation for the fear, may develop in such +a manner as to inflict serious and permanent damage." + + +SECTION 2.--CLINICS FOR THE TREATMENT OF VENEREAL DISEASE. + +Early in 1919 clinics for the treatment of venereal disease were +established in each of the four main centres. Arrangements were made by +the Department of Health for the treatment by Hospital Boards throughout +the Dominion of cases of venereal disease, and in the absence of local +institutions arrangements were made with private practitioners. There is +therefore opportunity for all to receive free treatment, wherever they +may be, in New Zealand. + +Table B sets out the work done at the four clinics during the two and a +half years ended 30th June, 1922. From this table it will be seen that +3,038 males and 596 females attended these clinics during the period +named. The total number of attendances was 110,792--101,995 males and +8,797 females. The disproportion between the number of males and females +attending is notable. It is clear from the evidence that this does not +represent a difference in the incidence of these diseases in the sexes, +but that women do not attend so freely when suffering. + +These clinics are attached to the public hospitals in each centre, and +all evidence goes to show that this is most desirable. If the clinics +were apart, the object of the patients' visits would be obvious, whereas +the actual purpose for which they go to a hospital is not so. It is to +be strongly emphasized that the less publicity given to the attendance +of these patients, the greater the number of patients who will be likely +to take advantage of the treatment offered. This applies especially to +the attendance of women. + +The clinics are now open only at certain hours. The Committee suggest +that they might with advantage remain open continuously (except at +certain fixed hours on Sunday). In the absence of the Medical Officer a +sister could take charge of the women's clinic, and a trained orderly of +the men's clinic. It would be necessary in this case to have separate +clinics for male and female patients--the same rooms would not be +available for both sexes. + +The majority of witnesses asked were of opinion that if a lady doctor +were made available for the treatment of women the number of women +attending would increase. + +It is suggested that in certain cases of gonorrhoea, where it is an +advantage that the treatment should be carried out twice or more often +daily, arrangements might he made for the supply of the necessary +apparatus and drugs to patients at cost price, and in indigent cases +free of charge. This is particularly important to women who may have to +continue treatment for several months. + +The clinics should be more widely advertised by notices in public +conveniences and other suitable places. + +The Committee are impressed with the valuable work done at these +clinics, and recommend their extension to other centres as opportunity +offers and necessity is shown to exist. + +The existing clinics are conducted by medical men who have had special +experience and training in the treatment of these diseases. The Dunedin +clinic is attended by medical students for purposes of instruction. In +view of recent advances in the processes of diagnosis and treatment of +these diseases, the Committee consider that opportunity should be given +to medical practitioners to attend these clinics in order to familiarize +themselves with the most recent advances in this field. It would he an +advantage also if nurses in the course of their training attended the +female clinics, so that they might he taught to recognize the commoner +manifestations of these diseases. + +The most disappointing feature in the records of the clinics is the +cessation of treatment by so many patients before they have ceased to be +infective. The following evidence was given in this connection:-- + +_Percentage of Cases attending till Non-infective._ Auckland Clinic: 80 +per cent. cases of syphilis, 50 per cent. cases of gonorrhoea. It was +stated that no woman suffering from gonorrhoea continued treatment till +non-infective. + +Wellington Clinic: 40 per cent. of all cases continued treatment till +non-infective, and very few of these were women. + +Christchurch Clinic: Men with syphilis, 75 per cent.: men with +gonorrhoea, 98 per cent.: women with syphilis, 50 per cent.: women with +gonorrhoea, 14 per cent. + +Dunedin Clinic: In this clinic only thirty-one males suffering from +gonorrhoea were discharged cured: thirty-two absented themselves while +still infective; three female cases remained under treatment till cured, +and six ceased to attend while still infective. Forty male syphilitics +remained till non-infective, and seventy-four ceased treatment before it +was completed. For female syphilitics the figures are four and eighteen. + +It will be noted that in each case the proportion of women who attend +till non-infective is much smaller than of men, especially in cases of +gonorrhoea. The reasons for this are probably that owing to anatomical +considerations women infected with venereal disease suffer less pain and +the disease is less obvious than in men. On cessation of the more urgent +and obvious signs and symptoms they stop treatment. Again, it is +probable that the publicity of attending the clinics is felt more by +women than men. A third reason is the prolonged period of treatment +(often extending over many months) necessary to eradicate gonorrhoea in +women. These difficulties could to some extent be mitigated by the +provision of arrangements for women to carry out treatment in their +homes, which would avoid the publicity and loss of time entailed in +attending clinics. + +The Committee were impressed with the value of the work done by the lady +patrol in Christchurch, and considers that lady patrols would help +greatly in securing the attendance of women at the clinics. It is +recommended that these patrols should be attached to the Hospital Boards +and that they should be trained nurses. They would be available to give +advice to patients as to treatment in their homes. + +The Committee would also draw attention to the very valuable work done +by the Social Hygiene Society in Christchurch, and recommended the +establishment of similar voluntary societies in other centres. + +The Committee recommend that all bacteriological and other examinations +required for the diagnosis and treatment of cases of venereal diseases +should be carried out in laboratories of the Department of Health and +public hospitals free of cost, on the recommendation of medical +practitioners. + +The Committee made inquiries from competent witnesses as to the present +position of the complement fixation test in gonorrhoea. It appears that +this test has not reached yet such a degree of reliability as to render +it of great diagnostic value, but that it is reasonable to hope that it +may be perfected to such an extent to give it a value in the diagnosis +of gonorrhoea comparable to that of the Wassermann test in syphilis. + + +SECTION 3.--LICENSED BROTHELS. + +Inasmuch as one of the many letters addressed to the Committee favoured +the adoption of the Continental system of licensed houses of +prostitution, with medical inspection of the inmates, it seems desirable +to examine the arguments for and against such a proposal. Those who +support it contend that so long as human nature remains as it is +prostitution will continue, therefore it is better that it should be +regulated with a view to controlling the spread of disease. It is also +urged that the system acts as a safeguard against sexual perversion by +providing an outlet for the unrestricted appetites of men; that in its +absence clandestine prostitution increases, and innocent girls are more +likely to be led astray or become the victims of sexual violence. Apart +from the moral aspect of the case, these arguments are entirely +fallacious; and even in the countries where the licensed-house system +prevails enlightened public opinion has come to that conclusion. In the +first place, the idea that the system tends to lessen disease is a +dangerous delusion. Owing to the fact, already referred to, that +venereal disease in the early stages is difficult to detect in women, +even by skilled experts working with the best methods and with +practically unlimited time at their disposal, the routine inspection +given, for example, in the French and German houses is no guarantee of +the inmates being free from communicable disease even at the time of +inspection. + +Flexner, who spent two years in making inquiries and writing his classic +work on "Prostitution in Europe," is most emphatic on this point. The +experience of the American troops in the Great War is further strong +confirmation. The following is an extract from an article published by +the American Red Cross in May, 1918: "During the months of August, +September, October, and the first half of November, the houses of +prostitution flourished and were half-filled with soldiers. On November +15th rigid orders were issued placing these houses out of bounds, and +the immediate result was a great reduction of sexual contacts. As a +result there was a steady decline in venereal infections, and the +monthly rate per 1,000, which in October reached 16.8, dropped in +January to 2.1 among the white troops. During the same period there was +an even more striking drop in the infections among the negro labourers, +the percentage dropping from 108.7 per 1,000 a month to 11 per 1,000. No +statistics could speak more eloquently for the doctrine of closing the +houses of prostitution. Our studies showed numerous infections coming +from houses 'inspected' three times a week." + +In May, 1921, a conference (the North European Conference on Venereal +Diseases), in which England, Finland, Germany, Holland, Norway, Sweden, +and Denmark participated, passed the following resolution: "This +conference, having considered the general measures for the combating of +venereal diseases which have been adopted by the participating +countries, is unanimously of the opinion, so far as the experience of +these countries is concerned, that the legal and official toleration of +professional prostitution has been found to be medically useless as a +check on the spread of venereal diseases, and may even prove positively +harmful, tending as it does to give official sanction to a vicious +trade." + +On the same point Flexner says: "It is a truism that physicians +requiring to equip themselves as specialists in venereal disease resort +to the crowded clinics of Paris, Vienna, and Berlin, all regulated +towns, because there disease is found in greatest abundance and richest +variety--a strange comment on the alleged efficacy of regulation." + +Dr. Clarkson, in "The Venereal Clinic," already quoted, says, in +reference to the fancied security of licensed houses, "It may strengthen +the hands of practitioners to be able to tell interrogators in this +subject that in the opinion of leading venereologists, &c., no +foundation exists for any such feeling of confidence or security. In +other words, the system of licensed houses is a failure, and the 'red +light' of lust shines out as the lurid signal of disease and death." + +It is surely hardly necessary to urge the moral objections to the +proposal. The United States Public Health Service not long ago sent out +a _questionnaire_ to representative citizens in various walks of life +asking for opinion in regard to open houses of prostitution. There was +an overwhelming preponderance of replies against the system on moral as +well as hygienic grounds. One Illinois miner answered: "The life of a +prostitute is short, and her place must be filled when she dies, and, +being the father of two girls, I would not want mine to fill a vacancy, +and I think all parents think the same." A Colorado carpenter replied: +"The woman engaged in such business may not be my wife, mother, sister, +or daughter, but she is somebody's wife, mother, sister, or daughter. It +is a violation of all law." One Chief of Police wrote: "Open houses of +prostitution breed disease, crime, increase the number of prostitutes, +corrupt the morals of the community, and are a menace to the youth of +the country." Another replied: "The only reason I have ever heard +advanced in favour of houses of prostitution is that they protect +innocent girls. I am opposed to sacrificing any woman to benefit +others." + +If statistics could be obtained it would be probably found that the +system tends not only to increase disease, but the volume of sexual +immorality and crime. From the most materialistic point of view the +system is indefensible; while, looking at it from the moral aspect, it +is inconceivable that British people, who spent millions of money to +stop the traffic in black slaves, would ever officially countenance a +system which enslaves the souls as well as the bodies of its victims and +defiles the community in which it exists. + + +SECTION 4.--EXCLUSION OF VENEREAL CASES FROM OVERSEAS. + +The Committee are of the opinion that by the strict exercise of the +provisions of section 111 of the Health Act, 1920, much may be done to +prevent introduction of venereal diseases from overseas. They suggest, +however, that where any person so suffering is required or permitted to +attend a clinic he should be accompanied by some responsible officer of +the ship, or person authorized by the shipping company concerned, and +that the question on the "Report of Master of the Ship" defined by +regulations--"Are you aware of the presence on board of any person +suffering from ... _(b)_ venereal disease?"--might be strengthened by +adopting the Australian quarantine service equivalent viz., "Is there +now or has there been on board during the voyage any person suffering +from demonstrable syphilis in an active condition, or other communicable +disease?" + +The evidence given does not show that the number of venereal-diseases +cases already in the Dominion is greatly added to by the introduction of +cases from overseas. Since 1903 persons suffering from syphilis have +been "prohibited immigrants" within the meaning of the Immigration +Restriction Act. + + +SECTION 5.--PROPHYLAXIS. + +Before discussing this question it is desirable clearly to distinguish +between the procedures which are included under this term. These are-- + + (1.) The supply of drugs and appliances which are made available + for use by the individual before exposure to infection. This may be + described as "anticipatory prophylaxis," and has commonly been + designated the "packet system." + + The Committee condemn this procedure, for these reasons: (i) That + the system suggests a moral sanction to vice; (ii) that the + individual is lulled into a false sense of security, and may + thereby be encouraged repeatedly to expose himself to infection; + (iii) that the individual may be thereby deterred from seeking + early advice or treatment; (iv) that the drugs supplied may be used + for treating disease should it arise, and so delay may result in + seeking skilled treatment in the early stages when it is likely to + be most effective. + + (2.) Treatment applied after exposure to infection. This is called + "early treatment." This term is inapplicable, as a disease cannot + be treated before it exists. It is also likely to be confused with + "abortive treatment," which implies treatment immediately on the + appearance of symptoms. + + The evidence before the Committee shows that this form of + prophylaxis, if applied by skilled persons and within a few hours + of exposure, is effective in preventing disease in a great majority + of the cases in which it is used. + +The Inter-departmental Committee on Infectious Diseases set up by the +Ministry of Health in 1919 in connection with demobilization, in a note +on "Prophylaxis against venereal disease," reported among its +conclusions based on service experience, "That where preventive +treatment is provided by a skilled attendant after exposure to infection +the results are better than when the same measures are taken by the +individual affected, even after the most careful instruction." After +exposure to infection there appears no reason why these diseases should +not be regarded in precisely the same manner as other infectious +diseases, and precautions taken to sterilize the parts which have been +exposed to infection. + +It is to be noted that it is recommended that the prophylactic treatment +is to be carried out by some properly instructed person. This need not +necessarily be a medical man. It is suggested that this form of +prophylaxis might be carried out by an orderly at the venereal-disease +clinics. The notices posted in the public conveniences and other +suitable places indicating the existence of the clinics and the +necessity for treatment might include a guarded reference to their use +for this purpose. + +This form of prophylaxis applies to males. In the case of females the +methods adopted would be also contraceptive, and the Committee do not +recommend that facilities should be provided for this. + +The Committee must not be supposed to advocate prophylaxis as in any way +a substitute for continence and the cultivation of that high moral tone +that repels any suggestion of promiscuous sexual relationships, but they +feel that they could not properly ignore reference to a method of +prevention of these diseases which has proved very efficient in the +services, to which there appears no reasonable ethical objection, and +which brings their prophylaxis into line with that of other infectious +diseases. + + +SECTION 6.--LEGISLATION REQUIRED. + +(A.) _Conditional Notification._ + +The only subjects of importance upon which the witnesses examined +differed materially in opinion were--(1) whether there ought to be any +system of notification of cases of venereal disease, and (2) what steps, +if any, should be taken to deal with persons suffering from such disease +in a communicable form who refused to be treated, and in some cases were +even known to be spreading the disease broadcast. Ladies who attended to +give evidence on behalf of the National Council of Women and one or two +other women's organizations objected to notification and compulsory +treatment. They argued that there was at present a "scare" on the +subject of venereal disease, and deprecated "panic legislation." They +contended that the adoption of notification would deter patients from +seeking treatment for fear of publicity. They were opposed to compulsory +treatment of recalcitrant patients, arguing that any law of the kind +would be used most oppressively against women. They contended that +reliance should be placed on greater facilities for free treatment at +the clinics, the work of women patrols, suppression of liquor, and above +all education and propaganda on moral lines. + +When confronted with typical cases of difficulty already quoted some of +the witnesses admitted that it was not easy to see how such cases could +be dealt with satisfactorily without compulsion of some kind. But they +argued that, even so, it would be a greater evil if the fear of +publicity and the fear of compulsion should have the effect of deterring +sufferers from seeking treatment and so drive the disease underground. + +The National Council of Women, by a substantial majority, at a recent +conference in Christchurch, carried a resolution protesting against a +proposal to introduce compulsory notification and treatment of venereal +diseases, and urging the Government to increase the facilities for free +treatment. The President of the Council, however, informed the Committee +that most of the nineteen societies affiliated to the Auckland Branch of +the National Council are in favour of some form of compulsion, but a +number of the southern branches are opposed to it. Speaking as an +individual, and not as President of the National Council of Women, she +added: + +"Personally, I have no first-hand knowledge as to whether the disease is +so prevalent in the community as to demand urgent measures, but there is +an opinion among women social workers and medical practitioners, whom I +have consulted, that something should be done, and they are in favour of +compulsion under the Act, provided its administration is satisfactory. +There is no doubt that there is a genuine and widespread fear among a +large number of women that, although in the Act itself there is no +discrimination between men and women, in actual practice there will be, +and they fear that the Act will be enforced against women, and +particularly immoral women, while the men concerned will be allowed to +go free. This fear arises partly from the remembrance, particularly +among elderly women, of the old Contagious Diseases Acts, both here and +in England, and partly from the reports of the working of compulsion in +Western Australia and elsewhere. I am of opinion that there is no +serious ground for fear in view of the changed attitude in the public +mind in connection with these diseases, the fuller knowledge that people +generally have, and the high status of women in our country; also the +ready access that all persons have to the protection of the law and the +Courts in the event of false information being given, and the safeguards +embodied in the Bill as I understand it is drafted. My view is that the +objection to the compulsory clauses of the Bill would be removed in the +opinion of many women if women patrols or women police were appointed, +so that the administration of the Act in its compulsory clauses wherever +it treated women could be in the hands of those women officers." + +Among the witnesses questioned on this subject there was an overwhelming +preponderance of opinion that the time had now arrived for the adoption +of notification of all cases of venereal disease by number or symbol, if +only for the purpose of getting more accurate statistics; the +notification by name of those recalcitrant patients who refused to +continue treatment until cured; and compulsory examination of those whom +the Director-General of Health had good grounds for believing to be +suffering from the disease and likely to communicate it to others, and +who refused to produce a medical certificate as to their condition. Only +three medical men expressed themselves as being against these proposals. +On the other hand, the lady doctors examined (two of them members of the +National Council of Women, and the third representing the Young Women's +Christian Association) gave evidence in favour of conditional +notification, and compulsory examination, and compulsory treatment of +recalcitrants. It should be added that all the witnesses who were +engaged in rescue work, or other work bringing them face to face with +the horrors of venereal disease, were most emphatic in their opinion +that compulsory notification and treatment should be adopted. + +It is noteworthy that when the notification of ordinary infectious +disease was first proposed in England almost exactly the same arguments +were brought against the proposal as are now advanced against the +notification of venereal disease. Sir W. Foster, member for Ilkeston, +and a medical man of standing, speaking in the House of Commons in the +debate on the Infectious Diseases Notification Bill, on the 31st July, +1889, said, + +"The Bill calls upon medical men to perform something more than the +ordinary duties of citizenship by requiring them to become informers of +the occurrence of diseases. The relation of a medical men to his patient +ought to be one of complete confidence, and anything that comes to the +knowledge of a medical man in the practice of his profession is +practically an inviolable secret; and I do not like any Bill to +interfere with that relationship. I know myself that one of the results +of this Bill, if passed into law, will be that in scores of cases +medical men will not be called in to attend people suffering from +infectious diseases ... I admit the difficulty of the position, but I am +anxious that no measure should pass into law which will induce the +public to keep these diseases more secret than they have been in the +past, with the risk of adding to the spreading of them. We must be very +cautious not to do anything which will prevent the public from placing +full and implicit confidence in their medical man. I can quite conceive +it to be possible that, if an outbreak of infectious disease occurs in a +populous part of London, the people may, in order to prevent exposure, +refuse to allow a medical man to come in, and in such cases we shall +have tenfold more difficulty than at present. Therefore, while I am +anxious to promote the notification of disease, I do not want the +Government to promote rebellion on the part of the public." + +Needless to say, these gloomy anticipations have not been realized. +Probably the more enlightened generations to succeed us will wonder how +there could ever have been any opposition to the notification of +venereal disease, just as we to-day read Sir W. Foster's words and +marvel that any person of intelligence could have committed himself to +such statements. + +Notification of infectious diseases and isolation of patients suffering +from such diseases have for many years been compulsory. Isolation, when +spoken of by opponents to a similar measure for venereal diseases, is +opprobriously described as "compulsory detention." For twenty years it +has been the law in New Zealand that an authorized medical practitioner +may examine any person suspected to be suffering from any infectious +diseases (save venereal diseases), and the Medical Officer of Health +may, if he deems it expedient in the interests of the public health, +compel the removal to a hospital of any person so suffering. This +long-established procedure as referable to venereal diseases is by +antagonists termed "compulsory examination" and "compulsory removal." + +It is contended by some witnesses that notification will drive these +diseases underground; but syphilis and gonorrhoea for generations past +have been underground. + +Under the present system numbers of unfortunate persons either delay +calling in medical assistance until the case has become almost desperate +so far as the patient is concerned, or they resort to unqualified +persons, with the result that in most cases what was in the first +instance a simple attack, capable of treatment, results in serious +complications most difficult to deal with. In either case the patient +may be communicating diseases to others, and should this come to the +knowledge of the Health Department it has no effective means of checking +him--no power to warn those who are being endangered by his criminal +neglect. + +The Committee think there is some force in the argument that +notification by name, in the first instance, as in the case of ordinary +infectious diseases, would tend to discourage some from coming forward +for medical treatment. They recommend, therefore, the adoption of what +is known as the system of conditional notification embodied in the West +Australia Act. Under this plan the cases are notified by the doctor to +the Health Department by number or symbol only. The name is not sent in +unless the patient discontinues treatment before he is free from +infection and refuses either to go to a clinic or to another doctor. In +cases of those who "play the game," the name of the patient is kept +confidential, and does not pass beyond the medical man attending him. It +is only in cases of those who contumaciously refuse to do what is +necessary for their own safety and the safety of others that the name is +sent to the Health Department, in order that appropriate steps may be +taken in the interests of public health. Even then the name is given +only to officers who are pledged to keep it confidential. + +Following are the clauses in suggestions for a Bill, drawn up by the +Health Department, which in the opinion of the Committee should in +substance be adopted:--- + + "(1.) Every medical practitioner shall forthwith give notice to the + Director-General of Health, in the prescribed form, upon becoming + aware that any person attended or treated by him is suffering from + any venereal disease in a communicable form. The notice shall state + the age and sex and occupation of the patient and the nature of the + disease, but shall omit the patient's name and address. + + "(2.) Every medical practitioner, other than the medical officer in + charge of a public hospital or of a clinic established by direction + of the Minister of Health, shall be paid for each such notification + a fee to be prescribed by regulation. + + "(3.) The provisions of subsection (1) hereof shall apply in the + case of a child under the age of sixteen years who is suffering + from congenital syphilis. + + "(4.) Whenever a patient has changed his medical adviser, in + accordance with subsection (2) hereof, the medical practitioner + under whose care the patient has placed himself shall notify the + Director-General of Health in accordance with subsection (1) + hereof, and shall include in such notice the name and address of + the previous medical adviser." + +Without some such system of preliminary notification no adequate +statistics can be collected as to the prevalence of venereal diseases in +New Zealand, and no conclusion could be arrived at in the future as to +the effect of the whole or any part of the programme for combating these +scourges. Again, without such notification, and the attachment thereto +of some method of ensuring that the patient is made definitely +acquainted with his condition, it is practically impossible to enforce +the provisions of section 8 of the Social Hygiene Act for the crime of +"knowingly" infecting any other person. + +Here the Committee would refer to case 2 quoted above. Of what use is it +to provide free clinics if those who make use of them are permitted, as +soon as the urgent symptoms are relieved, to disseminate disease +broadcast, widening the circle of infection? Again, where is our +humanity if no step is to be taken to try to prevent a syphilitic child +being born to the man in case 1? + +A very valuable result of anonymous notification would be the +possibility afforded of observing any unusual "flare-up" or succession +of cases, especially in country districts and small towns. Study of case +4 will show the great value it would have been to have a record of an +unusual increase of syphilis in that township, giving an opportunity for +prompt investigation by the Medical Officer of Health for the district. + +(B.) _Compulsory Examination and Treatment._ + +This question obviously presents more difficulty than that of +notification, but it is clear that unless some means are provided of +bringing under treatment and, if necessary, isolating persons who are +suffering from highly contagious diseases, and who will not avail +themselves of medical treatment although this is provided free of cost +by the State, and who are knowingly or recklessly communicating the +disease to others, it will be impossible to keep in check this terrible +scourge. Without such provision any abandoned woman, as in case 4, or +any male libertine, may continue to sow disease broadcast without any +power to stop them. Failing some such measure, table articles and food +may continue to be smeared by hands soiled with syphilitic material, as +in case 1; section 6 of the Social Hygiene Act remains mere useless +verbiage, and the infecting of innocents, as in case 3, may continue +unchecked. + +Legislation dealing with this subject needs to be carefully framed with +suitable safeguards, but the Committee think that an amendment of the +Social Hygiene Act on the lines proposed by the Department of Health +should be adopted. These provisions are:-- + + (1.) That whenever the Director-General of Health has reason to + believe that any person is suffering from venereal disease, and has + infected or is liable to infect other persons, he may give notice + in writing to such person directing him to consult a medical + practitioner, and to produce within a time specified in the notice + a certificate from such medical practitioner to the satisfaction of + the Director-General of Health that such person is or is not + suffering from venereal disease. + + (2.) Should the person not comply with this request, the + Director-General of Health may obtain a warrant from a Magistrate + ordering such person to undergo examination to prove the existence, + or non-existence, of venereal disease. + + (3.) Making it possible for a Magistrate, on the application of the + Director-General of Health, to order the detention in a hospital or + other approved place of a person who is likely to be a danger to + other persons until that person is cured of venereal disease. + +These provisions are applicable equally to both sexes, and the Committee +see no reason to fear that the law would not be carefully and +impartially administered. If it should appear that more women than men +came under the operation of the law this result would be due to the fact +that, as disclosed in the evidence, a much larger proportion of women +than men fail to seek treatment, and of those treated a much larger +proportion of women fail to continue treatment until no longer +infectious. + +It is hardly conceivable that a responsible officer, such as the +Director-General of Health, would take action under these provisions +unless he had strong reason to believe that such action was justified. +But, even if he makes a mistake or is misinformed, the worst that can +happen to an innocent person wrongfully suspected is that he or she will +be required to produce a medical certificate, which can be procured free +of cost from any hospital or V.D. clinic. This is wholly different from +the provisions of the Contagious Diseases Act, under which a woman +suspected of prostitution was liable to be arrested by a constable in +the street. + +The Committee recommend that the serving of notices, &c., under these +sections be done by officers of the Health Department and not by the +police. They also recommend that all proceedings taken under any Act +having reference to venereal diseases should be heard in private unless +the defendant applies for a hearing in open Court. + +With regard to the effects of the actual operation of notification, +examination, and isolation, the Commissioner of Public Health for West +Australia, under date 25th August, 1922, advises the Committee that +there is an increase in the number of cases attending public clinics, +and that this is regarded not as evidence of increased incidence, but of +increased interest and appreciation of early treatment by those +suffering from the diseases. + + +SECTION 7.--MARRIAGE CERTIFICATE OF HEALTH. + +The Royal Commission on Venereal Disease reported that there was a vast +amount of ignorance as to the dangers arising from the sexual +intercourse of married persons one of whom had previously to the +marriage contracted syphilis or gonorrhoea. The effect upon the +birth-rate, and the misery caused during married life, and in many cases +to the offspring who survive, as they pointed out, are most serious, and +the fact that the actual cause of the trouble often remains unknown and +unrecognized prevents the calamity from serving the purpose of example +or warning. + +Some of the witnesses heard before the present Committee have urged that +a certificate of good health, or at least a certificate of freedom from +communicable disease, should be required from each party to a proposed +marriage before the Registrar issued a license to marry. The Royal +Commission considered that "it would not be possible at present to +organize a satisfactory method of certification of fitness for +marriage." The National Birth-rate Commission, however, reported that in +their opinion the question should be reconsidered with a view to +legislation. + +There is much to be said in favour of such a proposal from the point of +view of national health. If the system were adopted the certificate +should, in the opinion of the present Committee, include freedom from +mental disease as well as freedom from communicable disease. But there +are manifest difficulties in the way, chiefly in regard to the delicate +and searching examination which would be required in the case of women +before a doctor could certify positively to the absence of communicable +disease. + +The Committee recommend that instead of a medical certificate each party +to a proposed marriage should be required to answer appropriate +questions in regard to the presence or absence of communicable and +mental disease, and to make a sworn statement before the Registrar as to +the truth of the answers. It should be the duty of the Registrar to +communicate the contents of the statements to the other party in the +event of any admission of the presence of communicable disease. + +In addition to the penalty for making a false statement it might be +provided, as in the Queensland Act, that venereal disease shall be a +ground for annulling a marriage contract when one party is suffering at +the time of marriage from such disease in an infectious state, provided +the other party was not informed of the fact prior to marriage. + +The Committee would also recommend the adoption of a further provision +that it should be the duty of a medical practitioner attending a case of +venereal disease which is or is likely to become infective, if he has +reason to believe that the patient intends to marry, to warn him or her +against doing so, and if he or she persists it should be the duty of the +doctor forthwith to notify the case by name to the Director-General of +Health, whose duty it should be to inform the other party. It should +also be provided that _bonâ fide_ communications made in such a case, +either by the Director-General of Health or the doctor, to the other +party to the marriage, or to the parents or guardian of such party, +shall be privileged. + + +SECTION 8.--TREATMENT BY UNQUALIFIED PERSONS. + +The evidence given before the Committee shows that while reputable +chemists refer to a medical man patients coming to them for treatment +for venereal disease, and while these constitute the great majority of +the profession, there are still far too many cases of venereal disease +treated by chemists, herbalists, chiropractors, and other unqualified +persons. The treatment of venereal disease has become a specialized +branch of medicine, and many general practitioners prefer to refer such +cases to experts. The result of trusting to unqualified persons for the +treatment of such serious and difficult diseases is that the patient +usually drifts on uncured, and serious complications may occur. One +specialist in venereal disease informed the Committee that of 200 of his +cases whose cards showed particulars, 104 consulted chemists in the +first place and received more or less treatment from them. He was able +to give details of twenty-three cases showing the type of treatment +given. In several cases there were severe complications which could have +been avoided by proper treatment. There were also cases in which the +patient, after taking medicine for a time, had communicated the +infection to others. This witness further stated that some chemists +charged consultation fees in addition to charges for drugs applied, and +in certain cases charges for drugs were made which were little short of +blackmail. + +The Committee recommend that, in place of section 7 of the Social +Hygiene Act, a more comprehensive clause from the West Australian Act be +adopted. This is to the following effect: "No person [other than a +registered medical practitioner] should attend or prescribe for any +person for the purpose of curing, alleviating, or treating venereal +disease, whether such person is in fact suffering from such disease or +not." + +The Committee would suggest that if the Pharmaceutical Society were to +do all in its power to discourage its members from treating these +diseases it would have a good effect. + + +SECTION 9.--MENTALLY DEFECTIVE ADOLESCENTS. + +Mr. J. Caughley, Director of Education, stated in evidence: "From a +general inquiry made by the Department a few years ago it was +ascertained that there were at least six hundred or seven hundred mental +defectives in New Zealand under the age of twenty-one. I need scarcely +point out the moral danger to the community of so many of these +defectives being at large. In particular, the girls are a source of +danger to themselves and to the community, since they have little or no +will-power or sense of restraint. I am of opinion that all such cases +should be registered, and that, unless it can be shown that the mental +defective is under thoroughly safe and proper care at home, he should be +taken charge of by the State. I am certain that by this means the +increasing number of mental defectives would be reduced to a minimum, +since mental defectiveness is almost entirely hereditary." + +Mr. Beck, Officer in Charge of the Special Schools under the Education +Department, cited illustrative cases, one of which may be thus stated: +"Two feeble-minded parents in New Zealand have had up to the present +time ten degenerate children, all of whom are a lifelong burden on the +State. Taking the case of these children, and assessing the cost to the +State of maintaining them, the total amount for this family will not be +less than £16,000." + +The Committee are of opinion that supervision of mentally defective +children and adolescents is an important factor in lessening venereal +disease, and urge the Government as soon as possible to adopt a system +of registration and classification of mental defectives, and of +segregation where necessary, either in mental hospitals or in special +institutions where these defectives may be suitably taught, and, where +possible, usefully employed to defray the cost of their maintenance. + + + + +PART IV.--SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS. + + +SECTION 1.--CONCLUSIONS. + +Following are some of the conclusions drawn from the evidence by the +Committee:-- + +There is very general ignorance among the public on the subject of +venereal disease, and this has stood in the way of its being grappled +with effectively. + +Syphilis not only causes loss of life directly, but many deaths ascribed +to other causes in the Registrar-General's returns are due to the +after-effects of this disease. It is responsible for many still-births +and abortions, and its evil effects are seen in such children as +survive. These effects may persist until the third generation. + +Gonorrhoea, popularly, but quite erroneously, supposed to be a +comparatively mild complaint, is regarded by medical men as being as +serious a disease as syphilis. It is difficult to cure, especially in +women, unless properly treated at the outset. It is a great cause of +sterility in both sexes. + +Owing to the absence of accurate statistics it is impossible to make +comparisons between New Zealand and other countries as regards the +prevalence of venereal disease, or to say whether it is increasing or +decreasing in this country. + +There are in New Zealand no fewer than 3,031 persons being treated by +registered medical practitioners for venereal disease in some form, or +for the effects thereof--1 person in every 428 of our population. At the +clinics since their establishment 3,634 patients have been +treated--3,038 males, 596 females. + +An interesting calculation as to the prevalence of syphilis in New +Zealand has been made by Dr. Hay, Inspector-General of Mental Hospitals. +Working on what is known as Fournier's Index--the relation of the number +of cases of dementia paralytica existing at any one time to the number +of concurrent syphilitic infectious--he computes the number of persons +in New Zealand now who have or have had syphilis to be 33,000, or 1 to +every 38 of the population. + +The Committee desire to state, however, that in their opinion there can +be no accurate estimate of the prevalence of venereal disease until some +system of obtaining accurate statistics has been adopted. One point +which has come out clearly in their investigations is that venereal +disease is sufficiently prevalent to cause serious concern and to call +for energetic action. + +Evidence was given to the Committee to show that children with mental +and physical defects due to venereal diseases may become a charge on the +State; that a proportion of these on being released become parents of +defective children, who in their turn have to be supported at the public +expense. It was also shown that such defectives have little sexual +control, and are usually very prolific. + +According to the Commissioner of Police there are only 104 professional +prostitutes in New Zealand. + +There is, however, a great deal of "amateur" prostitution, and this is +chiefly responsible for the spread of venereal diseases. + +The evidence points to a good deal of laxity of conduct among young +people of all social conditions, especially in the large towns. This is +generally attributed by the witnesses to the weakening of home influence +and the restlessness of the age. + +Apart from the venereal disease among those who indulge in promiscuous +intercourse, there are many cases in which innocent wives are infected +by their husbands, and other cases (not so frequent) of innocent +husbands being infected by their wives. + +Children suffer innocently from venereal disease, not only by +inheritance from infected parents, but by accidently coming in contact +with the germs on towels, &c., which have been used by a patient. There +are also cases which come before the Courts where disease has been +conveyed directly in crimes of violence by sexual perverts. + +The free clinics in the chief centres are conducted by experts, and are +doing good work. Their influence for good is greatly impaired, however, +by the fact that a proportion of the male patients and the majority of +the female patients leave off treatment before they are cured. As the +law stands there is no power to compel them to continue treatment, and +in many cases they resume promiscuous intercourse and spread the +disease. + +Evidence has been given of other cases, some of them of a very shocking +character, in which persons suffering from venereal disease are not +seeking medical treatment and are communicating the disease to others. +As the law stands at present there is no power to restrain them from +such conduct or to compel them to receive medical treatment. + + +SECTION 2.--RECOMMENDATIONS. + +The Committee stress in the strongest terms the duty of moral +self-control. + +They urge the cultivation of a healthier state of public opinion. The +stigma at present attached to sufferers from venereal disease should be +transferred to those who indulge in promiscuous sexual intercourse. + +Parents have a great responsibility as regards the instruction and +training of their children so as to safeguard them against the dangers +resulting from ignorance of sexual laws. There is too little parental +control generally in New Zealand. The Committee recommend the training +of teachers, and provision for giving appropriate instruction in +schools. + +Classification and, where necessary, segregation of mentally defective +adolescents is recommended. + +The following medical measures for preventing and combating the disease +are recommended:-- + +The clinics should be made more available by being open continuously. +Every effort should be made to secure privacy. A specially trained nurse +should be in attendance at women's clinics, and women doctors should be +secured where possible. + +The Committee recommend that provision be made at the clinics for prompt +preventive treatment of those who have exposed themselves to infection. + +Lady patrols should be appointed in other centres to perform the kind of +work that is being carried on in Christchurch. + +The Committee, having regard to the good work especially of an +educational nature which is being done by the Social Hygiene Society, +Christchurch, consider voluntary effort of the same kind in other +centres would be very helpful. + +The Committee are entirely opposed to the Continental system of licensed +brothels, or a revival of the C.D. Acts in any shape or form. + +They recommend legislation be introduced providing for what is known as +conditional notification of venereal disease. It will be the duty of a +doctor to notify to the Health Department, by number or symbol only, +each case of venereal disease he treats. If a patient, however, refuses +to continue treatment until cured, and will not consult some other +doctor or attend a clinic, it will then be the duty of the doctor last +in attendance to notify the case to the Department by name. + +If the patient continues recalcitrant and refuses to allow himself to be +examined by the medical practitioner appointed by the Director-General +of Health, then the latter should be empowered to apply to a Magistrate +for the arrest of such person and his detention in a public hospital or +other place of treatment until he is non-infective. + +The Committee also recommend further provision to deal with cases in +which persons suffering from venereal disease are not under medical +treatment and are likely to infect others. If the Director-General of +Health has reason to believe that any person is so suffering he may call +on that person to produce a medical certificate, which may be procured +free of charge from any hospital or venereal-disease clinic. If the +person refuses to produce such a certificate he or she may be taken +before a Magistrate, who may order a medical examination. Penalties, +including detention in a prison hospital, should be provided for +recalcitrant cases. The proceedings in all these cases are to be heard +in private unless defendant desires a public hearing. + +The Committee recommend that before a license to marry is issued the +intending parties must sign a paper answering certain questions as to +freedom from communicable disease and from mental disease, and must make +a sworn statement that the answers to such questions are true. + +They recommend the adoption of a provision in the Queensland Act making +venereal disease a ground for annulling a marriage contracted whilst one +party is suffering from such a disease in an infectious stage, provided +the other party was not informed of the fact prior to marriage. Also +that it should be the duty of a medical practitioner attending a case of +venereal disease, if he has reason to believe that the patient intends +to marry, to warn him or her against doing so, and if he or she persists +it should be the duty of the doctor to notify the case by name to the +Director-General of Health, whose duty it should be to inform the other +party, or the parents or guardian of such other party. Such +communications made in good faith either by the doctor or the +Director-General of Health should be absolutely privileged. + +The Committee recommend that the law prohibiting treatment of patients +for venereal disease by unqualified persons shall be strengthened, and +suggest that the Pharmaceutical Society might assist in preventing such +practices. + + +SECTION 3.--CONCLUDING REMARKS. + +The Committee in carrying out their task have been brought into contact +with some uninviting aspects of our social life. Some of the facts +disclosed are of a character to give serious concern to those lovers of +their country who rightly regard it as exceptionally favoured by nature, +and desire to see its people healthy and vigorous, clean in body and +mind, worthy of their heritage. The late war showed that the pick of our +population, physically as well as mentally, were of the finest possible +type, the admiration of all who saw them; but the medical examination of +the recruits disclosed that of 135,282 examined after the introduction +of the Military Service Act--mostly young men in the prime of life--only +57,382, or say, 42½ per cent., could be accepted as fit for training, +unmistakably proving that the nation as a whole was much below the +standard of physical fitness which it ought to exhibit. + +The investigations of the Committee show that already there is far too +large a proportion of mental and physical defectives reproducing their +kind. In the absence of accurate statistics it is impossible to say what +proportion of these defectives are the direct product of venereal +disease, but there is clear evidence that a tendency to lead dissolute +lives is especially noticeable in the females belonging to this +unfortunate class. "A feeble-minded girl," says Mr. Beck, "has not sense +enough to protect herself from the perils to which women are subjected. +Often amiable in disposition and physically attractive, they either +marry and bring forth a new generation of defectives, or they become +irresponsible sources of corruption and debauchery in the communities +where they live." Obviously some method of dealing with mental +defectives--by segregation or otherwise--must be found as part of the +problem of dealing with venereal disease. + +As regards the effect of venereal disease on the general health of the +community, we have the statement of the late Sir William Osler that he +regards syphilis as "third on the list of killing diseases"; while +Neisser, a leading authority, says that "with the exception of measles, +gonorrhoea is the most widely spread of all diseases. It is the most +potent factor in the production of involuntary race suicide, and by +sterilization and abortion does more to depopulate the country than does +any other cause." + +In view of the facts brought out in the course of the inquiry, the +Committee are strongly of opinion that it would be criminal neglect to +allow the evil to go on without taking energetic steps to check its +ravages. They believe that the legislative and other measures which they +recommend for the medical prevention and treatment of venereal disease +will, if given effect to with the loyal co-operation of the medical +profession, have a very beneficial result in reducing the prevalence of +disease, and will save an incalculable amount of sorrow and suffering +which in too many cases falls upon the innocent. In what is proposed in +this report there is nothing approaching a revival of the old Contagious +Diseases Acts. To use the words of Dr. Emily Seideberg, the principle of +the legislation now proposed is "To improve the health of the community, +and not, as in the old Contagious Diseases Acts, to make sexual +immorality safe for men of low morals." + +The Committee are of opinion that, far from conditional notification and +compulsory treatment on the lines proposed being prejudicial to woman in +any way, it is they who will reap the greatest benefit from these +measures. In fact, sufferers from venereal disease, as a whole, have +everything to gain and nothing to lose so long as they will continue +under treatment, and to enable them to do this the best medical skill is +placed at their disposal free of cost. The only persons in the community +who will be penalized by the proposed legislation are those who, having +contracted venereal disease, are so reckless and unprincipled that they +will take no pains to avoid communicating it to others. + +The Committee, it will be seen, regard the legislative and medical +measures which they propose as of great importance, but with all the +earnestness at their command they desire in conclusion to emphasize the +moral and social aspects of the question. With the changing social +conditions, especially in the larger towns, we are losing the home +influence and home training which are the best safeguards to preserve +the young against the temptations and dangers which beset their path in +life. The Committee would impress upon parents the paramount duty they +owe to their children in this matter. There is also a duty cast upon all +leaders of public opinion, and upon the community at large, to do what +is possible to bring about better living-conditions, especially for +girls in the towns, to encourage all forms of healthy sport and +amusement, and to cultivate a higher moral standard. Whatever sanitary +laws may be passed, and whatever success may be attained in dealing with +bodily disease, there can be no true health if the soul of the nation +remains corrupt. If this inquiry should serve to remove some of the +popular ignorance regarding venereal disease, and to quicken the public +conscience so that appropriate steps may be taken to deal with this +dreadful scourge, the Committee feel that their labours will not have +been in vain. + +W.H. TRIGGS, Chairman. +J.S. ELLIOTT, \ +M. FRASER, \ Members +J.P. FRENGLEY, > of +JACOBINA LUKE, / Committee. +D. McGAVIN, / + + + + +APPENDIX. + + +GRAPH A. + +AVERAGE AGES OF BRIDEGROOM AND BRIDE AT MARRIAGE, 1900-1921. + +[Illustration] + + +TABLE A. + +ILLEGITIMATE BIRTHS, AND BIRTHS WITHIN ONE YEAR AFTER MARRIAGE, IN NEW +ZEALAND, 1913-21. + +NOTE.