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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."