Venereal Diseases in New Zealand (1922) Report of the Special Committee of the Board of Health appointed by the Hon. Minister of Health online

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