Flexner, who spent two years in making inquiries and writing his classic work on "Prostitution in Europe," is most emphatic on this point. The experience of the American troops in the Great War is further strong confirmation. The following is an extract from an article published by the American Red Cross in May, 1918: "During the months of August, September, October, and the first half of November, the houses of prostitution flourished and were half-filled with soldiers. On November 15th rigid orders were issued placing these houses out of bounds, and the immediate result was a great reduction of sexual contacts. As a result there was a steady decline in venereal infections, and the monthly rate per 1,000, which in October reached 16.8, dropped in January to 2.1 among the white troops. During the same period there was an even more striking drop in the infections among the negro labourers, the percentage dropping from 108.7 per 1,000 a month to 11 per 1,000. No statistics could speak more eloquently for the doctrine of closing the houses of prostitution. Our studies showed numerous infections coming from houses 'inspected' three times a week."

In May, 1921, a conference (the North European Conference on Venereal Diseases), in which England, Finland, Germany, Holland, Norway, Sweden, and Denmark participated, passed the following resolution: "This conference, having considered the general measures for the combating of venereal diseases which have been adopted by the participating countries, is unanimously of the opinion, so far as the experience of these countries is concerned, that the legal and official toleration of professional prostitution has been found to be medically useless as a check on the spread of venereal diseases, and may even prove positively harmful, tending as it does to give official sanction to a vicious trade."

On the same point Flexner says: "It is a truism that physicians requiring to equip themselves as specialists in venereal disease resort to the crowded clinics of Paris, Vienna, and Berlin, all regulated towns, because there disease is found in greatest abundance and richest variety—a strange comment on the alleged efficacy of regulation."

Dr. Clarkson, in "The Venereal Clinic," already quoted, says, in reference to the fancied security of licensed houses, "It may strengthen the hands of practitioners to be able to tell interrogators in this subject that in the opinion of leading venereologists, &c., no foundation exists for any such feeling of confidence or security. In other words, the system of licensed houses is a failure, and the 'red light' of lust shines out as the lurid signal of disease and death."

It is surely hardly necessary to urge the moral objections to the proposal. The United States Public Health Service not long ago sent out a questionnaire to representative citizens in various walks of life asking for opinion in regard to open houses of prostitution. There was an overwhelming preponderance of replies against the system on moral as well as hygienic grounds. One Illinois miner answered: "The life of a prostitute is short, and her place must be filled when she dies, and, being the father of two girls, I would not want mine to fill a vacancy, and I think all parents think the same." A Colorado carpenter replied: "The woman engaged in such business may not be my wife, mother, sister, or daughter, but she is somebody's wife, mother, sister, or daughter. It is a violation of all law." One Chief of Police wrote: "Open houses of prostitution breed disease, crime, increase the number of prostitutes, corrupt the morals of the community, and are a menace to the youth of the country." Another replied: "The only reason I have ever heard advanced in favour of houses of prostitution is that they protect innocent girls. I am opposed to sacrificing any woman to benefit others."

If statistics could be obtained it would be probably found that the system tends not only to increase disease, but the volume of sexual immorality and crime. From the most materialistic point of view the system is indefensible; while, looking at it from the moral aspect, it is inconceivable that British people, who spent millions of money to stop the traffic in black slaves, would ever officially countenance a system which enslaves the souls as well as the bodies of its victims and defiles the community in which it exists.

SECTION 4.—EXCLUSION OF VENEREAL CASES FROM OVERSEAS.

The Committee are of the opinion that by the strict exercise of the provisions of section 111 of the Health Act, 1920, much may be done to prevent introduction of venereal diseases from overseas. They suggest, however, that where any person so suffering is required or permitted to attend a clinic he should be accompanied by some responsible officer of the ship, or person authorized by the shipping company concerned, and that the question on the "Report of Master of the Ship" defined by regulations—"Are you aware of the presence on board of any person suffering from ... (b) venereal disease?"—might be strengthened by adopting the Australian quarantine service equivalent viz., "Is there now or has there been on board during the voyage any person suffering from demonstrable syphilis in an active condition, or other communicable disease?"

