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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 Gonorrhœa, 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, 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 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 Gonorrhœa 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, 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.

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 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.

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.

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.

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."

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.

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 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.

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 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.

_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 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 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 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.

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 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.

_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 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.

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 gonorrhœa. It was
stated that no woman suffering from gonorrhœa 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
gonorrhœa, 98 per cent.: women with syphilis, 50 per cent.: women with
gonorrhœa, 14 per cent.

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.

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.

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 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.


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 gonorrhœa 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 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.

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.

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.

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,
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."

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| ..|
    Gonorrhœa              |   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| ..|
    Gonorrhœa              |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               |   ..| ..|   ..| ..|   ..| ..|
    Gonorrhœa              |   ..| ..|   ..| ..|   ..| ..|
---------------------------+-----+---+-----+---+-----+---+


---------------------------+--------------------------------+
                           |           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| ..|
    Gonorrhœa              |   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| ..|
    Gonorrhœa              |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| ..|
    Gonorrhœa              | 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|  ..|
    Gonorrhœa              |  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|  ..|
    Gonorrhœa              |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|
    Gonorrhœa              |  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              | ..| ..| ..| ..| ..| ..|
    Gonorrhœa              | 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              | ..| ..| ..| ..| ..| ..|
    Gonorrhœa              |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| ..|
    Gonorrhœa              | 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|   ..|
    Gonorrhœa              |   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|   ..|
    Gonorrhœa              |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|
    Gonorrhœa              | 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|
    Gonorrhœa              |  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|
    Gonorrhœa              | 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|
    Gonorrhœa              | 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._) Gonorrhœa (including gonorrhœal ophthalmia)
  (_b._) Soft chancre
  (_c._) Syphilis, primary and/or secondary
2. Cases of distant infection:--
  (_a._) Chronic gonorrhœal affections or disabilities
    directly attributable to gonorrhœa 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       |Gonorrhœa|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 |      |
               |Gonorrhœa|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 GONORRHŒA, SOFT CHANCRE, AND SYPHILIS, AND PERCENTAGE OF
GRAND TOTAL.

----------------+-------------------------------------+---------+
                | Totals (all Forms) of each Disease  |  Grand  |
Health District |-----------+--------------+----------+  Total  |
                | Gonorrhœa | 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  +-----------+--------------+-----------+
                 | Gonorrhœa | 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    |
                 |          +----------+----------+----------+
                 |          |Gonorrhœa | 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   |          |
              |Gonorrhœa |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   |  Gonorrhœa   |   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   |                |
            |  Gonorrhœa   |  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|
--------------+-----+-----+------+

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