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.