--The figures refer to accouchements, not to children born, +multiple cases being counted once only (Only live births are included.) + +------+------------+-------------------------------------------------+ + |Illegitimate| Duration of Marriage (in Complete Months) | +Year |Births +---+---+-----+-----+-----+-----+-----+-----+-----+ + | | | | | | | | | | | + | | 0.| 1.| 2. | 3. | 4. | 5. | 6. | 7. | 8. | +------+------------+---+---+-----+-----+-----+-----+-----+-----+-----+ +1913 | 1,173| 96|122| 145| 241| 255| 350| 398| 306| 327| +1914 | 1,291| 83|122| 146| 216| 247| 354| 398| 294| 335| +1915 | 1,137| 56| 96| 158| 231| 219| 288| 353| 286| 336| +1916 | 1,139| 63| 95| 135| 170| 212| 269| 326| 266| 343| +1917 | 1,141| 68| 66| 119| 137| 184| 216| 291| 264| 250| +1918 | 1,169| 42| 64| 99| 141| 148| 215| 259| 213| 212| +1919 | 1,132| 52| 98| 101| 125| 161| 202| 258| 222| 238| +1920 | 1,414| 69|125| 167| 220| 295| 347| 445| 377| 407| +1921 | 1,245| 82|140| 177| 228| 253| 341| 456| 370| 382| + +------------+---+---+-----+-----+-----+-----+-----+-----+-----+ +Totals| 10,841|611|928|1,247|1,709|1,974|2,582|3,184|2,598|2,830| +------+------------+---+---+-----+-----+-----+-----+-----+-----+-----+ + +------+--------------------+----------------+----------+ + | |Total Legitimate| | +Year +------+------+------| First Births | Total | + | | | |within One Year |Registered| + | 9. | 10. | 11. | after Marriage | Births | +------+------+------+------+----------------+----------+ +1913 | 831| 669| 462| 4,202| 27,935| +1914 | 720| 642| 487| 4,044| 28,338| +1915 | 769| 621| 457| 3,870| 27,850| +1916 | 793| 694| 512| 3,878| 28,509| +1917 | 575| 505| 449| 3,124| 28,239| +1918 | 443| 298| 279| 2,413| 25,860| +1919 | 469| 397| 314| 2,637| 24,483| +1920 | 859| 802| 575| 4,688| 29,921| +1921 | 979| 804| 670| 4,882| 28,567| + +------+------+------+----------------+----------+ +Totals| 6,438| 5,432| 4,205| 33,738| 249,702| +------+------+------+------+----------------+----------+ + +MALCOLM FRASER, +Government Statistician. + + +TABLE B. + +TABLE SHOWING NUMBER OF CASES TREATED AND ATTENDANCES AT THE +VENEREAL-DISEASE CLINICS DURING THE YEARS 1920-21 AND UP TO JUNE, 1922. + +---------------------------+-----------------------------+ + | Auckland | + |---------+---------+---------| + | 1920 | 1921 | 1922 | +---------------------------+-----+---+-----+---+-----+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 174| 30| 100| 44| 81| 29| + Chancroid | 10| ..| 25| ..| 10| ..| + Gonorrhoea | 81| 8| 345| 24| 189| 20| + No V.D. | 59| 10| 73| 25| 21| 8| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis |1,875|462|1,759|474| 830|313| + Chancroid | 100| ..| 72| ..| 37| ..| + Gonorrhoea |4,702| 95|9,232|141|3,384|172| + No V.D. | 134| 26| 227| 35| 53| 17| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | ..| ..| ..| ..| ..| ..| + Gonorrhoea | ..| ..| ..| ..| ..| ..| +---------------------------+-----+---+-----+---+-----+---+ + + +---------------------------+--------------------------------+ + | Wellington | + |----------+----------+----------| + | 1920 | 1921 | 1922 | +---------------------------+------+---+------+---+------+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 93| 34| 80| 10| 41| 8| + Chancroid | 1| ..| 8| ..| 7| ..| + Gonorrhoea | 190| 18| 298| 11| 141| 9| + No V.D. | 40| 10| 52| 25| 33| 17| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 1,388|448| 2,089|616| 1,156|269| + Chancroid | 6| ..| 16| ..| 29| ..| + Gonorrhoea |13,436|180|19,369|520|10,853|423| + No V.D. | 40| 10| 89| 35| 68| 35| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 1,624| ..| 1,711| ..| 790| ..| + Gonorrhoea | 3,024| 77| 4,098| ..| 1,998| ..| +---------------------------+------+---+------+---+------+---+ + + +---------------------------+------------------------------+ + | Christchurch | + |---------+---------+----------| + | 1920 | 1921 | 1922 | +---------------------------+-----+---+-----+---+-----+----+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 60| 25| 46| 21| 25| 13| + Chancroid | 8| ..| 6| ..| 5| ..| + Gonorrhoea | 120| 32| 139| 35| 70| 21| + No V.D. | 20| 10| 62| 31| 31| 16| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 786|450| 903|473| 632| 248| + Chancroid | 110| ..| 45| ..| 37| ..| + Gonorrhoea |2,132|245|3,968|902|2,239| 339| + No V.D. | 186| 98| 215|187| 96| 52| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 232| 80| 619| 44| 310| 9| + Gonorrhoea | 460|216| 725|161| 221| 157| +---------------------------+-----+---+-----+---+-----+----+ + + +---------------------------+-----------------------+ + | Dunedin | + |-------+-------+-------| + | 1920 | 1921 | 1922 | +---------------------------+---+---+---+---+---+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M.| F.| M.| F.| M.| F.| + Syphilis | 54| 13| 55| 11| 12| 9| + Chancroid | ..| ..| ..| ..| ..| ..| + Gonorrhoea | 37| | 55| 9| 46| 6| + No V.D. | 6| 2| 28| 2| 1| ..| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis |816|143|505| 84|432|115| + Chancroid | ..| ..| ..| ..| ..| ..| + Gonorrhoea |465| ..|814| 67|638| 63| + No V.D. | 6| 2| 21| 1| 1| | +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 74| 55|169|106| 20| ..| + Gonorrhoea | 66| ..|335|166| 28| 59| +---------------------------+---+---+---+---+---+---+ + +---------------------------+--------------------------------------+ + | Total for Years | + |------------+------------+------------| + | 1920 | 1921 | 1922 | +---------------------------+------+-----+------+-----+------+-----+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F. | M. | F. | M. | F. | + Syphilis | 381| 102| 281| 86| 159| 59| + Chancroid | 19| ..| 39| ..| 22| ..| + Gonorrhoea | 428| 58| 837| 79| 446| 56| + No V.D. | 125| 32| 215| 83| 86| 41| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 4,865|1,503| 5,256|1,647| 3,050| 948| + Chancroid | 216| ..| 133| ..| 103| ..| + Gonorrhoea |20,105| 520|33,583|1,630|17,114|1,017| + No V.D. | 366| 136| 562| 258| 218| 108| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 1,930| 35| 2,499| 150| 1,120| 9| + Gonorrhoea | 3,550| 293| 5,168| 327| 2,157| 216| +---------------------------+------+-----+------+-----+------+-----+ + +---------------------------+-------------+-------+ + | Totals |Grand | + | according |Totals | + | to Sex | | +---------------------------+-------+-----+-------+ +Number of persons dealt | | | | + with at or in connection | | | | + with the out-patients' | | | | + clinic for the first time| | | | + and found to be | | | | + suffering from-- | M. | F. | | + Syphilis | 821| 247| 1,068| + Chancroid | 80| | 80| + Gonorrhoea | 1,711| 193| 1,904| + No V.D. | 426| 156| 582| +Total attendance of all |-------+-----+-------+ + persons at the | 3,038| 596| 3,634| + out-patients' clinic who |-------+-----+-------+ + were suffering from-- | | | | + Syphilis | 13,171|4,098| 17,269| + Chancroid | 452| ..| 452| + Gonorrhoea | 70,802|3,167| 73,969| + No V.D. | 1,146| 502| 1,648| +Aggregate number of | | | | + in-patients' days of | | | | + treatment given to | | | | + persons suffering from-- | | | | + Syphilis | 5,549| 194| 5,743| + Gonorrhoea | 10,875| 836| 11,711| +---------------------------+-------+-----+-------+ + + +TABLE C. + +REPLY FORM.--VENEREAL DISEASES. + +(_Confidential_.) + +I, the undersigned registered medical practitioner, desire to advise the +Committee on Venereal Diseases of the Board of Health that I had under +my personal care on Saturday, 16th September, 1922,[A] cases of venereal +disease, and of affections attributable to venereal disease, as under:-- + + NUMBER OF CASES. + Male. Female. Total. +1. Cases of recent infection:-- + (_a._) Gonorrhoea (including gonorrhoeal ophthalmia) + (_b._) Soft chancre + (_c._) Syphilis, primary and/or secondary +2. Cases of distant infection:-- + (_a._) Chronic gonorrhoeal affections or disabilities + directly attributable to gonorrhoea infection--_e.g._, + stricture, gleet, arthritis, abscesses, salpingitis, &c. + (_b._) Congenital syphilis + (_c._) Tertiary syphilitic manifestations or disabilities + directly attributable to syphilis infection:-- + (i.) Affecting nervous system--_e.g._, gumma, + locomotor, G.P.I., &c. + (ii.) Affecting ear, eye, &c. (special + senses)--_e.g._, optic atrophy, &c. + (iii.) Affecting respiratory system--_e.g._, + syphilitic laryngitis, &c. + (iv.) Affecting digestive system--_e.g._, + syphilitic stricture of rectum, &c. + (v.) Affecting circulatory system--_e.g._, + syphilitic angina, aneurism, &c. + (vi.) Affecting spleen + (vii.) Affecting skin, bones, joints, muscles + (viii.) Affecting genito-urinary system, including + abortions, &c. + +NOTE.--No case should be recorded under more than one of these headings. + +Total number of cases under my personal care + +My opinion is that venereal disease in this Dominion has [not] increased +in a greater proportion than the population during the last five years. + + [_Signature of medical practitioner._] +Date of posting: Town where practising or name or } + names of institutions concerned: } + + [A] "Under my personal care on Saturday, 16th September, 1922," + is to be interpreted to include all patients suffering from the + conditions enumerated whom you are attending or have attended, + and who you believe in the event of requiring further + attendance would call you in or consult you, in other words, + _bonâ fide_ patients of your own. It is not intended that you + are to enumerate only the patients actually seen by you on that + date. + + Medical superintendents or medical officers in charge of + institutions will regard all patients in or attending their + institutions as "under my personal care on Saturday, 16th + September, 1922," irrespective of whom the actual medical + attendant may be. + + Please post this Reply Form as soon as possible after 16th + September, 1922, and not later than 20th September, 1922. + + Additional copies of this form are obtainable from the Medical + Officers of Health, or the Secretary of the Board of Health, + P.O. Box 1146, Wellington. + + +TABLE D. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.--NUMBERS IN +HEALTH DISTRICTS. + +---------------+--------------------------------------+ + | Cases of Recent Infection. | +Health |---------+------------+--------+------| +District |Gonorrhoea|Soft Chancre|Syphilis|Total | +---------------+---------+------------+--------+------+ +North Auckland | 10| ..| 1| 14| +Auckland | 279| 3| 165| 447| +Hawke's Bay | 35| 3| 17| 55| +Wanganui | 59| 2| 37| 98| +Wellington | 187| 4| 114| 305| +Canterbury | 99| 2| 75| 176| +Otago | 79| ..| 104| 183| +---------------+---------+------------+--------+------+ +Dominion totals| 748| 14| 516| 1,278| +---------------+---------+------------+--------+------+ + +---------------+------------------------------------+------+ + | Cases of Distant Infection |Grand | +Health |---------+----------+--------+------+Total | +District |Chronic |Congenital|Tertiary|Total | | + |Gonorrhoea|Syphilis |Syphilis| | | +---------------+---------+----------+--------+------+------+ +North Auckland | 10| 1| 5| 16| 30| +Auckland | 229| 51| 239| 519| 966| +Hawke's Bay | 32| 10| 30| 72| 127| +Wanganui | 97| 10| 42| 149| 247| +Wellington | 279| 56| 220| 555| 860| +Canterbury | 83| 17| 111| 211| 387| +Otago | 120| 23| 88| 231| 414| +---------------+---------+----------+--------+------+------+ +Dominion totals| 850| 168| 735| 1,753| 3,031| +---------------+---------+----------+--------+------+------+ + +---------------+-------------------------+ + | Expression of Opinion | +Health |--------+--------+-------| +District |Increase|Decrease|Not | + | | |stated | +---------------+--------+--------+-------+ +North Auckland | 7| 2| 11| +Auckland | 34| 53| 82| +Hawke's Bay | 6| 19| 24| +Wanganui | 13| 16| 24| +Wellington | 29| 36| 68| +Canterbury | 16| 47| 53| +Otago | 14| 30| 51| +---------------+--------+--------+-------| +Dominion totals| 119| 203| 313| +---------------+--------+--------+-------+ + +Total replies received, 635. + + +TABLE E. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. TOTALS (ALL +FORMS) OF GONORRHOEA, SOFT CHANCRE, AND SYPHILIS, AND PERCENTAGE OF +GRAND TOTAL. + +----------------+-------------------------------------+---------+ + | Totals (all Forms) of each Disease | Grand | +Health District |-----------+--------------+----------+ Total | + | Gonorrhoea | Soft Chancre | Syphilis | | +----------------+-----------+--------------+----------+---------+ +North Auckland | 20| ..| 10| 30| +Auckland | 508| 3| 455| 966| +Hawke's Bay | 67| 3| 57| 127| +Wanganui | 156| 2| 89| 247| +Wellington | 466| 4| 390| 860| +Canterbury | 182| 2| 203| 387| +Otago | 199| ..| 215| 414| + |-----------+--------------+----------+---------+ +Dominion totals | 1,598| 14| 1,419| 3,031| +----------------+-----------+--------------+----------+---------+ + +-----------------+--------------------------------------+ + |Percentages (all forms) to Grand Total| +Health District +-----------+--------------+-----------+ + | Gonorrhoea | Soft Chancre | Syphilis | +-----------------+-----------+--------------+-----------+ +North Auckland | 66.67| ..| 33.33| +Auckland | 52.59| 0.31| 47.10| +Hawke's Bay | 52.76| 2.36| 44.88| +Wanganui | 63.16| 0.81| 36.03| +Wellington | 54.19| 0.46| 15.35| +Canterbury | 47.03| 0.52| 52.45| +Otago | 48.07| ..| 51.93| + +-----------+--------------+-----------+ +Dominion totals | 52.72| 0.46| 46.82| +-----------------+-----------+--------------+-----------+ + + +TABLE F. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.--INCIDENCE +IN CHIEF CENTRES SHOWING RATE PER 1,000 ESTIMATED POPULATION. + +-----------------+----------+--------------------------------+ + | | Cases of Recent Infection | + | +----------+----------+----------+ + | |Gonorrhoea | Syphilis | Total | + | | | | | + |Estimated +----+-----+----+-----+----+-----+ +Urban Area |Population| C |Rate | C |Rate | C |Rate | + |1st | a |per | a |per | a |per | + |April, | s |1,000| s |1,000| s |1,000| + |1922 | e | | e | | e | | + | | s | | s | | s | | +-----------------+----------+----+-----+----+-----+----+-----+ +Auckland | 164,450 | 214| 1.30| 146| 0.89| 360| 2.19| +Wellington | 110,680 | 159| 1.44| 99| 0.89| 258| 2.33| +Christchurch | 110,200 | 79| 0.72| 59| 0.53| 138| 1.25| +Dunedin | 73,470 | 54| 0.74| 102| 1.39| 156| 2.12| +Hamilton | 14,950 | 15| 1.01| 3| 0.20| 18| 1.20| +Cisborne | 14,920 | 7| 0.47| ..| ..| 7| 0.47| +Napier | 17,670 | 17| 0.96| 13| 0.74| 30| 1.70| +Hastings | 13,530 | ..| ..| 2| 0.15| 2| 0.15| +New Plymouth | 13,510 | 3| 0.22| ..| ..| 3| 0.22| +Wanganui | 24,170 | 14| 0.58| 12| 0.50| 26| 1.08| +Palmerston North | 17,510 | 5| 0.29| 13| 0.80| 18| 1.03| +Nelson | 10,880 | 1| 0.09| ..| ..| 1| 0.09| +Timaru | 16,040 | 6| 0.37| 1| 0.06| 7| 0.44| +Invercargill | 19,590 | 1| 0.05| ..| ..| 1| 0.05| +-----------------+----------+----+-----+----+-----+----+-----+ + +--------------+--------------------------------------------+----------+ + | Cases of Distant Infection | Grand | + |----------+-----------+----------+----------+ Total + + |Chronic |Congenital | Tertiary | Total | | + |Gonorrhoea |Syphilis | Syphilis | | | + |----------+----+------+----+-----+----+-----+----+-----+ +Urban Area. | C |Rate | C |Rate | C |Rate | C |Rate | C |Rate | + | a |per | a |per | a |per | a |per | a |per | + | s |1,000| s |1,000 | s |1,000| s |1,000| s |1,000| + | e | | e | | e | | e | | e | | + | s | | s | | s | | s | | s | | +--------------+----+-----+----+------+----+-----+----+-----+----+-----+ +Auckland | 147| 0.89| 42| 0.26| 194| 1.18| 383| 2.33| 743| 4.52| +Wellington | 240| 2.17| 42| 0.38| 183| 1.65| 465| 4.20| 723| 6.53| +Christchurch | 63| 0.57| 15| 0.14| 87| 0.79| 165| 1.50| 303| 2.75| +Dunedin | 96| 1.31| 18| 0.25| 59| 0.80| 173| 2.35| 329| 4.48| +Hamilton | 22| 1.47| ..| ..| 10| 0.67| 32| 2.14| 50| 3.34| +Cisborne | 9| 0.60| 2| 0.13| 9| 0.60| 20| 1.34| 27| 1.81| +Napier | 8| 0.45| 3| 0.17| 9| 0.51| 20| 1.13| 50| 2.83| +Hastings | 1| 0.07| 2| 0.15| 2| 0.15| 5| 0.37| 7| 0.52| +New Plymouth | 3| 0.22| ..| ..| ..| ..| 3| 0.22| 6| 0.52| +Wanganui | 29| 1.20| 6| 0.25| 21| 0.87| 56| 2.32| 82| 3.39| +Palmerston N. | 12| 0.69| 5| 0.29| 3| 0.17| 20| 1.14| 38| 2.17| +Nelson | ..| ..| 4| 0.37| 10| 0.92| 14| 1.29| 15| 1.38| +Timaru | 5| 0.31| ..| ..| 8| 0.50| 13| 0.81| 20| 1.25| +Invercargill | 7| 0.36| ..| ..| 10| 0.51| 17| 0.87| 18| 0.92| +--------------+----+-----+----+------+----+-----+----+-----+----+-----+ + + +TABLE G. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. +--PROPORTION OF CASES PER 1,000 OF POPULATION IN EACH HEALTH DISTRICT. + +-----------+----------+-------------------------+-------------------------+ + | | Total Cases Proportion Cases per 1,000| + Health |Estimated | (all Diseases) | Estimated Population | + District |Population+---------+---------+-----+---------+---------+-----+ + |1st April,|Recent |Distant |Grand|Recent |Distant |Grand| + |1922 |Infection|Infection|Total|Infection|Infection|Total| +-----------+----------+---------+---------+-----+---------+---------+-----+ +N. Auckland| 36,930| 14| 16| 30| 0.38| 0.43| 0.81| +Auckland | 323,436| 447| 519| 966| 1.38| 1.60| 2.99| +Hawke's Bay| 80,242| 55| 72| 127| 0.62| 0.81| 1.42| +Wanganui | 110,866| 98| 149| 247| 0.88| 1.34| 2.23| +Wellington | 242,830| 305| 555| 860| 1.26| 2.28| 3.54| +Canterbury | 240,387| 176| 211| 387| 0.73| 0.88| 1.61| +Otago | 200,574| 183| 231| 414| 0.91| 1.15| 2.06| +-----------+----------+---------+---------+-----+---------+---------+-----+ +Dominion | | | | | | | | +Totals | 1,244,265| 1,278| 1,753|3,031| 1.03| 1.41| 2.44| +-----------+----------+---------+---------+-----+---------+---------+-----+ + + +TABLE H. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. +--SEX NUMBERS AND PROPORTIONS IN HEALTH DISTRICTS. + +Key: %% = F. to 100 M. + +------------+--------------------------------------------+ + | Cases of Recent | + | Infection | + Health +--------------+--------------+--------------+ + District | Gonorrhoea | Syphilis | Totals | + +----+----+----+----+----+----+----+----+----+ + | M | F | %% | M | F | %% | M | F | %% | +------------+----+----+----+----+----+----+----+----+----+ +N. Auckland | 10| ..| ..| 3| 1| 33| 13| 1| 8| +Auckland | 224| 55| 25| 112| 53| 47| 336| 108| 32| +Hawke's Bay | 28| 7| 25| 12| 5| 42| 40| 12| 30| +Wanganui | 40| 19| 48| 25| 12| 48| 65| 31| 48| +Wellington | 143| 44| 31| 95| 19| 20| 238| 63| 26| +Canterbury | 63| 36| 57| 48| 27| 56| 111| 63| 57| +Otago | 62| 17| 27| 89| 15| 17| 151| 32| 21| +------------+----+----+----+----+----+----+----+----+----+ +Dominion | | | | | | | | | | +Totals | 570| 178| 31| 384| 132| 34 | 954| 310| 32| +------------+----+----+----+----+----+----+----+----+----+ + +------------+-----------------------------------------------------------+ + | Cases of Distant | + | Infection | + Health +--------------+-------------+-------------+----------------+ + District | Chronic | Congenital | Tertiary | | + | Gonorrhoea | Syphilis | Syphilis | Totals | + +-----+---+----+----+---+----+----+---+----+-----+-----+----+ + | M | F | %% | M | F | %% | M | F | %% | M | F | %% | +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ +N. Auckland | 8| 2| 25| ..| 1| ..| 4| 1| 25| 12| 4| 33| +Auckland | 156| 73| 47| 33| 18| 55| 168| 71| 42| 357| 162| 45| +Hawke's Bay | 27| 5| 19| 7| 3| 43| 22| 8| 36| 56| 16| 29| +Wanganui | 74| 23| 31| 5| 5| 100| 29| 13| 45| 108| 41| 38| +Wellington | 225| 54| 24| 31| 25| 81| 156| 64| 41| 412| 143| 35| +Canterbury | 65| 18| 29| 7| 10| 143| 81| 30| 37| 153| 58| 38| +Otago | 101| 19| 19| 15| 8| 53| 58| 30| 52| 174| 57| 33| +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ +Dominion | | | | | | | | | | | | | +Totals | 656 |194| 30| 98| 70| 71| 518|217| 42|1,272| 481| 38| +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ + +--------------+------------------+ + Health | Grand Totals | + District +-----+-----+------+ + | M | F | %% | +--------------+-----+-----+------+ +North Auckland| 25| 5| 20| +Auckland | 693| 270| 39| +Hawke's Bay | 96| 28| 29| +Wanganui | 173| 72| 42| +Wellington | 650| 206| 32| +Canterbury | 264| 121| 46| +Otago | 325| 89| 27| +--------------+-----+-----+------+ +Dominion | | | | +Totals |2,226| 791| 36| +--------------+-----+-----+------+ + + * * * * * + +_Approximate Cost of Paper._--Preparation, not given; + printing (1,225 copies), £45. + + * * * * * + +By Authority: W.A.G. SKINNER, Government Printer, Wellington.--1922. + +_Price 9d._ + + + + + + +End of the Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +*** END OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES *** + +***** This file should be named 15352-8.txt or 15352-8.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/5/3/5/15352/ + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +https://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at https://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +https://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at https://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit https://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including including checks, online payments and credit card +donations. To donate, please visit: https://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart was the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. diff --git a/15352-8.zip b/15352-8.zip Binary files differnew file mode 100644 index 0000000..6e64e6a --- /dev/null +++ b/15352-8.zip diff --git a/15352-h.zip b/15352-h.zip Binary files differnew file mode 100644 index 0000000..6a2be3a --- /dev/null +++ b/15352-h.zip diff --git a/15352-h/15352-h.htm b/15352-h/15352-h.htm new file mode 100644 index 0000000..7433924 --- /dev/null +++ b/15352-h/15352-h.htm @@ -0,0 +1,4611 @@ +<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" + "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> + +<html xmlns="http://www.w3.org/1999/xhtml"> + <head> + <meta http-equiv="Content-Type" content="text/html;charset=iso-8859-1" /> + <title> + The Project Gutenberg eBook of Venereal Diseases In New Zealand, by The Committee Of The Board Of Health. + </title> + <style type="text/css"> +/*<![CDATA[ XML blockout */ +<!-- + p { margin-top: .75em; + text-align: justify; + margin-bottom: .75em; + } + h1,h2,h3,h4,h5,h6 { + text-align: center; /* all headings centered */ + clear: both; + } + hr { width: 33%; + margin-top: 2em; + margin-bottom: 2em; + margin-left: auto; + margin-right: auto; + clear: both; + } + + table {margin-left: auto; margin-right: auto;} + + body{margin-left: 10%; + margin-right: 10%; + } + + .linenum {position: absolute; top: auto; left: 4%;} /* poetry number */ + .blockquot{margin-left: 5%; margin-right: 10%;} + .pagenum {position: absolute; left: 92%; font-size: smaller; text-align: right;} /* page numbers */ + .sidenote {width: 20%; padding-bottom: .5em; padding-top: .5em; + padding-left: .5em; padding-right: .5em; margin-left: 1em; + float: right; clear: right; margin-top: 1em; + font-size: smaller; background: #eeeeee; border: dashed 1px;} + + .bb {border-bottom: solid 2px;} + .bl {border-left: solid 2px;} + .bt {border-top: solid 2px;} + .br {border-right: solid 2px;} + .bbox {border: solid 2px;} + + .center {text-align: center;} + .smcap {font-variant: small-caps;} + .u {text-decoration: underline;} + + .caption {font-weight: bold;} + + .figcenter {margin: auto; text-align: center;} + + .figleft {float: left; clear: left; margin-left: 0; margin-bottom: 1em; margin-top: + 1em; margin-right: 1em; padding: 0; text-align: center;} + + .figright {float: right; clear: right; margin-left: 1em; margin-bottom: 1em; + margin-top: 1em; margin-right: 0; padding: 0; text-align: center;} + + .footnotes {border: dashed 1px;} + .footnote {margin-left: 10%; margin-right: 10%; font-size: 0.9em;} + .footnote .label {position: absolute; right: 84%; text-align: right;} + .fnanchor {vertical-align: super; font-size: .8em; text-decoration: none;} + + .poem {margin-left:10%; margin-right:10%; text-align: left;} + .poem br {display: none;} + .poem .stanza {margin: 1em 0em 1em 0em;} + .poem span {display: block; margin: 0; padding-left: 3em; text-indent: -3em;} + .poem span.i2 {display: block; margin-left: 2em;} + .poem span.i4 {display: block; margin-left: 4em;} + // --> + /* XML end ]]>*/ + </style> + </head> +<body> + + +<pre> + +The Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Venereal Diseases in New Zealand (1922) + Report of the Special Committee of the Board of Health appointed by + the Hon. Minister of Health + + +Author: Committee Of The Board Of Health + +Release Date: March 13, 2005 [EBook #15352] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES *** + + + + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + + + + + +</pre> + +<h3><a name="Page_1" id="Page_1"></a>1922.</h3> + +<h3>NEW ZEALAND.</h3> + + +<h1>VENEREAL DISEASES IN NEW ZEALAND.</h1> + + +<h2>REPORT OF THE COMMITTEE OF THE BOARD OF HEALTH APPOINTED BY THE HON. +MINISTER OF HEALTH.</h2> + + +<h4><i>Presented to both Houses of the General Assembly by Leave.</i></h4> + + +<p><br /><b>CONSTITUTION OF THE COMMITTEE.</b></p> + +<p> +Hon. W.H. <span class="smcap">Triggs</span>, M.L.C., Chairman.<br /> +J.S. <span class="smcap">Elliott</span>, M.D., Member of the Medical Board.<br /> +Mr. <span class="smcap">Murdoch Fraser</span> (New Plymouth), representing the Hospital Boards of the Dominion.<br /> +J.P. <span class="smcap">Frengley</span>, M.D., D.P.H., Deputy Director-General of Health.<br /> +Lady <span class="smcap">Luke</span>, C.B.E.<br /> +Sir <span class="smcap">Donald McGavin</span>, K.C.M.G., C.M.G., D.S.O., Director-General of Medical Services.<br /> +<br /></p> + +<hr /> + +<p><br /><b>CONTENTS.</b></p> + +<p> +<a href="#PART_I_INTRODUCTORY_AND_HISTORICAL"><span class="smcap">Part I.—Introductory and Historical.</span></a><br /> +<br /> +<a href="#Link01">Section 1</a>.—Origin and Scope of Inquiry: Witnesses; Sittings, Date and +Place of; Appreciation of Services rendered<br /> +<br /> +<a href="#Link02">Section 2</a>.—Venereal Diseases and their Effects: Ignorance, Effect of; +Sex Education for Young; Syphilis and Gonorrhœa, Origin and +Description; Treatment after Exposure; Diagnosis, Methods of; Treatment, +Importance of Early and Completed<br /> +<br /> +<a href="#Link03">Section 3</a>.—Accidental Infection: Sources of Infection; Metchnikoff's +Investigation; Food-conveyance; Lavatories, Towels, Drinking-cups, &c.<br /> +<br /> +<a href="#Link04">Section 4</a>.—Previous Inquiries and Conferences: Contagious Diseases Act, +England; Royal Commission, 1913, Evidence, View of Compulsory +Notification, Divorce and Venereal Disease, Sex Education, Instruction, +and Propaganda; Australasian Medical Congresses. Committee appointed; +Auckland Congress, 1914, Report presented, Nature of Notification +recommended; Melbourne Conference, 1922, Review of Legislation, Comments +and Recommendations; England, Committee recently appointed to report on +Venereal Diseases<br /> +<br /> +<a href="#Link05">Section 5</a>.—Legislation in New Zealand, Past and Present: Contagious +Diseases Act, 1869 (A), Reference to; Cases Cited (B) which require New +Legislation to deal with; Hospital and Charitable Institutions Act, 1913 +(C); Detention Provisions; The Prisoners Detention Act, 1915 (D); +Provisions for dealing with Venereal Diseases in Convicted Persons; +Social Hygiene Act, 1917 (E); Provisions of the Act outlined; Subsidy +for Maintenance in Hospitals<br /> +<br /> +<a href="#PART_II_PREVALENCE_OF_VENEREAL_DISEASES_IN_NEW_ZEALAND"><span class="smcap">Part II.—Prevalence of Venereal Disease in New Zealand.</span></a><br /> +<br /> +<a href="#Link06">Section 1</a>.—Medical Statistics (A): Medical Practitioners, Special +Returns from, Cases reported, Gonorrhœa and Syphilis: Chancroid; +Prevalence. Clinic Statistics (B): Department of Health Data; Clinic +Distribution; Age Distribution; Marital Condition. Mental Hospital +Statistics (C): Syphilis and Dementia Paralytica; Computations as to +Prevalence of Syphilis based on Fournier's Estimate. Incidence among +Maoris (D): Early Days, Miscarriages; Prevalence at Present, Origin. +Death-certificates (E): Two Certificates, one for Relatives, other for +Registrar; British Empire Statistical Conference, Resolutions passed; +Committee's Conclusion<br /> +<br /> +<a href="#Link07">Section 2</a>.—Causes of the Prevalence of Venereal Diseases in New +Zealand: Infected Individuals, neglect to undergo or continue Treatment; +Chiropractors; Herbalists: Overseas Introduction; Promiscuous Sexual +Intercourse; Professional Prostitution; Police Evidence; "Amateur" +Prostitution; Social Distribution; Extra-marital Sexual Intercourse, +Result of; Parental Control; Sex Education; Housing and Living +Conditions; Hostels, Advantages of; Moral Imbeciles, Danger from; +Delayed Marriages; Alcohol; Accidental Infections; Dances; Cinema; +Returned Soldiers <br /> +<br /> +<a href="#PART_III_BEST_MEANS_OF_COMBATING_AND_PREVENTING_VENEREAL_DISEASE"><span class="smcap">Part III.—Best Means of Combating and Preventing Venereal Diseases.</span></a><br /> +<br /> +<a href="#Link08">Section 1</a>.—Education and Moral Control: Chastity, Value of; +Relationship between Sexes; Infected Persons, Responsibility; Church and +Press influence; Parents duty to Children; Pamphlet for Parents; Sex +Hygiene in Schools, Mode of Teaching; School Mothers, Value of, in +Girls' School; Instruction in Sex Hygiene; Adolescents; Moral Standard, +Value of<br /> +<br /> +<a href="#Link09">Section 2</a>.—Clinics for the Treatment of Venereal Disease: Distribution; +Work performed; Male and Female Attendance; Locality of Clinics; Hours +of Attendance; Lady Doctors; Supply of Apparatus and Drugs for certain +Cases; Advertising Clinics; Extension of Clinics; Training at Clinics +for Nurses, Students, &c.; Cases attending until non-infective; Male and +Female; Lady Patrols; Social Hygiene Society, Work of; Laboratories and +Free Treatment: Complement Fixation Test for Gonorrhœa<a name="Page_2" id="Page_2"></a><br /> +<br /> +<a href="#Link10">Section 3</a>.—Licensed Brothels: Observations on; Dangers of Infection +from; Statistics; North European Conference's Resolution; Flexner's +Views; American Opinion<br /> +<br /> +<a href="#Link11">Section 4</a>.—Exclusion of Venereal Cases from Overseas: Health Act, 1920, +Provisions; Attendances at Clinics; Recommendations; Immigration +Restriction Act and Syphilis<br /> +<br /> +<a href="#Link12">Section 5</a>.—Prophylaxis: Packet System; Early Treatment; +Inter-departmental Committee on Infectious Diseases, Conclusions; +Notices in Public Conveniences; Prophylaxis, Efficiency of<br /> +<br /> +<a href="#Link13">Section 6</a>.—Legislation required: Conditional Notification (A)—National +Council of Women, View on; Number or Symbol Notification; Infectious +Diseases Notification Bill, England (1889), Opposition to, Comparisons +with Control of Infectious Diseases; Present System, Disadvantages of; +West Australia Act; New Zealand Legislation suggested. Compulsory +Examination and Treatment (B).—Department of Health, proposed +Legislation, Contagious Diseases Act compared with; West Australia +Legislation, Effect on Attendances at Clinics<br /> +<br /> +<a href="#Link14">Section 7</a>.—Marriage Certificate of Health: Royal Commission on Venereal +Diseases; National Birth-rate Commission; Medical Certificate; Statement +before Registrar, Communicable and Mental Disease; Recommendation; +Medical Practitioners' duty<br /> +<br /> +<a href="#Link15">Section 8</a>.—Treatment of Unqualified Persons: Chemists, Herbalists, +Chiropractors; Effect of such Treatment; Clinic Statistics relating to +same; West Australian<br /> +<br /> +<a href="#Link16">Section 9</a>.—Mentally Defective Adolescents: Danger and Cost to the +State; Supervision and Control proposed<br /> +<br /> +<a href="#PART_IV_SUMMARY_OF_CONCLUSIONS_AND_RECOMMENDATIONS"><span class="smcap">Part IV.—Summary of Conclusions and Recommendations.</span></a><br /> +<br /> +<a href="#Link17">Section 1</a>.—Conclusions<br /> +<br /> +<a href="#Link18">Section 2</a>.—Recommendations<br /> +<br /> +<a href="#Link19">Section 3</a>.—Concluding Remarks<br /> +<br /> +<a href="#APPENDIX"><span class="smcap">Appendix</span></a><br /> +</p> + +<hr style='width: 45%;' /> + +<h2>REPORT.</h2> + +<p>The Hon. the Minister of Health, Wellington.</p> + +<p><span class="smcap">SIR</span>,—</p> + +<p>The Committee of the Board of Health appointed by you to inquire into +and report upon the subject of venereal diseases in New Zealand have the +honour to submit herewith their report.<br /> </p> + +<h3><a name="PART_I_INTRODUCTORY_AND_HISTORICAL" id="PART_I_INTRODUCTORY_AND_HISTORICAL"></a>PART I.—INTRODUCTORY AND HISTORICAL.</h3> + + +<p><br /><a name="Link01" id="Link01"></a><span class="smcap">Section 1.—Origin and Scope of Inquiry.</span></p> + +<p>A perusal of departmental files reveals that many persons and bodies +have during recent times urged upon the Government the desirability of +setting up a Committee or Commission of Inquiry to go into this subject. +The appointment of the present Committee, however, arose out of a +suggestion forwarded to the Chairman of the Board of Health, under date +of the 20th June, 1922, from the Council of the New Zealand Branch of +the British Medical Association. The Board of Health duly considered the +representations of the Association and passed a resolution recommending +the Minister to set up a committee to gather data and to make +recommendations as to the best means of preventing and combating +venereal diseases. The proposal thereafter took concrete form, following +the receipt by the members of this Committee of the under-quoted letter, +dated 13th July, 1922, sent out under your direction by the Secretary of +the Board of Health:—</p> + +<div class="blockquot"><p>"I am directed by the Hon. the Minister of Health, Chairman of this + Board, to inform you that, acting upon the recommendation of the + Board, he has decided to appoint a special Committee from among the + members of the Board to conduct an inquiry into the question of + venereal diseases in New Zealand. The following members are being + asked to become members of the Committee, and the Chairman trusts + you will see your way to accept the position: Dr. Valintine, Dr. + Elliott, Lady Luke, Hon. Mr. Triggs, Sir Donald McGavin, Mr. + Fraser. The Hon. the Minister has asked the Hon. Mr. Triggs to + accept the chairmanship of the Committee.</p> + +<p> "I am further directed to state that the function and duty laid + upon the Committee is as follows:—</p> + +<p> "(1.) To inquire into and report upon the prevalence; of venereal + disease in New Zealand.</p> + +<p> "(2.) To inquire into and report any special reasons or causes for + the existence of venereal disease in New Zealand.</p> + +<p> "(3.) To advise as to the best means of combating and preventing + venereal disease in New Zealand, and especially as to the necessity + or otherwise of fresh legislation in the matter.</p> + +<p> "The Minister of Health is anxious that the Committee should hear + such evidence and representations on the above-mentioned matters as + may be necessary to fully inform the Committee on the items + referred to it, and with respect to which it is asked to report, + and he further suggests to the Committee that the various + organizations and persons likely to be interested should be + notified that the Committee will, at a certain place and date, in + Wellington, hear any evidence they may desire to tender."</p></div> + +<p>The Committee regrets that owing to ill health Dr. Valintine, +Director-General of Health, was unable to act as one of its members. His +place was taken by Dr. J.P. Frengley, Deputy Director-General of Health. +Unfortunately, illness also overtook Mr. Murdoch Fraser, who has been unable<a name="Page_3" id="Page_3"></a> +to attend the sittings of the Committee since the middle of August. The +remaining members have been present at all sittings of the Committee, +details of which are appended in the following table:—</p> + +<table border="1" cellpadding='4' cellspacing='0' summary="Time Table of Committee Work"> +<tr><td>Places and Dates of Sittings.</td> +<td>Witnesses examined or Work done.</td></tr> +<tr><td>Wellington, 26th July, 1922<br />(forenoon only)</td> +<td>Preliminary meeting.</td></tr> + +<tr><td>Wellington, 8th August, 1922<br />(forenoon only)</td> +<td>Dr. M.H. Watt, Director, Division of +Public Hygiene.<br /> +Dr. B.F. Aldred, Officer in Charge + Venereal Diseases Clinic.</td></tr> + +<tr><td>Wellington, 9th August, 1922<br />(forenoon only)</td> +<td>Hon. Dr. W.E. Collins, M.L.C.<br /> +Mr. J. Caughley, M.A., Director of Education.</td></tr> + +<tr><td>Auckland, 17th August, 1922</td> +<td>Dr. Falconer Brown, Officer in Charge + Venereal Diseases Clinic.<br /> +Dr. Hilda Northcroft.<br /> +Dr. Frank Macky.<br /> +Dr. W. Gilmour, Bacteriologist and + Pathologist, Auckland Hospital.<br /> +Dr. C.E. Maguire, Medical Superintendent, + Auckland Hospital.<br /> +Dr. W.H. Parkes.<br /> +Dr. J. Hardie Neil.<br /> +Dr. R. Tracy Inglis, Medical Officer, St. + Helens Hospital.<br /> +Dr. E.W. Sharman, Port Health Officer.<br /> +Dr. W.H. Pettit.</td></tr> + +<tr><td>Auckland, 18th August, 1922</td> +<td>Mrs. De Treeby, representing Women's + International and Political League.<br /> +Dr. D.N.W. Murray, Medical Officer to + Prisons Department.<br /> +Mr. R.J. Pudney.<br /> +Mr. Egerton Gill.<br /> +Mrs. Harrison Lee Cowie.<br /> +Mrs. E.B. Miller.<br /> +Dr. Kenneth Mackenzie.<br /> +Dr. E.H. Milsom.<br /> +Dr. E. Carrick Robertson.<br /> +Rev. Jasper Calder.<br /> +Mr. F.L. Armitage, Government + Bacteriologist.<br /> +Dr. W.A. Fairclough.<br /> +Dr. A.N. McKelvey, Medical Officer, + Costley Home.</td></tr> + +<tr><td>Christchurch, 29th August, 1922</td> +<td>Dr. A.C. Thomson, Officer in Charge + Venereal Diseases Clinic.<br /> +Dr. P.C. Fenwick.<br /> +Mrs. E. Roberts, President Women's + Branch, Social Hygiene Society.<br /> +Mrs. A.E. Herbert.<br /> +Dr. A.B. Pearson, Bacteriologist and + Pathologist, Christchurch Hospital.<br /> +Nurse E.M. Stringer, Health Patrol.<br /> +Dr. W. Fox, Medical Superintendent, + Christchurch Hospital.<br /> +Dr. C.H. Upham, Port Health Officer.<br /> +Dr. C.L. Nedwill, Medical Officer to + Prisons Department.<br /> +Dr. D.E. Currie.<br /> +Dr. J. Guthrie.<br /> +Dr. W. Irving, Medical Officer, St. + Helens Hospital.<br /> +Dr. A.C. Sandston, President, Men's + Branch Social Hygiene Society.<br /> +Major R. Barnes, Salvation Army Officer.<br /> +Dr. A.B. Lindsay.</td></tr> + +<tr><td>Dunedin, 31st August, 1922</td> +<td>Dr. A. Marshall, Officer in Charge + Venereal Diseases Clinic.<br /> +Dr. A.R. Falconer, Medical + Superintendent, Dunedin Hospital.<br /> +Dr. H.L. Ferguson, Dean Medical Faculty, + Otago University.<br /> +Dr. Emily H. Seideberg, Medical Officer, + St. Helens Hospital.<br /> +Dr. J.A. Jenkins.<br /> +Canon E.R. Nevill, representing the + Dunedin Council of Sex Education.<br /> +Miss Pattrick, Director of Plunket + Nursing.<br /> +Mr. J.M. Galloway, representing Society + for Protection of Women and Children.<br /> +Dr. F.R. Riley.</td></tr> + +<tr><td>Wellington, 12th September<br />(forenoon only)</td> +<td>Dr. W. Young.<br /> +Mr. T.R. Cresswell, Headmaster, + Wellington College.<br /> +Mr. W.W. Cook, Registrar-General.<br /> +Mr. Malcolm Fraser, Government + Statistician.<br /> +Mr. W.D. Hunt.<br /> +Rev. R.S. Gray.</td></tr> + +<tr><td>Wellington, 13th September<br />(forenoon only)</td> +<td>Dr. Frank Hay, Inspector-General of +Mental Defectives.<br /> +Mrs. Henderson, Representative Women Prisoners' Welfare Society and Wellington Branch National Council of + Women.<br /> +Rev. Van Staveren, Jewish Rabbi.</td></tr> + +<tr><td>Wellington, 14th September</td> +<td>Dr. Agnes Bennett, Medical Officer, St. + Helens Hospital.<br /> +Mrs. F. McHugh, Health Patrol.<br /> +Mr. F. Castle, President Pharmacy Board, + and Chairman Wellington Hospital Board.<br /> +Dr. D.M. Wilson, Medical Superintendent, + Wellington Hospital.<br /> +Mr. A.H. Wright, Commissioner of Police.<br /> +Mr. W. Dinnie, ex-Commissioner of Police, + representing Bible in Schools + Propaganda Committee.<br /> +Rev. J.T. Pinfold, D.D., representing + Wellington Ministers' Association.<br /> +Canon T. Feilden Taylor, appointed by the + Bishop of Wellington.</td></tr> + +<tr><td>Wellington, 15th September</td> +<td>Major Winton, Salvation Army.<br /> +Mr. W. Beck, Officer in Charge Special + Schools Branch, Education Department.<br /> +Dr. D.E. Platts-Mills, representing Young + Women's Christian Association.<br /> +Mrs. Morpeth, representing Young Women's + Christian Association.<br /> +Miss Dunlop, representing Young Women's + Christian Association.<br /> +Mrs. Glover, Salvation Army.</td></tr> +<tr><td>Wellington, 26th September</td> +<td>Consideration of report.</td></tr> +<tr><td>Wellington, 10th October</td> +<td>Consideration of report.</td></tr> +<tr><td>Wellington, 12th October</td> +<td>Consideration of report.</td></tr> +<tr><td>Wellington, 13th October</td> +<td>Consideration of report.</td></tr> +<tr><td>Wellington, 18th October</td> +<td>Final meeting.</td></tr> +</table> + +<p><a name="Page_4" id="Page_4"></a>It will thus be seen that, apart from time spent in travelling, the +Committee have met on seventeen days and have heard seventy-four +witnesses in person.</p> + +<p>The Committee would like to express their thanks to the witnesses, many +of whom had gone to considerable trouble to collect information and +prepare their evidence. Thanks are also due to the British Medical +Association for their willing co-operation and assistance; to the large +number of members of the medical profession throughout the Dominion who +responded to the Committee's request for information; to Dr. J.H.L. +Cumpston, Federal Director-General of Health, Melbourne, for much +Australian information on the subject, particularly in relation to +Commonwealth quarantine provisions; to Dr. Everitt Atkinson, +Commissioner of Public Health, Perth, West Australia, for a most lucid +and informative report on the working of the legislation in force in +that State; and to many other persons who by means of correspondence and +literature have placed at the Committee's disposal a large amount of +information which has been of material assistance in considering various +aspects of the problems involved.</p> + +<p>The Committee desire to acknowledge their indebtedness to their +secretary, Mr. C.J. Drake, whose wide knowledge of public-health matters +has been of material assistance in their investigations and who has +discharged his duties with marked zeal and ability.</p> + + +<p><br /><a name="Link02" id="Link02"></a><span class="smcap">Section 2.—Venereal Diseases and their Effects.</span></p> + +<p>One result of the Committee's investigations has been to show that the +public in general are very ignorant regarding the nature of venereal +diseases, and their lamentable effects not only upon the individuals +infected, but upon the health and well-being of the community as a +whole. This ignorance of the nature of the problem and of the grave +issues involved naturally stands in the way of the evil being grappled +with effectually. Furthermore, the policy of reticence which has +prevailed in the past, while it has led to the omission of proper +instruction of the young, either by their parents or as part of our +system of education, has not prevented the dissemination of an +incomplete or perverted knowledge of the facts relating to sex, which, +being derived as a rule from tainted sources of information, has been +productive of a great deal of evil.</p> + +<p>In these circumstances the Committee feel it their duty, before making +known their recommendations, to state in as plain terms as possible the +medical aspects of the problem they have had to consider.</p> + +<p>There are three forms of venereal diseases namely, syphilis, gonorrhœa, +and chancroid—and of these the first two are the common and most +serious diseases. That sporadic syphilis existed in antiquity and even +in prehistoric times is probable, but there is no doubt that the disease +was a malignant European pandemic in the closing years of the fifteenth +century. The first reference to its origin is in a work written about +the year 1510, wherein it is described as a new affection in Barcelona, +unheard of until brought from Hayti by the sailors of Columbus in 1493. +The army of Charles VIII carried the scourge through Italy, and soon +Europe was aflame. "Its enormous prevalence in modern times," says Dr. +Creighton, "dates, without doubt, from the European libertinism of the +latter part of the fifteenth century." Gonorrhœa also has its origin in +the shades of antiquity, but that it became common in Europe about 1520 +is a fact based on the highest authority.</p> + +<p>Syphilization follows civilization, and syphilis is an important factor +in the extermination of aboriginal races. Syphilis was introduced into +Uganda when that country was opened to trade with the coast, and Colonel +Lambkin reported that "In some districts 90 per cent. suffer from it.... +Owing to the presence of syphilis the entire population stands a good +chance of being exterminated in a very few years, or left a degenerate +race fit for nothing." The earliest known account of the introduction of +syphilis into the Maori race is in an old Maori song composed in the far +North. The Maori population in a village on the shores of Tom Bowline's +Bay was employed in a whaling-station on the Three Kings Islands, and +there they became infected and carried the disease to the mainland. +Venereal disease is not common now among the Maoris, but it made great +ravages in the early days of colonization, to which may be attributed +much of the sterility and repeated miscarriages in the transitional +period of Maori history.</p> + +<p>Through the ages great confusion existed as to the origin and nature of +venereal disease, but in 1905 a micro-organism, the <i>Spironema +pallidum</i>, was demonstrated as the infective agent in syphilis, and the +gonococcus as the infecting organism of gonorrhœa had been discovered in +1879. As regards modes of infection, syphilis is contracted usually by +sexual congress; occasionally the mode of infection is accidental and +innocent, and congenital transmission is not uncommon. Gonorrhœa is +contracted by sexual congress as a rule, but occasionally from innocent +contact with discharges, as in lavatories.</p> + +<p>Syphilis, therefore, is a markedly contagious and inoculable disease. It +gains entrance, and usually in three weeks (although this period may be +much shorter) a slight sore appears at the site of infection. It may be +so slight as to pass unnoticed. This is the primary stage of syphilis. +Later, often after two months, the secondary stage begins, and if not +properly treated may last for two years. The patient is not too ill +usually to attend to his avocation, and has severe headache, skin +rashes, loss of hair, inflammation of the eyes, or other varied +symptoms. The tertiary stage may be early or delayed, and its effects +are serious. Masses of cells of low vitality, known as "gummata," with a +tendency to break down or ulcerate, may form in almost any part of the +body, and the damage that occurs is considerable indeed. Various +diseases result which the lay mind would not associate with syphilis, +but it would be difficult to overestimate the resultant diseases that +may occur in any organ of the body:—</p> + +<p> +<span style="margin-left: 2em;">This racks the joints; this fires the veins:</span><br /> +<span style="margin-left: 2em;">That every labouring sinew strains;</span><br /> +<span style="margin-left: 2em;">Those in the deeper vitals rage.</span><br /> +</p> + + +<p><a name="Page_5" id="Page_5"></a>Many deaths ascribed to other causes are the direct consequence of +syphilis. It cuts off life at its source, being a frequent cause of +abortion and early death of infants. It slays those who otherwise would +be strong and vigorous, sometimes striking down with palsy men in their +prime, or extinguishing the light of reason. It is an important factor +in the production of blindness, deafness, throat affections, +heart-disease and degeneration of the arteries, stomach and bowel +disease, kidney-disease, and affections of the bones. Congenital +syphilis often leads to epilepsy or to idiocy, and most of the victims +who survive are a charge on the State. This indictment against syphilis +is by no means complete. The economic loss resulting from this disease +is enormous as regards young, old, middle-aged. It respects not sex, +social rank, or years.</p> + +<p>Gonorrhœa is characterized in its commonest form by a discharge of pus +from the urethra, and causes acute pain at its onset in the male, but in +the female it commonly causes little or no discomfort. Unless carefully +treated, and treated early, it gives rise to many complications, such as +inflammation of the bladder, gleet, stricture, inflammation of joints, +abscesses, and rheumatism. It is a common cause of sterility and of +miscarriages, and, in the female, of many internal inflammations and +disablement, and in its later effects requires often surgical operations +on women. It is a very common disease, and the public know little of the +evil consequences which may follow what they have persisted in regarding +as a simple complaint. From its prevalence and its complications it is +one of the most serious diseases that affect mankind.</p> + +<p>As regards treatment of venereal disease of all kinds, it should be +clearly understood that the causative germs are well known and can +readily be destroyed immediately after exposure to infection by thorough +cleansing with antiseptic lotion or ointment. The use of soap and water +only would lessen the incidence of infection. On the first suspicious +sign of venereal disease the patient should apply at once for medical +advice. There are methods of diagnosis, such as microscopic examination +and the Wassermann test, the result of recent discovery, which make +diagnosis simple and certain; and if treatment is begun early according +to modern methods, which are much more effective than the remedies +formerly applied, the germs of infection are easily vanquished. When +sufficient time, however, is lost to enable these germs to become +entrenched in parts of the body not readily accessible to treatment, +cure is difficult, prolonged, and perhaps in some cases uncertain.</p> + +<p>For their own sakes, as well as for the sake of others, patients +suffering from any form of venereal disease should continue treatment, +which may be prolonged in the case of syphilis for two years, until +their medical adviser is satisfied that further treatment is +unnecessary.</p> + +<p>Women suffer less pain than men in these diseases, and consequently are +more apt to neglect securing medical advice and treatment, and more +ready to discontinue treatment before a cure is effected.</p> + + +<p><br /><a name="Link03" id="Link03"></a><span class="smcap">Section 3.—Accidental Infection.</span></p> + +<p>Occasionally cases are met with in which syphilis is acquired innocently +by direct or indirect contact with syphilitic material, and then the +primary sore is often located on some other part of the body than the +genitals. Thus the lip may be infected by kissing, or by drinking out of +the same glass, or smoking the same pipe as a syphilitic patient. A +medical witness reported a case to the Committee in which syphilis was +conveyed to two girls "through a young fellow handing them a cigarette +which he was smoking." Metchnikoff has proved that the spironema of +syphilis is a delicate organism and quickly loses its virulence outside +the human body, and it cannot enter the system through unbroken skin or +mucous membrane. It is extremely doubtful if any form of venereal +infection can be conveyed in food. Frequently venereal disease is +deceitfully attributed by patients to innocent infection, and no doubt +some genuine cases do occur, but how seldom is illustrated by the +statement of the Officer in Charge of the V.D. Clinic at Christchurch, +who said, "I cannot remember a case where I was absolutely certain that +infection was acquired innocently or extragenitally."</p> + +<p>Gonorrhœa may be conveyed innocently from infective discharge on a +closet-seat, or from an infected towel, &c., and undoubtedly gonorrhœal +discharge if brought into contact with the eye sets up a violent +suppuration.</p> + +<p>The Committee are of opinion that the extent of accidental infection is +greatly exaggerated in the public mind, but a few cases occasionally +occur, and the Committee recommend that there should be better provision +of public conveniences, especially for women, and the U-shaped +closet-seat should be adopted. The use of common towels and +drinking-cups in railway-trains, schools, factories, and elsewhere is +condemned not only for the reasons stated above, but on general sanitary +grounds.</p> + + +<p><br /><a name="Link04" id="Link04"></a><span class="smcap">Section 4.—Previous Inquiries and Conferences.</span></p> + +<p>After the repeal of the Contagious Diseases Act in England in 1886, +various Committees and Royal Commissions, such as the Inter-departmental +Committee on Physical Deterioration in 1904, the Royal Commission on the +Poor-laws in 1909, and the Royal Commission on Divorce in 1912, drew +attention to the frightful havoc wrought by venereal disease, and urged +that further action should be taken to deal with the evil. In 1913 the +British Government appointed a Royal Commission to inquire into the +prevalence of venereal diseases in the United Kingdom, their effects +upon the health of the community, and the means by which these effects +could be alleviated or prevented, it being understood that no return to +the policy or provisions of the Contagious Diseases Acts was to be +regarded as falling within the scope of the inquiry.</p> + +<p>The Commission took a great deal of most valuable evidence, and did not +present their final report until 1916. They recommended improved +facilities for diagnosis and treatment, including free clinics. They +came to the conclusion that at that time any system of compulsory +personal notification would fail to secure the advantages claimed. The +Commission added, however, "it is possible that the situation may be +modified when these facilities for diagnosis and treatment [recommended +by the<a name="Page_6" id="Page_6"></a> Commission] have been in operation for some time, and the +question of notification should then be further considered. It is also +possible that when the general public become alive to the grave dangers +arising from venereal disease, notification in some form will be +demanded." The Commission supported the adoption of a recommendation by +the Royal Commission on Divorce to the effect that where one of the +parties at the time of marriage is suffering from venereal disease in a +communicable form and the fact is not disclosed by the party, the other +party shall be entitled to obtain a decree annulling the marriage, +provided that the suit is instituted within a year of the celebration of +the marriage, and there has been no marital intercourse after the +discovery of the infection. The Commission urged that more careful +instruction should be provided in regard to moral conduct as bearing +upon sexual relations throughout all types and grades of education. Such +instruction, they urged, should be based upon moral principles and +spiritual considerations, and should not be based only on the physical +consequences of immoral conduct. They also favoured general propaganda +work, and urged that the National Council for Combating Venereal +Diseases should be recognized by Government as an authoritative body for +the purpose of spreading knowledge and giving advice.</p> + +<p>Another important Commission, sitting almost simultaneously with that +just referred to, was the National Birth-rate Commission, which began +its labours on the 24th October, 1913, and presented its first Report on +the 28th June, 1916. The Commission was reconstituted, with the Bishop +of Birmingham as Chairman, in 1918, to further consider the question, +and especially in view of the effects of the Great War upon vital +problems of population. Among the terms of reference the Commission were +requested to inquire into "the present spread of venereal disease, the +chief causes of sterility and degeneracy, and the further menace of +these diseases during demobilization." The Commission in their report, +presented in 1920, stated that they realized the difficulties involved +in the introduction of any efficient scheme of compulsory notification +and treatment of venereal diseases, but, they added, they "feel that it +has now passed the experimental stage both in our colonies and in forty +of the forty-eight of the United States of America, and think it is +advisable for the State to make a trial of compulsory notification and +treatment in this country, provided that there should be no return to +the principles or practice of the Contagious Diseases Act." Referring to +the finding of the Royal Commission on Venereal Disease that it would +not be possible at present to organize a satisfactory method of +certification of fitness for marriage, the National Birth-rate +Commission thought this question should now be reconsidered with a view +to legislation. "If," says the report, "a certificate of health was to +become a legal obligation for persons contemplating marriage, many of +the legal, ethical, and professional difficulties surrounding this +question would be removed."</p> + +<p>In Sweden, where a Venereal Diseases Law was passed in 1918, stress was +laid on the importance of general enlightenment with regard to venereal +disease and germane subjects, such as sex hygiene. A committee was +appointed, consisting of experts in medicine and pedagogy, to inquire +into the best means of providing such education. Their report, which has +just been issued, is described by the <i>British Medical Journal</i> as a +document of considerable value, promising to become the charter of a new +and complete system of sex education and hygiene in schools throughout +Sweden. Further reference will be made to this document in the section +of this report dealing with education.</p> + +<p>The subject of venereal disease has also been considered by more than +one important Medical Conference in Australia and New Zealand.</p> + +<p>At a general meeting of the Australasian Medical Congress held in +Melbourne in October, 1908, it was resolved that the executive be +recommended to appoint a committee to investigate and report on the +facts in regard to syphilis. Such a committee was appointed, and +reported to the Congress in Sydney in 1911. In 1914 the Congress was +held in Auckland, and a special committee which had been appointed, with +the Hon. Dr. W.E. Collins, M.L.C., as chairman, presented a valuable +report giving some interesting information in regard to the prevalence +of venereal disease, in New Zealand. The committee recommended that +syphilis be declared a notifiable disease; that notification be +encouraged and discretionary, but not compulsory; and that the Chief +Medical Officer of Health be the only person to whom the notification be +made. They also recommended the provision of laboratories for the +diagnosis of syphilis, and that free treatment for syphilis be provided +in the public hospitals and dispensaries. These recommendations were +embodied in the report adopted by the Congress.</p> + +<p>In February of the present year an important Conference, convened by the +Prime Minister of Australia, was held in Parliament House, Melbourne. It +was attended by official representatives of the Health Departments of +all the States, together with representatives from the British Medical +Association, the Women's Medical Staff at the Queen Victoria Hospital +Diseases Clinic in Melbourne, and other scientific and medical +authorities. The Commonwealth subsidizes the work of the States in +combating venereal disease, and the object of the Prime Minister in +calling the Conference was in order that it might inquire into the +effectiveness of the present system of legislation, of administrative +measures, and of clinical methods, with a view of determining whether +the best results were being obtained for the expenditure of the money.</p> + +<p>Western Australia has an Act, which came into operation in June, 1916, +providing for what is known as conditional notification of patients, +together with other provisions for the control of venereal disease which +are on a more comprehensive scale than has been attempted anywhere with +the possible exception of Denmark. In December, 1916, Victoria passed a +similar Act, and this example was followed by Queensland, Tasmania, and +New South Wales.</p> + +<p>The Conference, answering the several questions put to it, found that a +greater proportion of persons infected with venereal disease were +receiving more effective treatment than before the passing of the +Venereal Diseases Act. In the opinion of the Conference this was due +partly to the passing of legislation and partly to the opening of +clinics affording greater opportunities for free treatment.<a name="Page_7" id="Page_7"></a> They +considered the operations of the Act had been more successful in +bringing men under treatment than it had been in the case of women. +Among the opinions expressed by the committee were the following: The +Act was not equally successful in respect of private and hospital +patients in regard to notification, but was equally successful in +respect of securing to both more effective treatment. There has been an +apparent reduction in the prevalence of venereal diseases, and the +Conference were strongly of opinion that the results so far justify the +continuance of these Acts in operation.</p> + +<p>The Conference found that venereal diseases are the most potent of all +causes of sterility and of infant and fœtal morbidity and mortality. It +recommended, among other remedial measures, that prophylactic depots, +both for males and females, should be established as widely in the +community as possible. Referring to the educational aspect, the +Conference urged that children should be instructed in general +biological facts up to the age of puberty, when more explicit +information concerning facts of sexual life should be given. They urged +on all parents and educational, philanthropic, and religious +organizations the pressing necessity for a sustained campaign, in +co-operation with the medical profession, in order to inculcate in the +community higher ideals of personal hygiene and health.</p> + +<p>Lastly, it may be mentioned that, at the instance of Lord Dawson of +Penn, a highly qualified and representative committee of medical men, +with Lord Trevethin as chairman, has been appointed in England to report +to the Minister of Health upon "the best medical measures for preventing +venereal disease in the civil community, having regard to administrative +practicability, including cost." The appointment of such a committee was +requested by Lord Dawson chiefly with a view to obtaining an +authoritative pronouncement on the subject of medical preventive +measures, and the committee's report will be awaited with much interest.</p> + + +<p><br /><a name="Link05" id="Link05"></a><span class="smcap">Section 5.—Legislation in New Zealand, Past and Present.</span></p> + +<p>(A) <i>Contagious Diseases Act (repealed).</i></p> + +<p>The Contagious Diseases Act was passed in 1869, and repealed in 1910. +Briefly, its aim was to secure periodical examinations of prostitutes, +and to detain for treatment those prostitutes found infected with +venereal disease.</p> + +<p>There appears to be, in some quarters, an apprehension that hidden +beneath the movement to combat venereal diseases is an implied desire or +intention to reinstate the antiquated and detested provisions of that +Act. The Committee deem it necessary to say that they have not found +grounds for this suspicion; that no legislation can be effective unless +it deals equally and adequately with all men, women, and children +sufferers from venereal diseases of all kinds; that it finds little +evidence of a definite prostitute class in New Zealand, and, even if +there were such, the Contagious Diseases Acts have been proved to be +useless as measures towards the prevention of venereal infections; and +it is the Committee's individual and collective opinion that anything +involving a return to the administrative procedure of the Contagious +Diseases Act should have no part whatever in any new legislation in this +Dominion.</p> + +<p>(B.) <i>Examples of Difficulties—Concrete Cases.</i></p> + +<p>Before proceeding to refer to present and suggested legislation, a few +incidents and cases taken from the evidence may help, as concrete +examples, to indicate the difficulties to be contended with:—</p> + +<p><i>Case 1.</i>—A man—young and married, a municipal employee in a +city—associated sexually with a female employee in an eating-house +frequented by himself and co-employees. In due time he sought the advice +of the Medical Officer of Health for (what he suspected) severe +syphilis. Steps were taken to obtain his speedy admission to the local +hospital. The woman continued in her employment.</p> + +<p><i>Case 2.</i>—A social-hygiene worker in her evidence said: "I think the +majority of cases I deal with (girls attending a hospital clinic) are +caused through mental depravity, and in some instances you cannot +convince them—they continue to carry on. I have tried all I know how to +show them the dangers, but they just laugh at me. I think it is really +in many cases just a mental condition—mental degeneration, possibly." +This officer explained that even while actually attending the clinic +some of these girls (affected with gonorrhœa), without any semblance of +reserve or decency, would discuss arrangements for further intercourse +with men, and on leaving the clinic (still in an infectious state) were +even seen to go off with young men waiting for them.</p> + +<p><i>Case 3.</i>—Asked if he knew of any cases where the disease had been +contracted innocently, a medical practitioner stated in evidence: "I +know of a case where two girls in —— were infected (syphilis) on the +lip through a young fellow handing them a cigarette which he was +smoking."</p> + +<p><i>Case 4.</i>—A medical man in private practice, and Medical Superintendent +of the hospital in a small country town, states: "Although, judging from +an experience of over fifteen years, this district would appear to be +peculiarly free from any variety of venereal disease, I think it may be +of interest to your Committee to know what happened here in the early +part of 1918. At that time there came to reside with her father in ——, +a township about nine miles south of ——, a woman, ——, who, shortly +after her arrival consulted the late Dr. ——, and was found to be the +subject of secondary syphilis.... In all, three cases of gonorrhœa, four +of soft chancre (three of whom suffered from phagadœmic ulceration which +laid them up for weeks), and six cases of purely syphilitic infection +came under my care, all traceable to this same woman. As every case of +gonorrhœa and soft chancre afterwards developed syphilis, ultimately I +had thirteen cases of syphilis under my treatment alone. Others, I have +good reason to believe, went to other towns, and doubtless some failed +to seek any kind of help.... Having prevailed upon the woman to come to +my surgery ... I told her that she was suffering from three varieties of +venereal disease, which she was freely disseminating. I then read to her +that part of the Act which deals with those who "knowingly and wilfully +disseminate venereal infection." That same afternoon she left for ——, +where she continued<a name="Page_8" id="Page_8"></a> to ply her calling unhindered. Who can estimate the +sum of the damage done by one such person? Not one of those men infected +was properly treated, although I did all I possibly could to convince +them of their own danger and of the risk of spreading infection to +others. Gradually, as the obvious signs of active disease abated, they +drifted away. I may say the Wassermann reaction proved strongly positive +in every case.... One of these men passed on his infection (syphilis) to +a young girl in this town, and she in turn infected other men, one of +whom came to me, while others went to my colleagues. Another man of the +first group, about middle age, and previously a very healthy, sober, +hard-working fellow, has developed thrombosis of his middle cerebral +artery as the result of a syphilitic endarteritis. He is totally +incapacitated, and in the Old Men's Home at ——. He remains a permanent +charge on the community."</p> + +<p>(C.) <i>Hospital and Charitable Institutions Act, 1913, Section 19.</i></p> + +<p>In 1913 the need for detention provisions, to cover any infectious or +contagious disease, received the attention of Parliament, and these are +embodied in section 19 of the Hospitals and Charitable Institutions Act, +1913, thus:</p> + +<div class="blockquot"><p>"19. (1.) The Governor may from time to time, by Order in Council + gazetted, make regulations for the reception into any institution + under the principal Act of persons suffering from any contagious or + infectious disease, and for the detention of such persons in such + institution until they may be discharged without danger to the + public health.</p> + +<p> "(2.) Any person in respect of whom an order under this section is + made may at any time while such order remains in force appeal + therefrom to a Magistrate exercising jurisdiction in the locality, + and the Magistrate shall have jurisdiction to hear such appeal and + to make such order in the matter as he thinks fit. An order of a + Magistrate under this subsection shall be final and conclusive.</p> + +<p> "(3.) Regulations under this section may be made to apply generally + or to any specified institution or institutions."</p></div> + +<p>The Committee are advised that this section was not aimed solely at +venereal diseases. In that year, and prior thereto, was prominent the +difficulty of detaining consumptives who refused to take precautions to +prevent the spread of their disease to others; and, again, much +attention was being centred on the chronic typhoid and diphtheria +"carrier." It seemed rational to compel isolation of such persons in +hospital until there was some assurance that they would no longer be a +danger to the community if allowed their liberty. Regulations under the +Act were not issued, owing to opposition manifested at the time, and +consequently the section never became operative.</p> + +<p>(D.) <i>The Prisoners Detention Act, 1915.</i></p> + +<p>This Act secures that individuals of one class of the community—viz., +convicted persons—can be held until freed from venereal disease with +which they were known or found to be infected. The measure is of value, +but logically seems unsound, because the venereal diseases from which +such persons suffer are in no way a greater danger to the public than +the same diseases in the law-abiding subject of any class, and, +furthermore, the Committee have no reason to conclude from the evidence +that convicted persons, as a whole, show a higher percentage of venereal +cases than those who never enter a prison. The Controller-General of +Prisons submitted a schedule showing that the number of prisoners +detained under the Prisoners Detention Act from its commencement in 1916 +to 1922 was twenty-eight, consisting of nineteen males and nine females.</p> + +<p>(E.) <i>Social Hygiene Act, 1917.</i></p> + +<p>In the words of the Commissioner for Public Health of West Australia, +who prepared the first comprehensive legislation on venereal diseases in +1915, this Act "can hardly be classed with recent Australian +legislation, for the reason that it provides for no notification of the +disease and no compulsory examination." By this Act infected persons are +required to consult a medical practitioner and go under treatment by +him, or at a hospital; but no penalty is provided, and there is nothing +to compel such persons to do either of these things.</p> + +<p>Reference to case 1 in the concrete examples cited above will show the +weakness of the Act. The waitress continued in employment, handling cups +and spoons and cakes, &c. The Medical Officer of Health had every reason +to believe she was infected with syphilis, but, not having the power to +insist on her obtaining medical advice, he could do nothing to enforce +the provisions of section 6 of the Act.</p> + +<p>Section 7, making it an offence for any person not being a registered +medical practitioner to undertake for payment or other reward the +treatment of any venereal disease, has, in the opinion of the +Commissioner of Police, proved beneficial in restricting the operation +of quacks, but he suggests that it should be amended by deleting the +words "for payment or reward," as it is sometimes easy to prove the +treatment and difficult to prove the payment, and it is the treatment by +unqualified persons that is aimed at.</p> + +<p>Section 8, which makes it an offence knowingly to infect any person with +venereal disease, is practically inoperative, as will be shown later in +this report, owing to the extreme difficulty, in the absence of any +system of notification and compulsory treatment, of proving that the +offence was committed knowingly.</p> + +<p>The Committee desire to draw attention to section 13. Herein is provided +towards hospital maintenance a higher subsidy for venereal patients than +is receivable for the maintenance of patients suffering from other +infectious diseases. They think that it is inadvisable to particularize +venereal<a name="Page_9" id="Page_9"></a> sufferers, or, indeed, to draw any distinction between +different classes of diseases in a hospital, and that the ordinary +subsidy should be paid in all cases.</p> + +<p>In this Act also is power to make regulations for the "classification, +treatment, control, and discipline of persons <i>detained</i> in such +hospitals," but apparently, owing to the opposition to the almost +analagous provision in the Hospitals and Charitable Institutions Act, +1913, no such regulations have as yet been made.</p> + + + +<hr style="width: 65%;" /> +<h3><a name="PART_II_PREVALENCE_OF_VENEREAL_DISEASES_IN_NEW_ZEALAND" id="PART_II_PREVALENCE_OF_VENEREAL_DISEASES_IN_NEW_ZEALAND"> </a>PART II—PREVALENCE OF VENEREAL DISEASES IN NEW ZEALAND.</h3> + + +<p><br /><a name="Link06" id="Link06"></a><span class="smcap">Section 1.—Statistical.</span></p> + +<p>(A.) <i>Medical Statistics.</i></p> + +<p>The first item on the Committee's order of reference is "To inquire and +report, as to prevalence of venereal diseases in New Zealand."</p> + +<p>One of the first matters which engaged the attention of the Committee +was the question how reliable information could be gathered which would +indicate the present prevalence of these diseases in this country. +Recognizing that it would be impossible to obtain trustworthy figures +without securing the widespread co-operation of the medical profession, +the Committee at an early stage sought and was readily given the help of +the British Medical Association in the matter. Representatives of the +Association gave their assistance in the preparation of a form to be +sent to and filled in by all practising members of the profession, and +in the current number of the <i>New Zealand Medical Journal</i> an appeal to +members for their collaboration was made. Suitable circular letters were +also prepared by the Committee asking medical practitioners for their +co-operation, and the Committee are pleased to be able to report that +out of about 750 in actual practice, no fewer than 635 medical +practitioners sent in completed returns. A copy of the form used for +these returns will be found as an appendix to this report, as also a +tabulated return of the replies received and compilations therefrom.</p> + +<p>It will be seen that the total number of cases of all forms of venereal +diseases and of diseases attributable to venereal disease under the +personal care of the doctors reporting is 3,031; and, taking the +population of New Zealand as 1,296,986 (estimated population 31st March, +1922), this means that about one person in every 428 of our population +is at present being treated for venereal infection or for the results +thereof. Acute and chronic gonorrhœal infections give a total of 1,598, +being about one person in every 812 of the population. This is most +likely a very low estimate, for the Committee have had it very +definitely in evidence that many persons suffering, at least from acute +gonorrhœa, seek treatment at the hands of persons other than registered +medical practitioners. For syphilitic infections in all forms the total +is 1,419, about one person in every 914 of the population. The return +bears out other evidence showing that the chancroid or soft-sore type of +infection is rare in this Dominion.</p> + +<p>The Committee regard the result obtained as furnishing some indication +of the amount of active venereal disease existing in the Dominion. The +Committee consider, however, that these figures must be considerably on +the low side, for these reasons: (<i>a</i>) that a number of medical +practitioners have not replied: (<i>b</i>) that some diseases attributable to +venereal disease may not have been conclusively diagnosed as such, and, +therefore, not included in the return. The return necessarily does not +include cases, probably numerous, which have not been under medical care +for some time, if at all; (<i>c</i>) to secure a complete return would have +involved the keeping by each doctor of full records of all cases and a +careful and laborious collation of figures.</p> + +<p>With respect to the expression of opinion asked of medical practitioners +upon the question "If venereal disease in this Dominion has or has not +increased in a greater proportion than the population during the last +five years," it will be seen that of 322 who replied, 199 answered "Yes" +and 203 "No." This is necessarily purely a matter of impression, and it +must also be borne in mind that the evidence shows that patients are now +using the clinics in large numbers, while others who formerly went to +general practitioners now consult specialists who have recently started +in practice. On the other hand, it is possible there is a compensating +influence in the fact that the public are being educated to the +importance of seeking skilled medical treatment for these diseases.</p> + +<p>(B.) <i>Clinic Statistics.</i></p> + +<p>A second source of information as to the prevalence of venereal diseases +was provided by the statistics which have been compiled by the +Department of Health as the result of the establishment of the +venereal-diseases clinics. Among the appendices to this report will be +found a return showing the number of persons attending at each of these +clinics for the years 1920, 1921, and part of 1922, and recorded under +the headings "Sexes" and "Diseases." These statistics are valuable +insomuch as they record facts, but with respect to the total prevalence +they are but an indication, since they relate only to a small proportion +of the population who have become infected and sought treatment. From +this table (B) it will be found that the males attending for the first +time represent 83.60 per cent. of the total, and females 16.40 per +cent., or, roughly, a ratio of six males to every female.</p> + +<p><i>Clinic Distribution.</i>—In the figures for syphilis the following points +are worthy of note: Auckland: A distinctly higher number of cases than +the other centres. A marked drop in 1921 for males, but the return for +this year indicates a rise; female cases show a rise for this year. +Wellington: Returns appear fairly uniform, with a slight falling +tendency, most marked in the females. Christchurch: A drop in male +cases, with a fairly uniform rate of females. Dunedin: Here the rates +appear uniform, with exception of a fall for males in 1922.</p> + +<p>As to gonorrhœa, these points may be noted: Auckland: A marked rise. +Wellington: Steady rise with exception of females. Christchurch: Slight +rise since 1920: females uniform rate. Dunedin: Slight rise, with +indication of male increase in 1922.</p> + +<p><a name="Page_10" id="Page_10"></a><i>Age Distribution.</i>—The age-period of persons attending the clinics is +mainly eighteen to thirty.</p> + +<p><i>Marital Condition.</i>—From the evidence of the clinics it is very +apparent that venereal disease is especially a problem associated with +the unmarried.</p> + +<p>(C.) <i>Mental Hospital Statistics.</i></p> + +<p>A third source of estimation of prevalence was opened to the Committee +by the Inspector-General of Mental Hospitals. The method of +investigation adopted by Dr. Hay is based on Fournier's estimate that 3 +per cent. of the cases of syphilis existing at any one time will +ultimately develop dementia paralytica.</p> + +<p>The introduction of the Wassermann test and treatment by salvarsan or +other arsenical preparations will vitiate this index in future, for the +reasons that by the Wassermann test more cases will be diagnosed, and by +the use of recent remedies the complete cure of many more cases will be +effected, and consequently fewer will develop dementia paralytica. This +disability does not develop until about ten to fifteen years after +infection. The Wassermann test and the modern arsenical preparations +have not yet been in use for that period, therefore these figures, as an +estimate of the prevalence of syphilis in 1921, would not be materially +affected by these developments. An estimate based on these data may +therefore be regarded in the meantime as approximately correct.</p> + +<p>During the past ten years 4,763 males and 3,747 females have been +admitted into New Zealand mental hospitals. The percentage of syphilitic +admissions of all types was 4.74, while the percentage of cases of +dementia paralytica was 3.89. In other words, of the admission of +syphilitics 82 out of every 100 cases were dementia paralytica. The +average yearly number of deaths from dementia paralytica according to +the Government Statistician's returns between 1908 and 1921 was just +under 40.</p> + +<p>If Fournier's estimate that 3 per cent. of syphilitics ultimately +develop dementia paralytica be accepted, one would arrive at the annual +infection by multiplying 40 by 33, which gives 1,320. Assuming the +average duration of life, after infection, to be twenty-five years, this +means that at any given time there are twenty-five years' infections on +hand. Dr. Hay computed from this the number of persons in New Zealand +now who have, or have had, syphilis to be 1,320 x 25, equalling 33,000, +or 1 to every 38 of the population. If the average duration of life +after infection were assumed to be thirty years, the figures would be 1 +to every 32 of the population.</p> + +<p>Taking the figure for syphilitic infections over a period of years at +1,320 per annum, this would mean for the population of New Zealand +(exclusive of Maoris) 1 fresh infection annually in about every 850 +persons.</p> + +<p>(D.) <i>Incidence among Maoris.</i></p> + +<p>It is even more difficult than in the case of the European population to +say what is the prevalence of venereal diseases amongst Maoris. The +Director of the Division of Maori Hygiene (Dr. Te Rangi Hiroa) in a +statement to the Committee says:—</p> + +<p>"Venereal disease made great ravages amongst the Maori population in the +early days of colonization. To this may be attributed much of the +sterility, with histories of repeated miscarriages, that existed in the +transitional period of Maori history. Most of the old men—hemiplegias, +and paraplegias, and subsequent general paralysis of the insane—gave an +old history of syphilis. These cases that I saw twenty years ago have +now disappeared.</p> + +<p>"In my experience of eighteen years' constant work amongst the Maoris +venereal disease has been comparatively rare. It disappeared amongst the +people, only to recrudesce in some localities as fresh infection was +introduced by the white man, or brought back to the settlements by +visits to the white towns. I see very little of it at present, but now +and again hear reports from medical officers that it has cropped up in +the settlements near them ... In all these cases I am convinced that the +origin is from a white source, and the problem amongst the Maoris is not +nearly so serious as amongst Europeans. It seems to me unjust that the +idea should be circulated that the Maoris are a source of danger to the +European community—the reverse is much more likely.</p> + +<p>"It is impossible for me to supply accurate data as to the incidence of +the disease amongst the Maori race at present, but I am confident that +reports have a natural tendency to become exaggerated. I do not consider +that returned Maori soldiers, owing to the treatment they received +before being discharged from the service, have been a factor in the +introduction of the disease amongst the settlements. If they have in +some areas, it has been from fresh infection, which their experience of +prostitution in Egypt and Europe has made them more liable to acquire +from professional and amateur prostitutes in towns. At the same time, +the experience of returned soldiers as to the value of treatment makes +them more likely to seek such aid."</p> + +<p>(E.) <i>Death-certificates.</i></p> + +<p>There are no trustworthy statistics in any part of the British Empire of +the deaths due to venereal disease. Many persons die from illnesses +which result from an initial syphilis contracted perhaps many years +prior to death. It is well known that medical practitioners, from a +laudable desire to spare the feelings of relatives, refrain from stating +the primary cause of death in such cases, and merely enter the secondary +or proximate cause. For the same reason, the statistics regarding deaths +due to alcoholism, and perhaps in a less degree some other factors in +the mortality returns, are incomplete and consequently useless.</p> + +<p>Both the Royal Commission on Venereal Diseases and the Birth-rate +Commission recommended that the medical attendant should issue two +certificates—one, which would be a simple certificate of death, to be +handed to the relatives, and the other, a confidential certificate +giving the primary cause of death, which would be transmitted to the +Registrar.</p> + +<p><a name="Page_11" id="Page_11"></a>The Registrar-General for New Zealand, Mr. W.W. Cook, in his evidence in +chief, stated that he did not favour these suggestions. A certificate of +death, he said, cannot be regarded as confidential, as the information +contained therein is recorded in the death entry, which may be inspected +by the public, and of which a copy may be obtained by any applicant. In +reply to questions, however, he stated that the law could no doubt be +altered so as to make the death-certificate confidential, the +information to be given up only on an order from a Court of justice. +Apart from the fact that the insurance companies might object, he did +not see any objection from the public point of view.</p> + +<p>Mr. Malcolm Fraser, the Government Statistician, said that there was +considerable division of opinion on this question at the British Empire +Statistical Conference held in London in 1920, when statisticians from +all parts of the Empire were present. It was generally agreed that the +system was good theoretically, but some doubt was expressed whether in +practice there would be as much improvement as was expected, since the +system would depend entirely on the medical attendant strictly complying +therewith and disclosing the true cause of death in every case. Any +system of confidential information always had that failing. The witness +thought the register must be open for persons having a right to call for +copies of entries. In dealing with insurance claims at death the truth +or otherwise of the statement in the proposal form was important, and +might require verification by inspection of the death entry. At the +Conference Dr. Stevenson, the Statistician to the Registrar-General of +the United Kingdom, was very pronounced in his advocacy of the +confidential form of certificate. The Conference passed the following +resolutions: "(1.) That the present system of open certification tends +to prevent candid statements of the causes of death, and thus introduces +a systematic error into death statistics. (2.) That the error would be +eliminated by a system of confidential certification."</p> + +<p>The Committee, while agreeing that such a system of registration of +deaths would undoubtedly afford better means of approximating to correct +returns of mortality not only from venereal diseases but also from +alcoholism and some other diseases, would point out that, if New Zealand +were to adopt the reform while the rest of the Empire retained the +present system, the result would be to place the Dominion in an +apparently unfavourable light in comparison with other parts of the +Empire in regard to the mortality from these diseases.</p> + + +<p><br /><a name="Link07" id="Link07"></a><span class="smcap">Section 2.—Causes of the Prevalence of Venereal Diseases in New +Zealand.</span></p> + +<p>In discussing this order of reference the Committee desire it clearly +understood that these causes are not peculiar to New Zealand, and do not +operate more extensively in New Zealand than elsewhere. The Committee +are concerned, however, in discussing this question only as it affects +New Zealand.</p> + +<p>The causes of the spread of venereal disease may be classified under two +main headings: (1) The presence of infected individuals acting as foci +of infection; (2) the occurrence of promiscuous sexual intercourse, by +which in the great majority of cases the disease is actually transmitted +from one individual to another.</p> + +<p>(1.) <i>The Presence of Infected Individuals.</i></p> + +<p>These sources of infection arise and persist for the following +reasons:—</p> + +<div class="blockquot"><p>(1.) Neglect by infected persons to undergo treatment. (2.) Neglect + to continue treatment till no longer infective. (3.) The treatment + of infected individuals by unqualified persons, such as chemists, + herbalists, chiropractors, &c. In these cases the disease becomes + chronic, and the best opportunity for its treatment and cure has + passed before the case is seen by a medical man. (4.) By the + introduction of venereal disease to this country from overseas.</p></div> + +<p>(2.) <i>The Occurrence of Promiscuous Sexual Intercourse.</i></p> + +<p>A striking portion of the evidence placed before the Committee was that +which showed the very small amount of professional prostitution in New +Zealand. This was supported by the valuable evidence of Mr. W. Dinnie, +ex-Commissioner of Police, and Mr. A.H. Wright, Commissioner of Police. +The latter witness stated that there were only 104 professional +prostitutes in the Dominion.</p> + +<p>It would appear also that the professional prostitute, as a result of +her knowledge and experience, is less likely to transmit venereal +disease than the "amateur." It is therefore principally to clandestine +or amateur prostitution that one must look for the dissemination of the +disease, and inquiry into the conditions which tend to the production of +the amateur prostitute is a direct inquiry into the causes of the +prevalence of venereal disease.</p> + +<p>The evidence before the Committee shows that this promiscuity is very +prevalent, and that it is not confined to any particular social strata. +The fact is also strikingly demonstrated by Table A in the appendix. +From this table it will be seen that during the period 1913-21 there +were 10,841 illegitimate births and 33,738 legitimate first births +within one year after marriage. If to the illegitimate births we add the +total number of live births occurring within the first seven months of +marriage viz., 12,235—which may be safely considered to have been +conceived before marriage, we get a total of 23,076 births in which +conception took place extra-maritally. In other words, more than 50 per +cent. of total first births occurring within twelve months of marriage +result from sexual contact prior to marriage.</p> + +<p>Some factors which contribute in a greater or less degree to the moral +laxity which leads to promiscuous sexual intercourse are:—</p> + +<div class="blockquot"><p>(1.) The relaxation of parental control, which was emphasized by + many witnesses. Girls stay less at home and assist less in the work + of the home, preferring whenever opportunity offers, to go to the + pictures or some other form of entertainment.</p> + +<p> <a name="Page_12" id="Page_12"></a>(2.) Lack of education of the young in the facts pertaining to sex. + Especially the Committee would call attention to the unfounded + belief of many that continence in young men is injurious to health.</p> + +<p> (3.) Bad housing and general conditions of living. When members of + both sexes are crowded together in restricted accommodation in + which often insufficient conveniences are supplied, it is easy to + conceive of a relaxation of the proprieties of life which might + lead to acts of immorality.</p> + +<p> In this connection the Committee desire to call attention to the + excellent work done by the Y.W.C.A. and other bodies in the + provision of hostels in which girls are provided with board and + lodging at very reasonable cost. The Committee were surprised to + learn that full advantage was not taken of these provisions, and + that the accommodation at these hostels was not fully occupied. It + would appear that many girls resent the very slight amount of + supervision and restraint exercised over them, precisely as they do + parental control.</p> + +<p> (4.) The presence in the community of individuals, especially + girls, who are to some degree mentally defective or morally + imbecile. The Committee were given several individual instances in + which such girls had acted as foci of infection; they are easily + approached, and facile victims for men. In spite of a degree of + mental or moral defect they may be physically attractive.</p> + +<p> (5.) Economic conditions which delay marriage may reasonably be + regarded as a factor in conducing to an increased frequency of + extra-marital sexual relationship. Graph A in the appendix shows + clearly that the age of marriage in both sexes has, with slight + fluctuations, steadily increased from 1900 to 1921.</p> + +<p> (6.) Alcohol tends to the dissemination and persistence of venereal + disease: it increases sexual desire, lessens control, causes the + individual to be less careful as regards cleanliness, &c., after + exposure to infection, and militates against effective treatment. + It is to be pointed out, however, that the lower control possessed + by some individuals may be the actual predisposing cause, both of + laxity in sexual matters and of the excessive ingestion of alcohol. + There appears no doubt that alcohol is an important factor in the + prevalence of venereal disease, although probably not so potent as + represented by some witnesses.</p> + +<p> (7.) Accidental infections are undoubtedly rare. They may arise + from contact with W.C. seats, dirty towels, and eating and drinking + utensils in public places.</p> + +<p> (8.) Other factors of minor importance which were mentioned in + evidence were the modern dress of women, which was stated to be in + certain cases sexually suggestive, and certain modern forms of + dancing. There appears some grounds to suppose that dances + conducted under undesirable conditions contribute to sexual + immorality, but the Committee see no reason to condemn dancing + generally because the coincident conditions under which it has been + or is conducted in some cases have contributed to impropriety. The + cinema was stated by some witnesses to have an immoral tendency + both in the nature of the pictures presented and in the conditions + under which they are viewed by the audience. The Committee suggest + that a stricter censorship might with advantage be exercised, and + should include the posters advertising the films.</p></div> + +<p>It has been stated that venereal disease has increased in New Zealand +with the return of the Expeditionary Force from overseas. Ample +evidence, however, was given to the Committee that there has been no +increase of the disease due to returned soldiers. These men were treated +prior to their discharge until non-infective.</p> + + + +<hr style="width: 65%;" /> +<h3><a name="PART_III_BEST_MEANS_OF_COMBATING_AND_PREVENTING_VENEREAL_DISEASE" id="PART_III_BEST_MEANS_OF_COMBATING_AND_PREVENTING_VENEREAL_DISEASE"> </a>PART III.—BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASE.</h3> + + +<p><br /><a name="Link08" id="Link08"></a><span class="smcap">Section 1.—Education and Moral Control.</span></p> + +<p>There is no question that the most effective way of avoiding venereal +disease is to refrain from promiscuous sexual intercourse. The problem +which the Committee have been asked to consider has very important +medical aspects, but, while these must not be neglected, it is essential +to the health and well-being of the nation that the enemy should be +attacked with every moral and spiritual weapon:—</p> + +<p> +<span style="margin-left: 2em;">Self reverence, self-knowledge, self-control,—</span><br /> +<span style="margin-left: 2em;">These three alone lead life to sovereign power.</span><br /> +</p> + +<p>The absence of proper training and instruction of the young is +undoubtedly responsible for a great deal of the evil which has been +shown to exist. Children are led into bad habits through ignorance, and +young men and young women grow up with utterly false ideals of life, and +in many cases fall into deplorable laxity of conduct.</p> + +<p>There is an impression among many young men that chastity is either +impossible or at least is inconsistent with physical health. There is +the highest medical authority for stating that this notion is absolutely +wrong, while there is no difference of opinion whatever as to the +serious risks of contracting diseases of a very loathsome character +incurred by those who do not restrain their passions. Apart from this +aspect of the question, it must be obvious to every thinking person that +looseness of conduct between the sexes such as is shown to exist in New +Zealand is destructive to the high ideals of family life associated with +the finest types of British manhood and womanhood, and if not checked +must lead to the decadence of the nation.</p> + +<p>A sounder state of public opinion needs to be cultivated. The moral +stigma at present attached to sufferers from venereal disease should +rest upon all who sacrifice to their own selfish passions the<a name="Page_13" id="Page_13"></a> +chivalrous relations which should subsist between the sexes. Those who +are unfortunate enough to contract disease incur a punishment so +terrible that they deserve our pity and our succour, always provided +that they seek skilled treatment and refrain from any conduct likely to +communicate the disease to others. The man or woman who negligently or +wilfully does anything likely to lead to the infection of any other +person is a criminal, and should be treated as such.</p> + +<p>To bring about this healthier state of public opinion much might be done +by the various Churches, by the Press, and by all who are in a position +to influence the thoughts of others. It is a duty which should be shared +by all—it cannot be left entirely to the Government, to Parliament, or +to the medical profession. If a healthier atmosphere were created for +the proper consideration of this subject, instead of the unwholesome fog +of prudery in which it has been enveloped in the past, a great deal will +have been gained.</p> + +<p>One result of the mistaken policy of reticence which has prevailed is to +be seen in the fact, already mentioned, that children are allowed to +grow up either in ignorance of sex physiology or with perverted ideas +due to the want of proper instruction. Nearly every witness who spoke on +the subject before the Committee agreed that such instruction would come +best from the parents, but there is also practical unanimity among those +who gave evidence that very few parents are capable of giving such +instruction in the right way, and the vast majority are unwilling to +attempt it. In these circumstances our chief hope for the future seems +to lie in an endeavour to educate the children in such a way that they, +the parents of the future, may be enabled to deal justly with their own +children in this vital matter. Nevertheless, the Committee would be +failing in their duty did they not point out that all parents have a +serious responsibility to their children which they cannot evade without +laying themselves open to grave reproach. It is probable, as one of the +witnesses remarked, that "nothing they could do for their children's +happiness in life would be of equal value to the outlook which they +might give to their children upon this matter. Apart from any +possibility of moral ruin or disease, such an outlook would colour the +whole mature life of their children in respect to what is probably the +foundation of the greatest human happiness—namely, home relationship."</p> + +<p>The Committee recommend that the Department of Health be asked to +prepare a suitable pamphlet to assist those parents who desire to +instruct their boys and girls on this subject. It is also suggested that +where parents feel themselves unable to undertake the necessary +instruction, the family doctor should be asked to talk to the boys. +Instruction to the girls should certainly come from the mother, but +failing this a little wise counsel and advice from a woman doctor should +be secured.</p> + +<p>In regard to the teaching of sex hygiene in schools some interesting +evidence was given to the Committee by Mr. Caughley, Director of +Education, Mr. T.R. Cresswell, Principal of the Wellington College +(speaking on behalf of the Secondary Schools Association), and by some +of the women doctors and others who were good enough to attend as +witnesses.</p> + +<p>Mr. Caughley stresses the point that it is not mere knowledge of +physiology that will meet the case. He considers that the most important +thing of all is to establish in the minds of the children noble ideals +with regard to infanthood and motherhood. Lessons in connection with the +care of all birds and animals for their young, with the love and +devotion of parents for their young, with all that is beautiful and +tender connected with the homes of animals and birds, would establish a +kind of reverence about everything that is connected with birth. He +deprecates mechanical, systematic, and consecutive instruction in the +mere facts of sex hygiene, for even the fullest knowledge on this +subject is known to have very little deterrent effect in the temptations +of life. He would rather aim at creating the right atmosphere in a +school, such as would make any coarse or unworthy mention of any of +these matters in the hearing of a child appear more or less repulsive, +and would in general enable him to put in its proper setting any +knowledge that might come to him from various sources.</p> + +<p>Mr. Cresswell gave the Committee an extremely interesting <i>résumé</i> of +the answers to a <i>questionnaire</i> which he addressed to the head of every +secondary school in the Dominion. He suggested—(1) That a determined +public effort should be made to rouse parents to a sense of their +responsibility in regard to this matter by means of broadcasted +pamphlets, and that they should be furnished with simple, specially +written leaflets to assist them in giving instruction to their children; +(2) that sex hygiene be made a compulsory subject in all +training-colleges, the instructors being specially qualified doctors; +(3) that regular courses of public lectures be delivered in suitable +centres; (4) that teachers, and especially physical instructors, be +encouraged to stress the value of physical fitness to pupils +collectively, and, where need is indicated, to have private talks with +individuals; (5) that teachers be advised to take every opportunity +during lessons in hygiene, physiology, botany, &c., to give children a +sane and normal outlook on sex matters.</p> + +<p>Incidentally it was suggested that girls' schools suffer somewhat +through being staffed almost exclusively by celibate teachers. "The +knowledge and sympathy of a real mother would," it was urged, "be +invaluable to many girls in our secondary schools. Does it seem a +trivial suggestion that in every girls' school there should be one +honoured official, the 'school mother,' a sympathetic motherly person +whose duty it should be to get into personal touch not only with +individual girls but also with individual parents?"</p> + +<p>The views expressed by the Swedish Committee of Experts in Medicine and +Pedagogy are well worthy of quotation: "It is illustrative of the broad +view taken by the committee of their task," says the <i>British Medical +Journal</i>, "that they deal with the education of the child from the time +it learns to speak and address inquiries as to how it came into the +world. The committee look forward to the time when parents will be so +enlightened that they will not tell their children silly stories about +babies being brought into the home by storks, but will give a simple +account which the child in later years will not discover to be +mendacious. The committee hope that the child, who is gradually taught +more and more about sex hygiene as it passes from one school grade to +another, will eventually become a parent wise enough to instil in the +next generation a frank and healthy<a name="Page_14" id="Page_14"></a> attitude towards sex problems. +Parents, it is hoped, will learn to protect their infants from the +undesirable caresses and kisses of strangers ... As for sex teaching in +school, this should be associated with the teaching of biology, +Christianity, sociology, and psychology. The question of venereal +disease should not come into the curriculum until comparatively late, +and until the physiology of fertilization and reproduction has been +fully taught. Advanced sex teaching should preferably be in the hands of +doctors; but they are not always available, in which case other teachers +should give instruction on this subject, male teachers dealing with boys +and female teachers with girls. Teaching of sex hygiene in high schools +for girls should include the subject of venereal disease, and special +emphasis should be laid on the protection of infants from infection. A +further recommendation is that a carefully supervised library of works +on sex hygiene and venereal disease should be compiled at the cost of +the State for the use of teachers and classes."</p> + +<p>The Committee of the Board of Health agree with the suggestion that +teachers should be trained to deal with this question, and that school +medical officers or other qualified practitioners should give occasional +"talks" to the elder boys and girls. A great deal may be done by +physical instructors preaching the gospel of "physical fitness" and +personal cleanliness in thought, word, and deed. Bathing and outdoor +sports and games of all kinds should be encouraged. The Committee would +point out, however, that not all teachers and not all medical men +possess the qualities fitting them to give instruction and advice in +this delicate matter. The task should be entrusted to those who have +shown themselves specially adapted by sympathy and tactfulness for the +work, and preferably those who are parents, otherwise harm instead of +good may result.</p> + +<p>More than one witness spoke with approval of "The Cradleship" and other +books by Miss Edith Howes as suitable for use with young children.</p> + +<p>The Committee are of opinion that addresses on sex questions by lay +persons, except selected teachers, to young people in mass are of +doubtful value.</p> + +<p>Sufficient instruction should be given to adolescents regarding venereal +diseases and their effects to ensure that if they do contract them it +shall not be through ignorance. The Committee cannot too strongly +emphasize their belief, however, that knowledge of the effects of +venereal diseases is in itself by no means a sufficient safeguard; that +in addition to such knowledge the cultivation of a high moral standard +is necessary, and if this is reinforced by religious sanctions it is +likely to be more effective.</p> + +<p>The Committee agree with the view expressed by Dr. E.T.R. Clarkson in a +recent text-book, entitled "The Venereal Clinic," that in many instances +an excessive stress has been placed upon the factor of fear. He says +that a very small proportion of the community are restrained from +indulging in promiscuous sexual intercourse through fear, and it is +irrational to rely so much upon an emotion which at the best is but +slightly inhibitory, and which cannot in itself exercise a direct +energizing influence for good. "We do not," he continues, "wish to deter +the community from living a life of sexual promiscuity by rendering them +fearful of the possibilities of acquiring venereal disease, but we want +rather to instil such an ideal into them, whether it be of a religious, +ethical, or altruistic nature, as will tend to make them regard such a +life as incongruous with those tenets and therefore as undesirable, +however much it may be desired on other grounds." He adds that the +emphatic reiteration of fear possesses another and dangerous +disadvantage. "There is no doubt, as venereologists will testify, that +many individuals are seriously suffering from the effects of fear thus +engendered in their minds. In some instances the resultant damage to +their mentality is more serious than the venereal disease from which +they are suffering: whilst in others an obsession that they are +infected, when there is no foundation for the fear, may develop in such +a manner as to inflict serious and permanent damage."</p> + + +<p><br /><a name="Link09" id="Link09"></a><span class="smcap">Section 2.—Clinics for the Treatment of Venereal Disease.</span></p> + +<p>Early in 1919 clinics for the treatment of venereal disease were +established in each of the four main centres. Arrangements were made by +the Department of Health for the treatment by Hospital Boards throughout +the Dominion of cases of venereal disease, and in the absence of local +institutions arrangements were made with private practitioners. There is +therefore opportunity for all to receive free treatment, wherever they +may be, in New Zealand.</p> + +<p>Table B sets out the work done at the four clinics during the two and a +half years ended 30th June, 1922. From this table it will be seen that +3,038 males and 596 females attended these clinics during the period +named. The total number of attendances was 110,792—101,995 males and +8,797 females. The disproportion between the number of males and females +attending is notable. It is clear from the evidence that this does not +represent a difference in the incidence of these diseases in the sexes, +but that women do not attend so freely when suffering.</p> + +<p>These clinics are attached to the public hospitals in each centre, and +all evidence goes to show that this is most desirable. If the clinics +were apart, the object of the patients' visits would be obvious, whereas +the actual purpose for which they go to a hospital is not so. It is to +be strongly emphasized that the less publicity given to the attendance +of these patients, the greater the number of patients who will be likely +to take advantage of the treatment offered. This applies especially to +the attendance of women.</p> + +<p>The clinics are now open only at certain hours. The Committee suggest +that they might with advantage remain open continuously (except at +certain fixed hours on Sunday). In the absence of the Medical Officer a +sister could take charge of the women's clinic, and a trained orderly of +the men's clinic. It would be necessary in this case to have separate +clinics for male and female patients—the same rooms would not be +available for both sexes.</p> + +<p>The majority of witnesses asked were of opinion that if a lady doctor +were made available for the treatment of women the number of women +attending would increase.</p> + +<p><a name="Page_15" id="Page_15"></a>It is suggested that in certain cases of gonorrhœa, where it is an +advantage that the treatment should be carried out twice or more often +daily, arrangements might he made for the supply of the necessary +apparatus and drugs to patients at cost price, and in indigent cases +free of charge. This is particularly important to women who may have to +continue treatment for several months.</p> + +<p>The clinics should be more widely advertised by notices in public +conveniences and other suitable places.</p> + +<p>The Committee are impressed with the valuable work done at these +clinics, and recommend their extension to other centres as opportunity +offers and necessity is shown to exist.</p> + +<p>The existing clinics are conducted by medical men who have had special +experience and training in the treatment of these diseases. The Dunedin +clinic is attended by medical students for purposes of instruction. In +view of recent advances in the processes of diagnosis and treatment of +these diseases, the Committee consider that opportunity should be given +to medical practitioners to attend these clinics in order to familiarize +themselves with the most recent advances in this field. It would he an +advantage also if nurses in the course of their training attended the +female clinics, so that they might he taught to recognize the commoner +manifestations of these diseases.</p> + +<p>The most disappointing feature in the records of the clinics is the +cessation of treatment by so many patients before they have ceased to be +infective. The following evidence was given in this connection:—</p> + +<p><i>Percentage of Cases attending till Non-infective.</i> Auckland Clinic: 80 +per cent. cases of syphilis, 50 per cent. cases of gonorrhœa. It was +stated that no woman suffering from gonorrhœa continued treatment till +non-infective.</p> + +<p>Wellington Clinic: 40 per cent. of all cases continued treatment till +non-infective, and very few of these were women.</p> + +<p>Christchurch Clinic: Men with syphilis, 75 per cent.: men with +gonorrhœa, 98 per cent.: women with syphilis, 50 per cent.: women with +gonorrhœa, 14 per cent.</p> + +<p>Dunedin Clinic: In this clinic only thirty-one males suffering from +gonorrhœa were discharged cured: thirty-two absented themselves while +still infective; three female cases remained under treatment till cured, +and six ceased to attend while still infective. Forty male syphilitics +remained till non-infective, and seventy-four ceased treatment before it +was completed. For female syphilitics the figures are four and eighteen.</p> + +<p>It will be noted that in each case the proportion of women who attend +till non-infective is much smaller than of men, especially in cases of +gonorrhœa. The reasons for this are probably that owing to anatomical +considerations women infected with venereal disease suffer less pain and +the disease is less obvious than in men. On cessation of the more urgent +and obvious signs and symptoms they stop treatment. Again, it is +probable that the publicity of attending the clinics is felt more by +women than men. A third reason is the prolonged period of treatment +(often extending over many months) necessary to eradicate gonorrhœa in +women. These difficulties could to some extent be mitigated by the +provision of arrangements for women to carry out treatment in their +homes, which would avoid the publicity and loss of time entailed in +attending clinics.</p> + +<p>The Committee were impressed with the value of the work done by the lady +patrol in Christchurch, and considers that lady patrols would help +greatly in securing the attendance of women at the clinics. It is +recommended that these patrols should be attached to the Hospital Boards +and that they should be trained nurses. They would be available to give +advice to patients as to treatment in their homes.</p> + +<p>The Committee would also draw attention to the very valuable work done +by the Social Hygiene Society in Christchurch, and recommended the +establishment of similar voluntary societies in other centres.</p> + +<p>The Committee recommend that all bacteriological and other examinations +required for the diagnosis and treatment of cases of venereal diseases +should be carried out in laboratories of the Department of Health and +public hospitals free of cost, on the recommendation of medical +practitioners.</p> + +<p>The Committee made inquiries from competent witnesses as to the present +position of the complement fixation test in gonorrhœa. It appears that +this test has not reached yet such a degree of reliability as to render +it of great diagnostic value, but that it is reasonable to hope that it +may be perfected to such an extent to give it a value in the diagnosis +of gonorrhœa comparable to that of the Wassermann test in syphilis.</p> + + +<p><br /><a name="Link10" id="Link10"></a><span class="smcap">Section 3.—Licensed Brothels.</span></p> + +<p>Inasmuch as one of the many letters addressed to the Committee favoured +the adoption of the Continental system of licensed houses of +prostitution, with medical inspection of the inmates, it seems desirable +to examine the arguments for and against such a proposal. Those who +support it contend that so long as human nature remains as it is +prostitution will continue, therefore it is better that it should be +regulated with a view to controlling the spread of disease. It is also +urged that the system acts as a safeguard against sexual perversion by +providing an outlet for the unrestricted appetites of men; that in its +absence clandestine prostitution increases, and innocent girls are more +likely to be led astray or become the victims of sexual violence. Apart +from the moral aspect of the case, these arguments are entirely +fallacious; and even in the countries where the licensed-house system +prevails enlightened public opinion has come to that conclusion. In the +first place, the idea that the system tends to lessen disease is a +dangerous delusion. Owing to the fact, already referred to, that +venereal disease in the early stages is difficult to detect in women, +even by skilled experts working with the best methods and with +practically unlimited time at their disposal, the routine inspection +given, for example, in the French and German houses is no guarantee of +the inmates being free from communicable disease even at the time of +inspection.</p> + +<p>Flexner, who spent two years in making inquiries and writing his classic +work on "Prostitution in Europe," is most emphatic on this point. The +experience of the American troops in the Great War<a name="Page_16" id="Page_16"></a> is further strong +confirmation. The following is an extract from an article published by +the American Red Cross in May, 1918: "During the months of August, +September, October, and the first half of November, the houses of +prostitution flourished and were half-filled with soldiers. On November +15th rigid orders were issued placing these houses out of bounds, and +the immediate result was a great reduction of sexual contacts. As a +result there was a steady decline in venereal infections, and the +monthly rate per 1,000, which in October reached 16.8, dropped in +January to 2.1 among the white troops. During the same period there was +an even more striking drop in the infections among the negro labourers, +the percentage dropping from 108.7 per 1,000 a month to 11 per 1,000. No +statistics could speak more eloquently for the doctrine of closing the +houses of prostitution. Our studies showed numerous infections coming +from houses 'inspected' three times a week."</p> + +<p>In May, 1921, a conference (the North European Conference on Venereal +Diseases), in which England, Finland, Germany, Holland, Norway, Sweden, +and Denmark participated, passed the following resolution: "This +conference, having considered the general measures for the combating of +venereal diseases which have been adopted by the participating +countries, is unanimously of the opinion, so far as the experience of +these countries is concerned, that the legal and official toleration of +professional prostitution has been found to be medically useless as a +check on the spread of venereal diseases, and may even prove positively +harmful, tending as it does to give official sanction to a vicious +trade."</p> + +<p>On the same point Flexner says: "It is a truism that physicians +requiring to equip themselves as specialists in venereal disease resort +to the crowded clinics of Paris, Vienna, and Berlin, all regulated +towns, because there disease is found in greatest abundance and richest +variety—a strange comment on the alleged efficacy of regulation."</p> + +<p>Dr. Clarkson, in "The Venereal Clinic," already quoted, says, in +reference to the fancied security of licensed houses, "It may strengthen +the hands of practitioners to be able to tell interrogators in this +subject that in the opinion of leading venereologists, &c., no +foundation exists for any such feeling of confidence or security. In +other words, the system of licensed houses is a failure, and the 'red +light' of lust shines out as the lurid signal of disease and death."</p> + +<p>It is surely hardly necessary to urge the moral objections to the +proposal. The United States Public Health Service not long ago sent out +a <i>questionnaire</i> to representative citizens in various walks of life +asking for opinion in regard to open houses of prostitution. There was +an overwhelming preponderance of replies against the system on moral as +well as hygienic grounds. One Illinois miner answered: "The life of a +prostitute is short, and her place must be filled when she dies, and, +being the father of two girls, I would not want mine to fill a vacancy, +and I think all parents think the same." A Colorado carpenter replied: +"The woman engaged in such business may not be my wife, mother, sister, +or daughter, but she is somebody's wife, mother, sister, or daughter. It +is a violation of all law." One Chief of Police wrote: "Open houses of +prostitution breed disease, crime, increase the number of prostitutes, +corrupt the morals of the community, and are a menace to the youth of +the country." Another replied: "The only reason I have ever heard +advanced in favour of houses of prostitution is that they protect +innocent girls. I am opposed to sacrificing any woman to benefit +others."</p> + +<p>If statistics could be obtained it would be probably found that the +system tends not only to increase disease, but the volume of sexual +immorality and crime. From the most materialistic point of view the +system is indefensible; while, looking at it from the moral aspect, it +is inconceivable that British people, who spent millions of money to +stop the traffic in black slaves, would ever officially countenance a +system which enslaves the souls as well as the bodies of its victims and +defiles the community in which it exists.</p> + + +<p><br /><a name="Link11" id="Link11"></a><span class="smcap">Section 4.—Exclusion of Venereal Cases from Overseas.</span></p> + +<p>The Committee are of the opinion that by the strict exercise of the +provisions of section 111 of the Health Act, 1920, much may be done to +prevent introduction of venereal diseases from overseas. They suggest, +however, that where any person so suffering is required or permitted to +attend a clinic he should be accompanied by some responsible officer of +the ship, or person authorized by the shipping company concerned, and +that the question on the "Report of Master of the Ship" defined by +regulations—"Are you aware of the presence on board of any person +suffering from ... <i>(b)</i> venereal disease?"—might be strengthened by +adopting the Australian quarantine service equivalent viz., "Is there +now or has there been on board during the voyage any person suffering +from demonstrable syphilis in an active condition, or other communicable +disease?"</p> + +<p>The evidence given does not show that the number of venereal-diseases +cases already in the Dominion is greatly added to by the introduction of +cases from overseas. Since 1903 persons suffering from syphilis have +been "prohibited immigrants" within the meaning of the Immigration +Restriction Act.</p> + + +<p><br /><a name="Link12" id="Link12"></a><span class="smcap">Section 5.—Prophylaxis.</span></p> + +<p>Before discussing this question it is desirable clearly to distinguish +between the procedures which are included under this term. These are—</p> + +<div class="blockquot"><p>(1.) The supply of drugs and appliances which are made available + for use by the individual before exposure to infection. This may be + described as "anticipatory prophylaxis," and has commonly been + designated the "packet system."</p> + +<p> The Committee condemn this procedure, for these reasons: (i) That + the system suggests a moral sanction to vice; (ii) that the + individual is lulled into a false sense of security, and may + thereby be encouraged repeatedly to expose himself to infection; + (iii) that the individual may be thereby deterred from seeking + early advice or treatment; (iv) that the drugs supplied may be used + for treating disease should it arise, and so delay may result in + seeking skilled treatment in the early stages when it is likely to + be most effective.</p> + +<p> <a name="Page_17" id="Page_17"></a>(2.) Treatment applied after exposure to infection. This is called + "early treatment." This term is inapplicable, as a disease cannot + be treated before it exists. It is also likely to be confused with + "abortive treatment," which implies treatment immediately on the + appearance of symptoms.</p> + +<p> The evidence before the Committee shows that this form of + prophylaxis, if applied by skilled persons and within a few hours + of exposure, is effective in preventing disease in a great majority + of the cases in which it is used.</p></div> + +<p>The Inter-departmental Committee on Infectious Diseases set up by the +Ministry of Health in 1919 in connection with demobilization, in a note +on "Prophylaxis against venereal disease," reported among its +conclusions based on service experience, "That where preventive +treatment is provided by a skilled attendant after exposure to infection +the results are better than when the same measures are taken by the +individual affected, even after the most careful instruction." After +exposure to infection there appears no reason why these diseases should +not be regarded in precisely the same manner as other infectious +diseases, and precautions taken to sterilize the parts which have been +exposed to infection.</p> + +<p>It is to be noted that it is recommended that the prophylactic treatment +is to be carried out by some properly instructed person. This need not +necessarily be a medical man. It is suggested that this form of +prophylaxis might be carried out by an orderly at the venereal-disease +clinics. The notices posted in the public conveniences and other +suitable places indicating the existence of the clinics and the +necessity for treatment might include a guarded reference to their use +for this purpose.</p> + +<p>This form of prophylaxis applies to males. In the case of females the +methods adopted would be also contraceptive, and the Committee do not +recommend that facilities should be provided for this.</p> + +<p>The Committee must not be supposed to advocate prophylaxis as in any way +a substitute for continence and the cultivation of that high moral tone +that repels any suggestion of promiscuous sexual relationships, but they +feel that they could not properly ignore reference to a method of +prevention of these diseases which has proved very efficient in the +services, to which there appears no reasonable ethical objection, and +which brings their prophylaxis into line with that of other infectious +diseases.</p> + + +<p><br /><a name="Link13" id="Link13"></a><span class="smcap">Section 6.—Legislation Required.</span></p> + +<p>(A.) <i>Conditional Notification.</i></p> + +<p>The only subjects of importance upon which the witnesses examined +differed materially in opinion were—(1) whether there ought to be any +system of notification of cases of venereal disease, and (2) what steps, +if any, should be taken to deal with persons suffering from such disease +in a communicable form who refused to be treated, and in some cases were +even known to be spreading the disease broadcast. Ladies who attended to +give evidence on behalf of the National Council of Women and one or two +other women's organizations objected to notification and compulsory +treatment. They argued that there was at present a "scare" on the +subject of venereal disease, and deprecated "panic legislation." They +contended that the adoption of notification would deter patients from +seeking treatment for fear of publicity. They were opposed to compulsory +treatment of recalcitrant patients, arguing that any law of the kind +would be used most oppressively against women. They contended that +reliance should be placed on greater facilities for free treatment at +the clinics, the work of women patrols, suppression of liquor, and above +all education and propaganda on moral lines.</p> + +<p>When confronted with typical cases of difficulty already quoted some of +the witnesses admitted that it was not easy to see how such cases could +be dealt with satisfactorily without compulsion of some kind. But they +argued that, even so, it would be a greater evil if the fear of +publicity and the fear of compulsion should have the effect of deterring +sufferers from seeking treatment and so drive the disease underground.</p> + +<p>The National Council of Women, by a substantial majority, at a recent +conference in Christchurch, carried a resolution protesting against a +proposal to introduce compulsory notification and treatment of venereal +diseases, and urging the Government to increase the facilities for free +treatment. The President of the Council, however, informed the Committee +that most of the nineteen societies affiliated to the Auckland Branch of +the National Council are in favour of some form of compulsion, but a +number of the southern branches are opposed to it. Speaking as an +individual, and not as President of the National Council of Women, she +added:</p> + +<p>"Personally, I have no first-hand knowledge as to whether the disease is +so prevalent in the community as to demand urgent measures, but there is +an opinion among women social workers and medical practitioners, whom I +have consulted, that something should be done, and they are in favour of +compulsion under the Act, provided its administration is satisfactory. +There is no doubt that there is a genuine and widespread fear among a +large number of women that, although in the Act itself there is no +discrimination between men and women, in actual practice there will be, +and they fear that the Act will be enforced against women, and +particularly immoral women, while the men concerned will be allowed to +go free. This fear arises partly from the remembrance, particularly +among elderly women, of the old Contagious Diseases Acts, both here and +in England, and partly from the reports of the working of compulsion in +Western Australia and elsewhere. I am of opinion that there is no +serious ground for fear in view of the changed attitude in the public +mind in connection with these diseases, the fuller knowledge that people +generally have, and the high status of women in our country; also the +ready access that all persons have to the protection of the law and the +Courts in the event of false information being given, and the safeguards +embodied in the Bill as I understand it is drafted. My view is that the +objection to the compulsory clauses of the Bill would be removed in the +opinion of many women if women patrols or women police were appointed, +so that the administration of the Act in its compulsory clauses wherever +it treated women could be in the hands of those women officers."</p> + +<p><a name="Page_18" id="Page_18"></a>Among the witnesses questioned on this subject there was an overwhelming +preponderance of opinion that the time had now arrived for the adoption +of notification of all cases of venereal disease by number or symbol, if +only for the purpose of getting more accurate statistics; the +notification by name of those recalcitrant patients who refused to +continue treatment until cured; and compulsory examination of those whom +the Director-General of Health had good grounds for believing to be +suffering from the disease and likely to communicate it to others, and +who refused to produce a medical certificate as to their condition. Only +three medical men expressed themselves as being against these proposals. +On the other hand, the lady doctors examined (two of them members of the +National Council of Women, and the third representing the Young Women's +Christian Association) gave evidence in favour of conditional +notification, and compulsory examination, and compulsory treatment of +recalcitrants. It should be added that all the witnesses who were +engaged in rescue work, or other work bringing them face to face with +the horrors of venereal disease, were most emphatic in their opinion +that compulsory notification and treatment should be adopted.</p> + +<p>It is noteworthy that when the notification of ordinary infectious +disease was first proposed in England almost exactly the same arguments +were brought against the proposal as are now advanced against the +notification of venereal disease. Sir W. Foster, member for Ilkeston, +and a medical man of standing, speaking in the House of Commons in the +debate on the Infectious Diseases Notification Bill, on the 31st July, +1889, said,</p> + +<p>"The Bill calls upon medical men to perform something more than the +ordinary duties of citizenship by requiring them to become informers of +the occurrence of diseases. The relation of a medical men to his patient +ought to be one of complete confidence, and anything that comes to the +knowledge of a medical man in the practice of his profession is +practically an inviolable secret; and I do not like any Bill to +interfere with that relationship. I know myself that one of the results +of this Bill, if passed into law, will be that in scores of cases +medical men will not be called in to attend people suffering from +infectious diseases ... I admit the difficulty of the position, but I am +anxious that no measure should pass into law which will induce the +public to keep these diseases more secret than they have been in the +past, with the risk of adding to the spreading of them. We must be very +cautious not to do anything which will prevent the public from placing +full and implicit confidence in their medical man. I can quite conceive +it to be possible that, if an outbreak of infectious disease occurs in a +populous part of London, the people may, in order to prevent exposure, +refuse to allow a medical man to come in, and in such cases we shall +have tenfold more difficulty than at present. Therefore, while I am +anxious to promote the notification of disease, I do not want the +Government to promote rebellion on the part of the public."</p> + +<p>Needless to say, these gloomy anticipations have not been realized. +Probably the more enlightened generations to succeed us will wonder how +there could ever have been any opposition to the notification of +venereal disease, just as we to-day read Sir W. Foster's words and +marvel that any person of intelligence could have committed himself to +such statements.</p> + +<p>Notification of infectious diseases and isolation of patients suffering +from such diseases have for many years been compulsory. Isolation, when +spoken of by opponents to a similar measure for venereal diseases, is +opprobriously described as "compulsory detention." For twenty years it +has been the law in New Zealand that an authorized medical practitioner +may examine any person suspected to be suffering from any infectious +diseases (save venereal diseases), and the Medical Officer of Health +may, if he deems it expedient in the interests of the public health, +compel the removal to a hospital of any person so suffering. This +long-established procedure as referable to venereal diseases is by +antagonists termed "compulsory examination" and "compulsory removal."</p> + +<p>It is contended by some witnesses that notification will drive these +diseases underground; but syphilis and gonorrhœa for generations past +have been underground.</p> + +<p>Under the present system numbers of unfortunate persons either delay +calling in medical assistance until the case has become almost desperate +so far as the patient is concerned, or they resort to unqualified +persons, with the result that in most cases what was in the first +instance a simple attack, capable of treatment, results in serious +complications most difficult to deal with. In either case the patient +may be communicating diseases to others, and should this come to the +knowledge of the Health Department it has no effective means of checking +him—no power to warn those who are being endangered by his criminal +neglect.</p> + +<p>The Committee think there is some force in the argument that +notification by name, in the first instance, as in the case of ordinary +infectious diseases, would tend to discourage some from coming forward +for medical treatment. They recommend, therefore, the adoption of what +is known as the system of conditional notification embodied in the West +Australia Act. Under this plan the cases are notified by the doctor to +the Health Department by number or symbol only. The name is not sent in +unless the patient discontinues treatment before he is free from +infection and refuses either to go to a clinic or to another doctor. In +cases of those who "play the game," the name of the patient is kept +confidential, and does not pass beyond the medical man attending him. It +is only in cases of those who contumaciously refuse to do what is +necessary for their own safety and the safety of others that the name is +sent to the Health Department, in order that appropriate steps may be +taken in the interests of public health. Even then the name is given +only to officers who are pledged to keep it confidential.</p> + +<p>Following are the clauses in suggestions for a Bill, drawn up by the +Health Department, which in the opinion of the Committee should in +substance be adopted:—-</p> + +<div class="blockquot"><p>"(1.) Every medical practitioner shall forthwith give notice to the + Director-General of Health, in the prescribed form, upon becoming + aware that any person attended or treated by him is suffering from + any venereal disease in a communicable form. The notice shall state + the age and sex and occupation of the patient and the nature of the + disease, but shall omit the patient's name and address.</p> + +<p> "<a name="Page_19" id="Page_19"></a>(2.) Every medical practitioner, other than the medical officer in + charge of a public hospital or of a clinic established by direction + of the Minister of Health, shall be paid for each such notification + a fee to be prescribed by regulation.</p> + +<p> "(3.) The provisions of subsection (1) hereof shall apply in the + case of a child under the age of sixteen years who is suffering + from congenital syphilis.</p> + +<p> "(4.) Whenever a patient has changed his medical adviser, in + accordance with subsection (2) hereof, the medical practitioner + under whose care the patient has placed himself shall notify the + Director-General of Health in accordance with subsection (1) + hereof, and shall include in such notice the name and address of + the previous medical adviser."</p></div> + +<p>Without some such system of preliminary notification no adequate +statistics can be collected as to the prevalence of venereal diseases in +New Zealand, and no conclusion could be arrived at in the future as to +the effect of the whole or any part of the programme for combating these +scourges. Again, without such notification, and the attachment thereto +of some method of ensuring that the patient is made definitely +acquainted with his condition, it is practically impossible to enforce +the provisions of section 8 of the Social Hygiene Act for the crime of +"knowingly" infecting any other person.</p> + +<p>Here the Committee would refer to case 2 quoted above. Of what use is it +to provide free clinics if those who make use of them are permitted, as +soon as the urgent symptoms are relieved, to disseminate disease +broadcast, widening the circle of infection? Again, where is our +humanity if no step is to be taken to try to prevent a syphilitic child +being born to the man in case 1?</p> + +<p>A very valuable result of anonymous notification would be the +possibility afforded of observing any unusual "flare-up" or succession +of cases, especially in country districts and small towns. Study of case +4 will show the great value it would have been to have a record of an +unusual increase of syphilis in that township, giving an opportunity for +prompt investigation by the Medical Officer of Health for the district.</p> + +<p>(B.) <i>Compulsory Examination and Treatment.</i></p> + +<p>This question obviously presents more difficulty than that of +notification, but it is clear that unless some means are provided of +bringing under treatment and, if necessary, isolating persons who are +suffering from highly contagious diseases, and who will not avail +themselves of medical treatment although this is provided free of cost +by the State, and who are knowingly or recklessly communicating the +disease to others, it will be impossible to keep in check this terrible +scourge. Without such provision any abandoned woman, as in case 4, or +any male libertine, may continue to sow disease broadcast without any +power to stop them. Failing some such measure, table articles and food +may continue to be smeared by hands soiled with syphilitic material, as +in case 1; section 6 of the Social Hygiene Act remains mere useless +verbiage, and the infecting of innocents, as in case 3, may continue +unchecked.</p> + +<p>Legislation dealing with this subject needs to be carefully framed with +suitable safeguards, but the Committee think that an amendment of the +Social Hygiene Act on the lines proposed by the Department of Health +should be adopted. These provisions are:—</p> + +<div class="blockquot"><p>(1.) That whenever the Director-General of Health has reason to + believe that any person is suffering from venereal disease, and has + infected or is liable to infect other persons, he may give notice + in writing to such person directing him to consult a medical + practitioner, and to produce within a time specified in the notice + a certificate from such medical practitioner to the satisfaction of + the Director-General of Health that such person is or is not + suffering from venereal disease.</p> + +<p> (2.) Should the person not comply with this request, the + Director-General of Health may obtain a warrant from a Magistrate + ordering such person to undergo examination to prove the existence, + or non-existence, of venereal disease.</p> + +<p> (3.) Making it possible for a Magistrate, on the application of the + Director-General of Health, to order the detention in a hospital or + other approved place of a person who is likely to be a danger to + other persons until that person is cured of venereal disease.</p></div> + +<p>These provisions are applicable equally to both sexes, and the Committee +see no reason to fear that the law would not be carefully and +impartially administered. If it should appear that more women than men +came under the operation of the law this result would be due to the fact +that, as disclosed in the evidence, a much larger proportion of women +than men fail to seek treatment, and of those treated a much larger +proportion of women fail to continue treatment until no longer +infectious.</p> + +<p>It is hardly conceivable that a responsible officer, such as the +Director-General of Health, would take action under these provisions +unless he had strong reason to believe that such action was justified. +But, even if he makes a mistake or is misinformed, the worst that can +happen to an innocent person wrongfully suspected is that he or she will +be required to produce a medical certificate, which can be procured free +of cost from any hospital or V.D. clinic. This is wholly different from +the provisions of the Contagious Diseases Act, under which a woman +suspected of prostitution was liable to be arrested by a constable in +the street.</p> + +<p>The Committee recommend that the serving of notices, &c., under these +sections be done by officers of the Health Department and not by the +police. They also recommend that all proceedings taken under any Act +having reference to venereal diseases should be heard in private unless +the defendant applies for a hearing in open Court.</p> + +<p>With regard to the effects of the actual operation of notification, +examination, and isolation, the Commissioner of Public Health for West +Australia, under date 25th August, 1922, advises the Committee that +there is an increase in the number of cases attending public clinics, +and that this is regarded not as evidence of increased incidence, but of +increased interest and appreciation of early treatment by those +suffering from the diseases.</p> + + +<p><a name="Page_20" id="Page_20"></a><br /> +<a name="Link14" id="Link14"></a><span class="smcap">Section 7.—Marriage Certificate Of Health.</span></p> + +<p>The Royal Commission on Venereal Disease reported that there was a vast +amount of ignorance as to the dangers arising from the sexual +intercourse of married persons one of whom had previously to the +marriage contracted syphilis or gonorrhœa. The effect upon the +birth-rate, and the misery caused during married life, and in many cases +to the offspring who survive, as they pointed out, are most serious, and +the fact that the actual cause of the trouble often remains unknown and +unrecognized prevents the calamity from serving the purpose of example +or warning.</p> + +<p>Some of the witnesses heard before the present Committee have urged that +a certificate of good health, or at least a certificate of freedom from +communicable disease, should be required from each party to a proposed +marriage before the Registrar issued a license to marry. The Royal +Commission considered that "it would not be possible at present to +organize a satisfactory method of certification of fitness for +marriage." The National Birth-rate Commission, however, reported that in +their opinion the question should be reconsidered with a view to +legislation.</p> + +<p>There is much to be said in favour of such a proposal from the point of +view of national health. If the system were adopted the certificate +should, in the opinion of the present Committee, include freedom from +mental disease as well as freedom from communicable disease. But there +are manifest difficulties in the way, chiefly in regard to the delicate +and searching examination which would be required in the case of women +before a doctor could certify positively to the absence of communicable +disease.</p> + +<p>The Committee recommend that instead of a medical certificate each party +to a proposed marriage should be required to answer appropriate +questions in regard to the presence or absence of communicable and +mental disease, and to make a sworn statement before the Registrar as to +the truth of the answers. It should be the duty of the Registrar to +communicate the contents of the statements to the other party in the +event of any admission of the presence of communicable disease.</p> + +<p>In addition to the penalty for making a false statement it might be +provided, as in the Queensland Act, that venereal disease shall be a +ground for annulling a marriage contract when one party is suffering at +the time of marriage from such disease in an infectious state, provided +the other party was not informed of the fact prior to marriage.</p> + +<p>The Committee would also recommend the adoption of a further provision +that it should be the duty of a medical practitioner attending a case of +venereal disease which is or is likely to become infective, if he has +reason to believe that the patient intends to marry, to warn him or her +against doing so, and if he or she persists it should be the duty of the +doctor forthwith to notify the case by name to the Director-General of +Health, whose duty it should be to inform the other party. It should +also be provided that <i>bonâ fide</i> communications made in such a case, +either by the Director-General of Health or the doctor, to the other +party to the marriage, or to the parents or guardian of such party, +shall be privileged.</p> + + +<p><br /><a name="Link15" id="Link15"></a><span class="smcap">Section 8.—Treatment by Unqualified Persons.</span></p> + +<p>The evidence given before the Committee shows that while reputable +chemists refer to a medical man patients coming to them for treatment +for venereal disease, and while these constitute the great majority of +the profession, there are still far too many cases of venereal disease +treated by chemists, herbalists, chiropractors, and other unqualified +persons. The treatment of venereal disease has become a specialized +branch of medicine, and many general practitioners prefer to refer such +cases to experts. The result of trusting to unqualified persons for the +treatment of such serious and difficult diseases is that the patient +usually drifts on uncured, and serious complications may occur. One +specialist in venereal disease informed the Committee that of 200 of his +cases whose cards showed particulars, 104 consulted chemists in the +first place and received more or less treatment from them. He was able +to give details of twenty-three cases showing the type of treatment +given. In several cases there were severe complications which could have +been avoided by proper treatment. There were also cases in which the +patient, after taking medicine for a time, had communicated the +infection to others. This witness further stated that some chemists +charged consultation fees in addition to charges for drugs applied, and +in certain cases charges for drugs were made which were little short of +blackmail.</p> + +<p>The Committee recommend that, in place of section 7 of the Social +Hygiene Act, a more comprehensive clause from the West Australian Act be +adopted. This is to the following effect: "No person [other than a +registered medical practitioner] should attend or prescribe for any +person for the purpose of curing, alleviating, or treating venereal +disease, whether such person is in fact suffering from such disease or +not."</p> + +<p>The Committee would suggest that if the Pharmaceutical Society were to +do all in its power to discourage its members from treating these +diseases it would have a good effect.</p> + + +<p><br /><a name="Link16" id="Link16"></a><span class="smcap">Section 9.—Mentally Defective Adolescents.</span></p> + +<p>Mr. J. Caughley, Director of Education, stated in evidence: "From a +general inquiry made by the Department a few years ago it was +ascertained that there were at least six hundred or seven hundred mental +defectives in New Zealand under the age of twenty-one. I need scarcely +point out the moral danger to the community of so many of these +defectives being at large. In particular, the girls are a source of +danger to themselves and to the community, since they have little or no +will-power or sense of restraint. I am of opinion that all such cases +should be registered, and that, unless it can be shown that the mental +defective is under thoroughly safe and proper care at home, he should be +taken charge of by the State. I am certain that by this means the +increasing number of mental defectives would be reduced to a minimum, +since mental defectiveness is almost entirely hereditary."</p> + +<p>Mr. Beck, Officer in Charge of the Special Schools under the Education +Department, cited illustrative cases, one of which may be thus stated: +"Two feeble-minded parents in New Zealand<a name="Page_21" id="Page_21"></a> have had up to the present +time ten degenerate children, all of whom are a lifelong burden on the +State. Taking the case of these children, and assessing the cost to the +State of maintaining them, the total amount for this family will not be +less than £16,000."</p> + +<p>The Committee are of opinion that supervision of mentally defective +children and adolescents is an important factor in lessening venereal +disease, and urge the Government as soon as possible to adopt a system +of registration and classification of mental defectives, and of +segregation where necessary, either in mental hospitals or in special +institutions where these defectives may be suitably taught, and, where +possible, usefully employed to defray the cost of their maintenance.</p> + + + +<hr style="width: 65%;" /> +<h3><a name="PART_IV_SUMMARY_OF_CONCLUSIONS_AND_RECOMMENDATIONS" id="PART_IV_SUMMARY_OF_CONCLUSIONS_AND_RECOMMENDATIONS"></a>PART IV.—SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS.</h3> + + +<p><br /><a name="Link17" id="Link17"></a><span class="smcap">Section 1.—Conclusions.</span></p> + +<p>Following are some of the conclusions drawn from the evidence by the +Committee:—</p> + +<p>There is very general ignorance among the public on the subject of +venereal disease, and this has stood in the way of its being grappled +with effectively.</p> + +<p>Syphilis not only causes loss of life directly, but many deaths ascribed +to other causes in the Registrar-General's returns are due to the +after-effects of this disease. It is responsible for many still-births +and abortions, and its evil effects are seen in such children as +survive. These effects may persist until the third generation.</p> + +<p>Gonorrhœa, popularly, but quite erroneously, supposed to be a +comparatively mild complaint, is regarded by medical men as being as +serious a disease as syphilis. It is difficult to cure, especially in +women, unless properly treated at the outset. It is a great cause of +sterility in both sexes.</p> + +<p>Owing to the absence of accurate statistics it is impossible to make +comparisons between New Zealand and other countries as regards the +prevalence of venereal disease, or to say whether it is increasing or +decreasing in this country.</p> + +<p>There are in New Zealand no fewer than 3,031 persons being treated by +registered medical practitioners for venereal disease in some form, or +for the effects thereof—1 person in every 428 of our population. At the +clinics since their establishment 3,634 patients have been +treated—3,038 males, 596 females.</p> + +<p>An interesting calculation as to the prevalence of syphilis in New +Zealand has been made by Dr. Hay, Inspector-General of Mental Hospitals. +Working on what is known as Fournier's Index—the relation of the number +of cases of dementia paralytica existing at any one time to the number +of concurrent syphilitic infectious—he computes the number of persons +in New Zealand now who have or have had syphilis to be 33,000, or 1 to +every 38 of the population.</p> + +<p>The Committee desire to state, however, that in their opinion there can +be no accurate estimate of the prevalence of venereal disease until some +system of obtaining accurate statistics has been adopted. One point +which has come out clearly in their investigations is that venereal +disease is sufficiently prevalent to cause serious concern and to call +for energetic action.</p> + +<p>Evidence was given to the Committee to show that children with mental +and physical defects due to venereal diseases may become a charge on the +State; that a proportion of these on being released become parents of +defective children, who in their turn have to be supported at the public +expense. It was also shown that such defectives have little sexual +control, and are usually very prolific.</p> + +<p>According to the Commissioner of Police there are only 104 professional +prostitutes in New Zealand.</p> + +<p>There is, however, a great deal of "amateur" prostitution, and this is +chiefly responsible for the spread of venereal diseases.</p> + +<p>The evidence points to a good deal of laxity of conduct among young +people of all social conditions, especially in the large towns. This is +generally attributed by the witnesses to the weakening of home influence +and the restlessness of the age.</p> + +<p>Apart from the venereal disease among those who indulge in promiscuous +intercourse, there are many cases in which innocent wives are infected +by their husbands, and other cases (not so frequent) of innocent +husbands being infected by their wives.</p> + +<p>Children suffer innocently from venereal disease, not only by +inheritance from infected parents, but by accidently coming in contact +with the germs on towels, &c., which have been used by a patient. There +are also cases which come before the Courts where disease has been +conveyed directly in crimes of violence by sexual perverts.</p> + +<p>The free clinics in the chief centres are conducted by experts, and are +doing good work. Their influence for good is greatly impaired, however, +by the fact that a proportion of the male patients and the majority of +the female patients leave off treatment before they are cured. As the +law stands there is no power to compel them to continue treatment, and +in many cases they resume promiscuous intercourse and spread the +disease.</p> + +<p>Evidence has been given of other cases, some of them of a very shocking +character, in which persons suffering from venereal disease are not +seeking medical treatment and are communicating the disease to others. +As the law stands at present there is no power to restrain them from +such conduct or to compel them to receive medical treatment.</p> + + +<p><br /><a name="Link18" id="Link18"></a><span class="smcap">Section 2.—Recommendations.</span></p> + +<p>The Committee stress in the strongest terms the duty of moral +self-control.</p> + +<p>They urge the cultivation of a healthier state of public opinion. The +stigma at present attached to sufferers from venereal disease should be +transferred to those who indulge in promiscuous sexual intercourse.</p> + +<p>Parents have a great responsibility as regards the instruction and +training of their children so as to safeguard them against the dangers +resulting from ignorance of sexual laws. There is too little parental +control generally in New Zealand. The Committee recommend the training +of teachers, and provision for giving appropriate instruction in +schools.</p> + +<p><a name="Page_22" id="Page_22"></a>Classification and, where necessary, segregation of mentally defective +adolescents is recommended.</p> + +<p>The following medical measures for preventing and combating the disease +are recommended:—</p> + +<p>The clinics should be made more available by being open continuously. +Every effort should be made to secure privacy. A specially trained nurse +should be in attendance at women's clinics, and women doctors should be +secured where possible.</p> + +<p>The Committee recommend that provision be made at the clinics for prompt +preventive treatment of those who have exposed themselves to infection.</p> + +<p>Lady patrols should be appointed in other centres to perform the kind of +work that is being carried on in Christchurch.</p> + +<p>The Committee, having regard to the good work especially of an +educational nature which is being done by the Social Hygiene Society, +Christchurch, consider voluntary effort of the same kind in other +centres would be very helpful.</p> + +<p>The Committee are entirely opposed to the Continental system of licensed +brothels, or a revival of the C.D. Acts in any shape or form.</p> + +<p>They recommend legislation be introduced providing for what is known as +conditional notification of venereal disease. It will be the duty of a +doctor to notify to the Health Department, by number or symbol only, +each case of venereal disease he treats. If a patient, however, refuses +to continue treatment until cured, and will not consult some other +doctor or attend a clinic, it will then be the duty of the doctor last +in attendance to notify the case to the Department by name.</p> + +<p>If the patient continues recalcitrant and refuses to allow himself to be +examined by the medical practitioner appointed by the Director-General +of Health, then the latter should be empowered to apply to a Magistrate +for the arrest of such person and his detention in a public hospital or +other place of treatment until he is non-infective.</p> + +<p>The Committee also recommend further provision to deal with cases in +which persons suffering from venereal disease are not under medical +treatment and are likely to infect others. If the Director-General of +Health has reason to believe that any person is so suffering he may call +on that person to produce a medical certificate, which may be procured +free of charge from any hospital or venereal-disease clinic. If the +person refuses to produce such a certificate he or she may be taken +before a Magistrate, who may order a medical examination. Penalties, +including detention in a prison hospital, should be provided for +recalcitrant cases. The proceedings in all these cases are to be heard +in private unless defendant desires a public hearing.</p> + +<p>The Committee recommend that before a license to marry is issued the +intending parties must sign a paper answering certain questions as to +freedom from communicable disease and from mental disease, and must make +a sworn statement that the answers to such questions are true.</p> + +<p>They recommend the adoption of a provision in the Queensland Act making +venereal disease a ground for annulling a marriage contracted whilst one +party is suffering from such a disease in an infectious stage, provided +the other party was not informed of the fact prior to marriage. Also +that it should be the duty of a medical practitioner attending a case of +venereal disease, if he has reason to believe that the patient intends +to marry, to warn him or her against doing so, and if he or she persists +it should be the duty of the doctor to notify the case by name to the +Director-General of Health, whose duty it should be to inform the other +party, or the parents or guardian of such other party. Such +communications made in good faith either by the doctor or the +Director-General of Health should be absolutely privileged.</p> + +<p>The Committee recommend that the law prohibiting treatment of patients +for venereal disease by unqualified persons shall be strengthened, and +suggest that the Pharmaceutical Society might assist in preventing such +practices.</p> + + +<p><br /><a name="Link19" id="Link19"></a><span class="smcap">Section 3.—Concluding Remarks.</span></p> + +<p>The Committee in carrying out their task have been brought into contact +with some uninviting aspects of our social life. Some of the facts +disclosed are of a character to give serious concern to those lovers of +their country who rightly regard it as exceptionally favoured by nature, +and desire to see its people healthy and vigorous, clean in body and +mind, worthy of their heritage. The late war showed that the pick of our +population, physically as well as mentally, were of the finest possible +type, the admiration of all who saw them; but the medical examination of +the recruits disclosed that of 135,282 examined after the introduction +of the Military Service Act—mostly young men in the prime of life—only +57,382, or say, 42½ per cent., could be accepted as fit for training, +unmistakably proving that the nation as a whole was much below the +standard of physical fitness which it ought to exhibit.</p> + +<p>The investigations of the Committee show that already there is far too +large a proportion of mental and physical defectives reproducing their +kind. In the absence of accurate statistics it is impossible to say what +proportion of these defectives are the direct product of venereal +disease, but there is clear evidence that a tendency to lead dissolute +lives is especially noticeable in the females belonging to this +unfortunate class. "A feeble-minded girl," says Mr. Beck, "has not sense +enough to protect herself from the perils to which women are subjected. +Often amiable in disposition and physically attractive, they either +marry and bring forth a new generation of defectives, or they become +irresponsible sources of corruption and debauchery in the communities +where they live." Obviously some method of dealing with mental +defectives—by segregation or otherwise—must be found as part of the +problem of dealing with venereal disease.</p> + +<p>As regards the effect of venereal disease on the general health of the +community, we have the statement of the late Sir William Osler that he +regards syphilis as "third on the list of killing diseases"; while +Neisser, a leading authority, says that "with the exception of measles, +gonorrhœa is the most widely spread of all diseases. It is the most +potent factor in the production of involuntary race suicide, and by +sterilization and abortion does more to depopulate the country than does +any other cause."</p> + +<p><a name="Page_23" id="Page_23"></a>In view of the facts brought out in the course of the inquiry, the +Committee are strongly of opinion that it would be criminal neglect to +allow the evil to go on without taking energetic steps to check its +ravages. They believe that the legislative and other measures which they +recommend for the medical prevention and treatment of venereal disease +will, if given effect to with the loyal co-operation of the medical +profession, have a very beneficial result in reducing the prevalence of +disease, and will save an incalculable amount of sorrow and suffering +which in too many cases falls upon the innocent. In what is proposed in +this report there is nothing approaching a revival of the old Contagious +Diseases Acts. To use the words of Dr. Emily Seideberg, the principle of +the legislation now proposed is "To improve the health of the community, +and not, as in the old Contagious Diseases Acts, to make sexual +immorality safe for men of low morals."</p> + +<p>The Committee are of opinion that, far from conditional notification and +compulsory treatment on the lines proposed being prejudicial to woman in +any way, it is they who will reap the greatest benefit from these +measures. In fact, sufferers from venereal disease, as a whole, have +everything to gain and nothing to lose so long as they will continue +under treatment, and to enable them to do this the best medical skill is +placed at their disposal free of cost. The only persons in the community +who will be penalized by the proposed legislation are those who, having +contracted venereal disease, are so reckless and unprincipled that they +will take no pains to avoid communicating it to others.</p> + +<p>The Committee, it will be seen, regard the legislative and medical +measures which they propose as of great importance, but with all the +earnestness at their command they desire in conclusion to emphasize the +moral and social aspects of the question. With the changing social +conditions, especially in the larger towns, we are losing the home +influence and home training which are the best safeguards to preserve +the young against the temptations and dangers which beset their path in +life. The Committee would impress upon parents the paramount duty they +owe to their children in this matter. There is also a duty cast upon all +leaders of public opinion, and upon the community at large, to do what +is possible to bring about better living-conditions, especially for +girls in the towns, to encourage all forms of healthy sport and +amusement, and to cultivate a higher moral standard. Whatever sanitary +laws may be passed, and whatever success may be attained in dealing with +bodily disease, there can be no true health if the soul of the nation +remains corrupt. If this inquiry should serve to remove some of the +popular ignorance regarding venereal disease, and to quicken the public +conscience so that appropriate steps may be taken to deal with this +dreadful scourge, the Committee feel that their labours will not have +been in vain.</p> + + +<table border="0" cellpadding="0" cellspacing="0" summary="The Committee" class="figright"> + <tr> + <td align="left" valign="middle" style="white-space: nowrap"> + W.H. <span class="smcap">Triggs</span>,</td> + <td valign="middle" class="tdleft" style="white-space: nowrap;"> </td> + <td valign="middle" class="tdleft">Chairman.</td> + </tr> + <tr> + <td align="left" valign="bottom" style="white-space: nowrap"> + J.S. <span class="smcap">Elliott</span>,<br /> + M. <span class="smcap">Fraser</span>,<br /> + J.P. <span class="smcap">Frengley</span>,<br /> + <span class="smcap">Jacobina Luke</span>,<br /> + D. <span class="smcap">McGavin</span>,<br /><br /></td> + <td valign="top" align="left" style="white-space: nowrap; font-size: 75pt"> + }</td> + <td valign="middle" align="left"> + Members of Committee.</td> + </tr> +</table> + + +<hr style="width: 65%;" /> +<h3><a name="APPENDIX" id="APPENDIX"></a><a name="Page_24" id="Page_24"></a>APPENDIX.</h3> + + +<p><b>GRAPH A.</b></p> + +<div class="figcenter" style="width: 750px;"> +<img src="images/img01.jpg" width="750" height="379" alt="piccieAverage ages of bridegroom and bride at marriage, 1900-1921." title="Average ages of bridegroom and bride at marriage, 1900-1921." /> +<span class="caption; smcap">Average Ages of Bridegroom and Bride at Marriage, 1900-1921.</span> +</div> + +<p><br /><br /><b>TABLE A.</b></p> + +<p><span class="smcap">Illegitimate Births, and Births within One Year after Marriage, in New +Zealand, 1913-21.</span></p> + +<p>NOTE.—The figures refer to accouchements, not to children born, +multiple cases being counted once only (Only live births are included.)</p> + +<table border='1' cellpadding='4' cellspacing='0' summary="Illegitimate births, and births within one year after marriage, in New Zealand"> +<tr><td align='center' rowspan='2'>Year</td> +<td align='center' rowspan='2'>Illegitimate Births</td> +<td align='center' colspan='12'>Duration of Marriage (in Complete Months)</td> +<td rowspan='2' align="center">Total Legitimate First Births within One Year of Marriage</td> +<td rowspan='2'>Total Registered Births</td></tr> +<tr><td align='center'>0.</td> +<td align='center'>1.</td> +<td align='center'>2.</td> +<td align='center'>3.</td> +<td align='center'>4.</td> +<td align='center'>5.</td> +<td align='center'>6.</td> +<td align='center'>7.</td> +<td align='center'>8.</td> +<td align='center'>9.</td> +<td align='center'>10.</td> +<td align='center'>11.</td></tr> +<tr><td align='left'>1913</td> +<td align='right'>1,173</td> +<td align='right'>96</td> +<td align='right'>122</td> +<td align='right'>145</td> +<td align='right'>241</td> +<td align='right'>255</td> +<td align='right'>350</td> +<td align='right'>398</td> +<td align='right'>306</td> +<td align='right'>327</td> +<td align='right'>831</td> +<td align='right'>669</td> +<td align='right'>462</td> +<td align='right'>4,202</td> +<td align='right'>27,935</td></tr> +<tr><td align='left'>1914</td> +<td align='right'>1,291</td> +<td align='right'>83</td> +<td align='right'>122</td> +<td align='right'>146</td> +<td align='right'>216</td> +<td align='right'>247</td> +<td align='right'>354</td> +<td align='right'>398</td> +<td align='right'>294</td> +<td align='right'>335</td> +<td align='right'>720</td> +<td align='right'>642</td> +<td align='right'>487</td> +<td align='right'>4,044</td> +<td align='right'>28,338</td></tr> +<tr><td align='left'>1915</td> +<td align='right'>1,137</td> +<td align='right'>56</td> +<td align='right'>96</td> +<td align='right'>158</td> +<td align='right'>231</td> +<td align='right'>219</td> +<td align='right'>288</td> +<td align='right'>353</td> +<td align='right'>286</td> +<td align='right'>336</td> +<td align='right'>769</td> +<td align='right'>621</td> +<td align='right'>457</td> +<td align='right'>3,870</td> +<td align='right'>27,850</td></tr> +<tr><td align='left'>1916</td> +<td align='right'>1,139</td> +<td align='right'>63</td> +<td align='right'>95</td> +<td align='right'>135</td> +<td align='right'>170</td> +<td align='right'>212</td> +<td align='right'>269</td> +<td align='right'>326</td> +<td align='right'>266</td> +<td align='right'>343</td> +<td align='right'>793</td> +<td align='right'>694</td> +<td align='right'>512</td> +<td align='right'>3,878</td> +<td align='right'>28,509</td></tr> +<tr><td align='left'>1917</td> +<td align='right'>1,141</td> +<td align='right'>68</td> +<td align='right'>66</td> +<td align='right'>119</td> +<td align='right'>137</td> +<td align='right'>184</td> +<td align='right'>216</td> +<td align='right'>291</td> +<td align='right'>264</td> +<td align='right'>250</td> +<td align='right'>575</td> +<td align='right'>505</td> +<td align='right'>449</td> +<td align='right'>3,124</td> +<td align='right'>28,239</td></tr> +<tr><td align='left'>1918</td> +<td align='right'>1,169</td> +<td align='right'>42</td> +<td align='right'>64</td> +<td align='right'>99</td> +<td align='right'>141</td> +<td align='right'>148</td> +<td align='right'>215</td> +<td align='right'>259</td> +<td align='right'>213</td> +<td align='right'>212</td> +<td align='right'>443</td> +<td align='right'>298</td> +<td align='right'>279</td> +<td align='right'>2,413</td> +<td align='right'>25,860</td></tr> +<tr><td align='left'>1919</td> +<td align='right'>1,132</td> +<td align='right'>52</td> +<td align='right'>98</td> +<td align='right'>101</td> +<td align='right'>125</td> +<td align='right'>161</td> +<td align='right'>202</td> +<td align='right'>258</td> +<td align='right'>222</td> +<td align='right'>238</td> +<td align='right'>469</td> +<td align='right'>397</td> +<td align='right'>314</td> +<td align='right'>2,637</td> +<td align='right'>24,483</td></tr> +<tr><td align='left'>1920</td> +<td align='right'>1,414</td> +<td align='right'>69</td> +<td align='right'>125</td> +<td align='right'>167</td> +<td align='right'>220</td> +<td align='right'>295</td> +<td align='right'>347</td> +<td align='right'>445</td> +<td align='right'>377</td> +<td align='right'>407</td> +<td align='right'>859</td> +<td align='right'>802</td> +<td align='right'>575</td> +<td align='right'>4,688</td> +<td align='right'>29,921</td></tr> +<tr><td align='left'>1921</td> +<td align='right'>1,245</td> +<td align='right'>82</td> +<td align='right'>140</td> +<td align='right'>177</td> +<td align='right'>228</td> +<td align='right'>253</td> +<td align='right'>341</td> +<td align='right'>456</td> +<td align='right'>370</td> +<td align='right'>382</td> +<td align='right'>979</td> +<td align='right'>804</td> +<td align='right'>670</td> +<td align='right'>4,882</td> +<td align='right'>28,567</td></tr> +<tr><td align='left'>Totals</td> +<td align='right'>10,841</td> +<td align='right'>611</td> +<td align='right'>928</td> +<td align='right'>1,247</td> +<td align='right'>1,709</td> +<td align='right'>1,974</td> +<td align='right'>2,582</td> +<td align='right'>3,184</td> +<td align='right'>2,598</td> +<td align='right'>2,830</td> +<td align='right'>6,438</td> +<td align='right'>5,432</td> +<td align='right'>4,205</td> +<td align='right'>33,738</td> +<td align='right'>249,702</td></tr> +</table> + +<p class="figright">MALCOLM FRASER,<br /> +Government Statistician.</p> + + +<p><br /><br /><b>TABLE B.</b></p> + +<p><span class="smcap">Table Showing Number of Cases Treated and Attendances at the +Venereal-disease Clinics during the years 1920-21 and up to June, 1922.</span></p> + +<div style="font-size: 8pt;"> +<table border="1" cellpadding="2" cellspacing="0" summary="Number of Cases Treated and Attendances at VD Clinics during the years 1920-21 and part 1922"> +<tr> +<td rowspan="2"> </td> +<td colspan="6" align="center">Auckland</td> +<td colspan="6" align="center">Wellington</td> +<td colspan="6" align="center">Christchurch</td> +<td colspan="6" align="center">Dunedin</td> +<td colspan="6" align="center">Total for Years</td> +<td colspan="2" rowspan="2" align="center">Totals according to Sex</td> +<td colspan="2" rowspan="2" align="center">Grand Totals</td> +</tr> +<tr> +<td colspan="2" align="center">1920</td> +<td colspan="2" align="center">1921</td> +<td colspan="2" align="center">1922</td> +<td colspan="2" align="center">1920</td> +<td colspan="2" align="center">1921</td> +<td colspan="2" align="center">1922</td> +<td colspan="2" align="center">1920</td> +<td colspan="2" align="center">1921</td> +<td colspan="2" align="center">1922</td> +<td colspan="2" align="center">1920</td> +<td colspan="2" align="center">1921</td> +<td colspan="2" align="center">1922</td> +<td colspan="2" align="center">1920</td> +<td colspan="2" align="center">1921</td> +<td colspan="2" align="center">1922</td></tr> +<tr><td> </td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center">M.</td> +<td align="center">F.</td> +<td align="center"> </td></tr> +<tr><td align="left">Number of persons dealt +with at or in connection +with the out-patients' +clinic for the first time +and found to be +suffering from--<br /> + Syphilis</td> +<td align="right" valign="bottom">174</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">100</td> +<td align="right" valign="bottom">44</td> +<td align="right" valign="bottom">81</td> +<td align="right" valign="bottom">29</td> +<td align="right" valign="bottom">93</td> +<td align="right" valign="bottom">34</td> +<td align="right" valign="bottom">80</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom">41</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">60</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">46</td> +<td align="right" valign="bottom">21</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">13</td> +<td align="right" valign="bottom">54</td> +<td align="right" valign="bottom">13</td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom">11</td> +<td align="right" valign="bottom">12</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">381</td> +<td align="right" valign="bottom">102</td> +<td align="right" valign="bottom">281</td> +<td align="right" valign="bottom">86</td> +<td align="right" valign="bottom">159</td> +<td align="right" valign="bottom">59</td> +<td align="right" valign="bottom">821</td> +<td align="right" valign="bottom">247</td> +<td align="right" valign="bottom">1,068</td></tr> +<tr><td align="left"> Chancroid</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">19</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">39</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">22</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">80</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">80</td></tr> +<tr><td align="left"> Gonorrhœa</td> +<td align="right" valign="bottom">81</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">345</td> +<td align="right" valign="bottom">24</td> +<td align="right" valign="bottom">189</td> +<td align="right" valign="bottom">20</td> +<td align="right" valign="bottom">190</td> +<td align="right" valign="bottom">18</td> +<td align="right" valign="bottom">298</td> +<td align="right" valign="bottom">11</td> +<td align="right" valign="bottom">141</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">120</td> +<td align="right" valign="bottom">32</td> +<td align="right" valign="bottom">139</td> +<td align="right" valign="bottom">35</td> +<td align="right" valign="bottom">70</td> +<td align="right" valign="bottom">21</td> +<td align="right" valign="bottom">37</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">46</td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom">428</td> +<td align="right" valign="bottom">58</td> +<td align="right" valign="bottom">837</td> +<td align="right" valign="bottom">79</td> +<td align="right" valign="bottom">446</td> +<td align="right" valign="bottom">56</td> +<td align="right" valign="bottom">1,711</td> +<td align="right" valign="bottom">193</td> +<td align="right" valign="bottom">1,904</td></tr> +<tr><td align="left"> No V.D.</td> +<td align="right" valign="bottom">59</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom">73</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">21</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">40</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom">52</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">33</td> +<td align="right" valign="bottom">17</td> +<td align="right" valign="bottom">20</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom">62</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">16</td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">28</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">125</td> +<td align="right" valign="bottom">32</td> +<td align="right" valign="bottom">215</td> +<td align="right" valign="bottom">83</td> +<td align="right" valign="bottom">86</td> +<td align="right" valign="bottom">41</td> +<td align="right" valign="bottom">426</td> +<td align="right" valign="bottom">156</td> +<td align="right" valign="bottom">582</td></tr> +<tr><td align="left">Totals</td> +<td colspan="30"> </td> +<td align="right" valign="bottom">3,038</td> +<td align="right" valign="bottom">596</td> +<td align="right" valign="bottom">3,634</td></tr> + +<tr><td align="left">Total attendance of all +persons at the +out-patients' clinic who +were suffering from--<br /> + Syphilis</td> +<td align="right" valign="bottom">1,875</td> +<td align="right" valign="bottom">462</td> +<td align="right" valign="bottom">1,759</td> +<td align="right" valign="bottom">474</td> +<td align="right" valign="bottom">830</td> +<td align="right" valign="bottom">313</td> +<td align="right" valign="bottom">1,388</td> +<td align="right" valign="bottom">448</td> +<td align="right" valign="bottom">2,089</td> +<td align="right" valign="bottom">616</td> +<td align="right" valign="bottom">1,156</td> +<td align="right" valign="bottom">269</td> +<td align="right" valign="bottom">786</td> +<td align="right" valign="bottom">450</td> +<td align="right" valign="bottom">903</td> +<td align="right" valign="bottom">473</td> +<td align="right" valign="bottom">632</td> +<td align="right" valign="bottom">248</td> +<td align="right" valign="bottom">816</td> +<td align="right" valign="bottom">143</td> +<td align="right" valign="bottom">505</td> +<td align="right" valign="bottom">84</td> +<td align="right" valign="bottom">432</td> +<td align="right" valign="bottom">115</td> +<td align="right" valign="bottom">4,865</td> +<td align="right" valign="bottom">1,503</td> +<td align="right" valign="bottom">5,256</td> +<td align="right" valign="bottom">1,647</td> +<td align="right" valign="bottom">3,050</td> +<td align="right" valign="bottom">948</td> +<td align="right" valign="bottom">13,171</td> +<td align="right" valign="bottom">4,098</td> +<td align="right" valign="bottom">17,269</td></tr> +<tr><td align="left"> Chancroid</td> +<td align="right" valign="bottom">100</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">72</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">37</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">16</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">29</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">110</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">45</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">37</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">216</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">133</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">103</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">452</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">452</td></tr> +<tr><td align="left"> Gonorrhœa</td> +<td align="right" valign="bottom">4,702</td> +<td align="right" valign="bottom">95</td> +<td align="right" valign="bottom">9,232</td> +<td align="right" valign="bottom">141</td> +<td align="right" valign="bottom">3,384</td> +<td align="right" valign="bottom">172</td> +<td align="right" valign="bottom">13,436</td> +<td align="right" valign="bottom">180</td> +<td align="right" valign="bottom">19,369</td> +<td align="right" valign="bottom">520</td> +<td align="right" valign="bottom">10,853</td> +<td align="right" valign="bottom">423</td> +<td align="right" valign="bottom">2,132</td> +<td align="right" valign="bottom">245</td> +<td align="right" valign="bottom">3,968</td> +<td align="right" valign="bottom">902</td> +<td align="right" valign="bottom">2,239</td> +<td align="right" valign="bottom"> 339</td> +<td align="right" valign="bottom">465</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">814</td> +<td align="right" valign="bottom"> 67</td> +<td align="right" valign="bottom">638</td> +<td align="right" valign="bottom"> 63</td> +<td align="right" valign="bottom">20,105</td> +<td align="right" valign="bottom">520</td> +<td align="right" valign="bottom">33,583</td> +<td align="right" valign="bottom">1,630</td> +<td align="right" valign="bottom">17,114</td> +<td align="right" valign="bottom">1,017</td> +<td align="right" valign="bottom"> 70,802</td> +<td align="right" valign="bottom">3,167</td> +<td align="right" valign="bottom"> 73,969</td></tr> +<tr><td align="left"> No V.D.</td> +<td align="right" valign="bottom">134</td> +<td align="right" valign="bottom">26</td> +<td align="right" valign="bottom">227</td> +<td align="right" valign="bottom">35</td> +<td align="right" valign="bottom">53</td> +<td align="right" valign="bottom"> 17</td> +<td align="right" valign="bottom">40</td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom">89</td> +<td align="right" valign="bottom"> 35</td> +<td align="right" valign="bottom">68</td> +<td align="right" valign="bottom"> 35</td> +<td align="right" valign="bottom">186</td> +<td align="right" valign="bottom"> 98</td> +<td align="right" valign="bottom">215</td> +<td align="right" valign="bottom">187</td> +<td align="right" valign="bottom">96</td> +<td align="right" valign="bottom">52</td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom"> 21</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">366</td> +<td align="right" valign="bottom">136</td> +<td align="right" valign="bottom">562</td> +<td align="right" valign="bottom">258</td> +<td align="right" valign="bottom">218</td> +<td align="right" valign="bottom">108</td> +<td align="right" valign="bottom">1,146</td> +<td align="right" valign="bottom">502</td> +<td align="right" valign="bottom">1,648</td></tr> +<tr><td align="left">Aggregate number of +in-patients' days of +treatment given to +persons suffering from--<br /> + Syphilis</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1,624</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1,711</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">790</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">232</td> +<td align="right" valign="bottom">80</td> +<td align="right" valign="bottom">619</td> +<td align="right" valign="bottom">44</td> +<td align="right" valign="bottom">310</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">74</td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom">169</td> +<td align="right" valign="bottom">106</td> +<td align="right" valign="bottom">20</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1,930</td> +<td align="right" valign="bottom">35</td> +<td align="right" valign="bottom">2,499</td> +<td align="right" valign="bottom">150</td> +<td align="right" valign="bottom">1,120</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">5,549</td> +<td align="right" valign="bottom">194</td> +<td align="right" valign="bottom">5,743</td></tr> +<tr><td align="left"> Gonorrhœa</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">3,024</td> +<td align="right" valign="bottom">77</td> +<td align="right" valign="bottom">4,098</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1,998</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">460</td> +<td align="right" valign="bottom">216</td> +<td align="right" valign="bottom">725</td> +<td align="right" valign="bottom">161</td> +<td align="right" valign="bottom">221</td> +<td align="right" valign="bottom">157</td> +<td align="right" valign="bottom">66</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">335</td> +<td align="right" valign="bottom">166</td> +<td align="right" valign="bottom">28</td> +<td align="right" valign="bottom">59</td> +<td align="right" valign="bottom">3,550</td> +<td align="right" valign="bottom">293</td> +<td align="right" valign="bottom">5,168</td> +<td align="right" valign="bottom">327</td> +<td align="right" valign="bottom">2,157</td> +<td align="right" valign="bottom">216</td> +<td align="right" valign="bottom">10,875</td> +<td align="right" valign="bottom">836</td> +<td align="right" valign="bottom">11,711</td></tr> +<tr><td align="left"> Totals</td> +<td colspan="30"> </td> +<td align="right" valign="bottom">101,995</td> +<td align="right" valign="bottom">8,797</td> +<td align="right" valign="bottom">110,792</td></tr> +</table> +</div> + +<p><a name="Page_25" id="Page_25"></a><br /><br /><b>TABLE C.</b></p> + +<p><span class="smcap">Reply Form.—Venereal Diseases.</span></p> + +<p>(<i>Confidential</i>.)</p> + +<p>I, the undersigned registered medical practitioner, desire to advise the +Committee on Venereal Diseases of the Board of Health that I had under +my personal care on Saturday, 16th September, 1922,<a name="FNanchor_A_1" id="FNanchor_A_1"></a><a href="#Footnote_A_1" class="fnanchor">[A]</a> cases of venereal +disease, and of affections attributable to venereal disease, as under:—</p> + +<p> +<span style="margin-left: 27em;" class="smcap">Number Of Cases.</span><br /> +<span style="margin-left: 27em;">Male. Female. Total.</span><br /> +1. Cases of recent infection:—<br /> +<span style="margin-left: 1em;">(<i>a.</i>) Gonorrhœa (including gonorrhœal ophthalmia)</span><br /> +<span style="margin-left: 1em;">(<i>b.</i>) Soft chancre</span><br /> +<span style="margin-left: 1em;">(<i>c.</i>) Syphilis, primary and/or secondary</span><br /> +2. Cases of distant infection:—<br /> +<span style="margin-left: 1em;">(<i>a.</i>) Chronic gonorrhœal affections or disabilities</span><br /> +<span style="margin-left: 2em;">directly attributable to gonorrhœa infection—<i>e.g.</i>,</span><br /> +<span style="margin-left: 2em;">stricture, gleet, arthritis, abscesses, salpingitis, &c.</span><br /> +<span style="margin-left: 1em;">(<i>b.</i>) Congenital syphilis</span><br /> +<span style="margin-left: 1em;">(<i>c.</i>) Tertiary syphilitic manifestations or disabilities</span><br /> +<span style="margin-left: 2em;">directly attributable to syphilis infection:—</span><br /> +<span style="margin-left: 3.5em;">(i.) Affecting nervous system—<i>e.g.</i>, gumma,</span><br /> +<span style="margin-left: 7em;">locomotor, G.P.I., &c.</span><br /> +<span style="margin-left: 3em;">(ii.) Affecting ear, eye, &c. (special</span><br /> +<span style="margin-left: 7em;">senses)—<i>e.g.</i>, optic atrophy, &c.</span><br /> +<span style="margin-left: 2.5em;">(iii.) Affecting respiratory system—<i>e.g.</i>,</span><br /> +<span style="margin-left: 7em;">syphilitic laryngitis, &c.</span><br /> +<span style="margin-left: 3em;">(iv.) Affecting digestive system—<i>e.g.</i>,</span><br /> +<span style="margin-left: 7em;">syphilitic stricture of rectum, &c.</span><br /> +<span style="margin-left: 3.5em;">(v.) Affecting circulatory system—<i>e.g.</i>,</span><br /> +<span style="margin-left: 7em;">syphilitic angina, aneurism, &c.</span><br /> +<span style="margin-left: 3em;">(vi.) Affecting spleen</span><br /> +<span style="margin-left: 2.5em;">(vii.) Affecting skin, bones, joints, muscles</span><br /> +<span style="margin-left: 2em;">(viii.) Affecting genito-urinary system, including</span><br /> +<span style="margin-left: 7em;">abortions, &c.</span><br /> +<br /> +NOTE.—No case should be recorded under more than one of these headings.<br /> +<br /> +Total number of cases under my personal care<br /> +</p> + +<p>My opinion is that venereal disease in this Dominion has [not] increased +in a greater proportion than the population during the last five years.</p> + +<p><br /><br /> +<span style="margin-left: 20em;">[<i>Signature of medical practitioner.</i>]</span><br /> +<br />Date of posting: <span style="margin-left: 8em;">Town where practising or name or names of institutions concerned:</span><br /> +<br /></p> + +<div class="footnote"><p><a name="Footnote_A_1" id="Footnote_A_1"></a><a href="#FNanchor_A_1"><span class="label">[A]</span></a> "Under my personal care on Saturday, 16th September, 1922," +is to be interpreted to include all patients suffering from the +conditions enumerated whom you are attending or have attended, and who +you believe in the event of requiring further attendance would call you +in or consult you, in other words, <i>bonâ fide</i> patients of your own. It +is not intended that you are to enumerate only the patients actually +seen by you on that date. +</p><p> +Medical superintendents or medical officers in charge of institutions +will regard all patients in or attending their institutions as "under my +personal care on Saturday, 16th September, 1922," irrespective of whom +the actual medical attendant may be. +</p><p> +Please post this Reply Form as soon as possible after 16th September, +1922, and not later than 20th September, 1922. +</p><p> +Additional copies of this form are obtainable from the Medical Officers +of Health, or the Secretary of the Board of Health, P.O. Box 1146, +Wellington.</p></div> + + +<p><a name="Page_26" id="Page_26"></a><br /><br /><b>TABLE D.</b></p> + +<p><span class="smcap">Venereal Diseases in New Zealand as at 16th September, 1922.—Numbers in +Health Districts.</span></p> + +<table border="1" cellpadding='4' cellspacing='0' summary="Numbers of Venereal Diseases in New Zealand's health districts as at 16th September, 1922"> +<tr><td rowspan="2" align="center">Health District</td> +<td colspan="4" align="center">Cases of Recent Infection.</td> +<td colspan="4" align="center">Cases of Distant Infection</td> +<td rowspan="2" align="center">Grand Total</td> +<td colspan="3" align="center">Expression of Opinion</td></tr> +<tr><td align="center">Gonorrhœa</td> +<td align="center">Soft Chancre</td> +<td align="center">Syphilis</td> +<td align="center">Total</td> +<td align="center">Chronic Gonorrhœa</td> +<td align="center">Congenital Syphilis</td> +<td align="center">Tertiary Syphilis</td> +<td align="center">Total</td> +<td align="center">Increase</td> +<td align="center">Decrease</td> +<td align="center">Not stated</td></tr> +<tr><td align="left">North Auckland</td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> 1</td> +<td align="right" valign="bottom">14</td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom"> 1</td> +<td align="right" valign="bottom"> 5</td> +<td align="right" valign="bottom">16</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom"> 7</td> +<td align="right" valign="bottom"> 2</td> +<td align="right" valign="bottom"> 11</td></tr> +<tr><td align="left">Auckland </td> +<td align="right" valign="bottom">279</td> +<td align="right" valign="bottom"> 3</td> +<td align="right" valign="bottom"> 165</td> +<td align="right" valign="bottom"> 447</td> +<td align="right" valign="bottom"> 229</td> +<td align="right" valign="bottom"> 51</td> +<td align="right" valign="bottom"> 239</td> +<td align="right" valign="bottom"> 519</td> +<td align="right" valign="bottom"> 966</td> +<td align="right" valign="bottom"> 34</td> +<td align="right" valign="bottom"> 53</td> +<td align="right" valign="bottom"> 82</td></tr> +<tr><td align="left">Hawke's Bay </td> +<td align="right" valign="bottom"> 35</td> +<td align="right" valign="bottom"> 3</td> +<td align="right" valign="bottom"> 17</td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom"> 32</td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom"> 30</td> +<td align="right" valign="bottom">72</td> +<td align="right" valign="bottom"> 127</td> +<td align="right" valign="bottom"> 6</td> +<td align="right" valign="bottom"> 19</td> +<td align="right" valign="bottom"> 24</td></tr> +<tr><td align="left">Wanganui </td> +<td align="right" valign="bottom"> 59</td> +<td align="right" valign="bottom"> 2</td> +<td align="right" valign="bottom"> 37</td> +<td align="right" valign="bottom">98</td> +<td align="right" valign="bottom"> 97</td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom"> 42</td> +<td align="right" valign="bottom"> 149</td> +<td align="right" valign="bottom"> 247</td> +<td align="right" valign="bottom"> 13</td> +<td align="right" valign="bottom"> 16</td> +<td align="right" valign="bottom"> 24</td></tr> +<tr><td align="left">Wellington </td> +<td align="right" valign="bottom">187</td> +<td align="right" valign="bottom"> 4</td> +<td align="right" valign="bottom"> 114</td> +<td align="right" valign="bottom"> 305</td> +<td align="right" valign="bottom"> 279</td> +<td align="right" valign="bottom"> 56</td> +<td align="right" valign="bottom"> 220</td> +<td align="right" valign="bottom"> 555</td> +<td align="right" valign="bottom"> 860</td> +<td align="right" valign="bottom"> 29</td> +<td align="right" valign="bottom"> 36</td> +<td align="right" valign="bottom"> 68</td></tr> +<tr><td align="left">Canterbury </td> +<td align="right" valign="bottom"> 99</td> +<td align="right" valign="bottom"> 2</td> +<td align="right" valign="bottom"> 75</td> +<td align="right" valign="bottom"> 176</td> +<td align="right" valign="bottom"> 83</td> +<td align="right" valign="bottom"> 17</td> +<td align="right" valign="bottom"> 111</td> +<td align="right" valign="bottom"> 211</td> +<td align="right" valign="bottom"> 387</td> +<td align="right" valign="bottom"> 16</td> +<td align="right" valign="bottom"> 47</td> +<td align="right" valign="bottom"> 53</td></tr> +<tr><td align="left">Otago </td> +<td align="right" valign="bottom"> 79</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> 104</td> +<td align="right" valign="bottom"> 183</td> +<td align="right" valign="bottom"> 120</td> +<td align="right" valign="bottom"> 23</td> +<td align="right" valign="bottom"> 88</td> +<td align="right" valign="bottom"> 231</td> +<td align="right" valign="bottom"> 414</td> +<td align="right" valign="bottom"> 14</td> +<td align="right" valign="bottom"> 30</td> +<td align="right" valign="bottom"> 51</td></tr> +<tr><td align="left">Dominion totals </td> +<td align="right" valign="bottom"> 748</td> +<td align="right" valign="bottom"> 14</td> +<td align="right" valign="bottom"> 516</td> +<td align="right" valign="bottom">1,278</td> +<td align="right" valign="bottom"> 850</td> +<td align="right" valign="bottom"> 168</td> +<td align="right" valign="bottom"> 735</td> +<td align="right" valign="bottom">1,753</td> +<td align="right" valign="bottom">3,031</td> +<td align="right" valign="bottom"> 119</td> +<td align="right" valign="bottom"> 203</td> +<td align="right" valign="bottom">313</td></tr> +</table> + +<p>Total replies received, 635.</p> + + +<p><br /><br /><b>TABLE E.</b></p> + +<p><span class="smcap">Venereal Diseases in New Zealand as at 16th September, 1922. Totals (All +Forms) of Gonorrhœa, Soft Chancre, and Syphilis, and Percentage of +Grand Total.</span></p> + +<table border="1" cellpadding='4' cellspacing='0' summary="Venereal Diseases in New Zealand as at 16th September, 1922"> +<tr><td rowspan="2">Health District</td> +<td colspan="3">Totals (all Forms) of each Disease</td> +<td rowspan="2">Grand Total</td> +<td colspan="3">Percentages (all forms) to Grand Total</td></tr> +<tr><td>Gonorrhœa</td> +<td>Soft Chancre</td> +<td>Syphilis</td> +<td>Gonorrhœa</td> +<td>Soft Chancre</td> +<td>Syphilis</td></tr> +<tr><td>North Auckland</td> +<td align="right" valign="bottom">20</td> +<td> </td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">66.67</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">33.33</td></tr> +<tr><td>Auckland</td> +<td align="right" valign="bottom">508</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">455</td> +<td align="right" valign="bottom">966</td> +<td align="right" valign="bottom">52.59</td> +<td align="right" valign="bottom">0.31</td> +<td align="right" valign="bottom">47.10</td></tr> +<tr><td>Hawke's Bay</td> +<td align="right" valign="bottom">67</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">57</td> +<td align="right" valign="bottom">127</td> +<td align="right" valign="bottom">52.76</td> +<td align="right" valign="bottom">2.36</td> +<td align="right" valign="bottom">44.88</td></tr> +<tr><td>Wanganui</td> +<td align="right" valign="bottom">156</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">89</td> +<td align="right" valign="bottom">247</td> +<td align="right" valign="bottom">63.16</td> +<td align="right" valign="bottom">0.81</td> +<td align="right" valign="bottom">36.03</td></tr> +<tr><td>Wellington</td> +<td align="right" valign="bottom">466</td> +<td align="right" valign="bottom">4</td> +<td align="right" valign="bottom">390</td> +<td align="right" valign="bottom">860</td> +<td align="right" valign="bottom">54.19</td> +<td align="right" valign="bottom">0.46</td> +<td align="right" valign="bottom">15.35</td></tr> +<tr><td>Canterbury</td> +<td align="right" valign="bottom">182</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">203</td> +<td align="right" valign="bottom">387</td> +<td align="right" valign="bottom">47.03</td> +<td align="right" valign="bottom">0.52</td> +<td align="right" valign="bottom">52.45</td></tr> +<tr><td>Otago</td> +<td align="right" valign="bottom">199</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">215</td> +<td align="right" valign="bottom">414</td> +<td align="right" valign="bottom">48.07</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">51.93</td></tr> +<tr><td>Dominion totals</td> +<td align="right" valign="bottom">1,598</td> +<td align="right" valign="bottom">14</td> +<td align="right" valign="bottom">1,419</td> +<td align="right" valign="bottom">3,031</td> +<td align="right" valign="bottom">52.72</td> +<td align="right" valign="bottom">0.46</td> +<td align="right" valign="bottom">46.82</td></tr> +</table> + + +<p><br /><br /><b>TABLE F.</b></p> + +<p><span class="smcap">Venereal Diseases in New Zealand as at 16th September, 1922.—Incidence +in Chief Centres showing Rate per 1,000 Estimated Population.</span></p> + +<table border="1" cellpadding='4' cellspacing='0' summary="Incidence rates for VD in New Zealand, 1922"> +<tr><td rowspan="3" align="center">Urban Area</td> +<td rowspan="3" align="center">Estimated Population 1st April, 1922</td> +<td colspan="6" align="center">Cases of Recent Infection</td> +<td colspan="8" align="center">Cases of Distant Infection</td> +<td colspan="2" rowspan="2" align="center">Grand Total</td></tr> +<tr><td colspan="2" align="center">Gonorrhœa</td> +<td colspan="2" align="center">Syphilis</td> +<td colspan="2" align="center">Total</td> +<td colspan="2" align="center">Chronic Gonorrhœa</td> +<td colspan="2" align="center">Congenital Syphilis</td> +<td colspan="2" align="center">Tertiary Syphilis</td> +<td colspan="2" align="center">Total</td></tr> +<tr><td align="center">Cases</td> +<td align="center">Rate per 1,000</td> +<td align="center">Cases</td> +<td align="center">Rate per 1,000</td> +<td align="center">Cases</td> +<td align="center">Rate per 1,000</td> +<td align="center">Cases</td> +<td>Rate per 1,000</td> +<td align="center">Cases</td> +<td align="center">Rate per 1,000</td> +<td>Cases</td> +<td align="center">Rate per 1,000</td> +<td align="center">Cases</td> +<td align="center">Rate per 1,000</td> +<td align="center">Cases</td> +<td align="center">Rate per 1,000</td></tr> + +<tr><td>Auckland</td> +<td align="right" valign="bottom">164,450</td> +<td align="right" valign="bottom">14</td> +<td align="right" valign="bottom">1.30</td> +<td align="right" valign="bottom">146</td> +<td align="right" valign="bottom">0.89</td> +<td align="right" valign="bottom">360</td> +<td align="right" valign="bottom">2.19</td> +<td align="right" valign="bottom">147</td> +<td align="right" valign="bottom">0.89</td> +<td align="right" valign="bottom"> 42</td> +<td align="right" valign="bottom">0.26</td> +<td align="right" valign="bottom">194</td> +<td align="right" valign="bottom">1.18</td> +<td align="right" valign="bottom">383</td> +<td align="right" valign="bottom">2.33</td> +<td align="right" valign="bottom">743</td> +<td align="right" valign="bottom">4.52</td></tr> +<tr><td>Wellington</td> +<td align="right" valign="bottom">110,680</td> +<td align="right" valign="bottom">159</td> +<td align="right" valign="bottom">1.44</td> +<td align="right" valign="bottom"> 99</td> +<td align="right" valign="bottom">0.89</td> +<td align="right" valign="bottom">258</td> +<td align="right" valign="bottom">2.33</td> +<td align="right" valign="bottom">240</td> +<td align="right" valign="bottom">2.17</td> +<td align="right" valign="bottom"> 42</td> +<td align="right" valign="bottom">0.38</td> +<td align="right" valign="bottom">183</td> +<td align="right" valign="bottom">1.65</td> +<td align="right" valign="bottom">465</td> +<td align="right" valign="bottom">4.20</td> +<td align="right" valign="bottom">723</td> +<td align="right" valign="bottom">6.53</td></tr> +<tr><td>Christchurch</td> +<td align="right" valign="bottom">110,200</td> +<td align="right" valign="bottom"> 79</td> +<td align="right" valign="bottom">0.72</td> +<td align="right" valign="bottom"> 59</td> +<td align="right" valign="bottom">0.53</td> +<td align="right" valign="bottom">138</td> +<td align="right" valign="bottom">1.25</td> +<td align="right" valign="bottom"> 63</td> +<td align="right" valign="bottom">0.57</td> +<td align="right" valign="bottom"> 15</td> +<td align="right" valign="bottom">0.14</td> +<td align="right" valign="bottom"> 87</td> +<td align="right" valign="bottom">0.79</td> +<td align="right" valign="bottom">165</td> +<td align="right" valign="bottom">1.50</td> +<td align="right" valign="bottom">303</td> +<td align="right" valign="bottom">2.75</td></tr> +<tr><td>Dunedin</td> +<td align="right" valign="bottom"> 73,470</td> +<td align="right" valign="bottom"> 54</td> +<td align="right" valign="bottom">0.74</td> +<td align="right" valign="bottom">102</td> +<td align="right" valign="bottom">1.39</td> +<td align="right" valign="bottom">156</td> +<td align="right" valign="bottom">2.12</td> +<td align="right" valign="bottom"> 96</td> +<td align="right" valign="bottom">1.31</td> +<td align="right" valign="bottom"> 18</td> +<td align="right" valign="bottom">0.25</td> +<td align="right" valign="bottom"> 59</td> +<td align="right" valign="bottom">0.80</td> +<td align="right" valign="bottom">173</td> +<td align="right" valign="bottom">2.35</td> +<td align="right" valign="bottom">329</td> +<td align="right" valign="bottom">4.48</td></tr> +<tr><td>Hamilton</td> +<td align="right" valign="bottom"> 14,950</td> +<td align="right" valign="bottom"> 15</td> +<td align="right" valign="bottom">1.01</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.20</td> +<td align="right" valign="bottom"> 18</td> +<td align="right" valign="bottom">1.20</td> +<td align="right" valign="bottom"> 22</td> +<td align="right" valign="bottom">1.47</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom">0.67</td> +<td align="right" valign="bottom"> 32</td> +<td align="right" valign="bottom">2.14</td> +<td align="right" valign="bottom"> 50</td> +<td align="right" valign="bottom">3.34</td></tr> +<tr><td>Cisborne</td> +<td align="right" valign="bottom"> 14,920</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">0.47</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">0.47</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">0.60</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">0.13</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">0.60</td> +<td align="right" valign="bottom"> 20</td> +<td align="right" valign="bottom">1.34</td> +<td align="right" valign="bottom"> 27</td> +<td align="right" valign="bottom">1.81</td></tr> +<tr><td>Napier </td> +<td align="right" valign="bottom"> 17,670</td> +<td align="right" valign="bottom"> 17</td> +<td align="right" valign="bottom">0.96</td> +<td align="right" valign="bottom"> 13</td> +<td align="right" valign="bottom">0.74</td> +<td align="right" valign="bottom"> 30</td> +<td align="right" valign="bottom">1.70</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">0.45</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.17</td> +<td align="right" valign="bottom">9</td> +<td align="right" valign="bottom">0.51</td> +<td align="right" valign="bottom"> 20</td> +<td align="right" valign="bottom">1.13</td> +<td align="right" valign="bottom"> 50</td> +<td align="right" valign="bottom">2.83</td></tr> +<tr><td>Hastings</td> +<td align="right" valign="bottom"> 13,530</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">0.15</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">0.15</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">0.07</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">0.15</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">0.15</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">0.37</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">0.52</td></tr> +<tr><td>New Plymouth</td> +<td align="right" valign="bottom"> 13,510</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.22</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.22</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.22</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.22</td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom">0.52</td></tr> +<tr><td>Wanganui</td> +<td align="right" valign="bottom"> 24,170</td> +<td align="right" valign="bottom"> 14</td> +<td align="right" valign="bottom">0.58</td> +<td align="right" valign="bottom"> 12</td> +<td align="right" valign="bottom">0.50</td> +<td align="right" valign="bottom"> 26</td> +<td align="right" valign="bottom">1.08</td> +<td align="right" valign="bottom"> 29</td> +<td align="right" valign="bottom">1.20</td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom">0.25</td> +<td align="right" valign="bottom"> 21</td> +<td align="right" valign="bottom">0.87</td> +<td align="right" valign="bottom"> 56</td> +<td align="right" valign="bottom">2.32</td> +<td align="right" valign="bottom"> 82</td> +<td align="right" valign="bottom">3.39</td></tr> +<tr><td>Palmerston North </td> +<td align="right" valign="bottom"> 17,510</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">0.29</td> +<td align="right" valign="bottom"> 13</td> +<td align="right" valign="bottom">0.80</td> +<td align="right" valign="bottom"> 18</td> +<td align="right" valign="bottom">1.03</td> +<td align="right" valign="bottom"> 12</td> +<td align="right" valign="bottom">0.69</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">0.29</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">0.17</td> +<td align="right" valign="bottom"> 20</td> +<td align="right" valign="bottom">1.14</td> +<td align="right" valign="bottom"> 38</td> +<td align="right" valign="bottom">2.17</td></tr> +<tr><td>Nelson </td> +<td align="right" valign="bottom"> 10,880</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">0.09</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">0.09</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">4</td> +<td align="right" valign="bottom">0.37</td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom">0.92</td> +<td align="right" valign="bottom"> 14</td> +<td align="right" valign="bottom">1.29</td> +<td align="right" valign="bottom"> 15</td> +<td align="right" valign="bottom">1.38</td></tr> +<tr><td>Timaru </td> +<td align="right" valign="bottom"> 16,040</td> +<td align="right" valign="bottom">6</td> +<td align="right" valign="bottom">0.37</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">0.06</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">0.44</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">0.31</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">0.50</td> +<td align="right" valign="bottom"> 13</td> +<td align="right" valign="bottom">0.81</td> +<td align="right" valign="bottom"> 20</td> +<td align="right" valign="bottom">1.25</td></tr> +<tr><td>Invercargill</td> +<td align="right" valign="bottom"> 19,590</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">0.05</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">0.05</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">0.36</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> 10</td> +<td align="right" valign="bottom">0.51</td> +<td align="right" valign="bottom"> 17</td> +<td align="right" valign="bottom">0.87</td> +<td align="right" valign="bottom"> 18</td> +<td align="right" valign="bottom">0.92</td></tr> +</table> + + +<p><a name="Page_27" id="Page_27"></a><br /><br /><b>TABLE G.</b></p> + +<p><span class="smcap">Venereal Diseases in New Zealand as at 16th September, 1922. +—Proportion of Cases Per 1,000 Of Population in each Health District.</span></p> + +<table border='1' cellpadding='4' cellspacing='0' summary="Proportion of population with VD in New Zealand, 1922"> +<tr><td rowspan="2" align="center">Health District</td> +<td rowspan="2" align="center">Estimated Population 1st April, 1922</td> +<td colspan="3" align="center">Total Cases (all Diseases)</td> +<td colspan="3" align="center">Proportion Cases per 1,000 Estimated Population</td></tr> +<tr><td align="center">Recent Infection</td> +<td align="center">Distant Infection</td> +<td align="center">Grand Total</td> +<td align="center">Recent Infection</td> +<td align="center">Distant Infection</td> +<td align="center">Grand Total</td></tr> +<tr><td>North Auckland</td> +<td align="right" valign="bottom">36,930</td> +<td align="right" valign="bottom">14</td> +<td align="right" valign="bottom">16</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">0.38</td> +<td align="right" valign="bottom">0.43</td> +<td align="right" valign="bottom">0.81</td></tr> +<tr><td>Auckland</td> +<td align="right" valign="bottom">323,436</td> +<td align="right" valign="bottom">447</td> +<td align="right" valign="bottom">519</td> +<td align="right" valign="bottom">966</td> +<td align="right" valign="bottom">1.38</td> +<td align="right" valign="bottom">1.60</td> +<td align="right" valign="bottom">2.99</td></tr> +<tr><td>Hawke's Bay</td> +<td align="right" valign="bottom">80,242</td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom">72</td> +<td align="right" valign="bottom">127</td> +<td align="right" valign="bottom">0.62</td> +<td align="right" valign="bottom">0.81</td> +<td align="right" valign="bottom">1.42</td></tr> +<tr><td>Wanganui</td> +<td align="right" valign="bottom">110,866</td> +<td align="right" valign="bottom">98</td> +<td align="right" valign="bottom">149</td> +<td align="right" valign="bottom">247</td> +<td align="right" valign="bottom">0.8</td> +<td align="right" valign="bottom">1.34</td> +<td align="right" valign="bottom">2.23</td></tr> +<tr><td>Wellington</td> +<td align="right" valign="bottom">242,830</td> +<td align="right" valign="bottom">305</td> +<td align="right" valign="bottom">555</td> +<td align="right" valign="bottom">860</td> +<td align="right" valign="bottom">1.26</td> +<td align="right" valign="bottom">2.28</td> +<td align="right" valign="bottom">3.54</td></tr> +<tr><td>Canterbury</td> +<td align="right" valign="bottom">240,387</td> +<td align="right" valign="bottom">176</td> +<td align="right" valign="bottom">211</td> +<td align="right" valign="bottom">387</td> +<td align="right" valign="bottom">0.73</td> +<td align="right" valign="bottom">0.88</td> +<td align="right" valign="bottom">1.61</td></tr> +<tr><td>Otago</td> +<td align="right" valign="bottom">200,574</td> +<td align="right" valign="bottom">183</td> +<td align="right" valign="bottom">231</td> +<td align="right" valign="bottom">414</td> +<td align="right" valign="bottom">0.91</td> +<td align="right" valign="bottom">1.15</td> +<td align="right" valign="bottom">2.06</td></tr> +<tr><td>Dominion totals</td> +<td align="right" valign="bottom">1,244,265</td> +<td align="right" valign="bottom">1,278</td> +<td align="right" valign="bottom">1,753</td> +<td align="right" valign="bottom">3,031</td> +<td align="right" valign="bottom">1.03</td> +<td align="right" valign="bottom">1.41</td> +<td align="right" valign="bottom">2.44</td></tr> +</table> + +<p><br /><br /><b>TABLE H.</b></p> + +<p><span class="smcap">Venereal Diseases in New Zealand as at 16th September, 1922. +—Sex Numbers and Proportions in Health Districts.</span></p> + +<table border="1" cellpadding='4' cellspacing='0' summary="Gender numbers and proportion of population with VD, New Zealand in 1922"> +<tr><td rowspan="3" align="center">Health District</td> +<td colspan="9" align="center">Cases of Recent Infection</td> +<td colspan="12" align="center">Cases of Distant Infection</td> +<td rowspan="2" align="center" colspan="3">Grand Totals</td></tr> +<tr><td align="center" colspan="3">Gonorrhœa</td> +<td align="center" colspan="3">Syphilis</td> +<td align="center" colspan="3">Totals</td> +<td align="center" colspan="3">Chronic Gonorrhœa</td> +<td align="center" colspan="3">Congenital Syphilis</td> +<td align="center" colspan="3">Tertiary Syphilis</td> +<td align="center" colspan="3">Totals</td></tr> +<tr><td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td> +<td>M</td> +<td>F</td> +<td>F. to 100 M</td></tr> +<tr><td align="left">North Auckland</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">33</td> +<td align="right" valign="bottom">13</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">2</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom"> </td> +<td align="right" valign="bottom">4</td> +<td align="right" valign="bottom">1</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">12</td> +<td align="right" valign="bottom">4</td> +<td align="right" valign="bottom">33</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">20</td></tr> +<tr><td align="left">Auckland </td> +<td align="right" valign="bottom">224</td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">112</td> +<td align="right" valign="bottom">53</td> +<td align="right" valign="bottom">47</td> +<td align="right" valign="bottom">336</td> +<td align="right" valign="bottom">108</td> +<td align="right" valign="bottom">32</td> +<td align="right" valign="bottom">156</td> +<td align="right" valign="bottom">73</td> +<td align="right" valign="bottom">47</td> +<td align="right" valign="bottom">33</td> +<td align="right" valign="bottom">18</td> +<td align="right" valign="bottom">55</td> +<td align="right" valign="bottom">168</td> +<td align="right" valign="bottom">71</td> +<td align="right" valign="bottom">42</td> +<td align="right" valign="bottom">357</td> +<td align="right" valign="bottom">162</td> +<td align="right" valign="bottom">45</td> +<td align="right" valign="bottom">693</td> +<td align="right" valign="bottom">270</td> +<td align="right" valign="bottom">39</td></tr> +<tr><td align="left">Hawke's Bay </td> +<td align="right" valign="bottom">28</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">12</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">42</td> +<td align="right" valign="bottom">40</td> +<td align="right" valign="bottom">12</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">27</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">19</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">3</td> +<td align="right" valign="bottom">43</td> +<td align="right" valign="bottom">22</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">36</td> +<td align="right" valign="bottom">56</td> +<td align="right" valign="bottom">16</td> +<td align="right" valign="bottom">29</td> +<td align="right" valign="bottom">96</td> +<td align="right" valign="bottom">28</td> +<td align="right" valign="bottom">29</td></tr> +<tr><td align="left">Wanganui </td> +<td align="right" valign="bottom">40</td> +<td align="right" valign="bottom">19</td> +<td align="right" valign="bottom">48</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">12</td> +<td align="right" valign="bottom">48</td> +<td align="right" valign="bottom">65</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">48</td> +<td align="right" valign="bottom">74</td> +<td align="right" valign="bottom">23</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">5</td> +<td align="right" valign="bottom">100</td> +<td align="right" valign="bottom">29</td> +<td align="right" valign="bottom">13</td> +<td align="right" valign="bottom">45</td> +<td align="right" valign="bottom">108</td> +<td align="right" valign="bottom">41</td> +<td align="right" valign="bottom">38</td> +<td align="right" valign="bottom">173</td> +<td align="right" valign="bottom">72</td> +<td align="right" valign="bottom">42</td></tr> +<tr><td align="left">Wellington </td> +<td align="right" valign="bottom">143</td> +<td align="right" valign="bottom">44</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">95</td> +<td align="right" valign="bottom">19</td> +<td align="right" valign="bottom">20</td> +<td align="right" valign="bottom">238</td> +<td align="right" valign="bottom">63</td> +<td align="right" valign="bottom">26</td> +<td align="right" valign="bottom">225</td> +<td align="right" valign="bottom">54</td> +<td align="right" valign="bottom">24</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">25</td> +<td align="right" valign="bottom">81</td> +<td align="right" valign="bottom">156</td> +<td align="right" valign="bottom">64</td> +<td align="right" valign="bottom">41</td> +<td align="right" valign="bottom">412</td> +<td align="right" valign="bottom">143</td> +<td align="right" valign="bottom">35</td> +<td align="right" valign="bottom">650</td> +<td align="right" valign="bottom">206</td> +<td align="right" valign="bottom">32</td></tr> +<tr><td align="left">Canterbury </td> +<td align="right" valign="bottom">63</td> +<td align="right" valign="bottom">36</td> +<td align="right" valign="bottom">57</td> +<td align="right" valign="bottom">48</td> +<td align="right" valign="bottom">27</td> +<td align="right" valign="bottom">56</td> +<td align="right" valign="bottom">111</td> +<td align="right" valign="bottom">63</td> +<td align="right" valign="bottom">57</td> +<td align="right" valign="bottom">65</td> +<td align="right" valign="bottom">18</td> +<td align="right" valign="bottom">29</td> +<td align="right" valign="bottom">7</td> +<td align="right" valign="bottom">10</td> +<td align="right" valign="bottom">143</td> +<td align="right" valign="bottom">81</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">37</td> +<td align="right" valign="bottom">153</td> +<td align="right" valign="bottom">58</td> +<td align="right" valign="bottom">38</td> +<td align="right" valign="bottom">264</td> +<td align="right" valign="bottom">121</td> +<td align="right" valign="bottom">46</td></tr> +<tr><td align="left">Otago </td> +<td align="right" valign="bottom">62</td> +<td align="right" valign="bottom">17</td> +<td align="right" valign="bottom">27</td> +<td align="right" valign="bottom">89</td> +<td align="right" valign="bottom">15</td> +<td align="right" valign="bottom">17</td> +<td align="right" valign="bottom">151</td> +<td align="right" valign="bottom">32</td> +<td align="right" valign="bottom">21</td> +<td align="right" valign="bottom">101</td> +<td align="right" valign="bottom">19</td> +<td align="right" valign="bottom">19</td> +<td align="right" valign="bottom">15</td> +<td align="right" valign="bottom">8</td> +<td align="right" valign="bottom">53</td> +<td align="right" valign="bottom">58</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">52</td> +<td align="right" valign="bottom">174</td> +<td align="right" valign="bottom">57</td> +<td align="right" valign="bottom">33</td> +<td align="right" valign="bottom">325</td> +<td align="right" valign="bottom">89</td> +<td align="right" valign="bottom">27</td></tr> +<tr><td align="left">Dominion totals</td> +<td align="right" valign="bottom">570</td> +<td align="right" valign="bottom">178</td> +<td align="right" valign="bottom">31</td> +<td align="right" valign="bottom">384</td> +<td align="right" valign="bottom">132</td> +<td align="right" valign="bottom">34</td> +<td align="right" valign="bottom">954</td> +<td align="right" valign="bottom">310</td> +<td align="right" valign="bottom">32</td> +<td align="right" valign="bottom">656</td> +<td align="right" valign="bottom">194</td> +<td align="right" valign="bottom">30</td> +<td align="right" valign="bottom">98</td> +<td align="right" valign="bottom">70</td> +<td align="right" valign="bottom">71</td> +<td align="right" valign="bottom">518</td> +<td align="right" valign="bottom">217</td> +<td align="right" valign="bottom">42</td> +<td align="right" valign="bottom">1,272</td> +<td align="right" valign="bottom">481</td> +<td align="right" valign="bottom">38</td> +<td align="right" valign="bottom">2,226</td> +<td align="right" valign="bottom">791</td> +<td align="right" valign="bottom">36</td></tr> +</table> + +<hr style='width: 45%;' /> + +<p><i>Approximate Cost of Paper.</i>—Preparation, not given; printing (1,225 +copies), £45.</p> + +<hr style='width: 45%;' /> + +<p>By Authority: W.A.G. <span class="smcap">Skinner</span>, Government Printer, Wellington.—1922.</p> + +<p><i>Price 9d.</i></p> + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +*** END OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES *** + +***** This file should be named 15352-h.htm or 15352-h.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/5/3/5/15352/ + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +https://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at https://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +https://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at https://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit https://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including including checks, online payments and credit card +donations. To donate, please visit: https://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart was the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. + + +</pre> + +</body> +</html> + diff --git a/15352-h/images/img01.jpg b/15352-h/images/img01.jpg Binary files differnew file mode 100644 index 0000000..8631d2e --- /dev/null +++ b/15352-h/images/img01.jpg diff --git a/15352.txt b/15352.txt new file mode 100644 index 0000000..f944f4f --- /dev/null +++ b/15352.txt @@ -0,0 +1,3511 @@ +The Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Venereal Diseases in New Zealand (1922) + Report of the Special Committee of the Board of Health appointed by + the Hon. Minister of Health + + +Author: Committee Of The Board Of Health + +Release Date: March 13, 2005 [EBook #15352] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES *** + + + + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + + + + + +1922. + +NEW ZEALAND. + + +VENEREAL DISEASES IN NEW ZEALAND. + + +REPORT OF THE COMMITTEE OF THE BOARD OF HEALTH APPOINTED BY THE HON. +MINISTER OF HEALTH. + + +_Presented to both Houses of the General Assembly by Leave._ + + +CONSTITUTION OF THE COMMITTEE. + +Hon. W.H. TRIGGS, M.L.C., Chairman. +J.S. ELLIOTT, M.D., Member of the Medical Board. +Mr. MURDOCH FRASER (New Plymouth), representing the + Hospital Boards of the Dominion. +J.P. FRENGLEY, M.D., D.P.H., Deputy Director-General of Health. +Lady LUKE, C.B.E. +Sir DONALD McGAVIN, K.C.M.G., C.M.G., D.S.O., Director-General of + Medical Services. + + +CONTENTS. + +PART I.--INTRODUCTORY AND HISTORICAL. Page + +Section 1.--Origin and Scope of Inquiry: Witnesses; Sittings, Date and +Place of; Appreciation of Services rendered 2 + +Section 2.--Venereal Diseases and their Effects: Ignorance, Effect of; +Sex Education for Young; Syphilis and Gonorrhoea, Origin and +Description; Treatment after Exposure; Diagnosis, Methods of; Treatment, +Importance of Early and Completed 4 + +Section 3.--Accidental Infection: Sources of Infection; Metchnikoff's +Investigation; Food-conveyance; Lavatories, Towels, Drinking-cups, &c. 5 + +Section 4.--Previous Inquiries and Conferences: Contagious Diseases Act, +England; Royal Commission, 1913, Evidence, View of Compulsory +Notification, Divorce and Venereal Disease, Sex Education, Instruction, +and Propaganda; Australasian Medical Congresses. Committee appointed; +Auckland Congress, 1914, Report presented, Nature of Notification +recommended; Melbourne Conference, 1922, Review of Legislation, Comments +and Recommendations; England, Committee recently appointed to report on +Venereal Diseases 5 + +Section 5.--Legislation in New Zealand, Past and Present: Contagious +Diseases Act, 1869 (A), Reference to; Cases Cited (B) which require New +Legislation to deal with; Hospital and Charitable Institutions Act, 1913 +(C); Detention Provisions; The Prisoners Detention Act, 1915 (D); +Provisions for dealing with Venereal Diseases in Convicted Persons; +Social Hygiene Act, 1917 (E); Provisions of the Act outlined; Subsidy +for Maintenance in Hospitals 7 + + +PART II.--PREVALENCE OF VENEREAL DISEASE IN NEW ZEALAND. + +Section 1.--Medical Statistics (A): Medical Practitioners, Special +Returns from, Cases reported, Gonorrhoea and Syphilis: Chancroid; +Prevalence. Clinic Statistics (B): Department of Health Data; Clinic +Distribution; Age Distribution; Marital Condition. Mental Hospital +Statistics (C): Syphilis and Dementia Paralytica; Computations as to +Prevalence of Syphilis based on Fournier's Estimate. Incidence among +Maoris (D): Early Days, Miscarriages; Prevalence at Present, Origin. +Death-certificates (E): Two Certificates, one for Relatives, other for +Registrar; British Empire Statistical Conference, Resolutions passed; +Committee's Conclusion 9 + +Section 2.--Causes of the Prevalence of Venereal Diseases in New +Zealand: Infected Individuals, neglect to undergo or continue Treatment; +Chiropractors; Herbalists: Overseas Introduction; Promiscuous Sexual +Intercourse; Professional Prostitution; Police Evidence; "Amateur" +Prostitution; Social Distribution; Extra-marital Sexual Intercourse, +Result of; Parental Control; Sex Education; Housing and Living +Conditions; Hostels, Advantages of; Moral Imbeciles, Danger from; +Delayed Marriages; Alcohol; Accidental Infections; Dances; Cinema; +Returned Soldiers 11 + + +PART III.--BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASES. + +Section 1.--Education and Moral Control: Chastity, Value of; +Relationship between Sexes; Infected Persons, Responsibility; Church and +Press influence; Parents duty to Children; Pamphlet for Parents; Sex +Hygiene in Schools, Mode of Teaching; School Mothers, Value of, in +Girls' School; Instruction in Sex Hygiene; Adolescents; Moral Standard, +Value of 12 + +Section 2.--Clinics for the Treatment of Venereal Disease: Distribution; +Work performed; Male and Female Attendance; Locality of Clinics; Hours +of Attendance; Lady Doctors; Supply of Apparatus and Drugs for certain +Cases; Advertising Clinics; Extension of Clinics; Training at Clinics +for Nurses, Students, &c.; Cases attending until non-infective; Male and +Female; Lady Patrols; Social Hygiene Society, Work of; Laboratories and +Free Treatment: Complement Fixation Test for Gonorrhoea 14 Page +Section 3.--Licensed Brothels: Observations on; Dangers of Infection +from; Statistics; North European Conference's Resolution; Flexner's +Views; American Opinion. 15 + +Section 4.--Exclusion of Venereal Cases from Overseas: Health Act, 1920, +Provisions; Attendances at Clinics; Recommendations; Immigration +Restriction Act and Syphilis. 16 + +Section 5.--Prophylaxis: Packet System; Early Treatment; +Inter-departmental Committee on Infectious Diseases, Conclusions; +Notices in Public Conveniences; Prophylaxis, Efficiency of 16 + +Section 6.--Legislation required: Conditional Notification (A)--National +Council of Women, View on; Number or Symbol Notification; Infectious +Diseases Notification Bill, England (1889), Opposition to, Comparisons +with Control of Infectious Diseases; Present System, Disadvantages of; +West Australia Act; New Zealand Legislation suggested. Compulsory +Examination and Treatment (B).--Department of Health, proposed +Legislation, Contagious Diseases Act compared with; West Australia +Legislation, Effect on Attendances at Clinics 17 + +Section 7.--Marriage Certificate of Health: Royal Commission on Venereal +Diseases; National Birth-rate Commission; Medical Certificate; Statement +before Registrar, Communicable and Mental Disease; Recommendation; +Medical Practitioners' duty 20 + +Section 8.--Treatment of Unqualified Persons: Chemists, Herbalists, +Chiropractors; Effect of such Treatment; Clinic Statistics relating to +same; West Australian 20 + +Section 9.--Mentally Defective Adolescents: Danger and Cost to the +State; Supervision and Control proposed 20 + + +PART IV.--SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS. + +Section 1.--Conclusions 21 + +Section 2.--Recommendations 21 + +Section 3.--Concluding Remarks 22 + +APPENDIX 24 + + * * * * * + +REPORT. + +The Hon. the Minister of Health, Wellington. + +SIR,-- + +The Committee of the Board of Health appointed by you to inquire into +and report upon the subject of venereal diseases in New Zealand have the +honour to submit herewith their report. + + + + +PART I.--INTRODUCTORY AND HISTORICAL. + + +SECTION 1.--ORIGIN AND SCOPE OF INQUIRY. + +A perusal of departmental files reveals that many persons and bodies +have during recent times urged upon the Government the desirability of +setting up a Committee or Commission of Inquiry to go into this subject. +The appointment of the present Committee, however, arose out of a +suggestion forwarded to the Chairman of the Board of Health, under date +of the 20th June, 1922, from the Council of the New Zealand Branch of +the British Medical Association. The Board of Health duly considered the +representations of the Association and passed a resolution recommending +the Minister to set up a committee to gather data and to make +recommendations as to the best means of preventing and combating +venereal diseases. The proposal thereafter took concrete form, following +the receipt by the members of this Committee of the under-quoted letter, +dated 13th July, 1922, sent out under your direction by the Secretary of +the Board of Health:-- + + "I am directed by the Hon. the Minister of Health, Chairman of this + Board, to inform you that, acting upon the recommendation of the + Board, he has decided to appoint a special Committee from among the + members of the Board to conduct an inquiry into the question of + venereal diseases in New Zealand. The following members are being + asked to become members of the Committee, and the Chairman trusts + you will see your way to accept the position: Dr. Valintine, Dr. + Elliott, Lady Luke, Hon. Mr. Triggs, Sir Donald McGavin, Mr. + Fraser. The Hon. the Minister has asked the Hon. Mr. Triggs to + accept the chairmanship of the Committee. + + "I am further directed to state that the function and duty laid + upon the Committee is as follows:-- + + "(1.) To inquire into and report upon the prevalence; of venereal + disease in New Zealand. + + "(2.) To inquire into and report any special reasons or causes for + the existence of venereal disease in New Zealand. + + "(3.) To advise as to the best means of combating and preventing + venereal disease in New Zealand, and especially as to the necessity + or otherwise of fresh legislation in the matter. + + "The Minister of Health is anxious that the Committee should hear + such evidence and representations on the above-mentioned matters as + may be necessary to fully inform the Committee on the items + referred to it, and with respect to which it is asked to report, + and he further suggests to the Committee that the various + organizations and persons likely to be interested should be + notified that the Committee will, at a certain place and date, in + Wellington, hear any evidence they may desire to tender." + +The Committee regrets that owing to ill health Dr. Valintine, +Director-General of Health, was unable to act as one of its members. His +place was taken by Dr. J.P. Frengley, Deputy Director-General of Health. +Unfortunately, illness also overtook Mr. Murdoch Fraser, who has been +unable to attend the sittings of the Committee since the middle of +August. The remaining members have been present at all sittings of the +Committee, details of which are appended in the following table:-- + +--------------------------------+------------------------------------------ + Places and Dates of Sittings. | Witnesses examined or Work done. +--------------------------------+------------------------------------------ +Wellington, 26th July, 1922 | Preliminary meeting. + (forenoon only) | +Wellington, 8th August, 1922 | Dr. M.H. Watt, Director, Division of + (forenoon only) | Public Hygiene. + | Dr. B.F. Aldred, Officer in Charge + | Venereal Diseases Clinic. +Wellington, 9th August, 1922 | Hon. Dr. W.E. Collins, M.L.C. + (forenoon only) | Mr. J. Caughley, M.A., Director of + | Education. +Auckland, 17th August, 1922 | Dr. Falconer Brown, Officer in Charge + | Venereal Diseases Clinic. + | Dr. Hilda Northcroft. + | Dr. Frank Macky. + | Dr. W. Gilmour, Bacteriologist and + | Pathologist, Auckland Hospital. + | Dr. C.E. Maguire, Medical Superintendent, + | Auckland Hospital. + | Dr. W.H. Parkes. + | Dr. J. Hardie Neil. + | Dr. R. Tracy Inglis, Medical Officer, St. + | Helens Hospital. + | Dr. E.W. Sharman, Port Health Officer. + | Dr. W.H. Pettit. +Auckland, 18th August, 1922 | Mrs. De Treeby, representing Women's + | International and Political League. + | Dr. D.N.W. Murray, Medical Officer to + | Prisons Department. + | Mr. R.J. Pudney. + | Mr. Egerton Gill. + | Mrs. Harrison Lee Cowie. + | Mrs. E.B. Miller. + | Dr. Kenneth Mackenzie. + | Dr. E.H. Milsom. + | Dr. E. Carrick Robertson. + | Rev. Jasper Calder. + | Mr. F.L. Armitage, Government + | Bacteriologist. + | Dr. W.A. Fairclough. + | Dr. A.N. McKelvey, Medical Officer, + | Costley Home. +Christchurch, 29th August, 1922 | Dr. A.C. Thomson, Officer in Charge + | Venereal Diseases Clinic. + | Dr. P.C. Fenwick. + | Mrs. E. Roberts, President Women's + | Branch, Social Hygiene Society. + | Mrs. A.E. Herbert. + | Dr. A.B. Pearson, Bacteriologist and + | Pathologist, Christchurch Hospital. + | Nurse E.M. Stringer, Health Patrol. + | Dr. W. Fox, Medical Superintendent, + | Christchurch Hospital. + | Dr. C.H. Upham, Port Health Officer. + | Dr. C.L. Nedwill, Medical Officer to + | Prisons Department. + | Dr. D.E. Currie. + | Dr. J. Guthrie. + | Dr. W. Irving, Medical Officer, St. + | Helens Hospital. + | Dr. A.C. Sandston, President, Men's + | Branch Social Hygiene Society. + | Major R. Barnes, Salvation Army Officer. + | Dr. A.B. Lindsay. +Dunedin, 31st August, 1922 | Dr. A. Marshall, Officer in Charge + | Venereal Diseases Clinic. + | Dr. A.R. Falconer, Medical + | Superintendent, Dunedin Hospital. + | Dr. H.L. Ferguson, Dean Medical Faculty, + | Otago University. + | Dr. Emily H. Seideberg, Medical Officer, + | St. Helens Hospital. + | Dr. J.A. Jenkins. + | Canon E.R. Nevill, representing the + | Dunedin Council of Sex Education. + | Miss Pattrick, Director of Plunket + | Nursing. + | Mr. J.M. Galloway, representing Society + | for Protection of Women and Children. + | Dr. F.R. Riley. +Wellington, 12th September | Dr. W. Young. + (forenoon only) | Mr. T.R. Cresswell, Headmaster, + | Wellington College. + | Mr. W.W. Cook, Registrar-General. + | Mr. Malcolm Fraser, Government + | Statistician. + | Mr. W.D. Hunt. + | Rev. R.S. Gray. +Wellington, 13th September | Dr. Frank Hay, Inspector-General of + (forenoon only) | Mental Defectives. + | Mrs. Henderson, Representative Women + | Prisoners' Welfare Society and + | Wellington Branch National Council of + | Women. + | Rev. Van Staveren, Jewish Rabbi. +Wellington, 14th September | Dr. Agnes Bennett, Medical Officer, St. + | Helens Hospital. + | Mrs. F. McHugh, Health Patrol. + | Mr. F. Castle, President Pharmacy Board, + | and Chairman Wellington Hospital Board. + | Dr. D.M. Wilson, Medical Superintendent, + | Wellington Hospital. + | Mr. A.H. Wright, Commissioner of Police. + | Mr. W. Dinnie, ex-Commissioner of Police, + | representing Bible in Schools + | Propaganda Committee. + | Rev. J.T. Pinfold, D.D., representing + | Wellington Ministers' Association. + | Canon T. Feilden Taylor, appointed by the + | Bishop of Wellington. +Wellington, 15th September | Major Winton, Salvation Army. + | Mr. W. Beck, Officer in Charge Special + | Schools Branch, Education Department. + | Dr. D.E. Platts-Mills, representing Young + | Women's Christian Association. + | Mrs. Morpeth, representing Young Women's + | Christian Association. + | Miss Dunlop, representing Young Women's + | Christian Association. + | Mrs. Glover, Salvation Army. +Wellington, 26th September | Consideration of report. +Wellington, 10th October | Consideration of report. +Wellington, 12th October | Consideration of report. +Wellington, 13th October | Consideration of report. +Wellington, 18th October | Final meeting. + | +--------------------------------+-------------------------------------- + +It will thus be seen that, apart from time spent in travelling, the +Committee have met on seventeen days and have heard seventy-four +witnesses in person. + +The Committee would like to express their thanks to the witnesses, many +of whom had gone to considerable trouble to collect information and +prepare their evidence. Thanks are also due to the British Medical +Association for their willing co-operation and assistance; to the large +number of members of the medical profession throughout the Dominion who +responded to the Committee's request for information; to Dr. J.H.L. +Cumpston, Federal Director-General of Health, Melbourne, for much +Australian information on the subject, particularly in relation to +Commonwealth quarantine provisions; to Dr. Everitt Atkinson, +Commissioner of Public Health, Perth, West Australia, for a most lucid +and informative report on the working of the legislation in force in +that State; and to many other persons who by means of correspondence and +literature have placed at the Committee's disposal a large amount of +information which has been of material assistance in considering various +aspects of the problems involved. + +The Committee desire to acknowledge their indebtedness to their +secretary, Mr. C.J. Drake, whose wide knowledge of public-health matters +has been of material assistance in their investigations and who has +discharged his duties with marked zeal and ability. + + +SECTION 2.--VENEREAL DISEASES AND THEIR EFFECTS. + +One result of the Committee's investigations has been to show that the +public in general are very ignorant regarding the nature of venereal +diseases, and their lamentable effects not only upon the individuals +infected, but upon the health and well-being of the community as a +whole. This ignorance of the nature of the problem and of the grave +issues involved naturally stands in the way of the evil being grappled +with effectually. Furthermore, the policy of reticence which has +prevailed in the past, while it has led to the omission of proper +instruction of the young, either by their parents or as part of our +system of education, has not prevented the dissemination of an +incomplete or perverted knowledge of the facts relating to sex, which, +being derived as a rule from tainted sources of information, has been +productive of a great deal of evil. + +In these circumstances the Committee feel it their duty, before making +known their recommendations, to state in as plain terms as possible the +medical aspects of the problem they have had to consider. + +There are three forms of venereal diseases namely, syphilis, gonorrhoea, +and chancroid--and of these the first two are the common and most +serious diseases. That sporadic syphilis existed in antiquity and even +in prehistoric times is probable, but there is no doubt that the disease +was a malignant European pandemic in the closing years of the fifteenth +century. The first reference to its origin is in a work written about +the year 1510, wherein it is described as a new affection in Barcelona, +unheard of until brought from Hayti by the sailors of Columbus in 1493. +The army of Charles VIII carried the scourge through Italy, and soon +Europe was aflame. "Its enormous prevalence in modern times," says Dr. +Creighton, "dates, without doubt, from the European libertinism of the +latter part of the fifteenth century." Gonorrhoea also has its origin in +the shades of antiquity, but that it became common in Europe about 1520 +is a fact based on the highest authority. + +Syphilization follows civilization, and syphilis is an important factor +in the extermination of aboriginal races. Syphilis was introduced into +Uganda when that country was opened to trade with the coast, and Colonel +Lambkin reported that "In some districts 90 per cent. suffer from it.... +Owing to the presence of syphilis the entire population stands a good +chance of being exterminated in a very few years, or left a degenerate +race fit for nothing." The earliest known account of the introduction of +syphilis into the Maori race is in an old Maori song composed in the far +North. The Maori population in a village on the shores of Tom Bowline's +Bay was employed in a whaling-station on the Three Kings Islands, and +there they became infected and carried the disease to the mainland. +Venereal disease is not common now among the Maoris, but it made great +ravages in the early days of colonization, to which may be attributed +much of the sterility and repeated miscarriages in the transitional +period of Maori history. + +Through the ages great confusion existed as to the origin and nature of +venereal disease, but in 1905 a micro-organism, the _Spironema +pallidum_, was demonstrated as the infective agent in syphilis, and the +gonococcus as the infecting organism of gonorrhoea had been discovered in +1879. As regards modes of infection, syphilis is contracted usually by +sexual congress; occasionally the mode of infection is accidental and +innocent, and congenital transmission is not uncommon. Gonorrhoea is +contracted by sexual congress as a rule, but occasionally from innocent +contact with discharges, as in lavatories. + +Syphilis, therefore, is a markedly contagious and inoculable disease. It +gains entrance, and usually in three weeks (although this period may be +much shorter) a slight sore appears at the site of infection. It may be +so slight as to pass unnoticed. This is the primary stage of syphilis. +Later, often after two months, the secondary stage begins, and if not +properly treated may last for two years. The patient is not too ill +usually to attend to his avocation, and has severe headache, skin +rashes, loss of hair, inflammation of the eyes, or other varied +symptoms. The tertiary stage may be early or delayed, and its effects +are serious. Masses of cells of low vitality, known as "gummata," with a +tendency to break down or ulcerate, may form in almost any part of the +body, and the damage that occurs is considerable indeed. Various +diseases result which the lay mind would not associate with syphilis, +but it would be difficult to overestimate the resultant diseases that +may occur in any organ of the body:-- + + This racks the joints; this fires the veins: + That every labouring sinew strains; + Those in the deeper vitals rage. + + +Many deaths ascribed to other causes are the direct consequence of +syphilis. It cuts off life at its source, being a frequent cause of +abortion and early death of infants. It slays those who otherwise would +be strong and vigorous, sometimes striking down with palsy men in their +prime, or extinguishing the light of reason. It is an important factor +in the production of blindness, deafness, throat affections, +heart-disease and degeneration of the arteries, stomach and bowel +disease, kidney-disease, and affections of the bones. Congenital +syphilis often leads to epilepsy or to idiocy, and most of the victims +who survive are a charge on the State. This indictment against syphilis +is by no means complete. The economic loss resulting from this disease +is enormous as regards young, old, middle-aged. It respects not sex, +social rank, or years. + +Gonorrhoea is characterized in its commonest form by a discharge of pus +from the urethra, and causes acute pain at its onset in the male, but in +the female it commonly causes little or no discomfort. Unless carefully +treated, and treated early, it gives rise to many complications, such as +inflammation of the bladder, gleet, stricture, inflammation of joints, +abscesses, and rheumatism. It is a common cause of sterility and of +miscarriages, and, in the female, of many internal inflammations and +disablement, and in its later effects requires often surgical operations +on women. It is a very common disease, and the public know little of the +evil consequences which may follow what they have persisted in regarding +as a simple complaint. From its prevalence and its complications it is +one of the most serious diseases that affect mankind. + +As regards treatment of venereal disease of all kinds, it should be +clearly understood that the causative germs are well known and can +readily be destroyed immediately after exposure to infection by thorough +cleansing with antiseptic lotion or ointment. The use of soap and water +only would lessen the incidence of infection. On the first suspicious +sign of venereal disease the patient should apply at once for medical +advice. There are methods of diagnosis, such as microscopic examination +and the Wassermann test, the result of recent discovery, which make +diagnosis simple and certain; and if treatment is begun early according +to modern methods, which are much more effective than the remedies +formerly applied, the germs of infection are easily vanquished. When +sufficient time, however, is lost to enable these germs to become +entrenched in parts of the body not readily accessible to treatment, +cure is difficult, prolonged, and perhaps in some cases uncertain. + +For their own sakes, as well as for the sake of others, patients +suffering from any form of venereal disease should continue treatment, +which may be prolonged in the case of syphilis for two years, until +their medical adviser is satisfied that further treatment is +unnecessary. + +Women suffer less pain than men in these diseases, and consequently are +more apt to neglect securing medical advice and treatment, and more +ready to discontinue treatment before a cure is effected. + + +SECTION 3.--ACCIDENTAL INFECTION. + +Occasionally cases are met with in which syphilis is acquired innocently +by direct or indirect contact with syphilitic material, and then the +primary sore is often located on some other part of the body than the +genitals. Thus the lip may be infected by kissing, or by drinking out of +the same glass, or smoking the same pipe as a syphilitic patient. A +medical witness reported a case to the Committee in which syphilis was +conveyed to two girls "through a young fellow handing them a cigarette +which he was smoking." Metchnikoff has proved that the spironema of +syphilis is a delicate organism and quickly loses its virulence outside +the human body, and it cannot enter the system through unbroken skin or +mucous membrane. It is extremely doubtful if any form of venereal +infection can be conveyed in food. Frequently venereal disease is +deceitfully attributed by patients to innocent infection, and no doubt +some genuine cases do occur, but how seldom is illustrated by the +statement of the Officer in Charge of the V.D. Clinic at Christchurch, +who said, "I cannot remember a case where I was absolutely certain that +infection was acquired innocently or extragenitally." + +Gonorrhoea may be conveyed innocently from infective discharge on a +closet-seat, or from an infected towel, &c., and undoubtedly gonorrhoeal +discharge if brought into contact with the eye sets up a violent +suppuration. + +The Committee are of opinion that the extent of accidental infection is +greatly exaggerated in the public mind, but a few cases occasionally +occur, and the Committee recommend that there should be better provision +of public conveniences, especially for women, and the U-shaped +closet-seat should be adopted. The use of common towels and +drinking-cups in railway-trains, schools, factories, and elsewhere is +condemned not only for the reasons stated above, but on general sanitary +grounds. + + +SECTION 4.--PREVIOUS INQUIRIES AND CONFERENCES. + +After the repeal of the Contagious Diseases Act in England in 1886, +various Committees and Royal Commissions, such as the Inter-departmental +Committee on Physical Deterioration in 1904, the Royal Commission on the +Poor-laws in 1909, and the Royal Commission on Divorce in 1912, drew +attention to the frightful havoc wrought by venereal disease, and urged +that further action should be taken to deal with the evil. In 1913 the +British Government appointed a Royal Commission to inquire into the +prevalence of venereal diseases in the United Kingdom, their effects +upon the health of the community, and the means by which these effects +could be alleviated or prevented, it being understood that no return to +the policy or provisions of the Contagious Diseases Acts was to be +regarded as falling within the scope of the inquiry. + +The Commission took a great deal of most valuable evidence, and did not +present their final report until 1916. They recommended improved +facilities for diagnosis and treatment, including free clinics. They +came to the conclusion that at that time any system of compulsory +personal notification would fail to secure the advantages claimed. The +Commission added, however, "it is possible that the situation may be +modified when these facilities for diagnosis and treatment [recommended +by the Commission] have been in operation for some time, and the +question of notification should then be further considered. It is also +possible that when the general public become alive to the grave dangers +arising from venereal disease, notification in some form will be +demanded." The Commission supported the adoption of a recommendation by +the Royal Commission on Divorce to the effect that where one of the +parties at the time of marriage is suffering from venereal disease in a +communicable form and the fact is not disclosed by the party, the other +party shall be entitled to obtain a decree annulling the marriage, +provided that the suit is instituted within a year of the celebration of +the marriage, and there has been no marital intercourse after the +discovery of the infection. The Commission urged that more careful +instruction should be provided in regard to moral conduct as bearing +upon sexual relations throughout all types and grades of education. Such +instruction, they urged, should be based upon moral principles and +spiritual considerations, and should not be based only on the physical +consequences of immoral conduct. They also favoured general propaganda +work, and urged that the National Council for Combating Venereal +Diseases should be recognized by Government as an authoritative body for +the purpose of spreading knowledge and giving advice. + +Another important Commission, sitting almost simultaneously with that +just referred to, was the National Birth-rate Commission, which began +its labours on the 24th October, 1913, and presented its first Report on +the 28th June, 1916. The Commission was reconstituted, with the Bishop +of Birmingham as Chairman, in 1918, to further consider the question, +and especially in view of the effects of the Great War upon vital +problems of population. Among the terms of reference the Commission were +requested to inquire into "the present spread of venereal disease, the +chief causes of sterility and degeneracy, and the further menace of +these diseases during demobilization." The Commission in their report, +presented in 1920, stated that they realized the difficulties involved +in the introduction of any efficient scheme of compulsory notification +and treatment of venereal diseases, but, they added, they "feel that it +has now passed the experimental stage both in our colonies and in forty +of the forty-eight of the United States of America, and think it is +advisable for the State to make a trial of compulsory notification and +treatment in this country, provided that there should be no return to +the principles or practice of the Contagious Diseases Act." Referring to +the finding of the Royal Commission on Venereal Disease that it would +not be possible at present to organize a satisfactory method of +certification of fitness for marriage, the National Birth-rate +Commission thought this question should now be reconsidered with a view +to legislation. "If," says the report, "a certificate of health was to +become a legal obligation for persons contemplating marriage, many of +the legal, ethical, and professional difficulties surrounding this +question would be removed." + +In Sweden, where a Venereal Diseases Law was passed in 1918, stress was +laid on the importance of general enlightenment with regard to venereal +disease and germane subjects, such as sex hygiene. A committee was +appointed, consisting of experts in medicine and pedagogy, to inquire +into the best means of providing such education. Their report, which has +just been issued, is described by the _British Medical Journal_ as a +document of considerable value, promising to become the charter of a new +and complete system of sex education and hygiene in schools throughout +Sweden. Further reference will be made to this document in the section +of this report dealing with education. + +The subject of venereal disease has also been considered by more than +one important Medical Conference in Australia and New Zealand. + +At a general meeting of the Australasian Medical Congress held in +Melbourne in October, 1908, it was resolved that the executive be +recommended to appoint a committee to investigate and report on the +facts in regard to syphilis. Such a committee was appointed, and +reported to the Congress in Sydney in 1911. In 1914 the Congress was +held in Auckland, and a special committee which had been appointed, with +the Hon. Dr. W.E. Collins, M.L.C., as chairman, presented a valuable +report giving some interesting information in regard to the prevalence +of venereal disease, in New Zealand. The committee recommended that +syphilis be declared a notifiable disease; that notification be +encouraged and discretionary, but not compulsory; and that the Chief +Medical Officer of Health be the only person to whom the notification be +made. They also recommended the provision of laboratories for the +diagnosis of syphilis, and that free treatment for syphilis be provided +in the public hospitals and dispensaries. These recommendations were +embodied in the report adopted by the Congress. + +In February of the present year an important Conference, convened by the +Prime Minister of Australia, was held in Parliament House, Melbourne. It +was attended by official representatives of the Health Departments of +all the States, together with representatives from the British Medical +Association, the Women's Medical Staff at the Queen Victoria Hospital +Diseases Clinic in Melbourne, and other scientific and medical +authorities. The Commonwealth subsidizes the work of the States in +combating venereal disease, and the object of the Prime Minister in +calling the Conference was in order that it might inquire into the +effectiveness of the present system of legislation, of administrative +measures, and of clinical methods, with a view of determining whether +the best results were being obtained for the expenditure of the money. + +Western Australia has an Act, which came into operation in June, 1916, +providing for what is known as conditional notification of patients, +together with other provisions for the control of venereal disease which +are on a more comprehensive scale than has been attempted anywhere with +the possible exception of Denmark. In December, 1916, Victoria passed a +similar Act, and this example was followed by Queensland, Tasmania, and +New South Wales. + +The Conference, answering the several questions put to it, found that a +greater proportion of persons infected with venereal disease were +receiving more effective treatment than before the passing of the +Venereal Diseases Act. In the opinion of the Conference this was due +partly to the passing of legislation and partly to the opening of +clinics affording greater opportunities for free treatment. They +considered the operations of the Act had been more successful in +bringing men under treatment than it had been in the case of women. +Among the opinions expressed by the committee were the following: The +Act was not equally successful in respect of private and hospital +patients in regard to notification, but was equally successful in +respect of securing to both more effective treatment. There has been an +apparent reduction in the prevalence of venereal diseases, and the +Conference were strongly of opinion that the results so far justify the +continuance of these Acts in operation. + +The Conference found that venereal diseases are the most potent of all +causes of sterility and of infant and foetal morbidity and mortality. It +recommended, among other remedial measures, that prophylactic depots, +both for males and females, should be established as widely in the +community as possible. Referring to the educational aspect, the +Conference urged that children should be instructed in general +biological facts up to the age of puberty, when more explicit +information concerning facts of sexual life should be given. They urged +on all parents and educational, philanthropic, and religious +organizations the pressing necessity for a sustained campaign, in +co-operation with the medical profession, in order to inculcate in the +community higher ideals of personal hygiene and health. + +Lastly, it may be mentioned that, at the instance of Lord Dawson of +Penn, a highly qualified and representative committee of medical men, +with Lord Trevethin as chairman, has been appointed in England to report +to the Minister of Health upon "the best medical measures for preventing +venereal disease in the civil community, having regard to administrative +practicability, including cost." The appointment of such a committee was +requested by Lord Dawson chiefly with a view to obtaining an +authoritative pronouncement on the subject of medical preventive +measures, and the committee's report will be awaited with much interest. + + +SECTION 5.--LEGISLATION IN NEW ZEALAND, PAST AND PRESENT. + +(A) _Contagious Diseases Act (repealed)._ + +The Contagious Diseases Act was passed in 1869, and repealed in 1910. +Briefly, its aim was to secure periodical examinations of prostitutes, +and to detain for treatment those prostitutes found infected with +venereal disease. + +There appears to be, in some quarters, an apprehension that hidden +beneath the movement to combat venereal diseases is an implied desire or +intention to reinstate the antiquated and detested provisions of that +Act. The Committee deem it necessary to say that they have not found +grounds for this suspicion; that no legislation can be effective unless +it deals equally and adequately with all men, women, and children +sufferers from venereal diseases of all kinds; that it finds little +evidence of a definite prostitute class in New Zealand, and, even if +there were such, the Contagious Diseases Acts have been proved to be +useless as measures towards the prevention of venereal infections; and +it is the Committee's individual and collective opinion that anything +involving a return to the administrative procedure of the Contagious +Diseases Act should have no part whatever in any new legislation in this +Dominion. + +(B.) _Examples of Difficulties--Concrete Cases._ + +Before proceeding to refer to present and suggested legislation, a few +incidents and cases taken from the evidence may help, as concrete +examples, to indicate the difficulties to be contended with:-- + +_Case 1._--A man--young and married, a municipal employee in a +city--associated sexually with a female employee in an eating-house +frequented by himself and co-employees. In due time he sought the advice +of the Medical Officer of Health for (what he suspected) severe +syphilis. Steps were taken to obtain his speedy admission to the local +hospital. The woman continued in her employment. + +_Case 2._--A social-hygiene worker in her evidence said: "I think the +majority of cases I deal with (girls attending a hospital clinic) are +caused through mental depravity, and in some instances you cannot +convince them--they continue to carry on. I have tried all I know how to +show them the dangers, but they just laugh at me. I think it is really +in many cases just a mental condition--mental degeneration, possibly." +This officer explained that even while actually attending the clinic +some of these girls (affected with gonorrhoea), without any semblance of +reserve or decency, would discuss arrangements for further intercourse +with men, and on leaving the clinic (still in an infectious state) were +even seen to go off with young men waiting for them. + +_Case 3._--Asked if he knew of any cases where the disease had been +contracted innocently, a medical practitioner stated in evidence: "I +know of a case where two girls in ---- were infected (syphilis) on the +lip through a young fellow handing them a cigarette which he was +smoking." + +_Case 4._--A medical man in private practice, and Medical Superintendent +of the hospital in a small country town, states: "Although, judging from +an experience of over fifteen years, this district would appear to be +peculiarly free from any variety of venereal disease, I think it may be +of interest to your Committee to know what happened here in the early +part of 1918. At that time there came to reside with her father in ----, +a township about nine miles south of ----, a woman, ----, who, shortly +after her arrival consulted the late Dr. ----, and was found to be the +subject of secondary syphilis.... In all, three cases of gonorrhoea, four +of soft chancre (three of whom suffered from phagadoemic ulceration which +laid them up for weeks), and six cases of purely syphilitic infection +came under my care, all traceable to this same woman. As every case of +gonorrhoea and soft chancre afterwards developed syphilis, ultimately I +had thirteen cases of syphilis under my treatment alone. Others, I have +good reason to believe, went to other towns, and doubtless some failed +to seek any kind of help.... Having prevailed upon the woman to come to +my surgery ... I told her that she was suffering from three varieties of +venereal disease, which she was freely disseminating. I then read to her +that part of the Act which deals with those who "knowingly and wilfully +disseminate venereal infection." That same afternoon she left for ----, +where she continued to ply her calling unhindered. Who can estimate the +sum of the damage done by one such person? Not one of those men infected +was properly treated, although I did all I possibly could to convince +them of their own danger and of the risk of spreading infection to +others. Gradually, as the obvious signs of active disease abated, they +drifted away. I may say the Wassermann reaction proved strongly positive +in every case.... One of these men passed on his infection (syphilis) to +a young girl in this town, and she in turn infected other men, one of +whom came to me, while others went to my colleagues. Another man of the +first group, about middle age, and previously a very healthy, sober, +hard-working fellow, has developed thrombosis of his middle cerebral +artery as the result of a syphilitic endarteritis. He is totally +incapacitated, and in the Old Men's Home at ----. He remains a permanent +charge on the community." + +(C.) _Hospital and Charitable Institutions Act, 1913, Section 19._ + +In 1913 the need for detention provisions, to cover any infectious or +contagious disease, received the attention of Parliament, and these are +embodied in section 19 of the Hospitals and Charitable Institutions Act, +1913, thus: + + "19. (1.) The Governor may from time to time, by Order in Council + gazetted, make regulations for the reception into any institution + under the principal Act of persons suffering from any contagious or + infectious disease, and for the detention of such persons in such + institution until they may be discharged without danger to the + public health. + + "(2.) Any person in respect of whom an order under this section is + made may at any time while such order remains in force appeal + therefrom to a Magistrate exercising jurisdiction in the locality, + and the Magistrate shall have jurisdiction to hear such appeal and + to make such order in the matter as he thinks fit. An order of a + Magistrate under this subsection shall be final and conclusive. + + "(3.) Regulations under this section may be made to apply generally + or to any specified institution or institutions." + +The Committee are advised that this section was not aimed solely at +venereal diseases. In that year, and prior thereto, was prominent the +difficulty of detaining consumptives who refused to take precautions to +prevent the spread of their disease to others; and, again, much +attention was being centred on the chronic typhoid and diphtheria +"carrier." It seemed rational to compel isolation of such persons in +hospital until there was some assurance that they would no longer be a +danger to the community if allowed their liberty. Regulations under the +Act were not issued, owing to opposition manifested at the time, and +consequently the section never became operative. + +(D.) _The Prisoners Detention Act, 1915._ + +This Act secures that individuals of one class of the community--viz., +convicted persons--can be held until freed from venereal disease with +which they were known or found to be infected. The measure is of value, +but logically seems unsound, because the venereal diseases from which +such persons suffer are in no way a greater danger to the public than +the same diseases in the law-abiding subject of any class, and, +furthermore, the Committee have no reason to conclude from the evidence +that convicted persons, as a whole, show a higher percentage of venereal +cases than those who never enter a prison. The Controller-General of +Prisons submitted a schedule showing that the number of prisoners +detained under the Prisoners Detention Act from its commencement in 1916 +to 1922 was twenty-eight, consisting of nineteen males and nine females. + +(E.) _Social Hygiene Act, 1917._ + +In the words of the Commissioner for Public Health of West Australia, +who prepared the first comprehensive legislation on venereal diseases in +1915, this Act "can hardly be classed with recent Australian +legislation, for the reason that it provides for no notification of the +disease and no compulsory examination." By this Act infected persons are +required to consult a medical practitioner and go under treatment by +him, or at a hospital; but no penalty is provided, and there is nothing +to compel such persons to do either of these things. + +Reference to case 1 in the concrete examples cited above will show the +weakness of the Act. The waitress continued in employment, handling cups +and spoons and cakes, &c. The Medical Officer of Health had every reason +to believe she was infected with syphilis, but, not having the power to +insist on her obtaining medical advice, he could do nothing to enforce +the provisions of section 6 of the Act. + +Section 7, making it an offence for any person not being a registered +medical practitioner to undertake for payment or other reward the +treatment of any venereal disease, has, in the opinion of the +Commissioner of Police, proved beneficial in restricting the operation +of quacks, but he suggests that it should be amended by deleting the +words "for payment or reward," as it is sometimes easy to prove the +treatment and difficult to prove the payment, and it is the treatment by +unqualified persons that is aimed at. + +Section 8, which makes it an offence knowingly to infect any person with +venereal disease, is practically inoperative, as will be shown later in +this report, owing to the extreme difficulty, in the absence of any +system of notification and compulsory treatment, of proving that the +offence was committed knowingly. + +The Committee desire to draw attention to section 13. Herein is provided +towards hospital maintenance a higher subsidy for venereal patients than +is receivable for the maintenance of patients suffering from other +infectious diseases. They think that it is inadvisable to particularize +venereal sufferers, or, indeed, to draw any distinction between +different classes of diseases in a hospital, and that the ordinary +subsidy should be paid in all cases. + +In this Act also is power to make regulations for the "classification, +treatment, control, and discipline of persons _detained_ in such +hospitals," but apparently, owing to the opposition to the almost +analagous provision in the Hospitals and Charitable Institutions Act, +1913, no such regulations have as yet been made. + + + + +PART II--PREVALENCE OF VENEREAL DISEASES IN NEW ZEALAND. + + +SECTION 1.--STATISTICAL. + +(A.) _Medical Statistics._ + +The first item on the Committee's order of reference is "To inquire and +report, as to prevalence of venereal diseases in New Zealand." + +One of the first matters which engaged the attention of the Committee +was the question how reliable information could be gathered which would +indicate the present prevalence of these diseases in this country. +Recognizing that it would be impossible to obtain trustworthy figures +without securing the widespread co-operation of the medical profession, +the Committee at an early stage sought and was readily given the help of +the British Medical Association in the matter. Representatives of the +Association gave their assistance in the preparation of a form to be +sent to and filled in by all practising members of the profession, and +in the current number of the _New Zealand Medical Journal_ an appeal to +members for their collaboration was made. Suitable circular letters were +also prepared by the Committee asking medical practitioners for their +co-operation, and the Committee are pleased to be able to report that +out of about 750 in actual practice, no fewer than 635 medical +practitioners sent in completed returns. A copy of the form used for +these returns will be found as an appendix to this report, as also a +tabulated return of the replies received and compilations therefrom. + +It will be seen that the total number of cases of all forms of venereal +diseases and of diseases attributable to venereal disease under the +personal care of the doctors reporting is 3,031; and, taking the +population of New Zealand as 1,296,986 (estimated population 31st March, +1922), this means that about one person in every 428 of our population +is at present being treated for venereal infection or for the results +thereof. Acute and chronic gonorrhoeal infections give a total of 1,598, +being about one person in every 812 of the population. This is most +likely a very low estimate, for the Committee have had it very +definitely in evidence that many persons suffering, at least from acute +gonorrhoea, seek treatment at the hands of persons other than registered +medical practitioners. For syphilitic infections in all forms the total +is 1,419, about one person in every 914 of the population. The return +bears out other evidence showing that the chancroid or soft-sore type of +infection is rare in this Dominion. + +The Committee regard the result obtained as furnishing some indication +of the amount of active venereal disease existing in the Dominion. The +Committee consider, however, that these figures must be considerably on +the low side, for these reasons: (_a_) that a number of medical +practitioners have not replied: (_b_) that some diseases attributable to +venereal disease may not have been conclusively diagnosed as such, and, +therefore, not included in the return. The return necessarily does not +include cases, probably numerous, which have not been under medical care +for some time, if at all; (_c_) to secure a complete return would have +involved the keeping by each doctor of full records of all cases and a +careful and laborious collation of figures. + +With respect to the expression of opinion asked of medical practitioners +upon the question "If venereal disease in this Dominion has or has not +increased in a greater proportion than the population during the last +five years," it will be seen that of 322 who replied, 199 answered "Yes" +and 203 "No." This is necessarily purely a matter of impression, and it +must also be borne in mind that the evidence shows that patients are now +using the clinics in large numbers, while others who formerly went to +general practitioners now consult specialists who have recently started +in practice. On the other hand, it is possible there is a compensating +influence in the fact that the public are being educated to the +importance of seeking skilled medical treatment for these diseases. + +(B.) _Clinic Statistics._ + +A second source of information as to the prevalence of venereal diseases +was provided by the statistics which have been compiled by the +Department of Health as the result of the establishment of the +venereal-diseases clinics. Among the appendices to this report will be +found a return showing the number of persons attending at each of these +clinics for the years 1920, 1921, and part of 1922, and recorded under +the headings "Sexes" and "Diseases." These statistics are valuable +insomuch as they record facts, but with respect to the total prevalence +they are but an indication, since they relate only to a small proportion +of the population who have become infected and sought treatment. From +this table (B) it will be found that the males attending for the first +time represent 83.60 per cent. of the total, and females 16.40 per +cent., or, roughly, a ratio of six males to every female. + +_Clinic Distribution._--In the figures for syphilis the following points +are worthy of note: Auckland: A distinctly higher number of cases than +the other centres. A marked drop in 1921 for males, but the return for +this year indicates a rise; female cases show a rise for this year. +Wellington: Returns appear fairly uniform, with a slight falling +tendency, most marked in the females. Christchurch: A drop in male +cases, with a fairly uniform rate of females. Dunedin: Here the rates +appear uniform, with exception of a fall for males in 1922. + +As to gonorrhoea, these points may be noted: Auckland: A marked rise. +Wellington: Steady rise with exception of females. Christchurch: Slight +rise since 1920: females uniform rate. Dunedin: Slight rise, with +indication of male increase in 1922. + +_Age Distribution._--The age-period of persons attending the clinics is +mainly eighteen to thirty. + +_Marital Condition._--From the evidence of the clinics it is very +apparent that venereal disease is especially a problem associated with +the unmarried. + +(C.) _Mental Hospital Statistics._ + +A third source of estimation of prevalence was opened to the Committee +by the Inspector-General of Mental Hospitals. The method of +investigation adopted by Dr. Hay is based on Fournier's estimate that 3 +per cent. of the cases of syphilis existing at any one time will +ultimately develop dementia paralytica. + +The introduction of the Wassermann test and treatment by salvarsan or +other arsenical preparations will vitiate this index in future, for the +reasons that by the Wassermann test more cases will be diagnosed, and by +the use of recent remedies the complete cure of many more cases will be +effected, and consequently fewer will develop dementia paralytica. This +disability does not develop until about ten to fifteen years after +infection. The Wassermann test and the modern arsenical preparations +have not yet been in use for that period, therefore these figures, as an +estimate of the prevalence of syphilis in 1921, would not be materially +affected by these developments. An estimate based on these data may +therefore be regarded in the meantime as approximately correct. + +During the past ten years 4,763 males and 3,747 females have been +admitted into New Zealand mental hospitals. The percentage of syphilitic +admissions of all types was 4.74, while the percentage of cases of +dementia paralytica was 3.89. In other words, of the admission of +syphilitics 82 out of every 100 cases were dementia paralytica. The +average yearly number of deaths from dementia paralytica according to +the Government Statistician's returns between 1908 and 1921 was just +under 40. + +If Fournier's estimate that 3 per cent. of syphilitics ultimately +develop dementia paralytica be accepted, one would arrive at the annual +infection by multiplying 40 by 33, which gives 1,320. Assuming the +average duration of life, after infection, to be twenty-five years, this +means that at any given time there are twenty-five years' infections on +hand. Dr. Hay computed from this the number of persons in New Zealand +now who have, or have had, syphilis to be 1,320 x 25, equalling 33,000, +or 1 to every 38 of the population. If the average duration of life +after infection were assumed to be thirty years, the figures would be 1 +to every 32 of the population. + +Taking the figure for syphilitic infections over a period of years at +1,320 per annum, this would mean for the population of New Zealand +(exclusive of Maoris) 1 fresh infection annually in about every 850 +persons. + +(D.) _Incidence among Maoris._ + +It is even more difficult than in the case of the European population to +say what is the prevalence of venereal diseases amongst Maoris. The +Director of the Division of Maori Hygiene (Dr. Te Rangi Hiroa) in a +statement to the Committee says:-- + +"Venereal disease made great ravages amongst the Maori population in the +early days of colonization. To this may be attributed much of the +sterility, with histories of repeated miscarriages, that existed in the +transitional period of Maori history. Most of the old men--hemiplegias, +and paraplegias, and subsequent general paralysis of the insane--gave an +old history of syphilis. These cases that I saw twenty years ago have +now disappeared. + +"In my experience of eighteen years' constant work amongst the Maoris +venereal disease has been comparatively rare. It disappeared amongst the +people, only to recrudesce in some localities as fresh infection was +introduced by the white man, or brought back to the settlements by +visits to the white towns. I see very little of it at present, but now +and again hear reports from medical officers that it has cropped up in +the settlements near them ... In all these cases I am convinced that the +origin is from a white source, and the problem amongst the Maoris is not +nearly so serious as amongst Europeans. It seems to me unjust that the +idea should be circulated that the Maoris are a source of danger to the +European community--the reverse is much more likely. + +"It is impossible for me to supply accurate data as to the incidence of +the disease amongst the Maori race at present, but I am confident that +reports have a natural tendency to become exaggerated. I do not consider +that returned Maori soldiers, owing to the treatment they received +before being discharged from the service, have been a factor in the +introduction of the disease amongst the settlements. If they have in +some areas, it has been from fresh infection, which their experience of +prostitution in Egypt and Europe has made them more liable to acquire +from professional and amateur prostitutes in towns. At the same time, +the experience of returned soldiers as to the value of treatment makes +them more likely to seek such aid." + +(E.) _Death-certificates._ + +There are no trustworthy statistics in any part of the British Empire of +the deaths due to venereal disease. Many persons die from illnesses +which result from an initial syphilis contracted perhaps many years +prior to death. It is well known that medical practitioners, from a +laudable desire to spare the feelings of relatives, refrain from stating +the primary cause of death in such cases, and merely enter the secondary +or proximate cause. For the same reason, the statistics regarding deaths +due to alcoholism, and perhaps in a less degree some other factors in +the mortality returns, are incomplete and consequently useless. + +Both the Royal Commission on Venereal Diseases and the Birth-rate +Commission recommended that the medical attendant should issue two +certificates--one, which would be a simple certificate of death, to be +handed to the relatives, and the other, a confidential certificate +giving the primary cause of death, which would be transmitted to the +Registrar. + +The Registrar-General for New Zealand, Mr. W.W. Cook, in his evidence in +chief, stated that he did not favour these suggestions. A certificate of +death, he said, cannot be regarded as confidential, as the information +contained therein is recorded in the death entry, which may be inspected +by the public, and of which a copy may be obtained by any applicant. In +reply to questions, however, he stated that the law could no doubt be +altered so as to make the death-certificate confidential, the +information to be given up only on an order from a Court of justice. +Apart from the fact that the insurance companies might object, he did +not see any objection from the public point of view. + +Mr. Malcolm Fraser, the Government Statistician, said that there was +considerable division of opinion on this question at the British Empire +Statistical Conference held in London in 1920, when statisticians from +all parts of the Empire were present. It was generally agreed that the +system was good theoretically, but some doubt was expressed whether in +practice there would be as much improvement as was expected, since the +system would depend entirely on the medical attendant strictly complying +therewith and disclosing the true cause of death in every case. Any +system of confidential information always had that failing. The witness +thought the register must be open for persons having a right to call for +copies of entries. In dealing with insurance claims at death the truth +or otherwise of the statement in the proposal form was important, and +might require verification by inspection of the death entry. At the +Conference Dr. Stevenson, the Statistician to the Registrar-General of +the United Kingdom, was very pronounced in his advocacy of the +confidential form of certificate. The Conference passed the following +resolutions: "(1.) That the present system of open certification tends +to prevent candid statements of the causes of death, and thus introduces +a systematic error into death statistics. (2.) That the error would be +eliminated by a system of confidential certification." + +The Committee, while agreeing that such a system of registration of +deaths would undoubtedly afford better means of approximating to correct +returns of mortality not only from venereal diseases but also from +alcoholism and some other diseases, would point out that, if New Zealand +were to adopt the reform while the rest of the Empire retained the +present system, the result would be to place the Dominion in an +apparently unfavourable light in comparison with other parts of the +Empire in regard to the mortality from these diseases. + + +SECTION 2.--CAUSES OF THE PREVALENCE OF VENEREAL DISEASES IN NEW +ZEALAND. + +In discussing this order of reference the Committee desire it clearly +understood that these causes are not peculiar to New Zealand, and do not +operate more extensively in New Zealand than elsewhere. The Committee +are concerned, however, in discussing this question only as it affects +New Zealand. + +The causes of the spread of venereal disease may be classified under two +main headings: (1) The presence of infected individuals acting as foci +of infection; (2) the occurrence of promiscuous sexual intercourse, by +which in the great majority of cases the disease is actually transmitted +from one individual to another. + +(1.) _The Presence of Infected Individuals._ + +These sources of infection arise and persist for the following +reasons:-- + + (1.) Neglect by infected persons to undergo treatment. (2.) Neglect + to continue treatment till no longer infective. (3.) The treatment + of infected individuals by unqualified persons, such as chemists, + herbalists, chiropractors, &c. In these cases the disease becomes + chronic, and the best opportunity for its treatment and cure has + passed before the case is seen by a medical man. (4.) By the + introduction of venereal disease to this country from overseas. + +(2.) _The Occurrence of Promiscuous Sexual Intercourse._ + +A striking portion of the evidence placed before the Committee was that +which showed the very small amount of professional prostitution in New +Zealand. This was supported by the valuable evidence of Mr. W. Dinnie, +ex-Commissioner of Police, and Mr. A.H. Wright, Commissioner of Police. +The latter witness stated that there were only 104 professional +prostitutes in the Dominion. + +It would appear also that the professional prostitute, as a result of +her knowledge and experience, is less likely to transmit venereal +disease than the "amateur." It is therefore principally to clandestine +or amateur prostitution that one must look for the dissemination of the +disease, and inquiry into the conditions which tend to the production of +the amateur prostitute is a direct inquiry into the causes of the +prevalence of venereal disease. + +The evidence before the Committee shows that this promiscuity is very +prevalent, and that it is not confined to any particular social strata. +The fact is also strikingly demonstrated by Table A in the appendix. +From this table it will be seen that during the period 1913-21 there +were 10,841 illegitimate births and 33,738 legitimate first births +within one year after marriage. If to the illegitimate births we add the +total number of live births occurring within the first seven months of +marriage viz., 12,235--which may be safely considered to have been +conceived before marriage, we get a total of 23,076 births in which +conception took place extra-maritally. In other words, more than 50 per +cent. of total first births occurring within twelve months of marriage +result from sexual contact prior to marriage. + +Some factors which contribute in a greater or less degree to the moral +laxity which leads to promiscuous sexual intercourse are:-- + + (1.) The relaxation of parental control, which was emphasized by + many witnesses. Girls stay less at home and assist less in the work + of the home, preferring whenever opportunity offers, to go to the + pictures or some other form of entertainment. + + (2.) Lack of education of the young in the facts pertaining to sex. + Especially the Committee would call attention to the unfounded + belief of many that continence in young men is injurious to health. + + (3.) Bad housing and general conditions of living. When members of + both sexes are crowded together in restricted accommodation in + which often insufficient conveniences are supplied, it is easy to + conceive of a relaxation of the proprieties of life which might + lead to acts of immorality. + + In this connection the Committee desire to call attention to the + excellent work done by the Y.W.C.A. and other bodies in the + provision of hostels in which girls are provided with board and + lodging at very reasonable cost. The Committee were surprised to + learn that full advantage was not taken of these provisions, and + that the accommodation at these hostels was not fully occupied. It + would appear that many girls resent the very slight amount of + supervision and restraint exercised over them, precisely as they do + parental control. + + (4.) The presence in the community of individuals, especially + girls, who are to some degree mentally defective or morally + imbecile. The Committee were given several individual instances in + which such girls had acted as foci of infection; they are easily + approached, and facile victims for men. In spite of a degree of + mental or moral defect they may be physically attractive. + + (5.) Economic conditions which delay marriage may reasonably be + regarded as a factor in conducing to an increased frequency of + extra-marital sexual relationship. Graph A in the appendix shows + clearly that the age of marriage in both sexes has, with slight + fluctuations, steadily increased from 1900 to 1921. + + (6.) Alcohol tends to the dissemination and persistence of venereal + disease: it increases sexual desire, lessens control, causes the + individual to be less careful as regards cleanliness, &c., after + exposure to infection, and militates against effective treatment. + It is to be pointed out, however, that the lower control possessed + by some individuals may be the actual predisposing cause, both of + laxity in sexual matters and of the excessive ingestion of alcohol. + There appears no doubt that alcohol is an important factor in the + prevalence of venereal disease, although probably not so potent as + represented by some witnesses. + + (7.) Accidental infections are undoubtedly rare. They may arise + from contact with W.C. seats, dirty towels, and eating and drinking + utensils in public places. + + (8.) Other factors of minor importance which were mentioned in + evidence were the modern dress of women, which was stated to be in + certain cases sexually suggestive, and certain modern forms of + dancing. There appears some grounds to suppose that dances + conducted under undesirable conditions contribute to sexual + immorality, but the Committee see no reason to condemn dancing + generally because the coincident conditions under which it has been + or is conducted in some cases have contributed to impropriety. The + cinema was stated by some witnesses to have an immoral tendency + both in the nature of the pictures presented and in the conditions + under which they are viewed by the audience. The Committee suggest + that a stricter censorship might with advantage be exercised, and + should include the posters advertising the films. + +It has been stated that venereal disease has increased in New Zealand +with the return of the Expeditionary Force from overseas. Ample +evidence, however, was given to the Committee that there has been no +increase of the disease due to returned soldiers. These men were treated +prior to their discharge until non-infective. + + + + +PART III.--BEST MEANS OF COMBATING AND PREVENTING VENEREAL DISEASE. + + +SECTION 1.--EDUCATION AND MORAL CONTROL. + +There is no question that the most effective way of avoiding venereal +disease is to refrain from promiscuous sexual intercourse. The problem +which the Committee have been asked to consider has very important +medical aspects, but, while these must not be neglected, it is essential +to the health and well-being of the nation that the enemy should be +attacked with every moral and spiritual weapon:-- + + Self reverence, self-knowledge, self-control,-- + These three alone lead life to sovereign power. + +The absence of proper training and instruction of the young is +undoubtedly responsible for a great deal of the evil which has been +shown to exist. Children are led into bad habits through ignorance, and +young men and young women grow up with utterly false ideals of life, and +in many cases fall into deplorable laxity of conduct. + +There is an impression among many young men that chastity is either +impossible or at least is inconsistent with physical health. There is +the highest medical authority for stating that this notion is absolutely +wrong, while there is no difference of opinion whatever as to the +serious risks of contracting diseases of a very loathsome character +incurred by those who do not restrain their passions. Apart from this +aspect of the question, it must be obvious to every thinking person that +looseness of conduct between the sexes such as is shown to exist in New +Zealand is destructive to the high ideals of family life associated with +the finest types of British manhood and womanhood, and if not checked +must lead to the decadence of the nation. + +A sounder state of public opinion needs to be cultivated. The moral +stigma at present attached to sufferers from venereal disease should +rest upon all who sacrifice to their own selfish passions the +chivalrous relations which should subsist between the sexes. Those who +are unfortunate enough to contract disease incur a punishment so +terrible that they deserve our pity and our succour, always provided +that they seek skilled treatment and refrain from any conduct likely to +communicate the disease to others. The man or woman who negligently or +wilfully does anything likely to lead to the infection of any other +person is a criminal, and should be treated as such. + +To bring about this healthier state of public opinion much might be done +by the various Churches, by the Press, and by all who are in a position +to influence the thoughts of others. It is a duty which should be shared +by all--it cannot be left entirely to the Government, to Parliament, or +to the medical profession. If a healthier atmosphere were created for +the proper consideration of this subject, instead of the unwholesome fog +of prudery in which it has been enveloped in the past, a great deal will +have been gained. + +One result of the mistaken policy of reticence which has prevailed is to +be seen in the fact, already mentioned, that children are allowed to +grow up either in ignorance of sex physiology or with perverted ideas +due to the want of proper instruction. Nearly every witness who spoke on +the subject before the Committee agreed that such instruction would come +best from the parents, but there is also practical unanimity among those +who gave evidence that very few parents are capable of giving such +instruction in the right way, and the vast majority are unwilling to +attempt it. In these circumstances our chief hope for the future seems +to lie in an endeavour to educate the children in such a way that they, +the parents of the future, may be enabled to deal justly with their own +children in this vital matter. Nevertheless, the Committee would be +failing in their duty did they not point out that all parents have a +serious responsibility to their children which they cannot evade without +laying themselves open to grave reproach. It is probable, as one of the +witnesses remarked, that "nothing they could do for their children's +happiness in life would be of equal value to the outlook which they +might give to their children upon this matter. Apart from any +possibility of moral ruin or disease, such an outlook would colour the +whole mature life of their children in respect to what is probably the +foundation of the greatest human happiness--namely, home relationship." + +The Committee recommend that the Department of Health be asked to +prepare a suitable pamphlet to assist those parents who desire to +instruct their boys and girls on this subject. It is also suggested that +where parents feel themselves unable to undertake the necessary +instruction, the family doctor should be asked to talk to the boys. +Instruction to the girls should certainly come from the mother, but +failing this a little wise counsel and advice from a woman doctor should +be secured. + +In regard to the teaching of sex hygiene in schools some interesting +evidence was given to the Committee by Mr. Caughley, Director of +Education, Mr. T.R. Cresswell, Principal of the Wellington College +(speaking on behalf of the Secondary Schools Association), and by some +of the women doctors and others who were good enough to attend as +witnesses. + +Mr. Caughley stresses the point that it is not mere knowledge of +physiology that will meet the case. He considers that the most important +thing of all is to establish in the minds of the children noble ideals +with regard to infanthood and motherhood. Lessons in connection with the +care of all birds and animals for their young, with the love and +devotion of parents for their young, with all that is beautiful and +tender connected with the homes of animals and birds, would establish a +kind of reverence about everything that is connected with birth. He +deprecates mechanical, systematic, and consecutive instruction in the +mere facts of sex hygiene, for even the fullest knowledge on this +subject is known to have very little deterrent effect in the temptations +of life. He would rather aim at creating the right atmosphere in a +school, such as would make any coarse or unworthy mention of any of +these matters in the hearing of a child appear more or less repulsive, +and would in general enable him to put in its proper setting any +knowledge that might come to him from various sources. + +Mr. Cresswell gave the Committee an extremely interesting _resume_ of +the answers to a _questionnaire_ which he addressed to the head of every +secondary school in the Dominion. He suggested--(1) That a determined +public effort should be made to rouse parents to a sense of their +responsibility in regard to this matter by means of broadcasted +pamphlets, and that they should be furnished with simple, specially +written leaflets to assist them in giving instruction to their children; +(2) that sex hygiene be made a compulsory subject in all +training-colleges, the instructors being specially qualified doctors; +(3) that regular courses of public lectures be delivered in suitable +centres; (4) that teachers, and especially physical instructors, be +encouraged to stress the value of physical fitness to pupils +collectively, and, where need is indicated, to have private talks with +individuals; (5) that teachers be advised to take every opportunity +during lessons in hygiene, physiology, botany, &c., to give children a +sane and normal outlook on sex matters. + +Incidentally it was suggested that girls' schools suffer somewhat +through being staffed almost exclusively by celibate teachers. "The +knowledge and sympathy of a real mother would," it was urged, "be +invaluable to many girls in our secondary schools. Does it seem a +trivial suggestion that in every girls' school there should be one +honoured official, the 'school mother,' a sympathetic motherly person +whose duty it should be to get into personal touch not only with +individual girls but also with individual parents?" + +The views expressed by the Swedish Committee of Experts in Medicine and +Pedagogy are well worthy of quotation: "It is illustrative of the broad +view taken by the committee of their task," says the _British Medical +Journal_, "that they deal with the education of the child from the time +it learns to speak and address inquiries as to how it came into the +world. The committee look forward to the time when parents will be so +enlightened that they will not tell their children silly stories about +babies being brought into the home by storks, but will give a simple +account which the child in later years will not discover to be +mendacious. The committee hope that the child, who is gradually taught +more and more about sex hygiene as it passes from one school grade to +another, will eventually become a parent wise enough to instil in the +next generation a frank and healthy attitude towards sex problems. +Parents, it is hoped, will learn to protect their infants from the +undesirable caresses and kisses of strangers ... As for sex teaching in +school, this should be associated with the teaching of biology, +Christianity, sociology, and psychology. The question of venereal +disease should not come into the curriculum until comparatively late, +and until the physiology of fertilization and reproduction has been +fully taught. Advanced sex teaching should preferably be in the hands of +doctors; but they are not always available, in which case other teachers +should give instruction on this subject, male teachers dealing with boys +and female teachers with girls. Teaching of sex hygiene in high schools +for girls should include the subject of venereal disease, and special +emphasis should be laid on the protection of infants from infection. A +further recommendation is that a carefully supervised library of works +on sex hygiene and venereal disease should be compiled at the cost of +the State for the use of teachers and classes." + +The Committee of the Board of Health agree with the suggestion that +teachers should be trained to deal with this question, and that school +medical officers or other qualified practitioners should give occasional +"talks" to the elder boys and girls. A great deal may be done by +physical instructors preaching the gospel of "physical fitness" and +personal cleanliness in thought, word, and deed. Bathing and outdoor +sports and games of all kinds should be encouraged. The Committee would +point out, however, that not all teachers and not all medical men +possess the qualities fitting them to give instruction and advice in +this delicate matter. The task should be entrusted to those who have +shown themselves specially adapted by sympathy and tactfulness for the +work, and preferably those who are parents, otherwise harm instead of +good may result. + +More than one witness spoke with approval of "The Cradleship" and other +books by Miss Edith Howes as suitable for use with young children. + +The Committee are of opinion that addresses on sex questions by lay +persons, except selected teachers, to young people in mass are of +doubtful value. + +Sufficient instruction should be given to adolescents regarding venereal +diseases and their effects to ensure that if they do contract them it +shall not be through ignorance. The Committee cannot too strongly +emphasize their belief, however, that knowledge of the effects of +venereal diseases is in itself by no means a sufficient safeguard; that +in addition to such knowledge the cultivation of a high moral standard +is necessary, and if this is reinforced by religious sanctions it is +likely to be more effective. + +The Committee agree with the view expressed by Dr. E.T.R. Clarkson in a +recent text-book, entitled "The Venereal Clinic," that in many instances +an excessive stress has been placed upon the factor of fear. He says +that a very small proportion of the community are restrained from +indulging in promiscuous sexual intercourse through fear, and it is +irrational to rely so much upon an emotion which at the best is but +slightly inhibitory, and which cannot in itself exercise a direct +energizing influence for good. "We do not," he continues, "wish to deter +the community from living a life of sexual promiscuity by rendering them +fearful of the possibilities of acquiring venereal disease, but we want +rather to instil such an ideal into them, whether it be of a religious, +ethical, or altruistic nature, as will tend to make them regard such a +life as incongruous with those tenets and therefore as undesirable, +however much it may be desired on other grounds." He adds that the +emphatic reiteration of fear possesses another and dangerous +disadvantage. "There is no doubt, as venereologists will testify, that +many individuals are seriously suffering from the effects of fear thus +engendered in their minds. In some instances the resultant damage to +their mentality is more serious than the venereal disease from which +they are suffering: whilst in others an obsession that they are +infected, when there is no foundation for the fear, may develop in such +a manner as to inflict serious and permanent damage." + + +SECTION 2.--CLINICS FOR THE TREATMENT OF VENEREAL DISEASE. + +Early in 1919 clinics for the treatment of venereal disease were +established in each of the four main centres. Arrangements were made by +the Department of Health for the treatment by Hospital Boards throughout +the Dominion of cases of venereal disease, and in the absence of local +institutions arrangements were made with private practitioners. There is +therefore opportunity for all to receive free treatment, wherever they +may be, in New Zealand. + +Table B sets out the work done at the four clinics during the two and a +half years ended 30th June, 1922. From this table it will be seen that +3,038 males and 596 females attended these clinics during the period +named. The total number of attendances was 110,792--101,995 males and +8,797 females. The disproportion between the number of males and females +attending is notable. It is clear from the evidence that this does not +represent a difference in the incidence of these diseases in the sexes, +but that women do not attend so freely when suffering. + +These clinics are attached to the public hospitals in each centre, and +all evidence goes to show that this is most desirable. If the clinics +were apart, the object of the patients' visits would be obvious, whereas +the actual purpose for which they go to a hospital is not so. It is to +be strongly emphasized that the less publicity given to the attendance +of these patients, the greater the number of patients who will be likely +to take advantage of the treatment offered. This applies especially to +the attendance of women. + +The clinics are now open only at certain hours. The Committee suggest +that they might with advantage remain open continuously (except at +certain fixed hours on Sunday). In the absence of the Medical Officer a +sister could take charge of the women's clinic, and a trained orderly of +the men's clinic. It would be necessary in this case to have separate +clinics for male and female patients--the same rooms would not be +available for both sexes. + +The majority of witnesses asked were of opinion that if a lady doctor +were made available for the treatment of women the number of women +attending would increase. + +It is suggested that in certain cases of gonorrhoea, where it is an +advantage that the treatment should be carried out twice or more often +daily, arrangements might he made for the supply of the necessary +apparatus and drugs to patients at cost price, and in indigent cases +free of charge. This is particularly important to women who may have to +continue treatment for several months. + +The clinics should be more widely advertised by notices in public +conveniences and other suitable places. + +The Committee are impressed with the valuable work done at these +clinics, and recommend their extension to other centres as opportunity +offers and necessity is shown to exist. + +The existing clinics are conducted by medical men who have had special +experience and training in the treatment of these diseases. The Dunedin +clinic is attended by medical students for purposes of instruction. In +view of recent advances in the processes of diagnosis and treatment of +these diseases, the Committee consider that opportunity should be given +to medical practitioners to attend these clinics in order to familiarize +themselves with the most recent advances in this field. It would he an +advantage also if nurses in the course of their training attended the +female clinics, so that they might he taught to recognize the commoner +manifestations of these diseases. + +The most disappointing feature in the records of the clinics is the +cessation of treatment by so many patients before they have ceased to be +infective. The following evidence was given in this connection:-- + +_Percentage of Cases attending till Non-infective._ Auckland Clinic: 80 +per cent. cases of syphilis, 50 per cent. cases of gonorrhoea. It was +stated that no woman suffering from gonorrhoea continued treatment till +non-infective. + +Wellington Clinic: 40 per cent. of all cases continued treatment till +non-infective, and very few of these were women. + +Christchurch Clinic: Men with syphilis, 75 per cent.: men with +gonorrhoea, 98 per cent.: women with syphilis, 50 per cent.: women with +gonorrhoea, 14 per cent. + +Dunedin Clinic: In this clinic only thirty-one males suffering from +gonorrhoea were discharged cured: thirty-two absented themselves while +still infective; three female cases remained under treatment till cured, +and six ceased to attend while still infective. Forty male syphilitics +remained till non-infective, and seventy-four ceased treatment before it +was completed. For female syphilitics the figures are four and eighteen. + +It will be noted that in each case the proportion of women who attend +till non-infective is much smaller than of men, especially in cases of +gonorrhoea. The reasons for this are probably that owing to anatomical +considerations women infected with venereal disease suffer less pain and +the disease is less obvious than in men. On cessation of the more urgent +and obvious signs and symptoms they stop treatment. Again, it is +probable that the publicity of attending the clinics is felt more by +women than men. A third reason is the prolonged period of treatment +(often extending over many months) necessary to eradicate gonorrhoea in +women. These difficulties could to some extent be mitigated by the +provision of arrangements for women to carry out treatment in their +homes, which would avoid the publicity and loss of time entailed in +attending clinics. + +The Committee were impressed with the value of the work done by the lady +patrol in Christchurch, and considers that lady patrols would help +greatly in securing the attendance of women at the clinics. It is +recommended that these patrols should be attached to the Hospital Boards +and that they should be trained nurses. They would be available to give +advice to patients as to treatment in their homes. + +The Committee would also draw attention to the very valuable work done +by the Social Hygiene Society in Christchurch, and recommended the +establishment of similar voluntary societies in other centres. + +The Committee recommend that all bacteriological and other examinations +required for the diagnosis and treatment of cases of venereal diseases +should be carried out in laboratories of the Department of Health and +public hospitals free of cost, on the recommendation of medical +practitioners. + +The Committee made inquiries from competent witnesses as to the present +position of the complement fixation test in gonorrhoea. It appears that +this test has not reached yet such a degree of reliability as to render +it of great diagnostic value, but that it is reasonable to hope that it +may be perfected to such an extent to give it a value in the diagnosis +of gonorrhoea comparable to that of the Wassermann test in syphilis. + + +SECTION 3.--LICENSED BROTHELS. + +Inasmuch as one of the many letters addressed to the Committee favoured +the adoption of the Continental system of licensed houses of +prostitution, with medical inspection of the inmates, it seems desirable +to examine the arguments for and against such a proposal. Those who +support it contend that so long as human nature remains as it is +prostitution will continue, therefore it is better that it should be +regulated with a view to controlling the spread of disease. It is also +urged that the system acts as a safeguard against sexual perversion by +providing an outlet for the unrestricted appetites of men; that in its +absence clandestine prostitution increases, and innocent girls are more +likely to be led astray or become the victims of sexual violence. Apart +from the moral aspect of the case, these arguments are entirely +fallacious; and even in the countries where the licensed-house system +prevails enlightened public opinion has come to that conclusion. In the +first place, the idea that the system tends to lessen disease is a +dangerous delusion. Owing to the fact, already referred to, that +venereal disease in the early stages is difficult to detect in women, +even by skilled experts working with the best methods and with +practically unlimited time at their disposal, the routine inspection +given, for example, in the French and German houses is no guarantee of +the inmates being free from communicable disease even at the time of +inspection. + +Flexner, who spent two years in making inquiries and writing his classic +work on "Prostitution in Europe," is most emphatic on this point. The +experience of the American troops in the Great War is further strong +confirmation. The following is an extract from an article published by +the American Red Cross in May, 1918: "During the months of August, +September, October, and the first half of November, the houses of +prostitution flourished and were half-filled with soldiers. On November +15th rigid orders were issued placing these houses out of bounds, and +the immediate result was a great reduction of sexual contacts. As a +result there was a steady decline in venereal infections, and the +monthly rate per 1,000, which in October reached 16.8, dropped in +January to 2.1 among the white troops. During the same period there was +an even more striking drop in the infections among the negro labourers, +the percentage dropping from 108.7 per 1,000 a month to 11 per 1,000. No +statistics could speak more eloquently for the doctrine of closing the +houses of prostitution. Our studies showed numerous infections coming +from houses 'inspected' three times a week." + +In May, 1921, a conference (the North European Conference on Venereal +Diseases), in which England, Finland, Germany, Holland, Norway, Sweden, +and Denmark participated, passed the following resolution: "This +conference, having considered the general measures for the combating of +venereal diseases which have been adopted by the participating +countries, is unanimously of the opinion, so far as the experience of +these countries is concerned, that the legal and official toleration of +professional prostitution has been found to be medically useless as a +check on the spread of venereal diseases, and may even prove positively +harmful, tending as it does to give official sanction to a vicious +trade." + +On the same point Flexner says: "It is a truism that physicians +requiring to equip themselves as specialists in venereal disease resort +to the crowded clinics of Paris, Vienna, and Berlin, all regulated +towns, because there disease is found in greatest abundance and richest +variety--a strange comment on the alleged efficacy of regulation." + +Dr. Clarkson, in "The Venereal Clinic," already quoted, says, in +reference to the fancied security of licensed houses, "It may strengthen +the hands of practitioners to be able to tell interrogators in this +subject that in the opinion of leading venereologists, &c., no +foundation exists for any such feeling of confidence or security. In +other words, the system of licensed houses is a failure, and the 'red +light' of lust shines out as the lurid signal of disease and death." + +It is surely hardly necessary to urge the moral objections to the +proposal. The United States Public Health Service not long ago sent out +a _questionnaire_ to representative citizens in various walks of life +asking for opinion in regard to open houses of prostitution. There was +an overwhelming preponderance of replies against the system on moral as +well as hygienic grounds. One Illinois miner answered: "The life of a +prostitute is short, and her place must be filled when she dies, and, +being the father of two girls, I would not want mine to fill a vacancy, +and I think all parents think the same." A Colorado carpenter replied: +"The woman engaged in such business may not be my wife, mother, sister, +or daughter, but she is somebody's wife, mother, sister, or daughter. It +is a violation of all law." One Chief of Police wrote: "Open houses of +prostitution breed disease, crime, increase the number of prostitutes, +corrupt the morals of the community, and are a menace to the youth of +the country." Another replied: "The only reason I have ever heard +advanced in favour of houses of prostitution is that they protect +innocent girls. I am opposed to sacrificing any woman to benefit +others." + +If statistics could be obtained it would be probably found that the +system tends not only to increase disease, but the volume of sexual +immorality and crime. From the most materialistic point of view the +system is indefensible; while, looking at it from the moral aspect, it +is inconceivable that British people, who spent millions of money to +stop the traffic in black slaves, would ever officially countenance a +system which enslaves the souls as well as the bodies of its victims and +defiles the community in which it exists. + + +SECTION 4.--EXCLUSION OF VENEREAL CASES FROM OVERSEAS. + +The Committee are of the opinion that by the strict exercise of the +provisions of section 111 of the Health Act, 1920, much may be done to +prevent introduction of venereal diseases from overseas. They suggest, +however, that where any person so suffering is required or permitted to +attend a clinic he should be accompanied by some responsible officer of +the ship, or person authorized by the shipping company concerned, and +that the question on the "Report of Master of the Ship" defined by +regulations--"Are you aware of the presence on board of any person +suffering from ... _(b)_ venereal disease?"--might be strengthened by +adopting the Australian quarantine service equivalent viz., "Is there +now or has there been on board during the voyage any person suffering +from demonstrable syphilis in an active condition, or other communicable +disease?" + +The evidence given does not show that the number of venereal-diseases +cases already in the Dominion is greatly added to by the introduction of +cases from overseas. Since 1903 persons suffering from syphilis have +been "prohibited immigrants" within the meaning of the Immigration +Restriction Act. + + +SECTION 5.--PROPHYLAXIS. + +Before discussing this question it is desirable clearly to distinguish +between the procedures which are included under this term. These are-- + + (1.) The supply of drugs and appliances which are made available + for use by the individual before exposure to infection. This may be + described as "anticipatory prophylaxis," and has commonly been + designated the "packet system." + + The Committee condemn this procedure, for these reasons: (i) That + the system suggests a moral sanction to vice; (ii) that the + individual is lulled into a false sense of security, and may + thereby be encouraged repeatedly to expose himself to infection; + (iii) that the individual may be thereby deterred from seeking + early advice or treatment; (iv) that the drugs supplied may be used + for treating disease should it arise, and so delay may result in + seeking skilled treatment in the early stages when it is likely to + be most effective. + + (2.) Treatment applied after exposure to infection. This is called + "early treatment." This term is inapplicable, as a disease cannot + be treated before it exists. It is also likely to be confused with + "abortive treatment," which implies treatment immediately on the + appearance of symptoms. + + The evidence before the Committee shows that this form of + prophylaxis, if applied by skilled persons and within a few hours + of exposure, is effective in preventing disease in a great majority + of the cases in which it is used. + +The Inter-departmental Committee on Infectious Diseases set up by the +Ministry of Health in 1919 in connection with demobilization, in a note +on "Prophylaxis against venereal disease," reported among its +conclusions based on service experience, "That where preventive +treatment is provided by a skilled attendant after exposure to infection +the results are better than when the same measures are taken by the +individual affected, even after the most careful instruction." After +exposure to infection there appears no reason why these diseases should +not be regarded in precisely the same manner as other infectious +diseases, and precautions taken to sterilize the parts which have been +exposed to infection. + +It is to be noted that it is recommended that the prophylactic treatment +is to be carried out by some properly instructed person. This need not +necessarily be a medical man. It is suggested that this form of +prophylaxis might be carried out by an orderly at the venereal-disease +clinics. The notices posted in the public conveniences and other +suitable places indicating the existence of the clinics and the +necessity for treatment might include a guarded reference to their use +for this purpose. + +This form of prophylaxis applies to males. In the case of females the +methods adopted would be also contraceptive, and the Committee do not +recommend that facilities should be provided for this. + +The Committee must not be supposed to advocate prophylaxis as in any way +a substitute for continence and the cultivation of that high moral tone +that repels any suggestion of promiscuous sexual relationships, but they +feel that they could not properly ignore reference to a method of +prevention of these diseases which has proved very efficient in the +services, to which there appears no reasonable ethical objection, and +which brings their prophylaxis into line with that of other infectious +diseases. + + +SECTION 6.--LEGISLATION REQUIRED. + +(A.) _Conditional Notification._ + +The only subjects of importance upon which the witnesses examined +differed materially in opinion were--(1) whether there ought to be any +system of notification of cases of venereal disease, and (2) what steps, +if any, should be taken to deal with persons suffering from such disease +in a communicable form who refused to be treated, and in some cases were +even known to be spreading the disease broadcast. Ladies who attended to +give evidence on behalf of the National Council of Women and one or two +other women's organizations objected to notification and compulsory +treatment. They argued that there was at present a "scare" on the +subject of venereal disease, and deprecated "panic legislation." They +contended that the adoption of notification would deter patients from +seeking treatment for fear of publicity. They were opposed to compulsory +treatment of recalcitrant patients, arguing that any law of the kind +would be used most oppressively against women. They contended that +reliance should be placed on greater facilities for free treatment at +the clinics, the work of women patrols, suppression of liquor, and above +all education and propaganda on moral lines. + +When confronted with typical cases of difficulty already quoted some of +the witnesses admitted that it was not easy to see how such cases could +be dealt with satisfactorily without compulsion of some kind. But they +argued that, even so, it would be a greater evil if the fear of +publicity and the fear of compulsion should have the effect of deterring +sufferers from seeking treatment and so drive the disease underground. + +The National Council of Women, by a substantial majority, at a recent +conference in Christchurch, carried a resolution protesting against a +proposal to introduce compulsory notification and treatment of venereal +diseases, and urging the Government to increase the facilities for free +treatment. The President of the Council, however, informed the Committee +that most of the nineteen societies affiliated to the Auckland Branch of +the National Council are in favour of some form of compulsion, but a +number of the southern branches are opposed to it. Speaking as an +individual, and not as President of the National Council of Women, she +added: + +"Personally, I have no first-hand knowledge as to whether the disease is +so prevalent in the community as to demand urgent measures, but there is +an opinion among women social workers and medical practitioners, whom I +have consulted, that something should be done, and they are in favour of +compulsion under the Act, provided its administration is satisfactory. +There is no doubt that there is a genuine and widespread fear among a +large number of women that, although in the Act itself there is no +discrimination between men and women, in actual practice there will be, +and they fear that the Act will be enforced against women, and +particularly immoral women, while the men concerned will be allowed to +go free. This fear arises partly from the remembrance, particularly +among elderly women, of the old Contagious Diseases Acts, both here and +in England, and partly from the reports of the working of compulsion in +Western Australia and elsewhere. I am of opinion that there is no +serious ground for fear in view of the changed attitude in the public +mind in connection with these diseases, the fuller knowledge that people +generally have, and the high status of women in our country; also the +ready access that all persons have to the protection of the law and the +Courts in the event of false information being given, and the safeguards +embodied in the Bill as I understand it is drafted. My view is that the +objection to the compulsory clauses of the Bill would be removed in the +opinion of many women if women patrols or women police were appointed, +so that the administration of the Act in its compulsory clauses wherever +it treated women could be in the hands of those women officers." + +Among the witnesses questioned on this subject there was an overwhelming +preponderance of opinion that the time had now arrived for the adoption +of notification of all cases of venereal disease by number or symbol, if +only for the purpose of getting more accurate statistics; the +notification by name of those recalcitrant patients who refused to +continue treatment until cured; and compulsory examination of those whom +the Director-General of Health had good grounds for believing to be +suffering from the disease and likely to communicate it to others, and +who refused to produce a medical certificate as to their condition. Only +three medical men expressed themselves as being against these proposals. +On the other hand, the lady doctors examined (two of them members of the +National Council of Women, and the third representing the Young Women's +Christian Association) gave evidence in favour of conditional +notification, and compulsory examination, and compulsory treatment of +recalcitrants. It should be added that all the witnesses who were +engaged in rescue work, or other work bringing them face to face with +the horrors of venereal disease, were most emphatic in their opinion +that compulsory notification and treatment should be adopted. + +It is noteworthy that when the notification of ordinary infectious +disease was first proposed in England almost exactly the same arguments +were brought against the proposal as are now advanced against the +notification of venereal disease. Sir W. Foster, member for Ilkeston, +and a medical man of standing, speaking in the House of Commons in the +debate on the Infectious Diseases Notification Bill, on the 31st July, +1889, said, + +"The Bill calls upon medical men to perform something more than the +ordinary duties of citizenship by requiring them to become informers of +the occurrence of diseases. The relation of a medical men to his patient +ought to be one of complete confidence, and anything that comes to the +knowledge of a medical man in the practice of his profession is +practically an inviolable secret; and I do not like any Bill to +interfere with that relationship. I know myself that one of the results +of this Bill, if passed into law, will be that in scores of cases +medical men will not be called in to attend people suffering from +infectious diseases ... I admit the difficulty of the position, but I am +anxious that no measure should pass into law which will induce the +public to keep these diseases more secret than they have been in the +past, with the risk of adding to the spreading of them. We must be very +cautious not to do anything which will prevent the public from placing +full and implicit confidence in their medical man. I can quite conceive +it to be possible that, if an outbreak of infectious disease occurs in a +populous part of London, the people may, in order to prevent exposure, +refuse to allow a medical man to come in, and in such cases we shall +have tenfold more difficulty than at present. Therefore, while I am +anxious to promote the notification of disease, I do not want the +Government to promote rebellion on the part of the public." + +Needless to say, these gloomy anticipations have not been realized. +Probably the more enlightened generations to succeed us will wonder how +there could ever have been any opposition to the notification of +venereal disease, just as we to-day read Sir W. Foster's words and +marvel that any person of intelligence could have committed himself to +such statements. + +Notification of infectious diseases and isolation of patients suffering +from such diseases have for many years been compulsory. Isolation, when +spoken of by opponents to a similar measure for venereal diseases, is +opprobriously described as "compulsory detention." For twenty years it +has been the law in New Zealand that an authorized medical practitioner +may examine any person suspected to be suffering from any infectious +diseases (save venereal diseases), and the Medical Officer of Health +may, if he deems it expedient in the interests of the public health, +compel the removal to a hospital of any person so suffering. This +long-established procedure as referable to venereal diseases is by +antagonists termed "compulsory examination" and "compulsory removal." + +It is contended by some witnesses that notification will drive these +diseases underground; but syphilis and gonorrhoea for generations past +have been underground. + +Under the present system numbers of unfortunate persons either delay +calling in medical assistance until the case has become almost desperate +so far as the patient is concerned, or they resort to unqualified +persons, with the result that in most cases what was in the first +instance a simple attack, capable of treatment, results in serious +complications most difficult to deal with. In either case the patient +may be communicating diseases to others, and should this come to the +knowledge of the Health Department it has no effective means of checking +him--no power to warn those who are being endangered by his criminal +neglect. + +The Committee think there is some force in the argument that +notification by name, in the first instance, as in the case of ordinary +infectious diseases, would tend to discourage some from coming forward +for medical treatment. They recommend, therefore, the adoption of what +is known as the system of conditional notification embodied in the West +Australia Act. Under this plan the cases are notified by the doctor to +the Health Department by number or symbol only. The name is not sent in +unless the patient discontinues treatment before he is free from +infection and refuses either to go to a clinic or to another doctor. In +cases of those who "play the game," the name of the patient is kept +confidential, and does not pass beyond the medical man attending him. It +is only in cases of those who contumaciously refuse to do what is +necessary for their own safety and the safety of others that the name is +sent to the Health Department, in order that appropriate steps may be +taken in the interests of public health. Even then the name is given +only to officers who are pledged to keep it confidential. + +Following are the clauses in suggestions for a Bill, drawn up by the +Health Department, which in the opinion of the Committee should in +substance be adopted:--- + + "(1.) Every medical practitioner shall forthwith give notice to the + Director-General of Health, in the prescribed form, upon becoming + aware that any person attended or treated by him is suffering from + any venereal disease in a communicable form. The notice shall state + the age and sex and occupation of the patient and the nature of the + disease, but shall omit the patient's name and address. + + "(2.) Every medical practitioner, other than the medical officer in + charge of a public hospital or of a clinic established by direction + of the Minister of Health, shall be paid for each such notification + a fee to be prescribed by regulation. + + "(3.) The provisions of subsection (1) hereof shall apply in the + case of a child under the age of sixteen years who is suffering + from congenital syphilis. + + "(4.) Whenever a patient has changed his medical adviser, in + accordance with subsection (2) hereof, the medical practitioner + under whose care the patient has placed himself shall notify the + Director-General of Health in accordance with subsection (1) + hereof, and shall include in such notice the name and address of + the previous medical adviser." + +Without some such system of preliminary notification no adequate +statistics can be collected as to the prevalence of venereal diseases in +New Zealand, and no conclusion could be arrived at in the future as to +the effect of the whole or any part of the programme for combating these +scourges. Again, without such notification, and the attachment thereto +of some method of ensuring that the patient is made definitely +acquainted with his condition, it is practically impossible to enforce +the provisions of section 8 of the Social Hygiene Act for the crime of +"knowingly" infecting any other person. + +Here the Committee would refer to case 2 quoted above. Of what use is it +to provide free clinics if those who make use of them are permitted, as +soon as the urgent symptoms are relieved, to disseminate disease +broadcast, widening the circle of infection? Again, where is our +humanity if no step is to be taken to try to prevent a syphilitic child +being born to the man in case 1? + +A very valuable result of anonymous notification would be the +possibility afforded of observing any unusual "flare-up" or succession +of cases, especially in country districts and small towns. Study of case +4 will show the great value it would have been to have a record of an +unusual increase of syphilis in that township, giving an opportunity for +prompt investigation by the Medical Officer of Health for the district. + +(B.) _Compulsory Examination and Treatment._ + +This question obviously presents more difficulty than that of +notification, but it is clear that unless some means are provided of +bringing under treatment and, if necessary, isolating persons who are +suffering from highly contagious diseases, and who will not avail +themselves of medical treatment although this is provided free of cost +by the State, and who are knowingly or recklessly communicating the +disease to others, it will be impossible to keep in check this terrible +scourge. Without such provision any abandoned woman, as in case 4, or +any male libertine, may continue to sow disease broadcast without any +power to stop them. Failing some such measure, table articles and food +may continue to be smeared by hands soiled with syphilitic material, as +in case 1; section 6 of the Social Hygiene Act remains mere useless +verbiage, and the infecting of innocents, as in case 3, may continue +unchecked. + +Legislation dealing with this subject needs to be carefully framed with +suitable safeguards, but the Committee think that an amendment of the +Social Hygiene Act on the lines proposed by the Department of Health +should be adopted. These provisions are:-- + + (1.) That whenever the Director-General of Health has reason to + believe that any person is suffering from venereal disease, and has + infected or is liable to infect other persons, he may give notice + in writing to such person directing him to consult a medical + practitioner, and to produce within a time specified in the notice + a certificate from such medical practitioner to the satisfaction of + the Director-General of Health that such person is or is not + suffering from venereal disease. + + (2.) Should the person not comply with this request, the + Director-General of Health may obtain a warrant from a Magistrate + ordering such person to undergo examination to prove the existence, + or non-existence, of venereal disease. + + (3.) Making it possible for a Magistrate, on the application of the + Director-General of Health, to order the detention in a hospital or + other approved place of a person who is likely to be a danger to + other persons until that person is cured of venereal disease. + +These provisions are applicable equally to both sexes, and the Committee +see no reason to fear that the law would not be carefully and +impartially administered. If it should appear that more women than men +came under the operation of the law this result would be due to the fact +that, as disclosed in the evidence, a much larger proportion of women +than men fail to seek treatment, and of those treated a much larger +proportion of women fail to continue treatment until no longer +infectious. + +It is hardly conceivable that a responsible officer, such as the +Director-General of Health, would take action under these provisions +unless he had strong reason to believe that such action was justified. +But, even if he makes a mistake or is misinformed, the worst that can +happen to an innocent person wrongfully suspected is that he or she will +be required to produce a medical certificate, which can be procured free +of cost from any hospital or V.D. clinic. This is wholly different from +the provisions of the Contagious Diseases Act, under which a woman +suspected of prostitution was liable to be arrested by a constable in +the street. + +The Committee recommend that the serving of notices, &c., under these +sections be done by officers of the Health Department and not by the +police. They also recommend that all proceedings taken under any Act +having reference to venereal diseases should be heard in private unless +the defendant applies for a hearing in open Court. + +With regard to the effects of the actual operation of notification, +examination, and isolation, the Commissioner of Public Health for West +Australia, under date 25th August, 1922, advises the Committee that +there is an increase in the number of cases attending public clinics, +and that this is regarded not as evidence of increased incidence, but of +increased interest and appreciation of early treatment by those +suffering from the diseases. + + +SECTION 7.--MARRIAGE CERTIFICATE OF HEALTH. + +The Royal Commission on Venereal Disease reported that there was a vast +amount of ignorance as to the dangers arising from the sexual +intercourse of married persons one of whom had previously to the +marriage contracted syphilis or gonorrhoea. The effect upon the +birth-rate, and the misery caused during married life, and in many cases +to the offspring who survive, as they pointed out, are most serious, and +the fact that the actual cause of the trouble often remains unknown and +unrecognized prevents the calamity from serving the purpose of example +or warning. + +Some of the witnesses heard before the present Committee have urged that +a certificate of good health, or at least a certificate of freedom from +communicable disease, should be required from each party to a proposed +marriage before the Registrar issued a license to marry. The Royal +Commission considered that "it would not be possible at present to +organize a satisfactory method of certification of fitness for +marriage." The National Birth-rate Commission, however, reported that in +their opinion the question should be reconsidered with a view to +legislation. + +There is much to be said in favour of such a proposal from the point of +view of national health. If the system were adopted the certificate +should, in the opinion of the present Committee, include freedom from +mental disease as well as freedom from communicable disease. But there +are manifest difficulties in the way, chiefly in regard to the delicate +and searching examination which would be required in the case of women +before a doctor could certify positively to the absence of communicable +disease. + +The Committee recommend that instead of a medical certificate each party +to a proposed marriage should be required to answer appropriate +questions in regard to the presence or absence of communicable and +mental disease, and to make a sworn statement before the Registrar as to +the truth of the answers. It should be the duty of the Registrar to +communicate the contents of the statements to the other party in the +event of any admission of the presence of communicable disease. + +In addition to the penalty for making a false statement it might be +provided, as in the Queensland Act, that venereal disease shall be a +ground for annulling a marriage contract when one party is suffering at +the time of marriage from such disease in an infectious state, provided +the other party was not informed of the fact prior to marriage. + +The Committee would also recommend the adoption of a further provision +that it should be the duty of a medical practitioner attending a case of +venereal disease which is or is likely to become infective, if he has +reason to believe that the patient intends to marry, to warn him or her +against doing so, and if he or she persists it should be the duty of the +doctor forthwith to notify the case by name to the Director-General of +Health, whose duty it should be to inform the other party. It should +also be provided that _bona fide_ communications made in such a case, +either by the Director-General of Health or the doctor, to the other +party to the marriage, or to the parents or guardian of such party, +shall be privileged. + + +SECTION 8.--TREATMENT BY UNQUALIFIED PERSONS. + +The evidence given before the Committee shows that while reputable +chemists refer to a medical man patients coming to them for treatment +for venereal disease, and while these constitute the great majority of +the profession, there are still far too many cases of venereal disease +treated by chemists, herbalists, chiropractors, and other unqualified +persons. The treatment of venereal disease has become a specialized +branch of medicine, and many general practitioners prefer to refer such +cases to experts. The result of trusting to unqualified persons for the +treatment of such serious and difficult diseases is that the patient +usually drifts on uncured, and serious complications may occur. One +specialist in venereal disease informed the Committee that of 200 of his +cases whose cards showed particulars, 104 consulted chemists in the +first place and received more or less treatment from them. He was able +to give details of twenty-three cases showing the type of treatment +given. In several cases there were severe complications which could have +been avoided by proper treatment. There were also cases in which the +patient, after taking medicine for a time, had communicated the +infection to others. This witness further stated that some chemists +charged consultation fees in addition to charges for drugs applied, and +in certain cases charges for drugs were made which were little short of +blackmail. + +The Committee recommend that, in place of section 7 of the Social +Hygiene Act, a more comprehensive clause from the West Australian Act be +adopted. This is to the following effect: "No person [other than a +registered medical practitioner] should attend or prescribe for any +person for the purpose of curing, alleviating, or treating venereal +disease, whether such person is in fact suffering from such disease or +not." + +The Committee would suggest that if the Pharmaceutical Society were to +do all in its power to discourage its members from treating these +diseases it would have a good effect. + + +SECTION 9.--MENTALLY DEFECTIVE ADOLESCENTS. + +Mr. J. Caughley, Director of Education, stated in evidence: "From a +general inquiry made by the Department a few years ago it was +ascertained that there were at least six hundred or seven hundred mental +defectives in New Zealand under the age of twenty-one. I need scarcely +point out the moral danger to the community of so many of these +defectives being at large. In particular, the girls are a source of +danger to themselves and to the community, since they have little or no +will-power or sense of restraint. I am of opinion that all such cases +should be registered, and that, unless it can be shown that the mental +defective is under thoroughly safe and proper care at home, he should be +taken charge of by the State. I am certain that by this means the +increasing number of mental defectives would be reduced to a minimum, +since mental defectiveness is almost entirely hereditary." + +Mr. Beck, Officer in Charge of the Special Schools under the Education +Department, cited illustrative cases, one of which may be thus stated: +"Two feeble-minded parents in New Zealand have had up to the present +time ten degenerate children, all of whom are a lifelong burden on the +State. Taking the case of these children, and assessing the cost to the +State of maintaining them, the total amount for this family will not be +less than L16,000." + +The Committee are of opinion that supervision of mentally defective +children and adolescents is an important factor in lessening venereal +disease, and urge the Government as soon as possible to adopt a system +of registration and classification of mental defectives, and of +segregation where necessary, either in mental hospitals or in special +institutions where these defectives may be suitably taught, and, where +possible, usefully employed to defray the cost of their maintenance. + + + + +PART IV.--SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS. + + +SECTION 1.--CONCLUSIONS. + +Following are some of the conclusions drawn from the evidence by the +Committee:-- + +There is very general ignorance among the public on the subject of +venereal disease, and this has stood in the way of its being grappled +with effectively. + +Syphilis not only causes loss of life directly, but many deaths ascribed +to other causes in the Registrar-General's returns are due to the +after-effects of this disease. It is responsible for many still-births +and abortions, and its evil effects are seen in such children as +survive. These effects may persist until the third generation. + +Gonorrhoea, popularly, but quite erroneously, supposed to be a +comparatively mild complaint, is regarded by medical men as being as +serious a disease as syphilis. It is difficult to cure, especially in +women, unless properly treated at the outset. It is a great cause of +sterility in both sexes. + +Owing to the absence of accurate statistics it is impossible to make +comparisons between New Zealand and other countries as regards the +prevalence of venereal disease, or to say whether it is increasing or +decreasing in this country. + +There are in New Zealand no fewer than 3,031 persons being treated by +registered medical practitioners for venereal disease in some form, or +for the effects thereof--1 person in every 428 of our population. At the +clinics since their establishment 3,634 patients have been +treated--3,038 males, 596 females. + +An interesting calculation as to the prevalence of syphilis in New +Zealand has been made by Dr. Hay, Inspector-General of Mental Hospitals. +Working on what is known as Fournier's Index--the relation of the number +of cases of dementia paralytica existing at any one time to the number +of concurrent syphilitic infectious--he computes the number of persons +in New Zealand now who have or have had syphilis to be 33,000, or 1 to +every 38 of the population. + +The Committee desire to state, however, that in their opinion there can +be no accurate estimate of the prevalence of venereal disease until some +system of obtaining accurate statistics has been adopted. One point +which has come out clearly in their investigations is that venereal +disease is sufficiently prevalent to cause serious concern and to call +for energetic action. + +Evidence was given to the Committee to show that children with mental +and physical defects due to venereal diseases may become a charge on the +State; that a proportion of these on being released become parents of +defective children, who in their turn have to be supported at the public +expense. It was also shown that such defectives have little sexual +control, and are usually very prolific. + +According to the Commissioner of Police there are only 104 professional +prostitutes in New Zealand. + +There is, however, a great deal of "amateur" prostitution, and this is +chiefly responsible for the spread of venereal diseases. + +The evidence points to a good deal of laxity of conduct among young +people of all social conditions, especially in the large towns. This is +generally attributed by the witnesses to the weakening of home influence +and the restlessness of the age. + +Apart from the venereal disease among those who indulge in promiscuous +intercourse, there are many cases in which innocent wives are infected +by their husbands, and other cases (not so frequent) of innocent +husbands being infected by their wives. + +Children suffer innocently from venereal disease, not only by +inheritance from infected parents, but by accidently coming in contact +with the germs on towels, &c., which have been used by a patient. There +are also cases which come before the Courts where disease has been +conveyed directly in crimes of violence by sexual perverts. + +The free clinics in the chief centres are conducted by experts, and are +doing good work. Their influence for good is greatly impaired, however, +by the fact that a proportion of the male patients and the majority of +the female patients leave off treatment before they are cured. As the +law stands there is no power to compel them to continue treatment, and +in many cases they resume promiscuous intercourse and spread the +disease. + +Evidence has been given of other cases, some of them of a very shocking +character, in which persons suffering from venereal disease are not +seeking medical treatment and are communicating the disease to others. +As the law stands at present there is no power to restrain them from +such conduct or to compel them to receive medical treatment. + + +SECTION 2.--RECOMMENDATIONS. + +The Committee stress in the strongest terms the duty of moral +self-control. + +They urge the cultivation of a healthier state of public opinion. The +stigma at present attached to sufferers from venereal disease should be +transferred to those who indulge in promiscuous sexual intercourse. + +Parents have a great responsibility as regards the instruction and +training of their children so as to safeguard them against the dangers +resulting from ignorance of sexual laws. There is too little parental +control generally in New Zealand. The Committee recommend the training +of teachers, and provision for giving appropriate instruction in +schools. + +Classification and, where necessary, segregation of mentally defective +adolescents is recommended. + +The following medical measures for preventing and combating the disease +are recommended:-- + +The clinics should be made more available by being open continuously. +Every effort should be made to secure privacy. A specially trained nurse +should be in attendance at women's clinics, and women doctors should be +secured where possible. + +The Committee recommend that provision be made at the clinics for prompt +preventive treatment of those who have exposed themselves to infection. + +Lady patrols should be appointed in other centres to perform the kind of +work that is being carried on in Christchurch. + +The Committee, having regard to the good work especially of an +educational nature which is being done by the Social Hygiene Society, +Christchurch, consider voluntary effort of the same kind in other +centres would be very helpful. + +The Committee are entirely opposed to the Continental system of licensed +brothels, or a revival of the C.D. Acts in any shape or form. + +They recommend legislation be introduced providing for what is known as +conditional notification of venereal disease. It will be the duty of a +doctor to notify to the Health Department, by number or symbol only, +each case of venereal disease he treats. If a patient, however, refuses +to continue treatment until cured, and will not consult some other +doctor or attend a clinic, it will then be the duty of the doctor last +in attendance to notify the case to the Department by name. + +If the patient continues recalcitrant and refuses to allow himself to be +examined by the medical practitioner appointed by the Director-General +of Health, then the latter should be empowered to apply to a Magistrate +for the arrest of such person and his detention in a public hospital or +other place of treatment until he is non-infective. + +The Committee also recommend further provision to deal with cases in +which persons suffering from venereal disease are not under medical +treatment and are likely to infect others. If the Director-General of +Health has reason to believe that any person is so suffering he may call +on that person to produce a medical certificate, which may be procured +free of charge from any hospital or venereal-disease clinic. If the +person refuses to produce such a certificate he or she may be taken +before a Magistrate, who may order a medical examination. Penalties, +including detention in a prison hospital, should be provided for +recalcitrant cases. The proceedings in all these cases are to be heard +in private unless defendant desires a public hearing. + +The Committee recommend that before a license to marry is issued the +intending parties must sign a paper answering certain questions as to +freedom from communicable disease and from mental disease, and must make +a sworn statement that the answers to such questions are true. + +They recommend the adoption of a provision in the Queensland Act making +venereal disease a ground for annulling a marriage contracted whilst one +party is suffering from such a disease in an infectious stage, provided +the other party was not informed of the fact prior to marriage. Also +that it should be the duty of a medical practitioner attending a case of +venereal disease, if he has reason to believe that the patient intends +to marry, to warn him or her against doing so, and if he or she persists +it should be the duty of the doctor to notify the case by name to the +Director-General of Health, whose duty it should be to inform the other +party, or the parents or guardian of such other party. Such +communications made in good faith either by the doctor or the +Director-General of Health should be absolutely privileged. + +The Committee recommend that the law prohibiting treatment of patients +for venereal disease by unqualified persons shall be strengthened, and +suggest that the Pharmaceutical Society might assist in preventing such +practices. + + +SECTION 3.--CONCLUDING REMARKS. + +The Committee in carrying out their task have been brought into contact +with some uninviting aspects of our social life. Some of the facts +disclosed are of a character to give serious concern to those lovers of +their country who rightly regard it as exceptionally favoured by nature, +and desire to see its people healthy and vigorous, clean in body and +mind, worthy of their heritage. The late war showed that the pick of our +population, physically as well as mentally, were of the finest possible +type, the admiration of all who saw them; but the medical examination of +the recruits disclosed that of 135,282 examined after the introduction +of the Military Service Act--mostly young men in the prime of life--only +57,382, or say, 421/2 per cent., could be accepted as fit for training, +unmistakably proving that the nation as a whole was much below the +standard of physical fitness which it ought to exhibit. + +The investigations of the Committee show that already there is far too +large a proportion of mental and physical defectives reproducing their +kind. In the absence of accurate statistics it is impossible to say what +proportion of these defectives are the direct product of venereal +disease, but there is clear evidence that a tendency to lead dissolute +lives is especially noticeable in the females belonging to this +unfortunate class. "A feeble-minded girl," says Mr. Beck, "has not sense +enough to protect herself from the perils to which women are subjected. +Often amiable in disposition and physically attractive, they either +marry and bring forth a new generation of defectives, or they become +irresponsible sources of corruption and debauchery in the communities +where they live." Obviously some method of dealing with mental +defectives--by segregation or otherwise--must be found as part of the +problem of dealing with venereal disease. + +As regards the effect of venereal disease on the general health of the +community, we have the statement of the late Sir William Osler that he +regards syphilis as "third on the list of killing diseases"; while +Neisser, a leading authority, says that "with the exception of measles, +gonorrhoea is the most widely spread of all diseases. It is the most +potent factor in the production of involuntary race suicide, and by +sterilization and abortion does more to depopulate the country than does +any other cause." + +In view of the facts brought out in the course of the inquiry, the +Committee are strongly of opinion that it would be criminal neglect to +allow the evil to go on without taking energetic steps to check its +ravages. They believe that the legislative and other measures which they +recommend for the medical prevention and treatment of venereal disease +will, if given effect to with the loyal co-operation of the medical +profession, have a very beneficial result in reducing the prevalence of +disease, and will save an incalculable amount of sorrow and suffering +which in too many cases falls upon the innocent. In what is proposed in +this report there is nothing approaching a revival of the old Contagious +Diseases Acts. To use the words of Dr. Emily Seideberg, the principle of +the legislation now proposed is "To improve the health of the community, +and not, as in the old Contagious Diseases Acts, to make sexual +immorality safe for men of low morals." + +The Committee are of opinion that, far from conditional notification and +compulsory treatment on the lines proposed being prejudicial to woman in +any way, it is they who will reap the greatest benefit from these +measures. In fact, sufferers from venereal disease, as a whole, have +everything to gain and nothing to lose so long as they will continue +under treatment, and to enable them to do this the best medical skill is +placed at their disposal free of cost. The only persons in the community +who will be penalized by the proposed legislation are those who, having +contracted venereal disease, are so reckless and unprincipled that they +will take no pains to avoid communicating it to others. + +The Committee, it will be seen, regard the legislative and medical +measures which they propose as of great importance, but with all the +earnestness at their command they desire in conclusion to emphasize the +moral and social aspects of the question. With the changing social +conditions, especially in the larger towns, we are losing the home +influence and home training which are the best safeguards to preserve +the young against the temptations and dangers which beset their path in +life. The Committee would impress upon parents the paramount duty they +owe to their children in this matter. There is also a duty cast upon all +leaders of public opinion, and upon the community at large, to do what +is possible to bring about better living-conditions, especially for +girls in the towns, to encourage all forms of healthy sport and +amusement, and to cultivate a higher moral standard. Whatever sanitary +laws may be passed, and whatever success may be attained in dealing with +bodily disease, there can be no true health if the soul of the nation +remains corrupt. If this inquiry should serve to remove some of the +popular ignorance regarding venereal disease, and to quicken the public +conscience so that appropriate steps may be taken to deal with this +dreadful scourge, the Committee feel that their labours will not have +been in vain. + +W.H. TRIGGS, Chairman. +J.S. ELLIOTT, \ +M. FRASER, \ Members +J.P. FRENGLEY, > of +JACOBINA LUKE, / Committee. +D. McGAVIN, / + + + + +APPENDIX. + + +GRAPH A. + +AVERAGE AGES OF BRIDEGROOM AND BRIDE AT MARRIAGE, 1900-1921. + +[Illustration] + + +TABLE A. + +ILLEGITIMATE BIRTHS, AND BIRTHS WITHIN ONE YEAR AFTER MARRIAGE, IN NEW +ZEALAND, 1913-21. + +NOTE.--The figures refer to accouchements, not to children born, +multiple cases being counted once only (Only live births are included.) + +------+------------+-------------------------------------------------+ + |Illegitimate| Duration of Marriage (in Complete Months) | +Year |Births +---+---+-----+-----+-----+-----+-----+-----+-----+ + | | | | | | | | | | | + | | 0.| 1.| 2. | 3. | 4. | 5. | 6. | 7. | 8. | +------+------------+---+---+-----+-----+-----+-----+-----+-----+-----+ +1913 | 1,173| 96|122| 145| 241| 255| 350| 398| 306| 327| +1914 | 1,291| 83|122| 146| 216| 247| 354| 398| 294| 335| +1915 | 1,137| 56| 96| 158| 231| 219| 288| 353| 286| 336| +1916 | 1,139| 63| 95| 135| 170| 212| 269| 326| 266| 343| +1917 | 1,141| 68| 66| 119| 137| 184| 216| 291| 264| 250| +1918 | 1,169| 42| 64| 99| 141| 148| 215| 259| 213| 212| +1919 | 1,132| 52| 98| 101| 125| 161| 202| 258| 222| 238| +1920 | 1,414| 69|125| 167| 220| 295| 347| 445| 377| 407| +1921 | 1,245| 82|140| 177| 228| 253| 341| 456| 370| 382| + +------------+---+---+-----+-----+-----+-----+-----+-----+-----+ +Totals| 10,841|611|928|1,247|1,709|1,974|2,582|3,184|2,598|2,830| +------+------------+---+---+-----+-----+-----+-----+-----+-----+-----+ + +------+--------------------+----------------+----------+ + | |Total Legitimate| | +Year +------+------+------| First Births | Total | + | | | |within One Year |Registered| + | 9. | 10. | 11. | after Marriage | Births | +------+------+------+------+----------------+----------+ +1913 | 831| 669| 462| 4,202| 27,935| +1914 | 720| 642| 487| 4,044| 28,338| +1915 | 769| 621| 457| 3,870| 27,850| +1916 | 793| 694| 512| 3,878| 28,509| +1917 | 575| 505| 449| 3,124| 28,239| +1918 | 443| 298| 279| 2,413| 25,860| +1919 | 469| 397| 314| 2,637| 24,483| +1920 | 859| 802| 575| 4,688| 29,921| +1921 | 979| 804| 670| 4,882| 28,567| + +------+------+------+----------------+----------+ +Totals| 6,438| 5,432| 4,205| 33,738| 249,702| +------+------+------+------+----------------+----------+ + +MALCOLM FRASER, +Government Statistician. + + +TABLE B. + +TABLE SHOWING NUMBER OF CASES TREATED AND ATTENDANCES AT THE +VENEREAL-DISEASE CLINICS DURING THE YEARS 1920-21 AND UP TO JUNE, 1922. + +---------------------------+-----------------------------+ + | Auckland | + |---------+---------+---------| + | 1920 | 1921 | 1922 | +---------------------------+-----+---+-----+---+-----+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 174| 30| 100| 44| 81| 29| + Chancroid | 10| ..| 25| ..| 10| ..| + Gonorrhoea | 81| 8| 345| 24| 189| 20| + No V.D. | 59| 10| 73| 25| 21| 8| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis |1,875|462|1,759|474| 830|313| + Chancroid | 100| ..| 72| ..| 37| ..| + Gonorrhoea |4,702| 95|9,232|141|3,384|172| + No V.D. | 134| 26| 227| 35| 53| 17| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | ..| ..| ..| ..| ..| ..| + Gonorrhoea | ..| ..| ..| ..| ..| ..| +---------------------------+-----+---+-----+---+-----+---+ + + +---------------------------+--------------------------------+ + | Wellington | + |----------+----------+----------| + | 1920 | 1921 | 1922 | +---------------------------+------+---+------+---+------+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 93| 34| 80| 10| 41| 8| + Chancroid | 1| ..| 8| ..| 7| ..| + Gonorrhoea | 190| 18| 298| 11| 141| 9| + No V.D. | 40| 10| 52| 25| 33| 17| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 1,388|448| 2,089|616| 1,156|269| + Chancroid | 6| ..| 16| ..| 29| ..| + Gonorrhoea |13,436|180|19,369|520|10,853|423| + No V.D. | 40| 10| 89| 35| 68| 35| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 1,624| ..| 1,711| ..| 790| ..| + Gonorrhoea | 3,024| 77| 4,098| ..| 1,998| ..| +---------------------------+------+---+------+---+------+---+ + + +---------------------------+------------------------------+ + | Christchurch | + |---------+---------+----------| + | 1920 | 1921 | 1922 | +---------------------------+-----+---+-----+---+-----+----+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F.| M. | F.| M. | F.| + Syphilis | 60| 25| 46| 21| 25| 13| + Chancroid | 8| ..| 6| ..| 5| ..| + Gonorrhoea | 120| 32| 139| 35| 70| 21| + No V.D. | 20| 10| 62| 31| 31| 16| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 786|450| 903|473| 632| 248| + Chancroid | 110| ..| 45| ..| 37| ..| + Gonorrhoea |2,132|245|3,968|902|2,239| 339| + No V.D. | 186| 98| 215|187| 96| 52| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 232| 80| 619| 44| 310| 9| + Gonorrhoea | 460|216| 725|161| 221| 157| +---------------------------+-----+---+-----+---+-----+----+ + + +---------------------------+-----------------------+ + | Dunedin | + |-------+-------+-------| + | 1920 | 1921 | 1922 | +---------------------------+---+---+---+---+---+---+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M.| F.| M.| F.| M.| F.| + Syphilis | 54| 13| 55| 11| 12| 9| + Chancroid | ..| ..| ..| ..| ..| ..| + Gonorrhoea | 37| | 55| 9| 46| 6| + No V.D. | 6| 2| 28| 2| 1| ..| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis |816|143|505| 84|432|115| + Chancroid | ..| ..| ..| ..| ..| ..| + Gonorrhoea |465| ..|814| 67|638| 63| + No V.D. | 6| 2| 21| 1| 1| | +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 74| 55|169|106| 20| ..| + Gonorrhoea | 66| ..|335|166| 28| 59| +---------------------------+---+---+---+---+---+---+ + +---------------------------+--------------------------------------+ + | Total for Years | + |------------+------------+------------| + | 1920 | 1921 | 1922 | +---------------------------+------+-----+------+-----+------+-----+ +Number of persons dealt | | | | | | | + with at or in connection | | | | | | | + with the out-patients' | | | | | | | + clinic for the first time| | | | | | | + and found to be | | | | | | | + suffering from-- | M. | F. | M. | F. | M. | F. | + Syphilis | 381| 102| 281| 86| 159| 59| + Chancroid | 19| ..| 39| ..| 22| ..| + Gonorrhoea | 428| 58| 837| 79| 446| 56| + No V.D. | 125| 32| 215| 83| 86| 41| +Total attendance of all | | | | | | | + persons at the | | | | | | | + out-patients' clinic who | | | | | | | + were suffering from-- | | | | | | | + Syphilis | 4,865|1,503| 5,256|1,647| 3,050| 948| + Chancroid | 216| ..| 133| ..| 103| ..| + Gonorrhoea |20,105| 520|33,583|1,630|17,114|1,017| + No V.D. | 366| 136| 562| 258| 218| 108| +Aggregate number of | | | | | | | + in-patients' days of | | | | | | | + treatment given to | | | | | | | + persons suffering from-- | | | | | | | + Syphilis | 1,930| 35| 2,499| 150| 1,120| 9| + Gonorrhoea | 3,550| 293| 5,168| 327| 2,157| 216| +---------------------------+------+-----+------+-----+------+-----+ + +---------------------------+-------------+-------+ + | Totals |Grand | + | according |Totals | + | to Sex | | +---------------------------+-------+-----+-------+ +Number of persons dealt | | | | + with at or in connection | | | | + with the out-patients' | | | | + clinic for the first time| | | | + and found to be | | | | + suffering from-- | M. | F. | | + Syphilis | 821| 247| 1,068| + Chancroid | 80| | 80| + Gonorrhoea | 1,711| 193| 1,904| + No V.D. | 426| 156| 582| +Total attendance of all |-------+-----+-------+ + persons at the | 3,038| 596| 3,634| + out-patients' clinic who |-------+-----+-------+ + were suffering from-- | | | | + Syphilis | 13,171|4,098| 17,269| + Chancroid | 452| ..| 452| + Gonorrhoea | 70,802|3,167| 73,969| + No V.D. | 1,146| 502| 1,648| +Aggregate number of | | | | + in-patients' days of | | | | + treatment given to | | | | + persons suffering from-- | | | | + Syphilis | 5,549| 194| 5,743| + Gonorrhoea | 10,875| 836| 11,711| +---------------------------+-------+-----+-------+ + + +TABLE C. + +REPLY FORM.--VENEREAL DISEASES. + +(_Confidential_.) + +I, the undersigned registered medical practitioner, desire to advise the +Committee on Venereal Diseases of the Board of Health that I had under +my personal care on Saturday, 16th September, 1922,[A] cases of venereal +disease, and of affections attributable to venereal disease, as under:-- + + NUMBER OF CASES. + Male. Female. Total. +1. Cases of recent infection:-- + (_a._) Gonorrhoea (including gonorrhoeal ophthalmia) + (_b._) Soft chancre + (_c._) Syphilis, primary and/or secondary +2. Cases of distant infection:-- + (_a._) Chronic gonorrhoeal affections or disabilities + directly attributable to gonorrhoea infection--_e.g._, + stricture, gleet, arthritis, abscesses, salpingitis, &c. + (_b._) Congenital syphilis + (_c._) Tertiary syphilitic manifestations or disabilities + directly attributable to syphilis infection:-- + (i.) Affecting nervous system--_e.g._, gumma, + locomotor, G.P.I., &c. + (ii.) Affecting ear, eye, &c. (special + senses)--_e.g._, optic atrophy, &c. + (iii.) Affecting respiratory system--_e.g._, + syphilitic laryngitis, &c. + (iv.) Affecting digestive system--_e.g._, + syphilitic stricture of rectum, &c. + (v.) Affecting circulatory system--_e.g._, + syphilitic angina, aneurism, &c. + (vi.) Affecting spleen + (vii.) Affecting skin, bones, joints, muscles + (viii.) Affecting genito-urinary system, including + abortions, &c. + +NOTE.--No case should be recorded under more than one of these headings. + +Total number of cases under my personal care + +My opinion is that venereal disease in this Dominion has [not] increased +in a greater proportion than the population during the last five years. + + [_Signature of medical practitioner._] +Date of posting: Town where practising or name or } + names of institutions concerned: } + + [A] "Under my personal care on Saturday, 16th September, 1922," + is to be interpreted to include all patients suffering from the + conditions enumerated whom you are attending or have attended, + and who you believe in the event of requiring further + attendance would call you in or consult you, in other words, + _bona fide_ patients of your own. It is not intended that you + are to enumerate only the patients actually seen by you on that + date. + + Medical superintendents or medical officers in charge of + institutions will regard all patients in or attending their + institutions as "under my personal care on Saturday, 16th + September, 1922," irrespective of whom the actual medical + attendant may be. + + Please post this Reply Form as soon as possible after 16th + September, 1922, and not later than 20th September, 1922. + + Additional copies of this form are obtainable from the Medical + Officers of Health, or the Secretary of the Board of Health, + P.O. Box 1146, Wellington. + + +TABLE D. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.--NUMBERS IN +HEALTH DISTRICTS. + +---------------+--------------------------------------+ + | Cases of Recent Infection. | +Health |---------+------------+--------+------| +District |Gonorrhoea|Soft Chancre|Syphilis|Total | +---------------+---------+------------+--------+------+ +North Auckland | 10| ..| 1| 14| +Auckland | 279| 3| 165| 447| +Hawke's Bay | 35| 3| 17| 55| +Wanganui | 59| 2| 37| 98| +Wellington | 187| 4| 114| 305| +Canterbury | 99| 2| 75| 176| +Otago | 79| ..| 104| 183| +---------------+---------+------------+--------+------+ +Dominion totals| 748| 14| 516| 1,278| +---------------+---------+------------+--------+------+ + +---------------+------------------------------------+------+ + | Cases of Distant Infection |Grand | +Health |---------+----------+--------+------+Total | +District |Chronic |Congenital|Tertiary|Total | | + |Gonorrhoea|Syphilis |Syphilis| | | +---------------+---------+----------+--------+------+------+ +North Auckland | 10| 1| 5| 16| 30| +Auckland | 229| 51| 239| 519| 966| +Hawke's Bay | 32| 10| 30| 72| 127| +Wanganui | 97| 10| 42| 149| 247| +Wellington | 279| 56| 220| 555| 860| +Canterbury | 83| 17| 111| 211| 387| +Otago | 120| 23| 88| 231| 414| +---------------+---------+----------+--------+------+------+ +Dominion totals| 850| 168| 735| 1,753| 3,031| +---------------+---------+----------+--------+------+------+ + +---------------+-------------------------+ + | Expression of Opinion | +Health |--------+--------+-------| +District |Increase|Decrease|Not | + | | |stated | +---------------+--------+--------+-------+ +North Auckland | 7| 2| 11| +Auckland | 34| 53| 82| +Hawke's Bay | 6| 19| 24| +Wanganui | 13| 16| 24| +Wellington | 29| 36| 68| +Canterbury | 16| 47| 53| +Otago | 14| 30| 51| +---------------+--------+--------+-------| +Dominion totals| 119| 203| 313| +---------------+--------+--------+-------+ + +Total replies received, 635. + + +TABLE E. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. TOTALS (ALL +FORMS) OF GONORRHOEA, SOFT CHANCRE, AND SYPHILIS, AND PERCENTAGE OF +GRAND TOTAL. + +----------------+-------------------------------------+---------+ + | Totals (all Forms) of each Disease | Grand | +Health District |-----------+--------------+----------+ Total | + | Gonorrhoea | Soft Chancre | Syphilis | | +----------------+-----------+--------------+----------+---------+ +North Auckland | 20| ..| 10| 30| +Auckland | 508| 3| 455| 966| +Hawke's Bay | 67| 3| 57| 127| +Wanganui | 156| 2| 89| 247| +Wellington | 466| 4| 390| 860| +Canterbury | 182| 2| 203| 387| +Otago | 199| ..| 215| 414| + |-----------+--------------+----------+---------+ +Dominion totals | 1,598| 14| 1,419| 3,031| +----------------+-----------+--------------+----------+---------+ + +-----------------+--------------------------------------+ + |Percentages (all forms) to Grand Total| +Health District +-----------+--------------+-----------+ + | Gonorrhoea | Soft Chancre | Syphilis | +-----------------+-----------+--------------+-----------+ +North Auckland | 66.67| ..| 33.33| +Auckland | 52.59| 0.31| 47.10| +Hawke's Bay | 52.76| 2.36| 44.88| +Wanganui | 63.16| 0.81| 36.03| +Wellington | 54.19| 0.46| 15.35| +Canterbury | 47.03| 0.52| 52.45| +Otago | 48.07| ..| 51.93| + +-----------+--------------+-----------+ +Dominion totals | 52.72| 0.46| 46.82| +-----------------+-----------+--------------+-----------+ + + +TABLE F. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.--INCIDENCE +IN CHIEF CENTRES SHOWING RATE PER 1,000 ESTIMATED POPULATION. + +-----------------+----------+--------------------------------+ + | | Cases of Recent Infection | + | +----------+----------+----------+ + | |Gonorrhoea | Syphilis | Total | + | | | | | + |Estimated +----+-----+----+-----+----+-----+ +Urban Area |Population| C |Rate | C |Rate | C |Rate | + |1st | a |per | a |per | a |per | + |April, | s |1,000| s |1,000| s |1,000| + |1922 | e | | e | | e | | + | | s | | s | | s | | +-----------------+----------+----+-----+----+-----+----+-----+ +Auckland | 164,450 | 214| 1.30| 146| 0.89| 360| 2.19| +Wellington | 110,680 | 159| 1.44| 99| 0.89| 258| 2.33| +Christchurch | 110,200 | 79| 0.72| 59| 0.53| 138| 1.25| +Dunedin | 73,470 | 54| 0.74| 102| 1.39| 156| 2.12| +Hamilton | 14,950 | 15| 1.01| 3| 0.20| 18| 1.20| +Cisborne | 14,920 | 7| 0.47| ..| ..| 7| 0.47| +Napier | 17,670 | 17| 0.96| 13| 0.74| 30| 1.70| +Hastings | 13,530 | ..| ..| 2| 0.15| 2| 0.15| +New Plymouth | 13,510 | 3| 0.22| ..| ..| 3| 0.22| +Wanganui | 24,170 | 14| 0.58| 12| 0.50| 26| 1.08| +Palmerston North | 17,510 | 5| 0.29| 13| 0.80| 18| 1.03| +Nelson | 10,880 | 1| 0.09| ..| ..| 1| 0.09| +Timaru | 16,040 | 6| 0.37| 1| 0.06| 7| 0.44| +Invercargill | 19,590 | 1| 0.05| ..| ..| 1| 0.05| +-----------------+----------+----+-----+----+-----+----+-----+ + +--------------+--------------------------------------------+----------+ + | Cases of Distant Infection | Grand | + |----------+-----------+----------+----------+ Total + + |Chronic |Congenital | Tertiary | Total | | + |Gonorrhoea |Syphilis | Syphilis | | | + |----------+----+------+----+-----+----+-----+----+-----+ +Urban Area. | C |Rate | C |Rate | C |Rate | C |Rate | C |Rate | + | a |per | a |per | a |per | a |per | a |per | + | s |1,000| s |1,000 | s |1,000| s |1,000| s |1,000| + | e | | e | | e | | e | | e | | + | s | | s | | s | | s | | s | | +--------------+----+-----+----+------+----+-----+----+-----+----+-----+ +Auckland | 147| 0.89| 42| 0.26| 194| 1.18| 383| 2.33| 743| 4.52| +Wellington | 240| 2.17| 42| 0.38| 183| 1.65| 465| 4.20| 723| 6.53| +Christchurch | 63| 0.57| 15| 0.14| 87| 0.79| 165| 1.50| 303| 2.75| +Dunedin | 96| 1.31| 18| 0.25| 59| 0.80| 173| 2.35| 329| 4.48| +Hamilton | 22| 1.47| ..| ..| 10| 0.67| 32| 2.14| 50| 3.34| +Cisborne | 9| 0.60| 2| 0.13| 9| 0.60| 20| 1.34| 27| 1.81| +Napier | 8| 0.45| 3| 0.17| 9| 0.51| 20| 1.13| 50| 2.83| +Hastings | 1| 0.07| 2| 0.15| 2| 0.15| 5| 0.37| 7| 0.52| +New Plymouth | 3| 0.22| ..| ..| ..| ..| 3| 0.22| 6| 0.52| +Wanganui | 29| 1.20| 6| 0.25| 21| 0.87| 56| 2.32| 82| 3.39| +Palmerston N. | 12| 0.69| 5| 0.29| 3| 0.17| 20| 1.14| 38| 2.17| +Nelson | ..| ..| 4| 0.37| 10| 0.92| 14| 1.29| 15| 1.38| +Timaru | 5| 0.31| ..| ..| 8| 0.50| 13| 0.81| 20| 1.25| +Invercargill | 7| 0.36| ..| ..| 10| 0.51| 17| 0.87| 18| 0.92| +--------------+----+-----+----+------+----+-----+----+-----+----+-----+ + + +TABLE G. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. +--PROPORTION OF CASES PER 1,000 OF POPULATION IN EACH HEALTH DISTRICT. + +-----------+----------+-------------------------+-------------------------+ + | | Total Cases Proportion Cases per 1,000| + Health |Estimated | (all Diseases) | Estimated Population | + District |Population+---------+---------+-----+---------+---------+-----+ + |1st April,|Recent |Distant |Grand|Recent |Distant |Grand| + |1922 |Infection|Infection|Total|Infection|Infection|Total| +-----------+----------+---------+---------+-----+---------+---------+-----+ +N. Auckland| 36,930| 14| 16| 30| 0.38| 0.43| 0.81| +Auckland | 323,436| 447| 519| 966| 1.38| 1.60| 2.99| +Hawke's Bay| 80,242| 55| 72| 127| 0.62| 0.81| 1.42| +Wanganui | 110,866| 98| 149| 247| 0.88| 1.34| 2.23| +Wellington | 242,830| 305| 555| 860| 1.26| 2.28| 3.54| +Canterbury | 240,387| 176| 211| 387| 0.73| 0.88| 1.61| +Otago | 200,574| 183| 231| 414| 0.91| 1.15| 2.06| +-----------+----------+---------+---------+-----+---------+---------+-----+ +Dominion | | | | | | | | +Totals | 1,244,265| 1,278| 1,753|3,031| 1.03| 1.41| 2.44| +-----------+----------+---------+---------+-----+---------+---------+-----+ + + +TABLE H. + +VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. +--SEX NUMBERS AND PROPORTIONS IN HEALTH DISTRICTS. + +Key: %% = F. to 100 M. + +------------+--------------------------------------------+ + | Cases of Recent | + | Infection | + Health +--------------+--------------+--------------+ + District | Gonorrhoea | Syphilis | Totals | + +----+----+----+----+----+----+----+----+----+ + | M | F | %% | M | F | %% | M | F | %% | +------------+----+----+----+----+----+----+----+----+----+ +N. Auckland | 10| ..| ..| 3| 1| 33| 13| 1| 8| +Auckland | 224| 55| 25| 112| 53| 47| 336| 108| 32| +Hawke's Bay | 28| 7| 25| 12| 5| 42| 40| 12| 30| +Wanganui | 40| 19| 48| 25| 12| 48| 65| 31| 48| +Wellington | 143| 44| 31| 95| 19| 20| 238| 63| 26| +Canterbury | 63| 36| 57| 48| 27| 56| 111| 63| 57| +Otago | 62| 17| 27| 89| 15| 17| 151| 32| 21| +------------+----+----+----+----+----+----+----+----+----+ +Dominion | | | | | | | | | | +Totals | 570| 178| 31| 384| 132| 34 | 954| 310| 32| +------------+----+----+----+----+----+----+----+----+----+ + +------------+-----------------------------------------------------------+ + | Cases of Distant | + | Infection | + Health +--------------+-------------+-------------+----------------+ + District | Chronic | Congenital | Tertiary | | + | Gonorrhoea | Syphilis | Syphilis | Totals | + +-----+---+----+----+---+----+----+---+----+-----+-----+----+ + | M | F | %% | M | F | %% | M | F | %% | M | F | %% | +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ +N. Auckland | 8| 2| 25| ..| 1| ..| 4| 1| 25| 12| 4| 33| +Auckland | 156| 73| 47| 33| 18| 55| 168| 71| 42| 357| 162| 45| +Hawke's Bay | 27| 5| 19| 7| 3| 43| 22| 8| 36| 56| 16| 29| +Wanganui | 74| 23| 31| 5| 5| 100| 29| 13| 45| 108| 41| 38| +Wellington | 225| 54| 24| 31| 25| 81| 156| 64| 41| 412| 143| 35| +Canterbury | 65| 18| 29| 7| 10| 143| 81| 30| 37| 153| 58| 38| +Otago | 101| 19| 19| 15| 8| 53| 58| 30| 52| 174| 57| 33| +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ +Dominion | | | | | | | | | | | | | +Totals | 656 |194| 30| 98| 70| 71| 518|217| 42|1,272| 481| 38| +------------+-----+---+----+----+---+----+----+---+----+-----+-----+----+ + +--------------+------------------+ + Health | Grand Totals | + District +-----+-----+------+ + | M | F | %% | +--------------+-----+-----+------+ +North Auckland| 25| 5| 20| +Auckland | 693| 270| 39| +Hawke's Bay | 96| 28| 29| +Wanganui | 173| 72| 42| +Wellington | 650| 206| 32| +Canterbury | 264| 121| 46| +Otago | 325| 89| 27| +--------------+-----+-----+------+ +Dominion | | | | +Totals |2,226| 791| 36| +--------------+-----+-----+------+ + + * * * * * + +_Approximate Cost of Paper._--Preparation, not given; + printing (1,225 copies), L45. + + * * * * * + +By Authority: W.A.G. SKINNER, Government Printer, Wellington.--1922. + +_Price 9d._ + + + + + + +End of the Project Gutenberg EBook of Venereal Diseases in New Zealand (1922) +by Committee Of The Board Of Health + +*** END OF THIS PROJECT GUTENBERG EBOOK VENEREAL DISEASES *** + +***** This file should be named 15352.txt or 15352.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/1/5/3/5/15352/ + +Produced by Jonathan Ah Kit, Cori Samuel and the Online Distributed +Proofreading Team (https://www.pgdp.net). + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +https://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at https://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +https://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at https://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit https://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including including checks, online payments and credit card +donations. To donate, please visit: https://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart was the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. diff --git a/15352.zip b/15352.zip Binary files differnew file mode 100644 index 0000000..ded6ae7 --- /dev/null +++ b/15352.zip diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..e52918f --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #15352 (https://www.gutenberg.org/ebooks/15352) |