The evidence given does not show that the number of venereal-diseases cases already in the Dominion is greatly added to by the introduction of cases from overseas. Since 1903 persons suffering from syphilis have been "prohibited immigrants" within the meaning of the Immigration Restriction Act.

SECTION 5.—PROPHYLAXIS.

Before discussing this question it is desirable clearly to distinguish between the procedures which are included under this term. These are—

(1.) The supply of drugs and appliances which are made available for use by the individual before exposure to infection. This may be described as "anticipatory prophylaxis," and has commonly been designated the "packet system."

The Committee condemn this procedure, for these reasons: (i) That the system suggests a moral sanction to vice; (ii) that the individual is lulled into a false sense of security, and may thereby be encouraged repeatedly to expose himself to infection; (iii) that the individual may be thereby deterred from seeking early advice or treatment; (iv) that the drugs supplied may be used for treating disease should it arise, and so delay may result in seeking skilled treatment in the early stages when it is likely to be most effective.

(2.) Treatment applied after exposure to infection. This is called "early treatment." This term is inapplicable, as a disease cannot be treated before it exists. It is also likely to be confused with "abortive treatment," which implies treatment immediately on the appearance of symptoms.

The evidence before the Committee shows that this form of prophylaxis, if applied by skilled persons and within a few hours of exposure, is effective in preventing disease in a great majority of the cases in which it is used.

The Inter-departmental Committee on Infectious Diseases set up by the Ministry of Health in 1919 in connection with demobilization, in a note on "Prophylaxis against venereal disease," reported among its conclusions based on service experience, "That where preventive treatment is provided by a skilled attendant after exposure to infection the results are better than when the same measures are taken by the individual affected, even after the most careful instruction." After exposure to infection there appears no reason why these diseases should not be regarded in precisely the same manner as other infectious diseases, and precautions taken to sterilize the parts which have been exposed to infection.

It is to be noted that it is recommended that the prophylactic treatment is to be carried out by some properly instructed person. This need not necessarily be a medical man. It is suggested that this form of prophylaxis might be carried out by an orderly at the venereal-disease clinics. The notices posted in the public conveniences and other suitable places indicating the existence of the clinics and the necessity for treatment might include a guarded reference to their use for this purpose.

This form of prophylaxis applies to males. In the case of females the methods adopted would be also contraceptive, and the Committee do not recommend that facilities should be provided for this.

The Committee must not be supposed to advocate prophylaxis as in any way a substitute for continence and the cultivation of that high moral tone that repels any suggestion of promiscuous sexual relationships, but they feel that they could not properly ignore reference to a method of prevention of these diseases which has proved very efficient in the services, to which there appears no reasonable ethical objection, and which brings their prophylaxis into line with that of other infectious diseases.

SECTION 6.—LEGISLATION REQUIRED.

(A.) Conditional Notification.

The only subjects of importance upon which the witnesses examined differed materially in opinion were—(1) whether there ought to be any system of notification of cases of venereal disease, and (2) what steps, if any, should be taken to deal with persons suffering from such disease in a communicable form who refused to be treated, and in some cases were even known to be spreading the disease broadcast. Ladies who attended to give evidence on behalf of the National Council of Women and one or two other women's organizations objected to notification and compulsory treatment. They argued that there was at present a "scare" on the subject of venereal disease, and deprecated "panic legislation." They contended that the adoption of notification would deter patients from seeking treatment for fear of publicity. They were opposed to compulsory treatment of recalcitrant patients, arguing that any law of the kind would be used most oppressively against women. They contended that reliance should be placed on greater facilities for free treatment at the clinics, the work of women patrols, suppression of liquor, and above all education and propaganda on moral lines.

When confronted with typical cases of difficulty already quoted some of the witnesses admitted that it was not easy to see how such cases could be dealt with satisfactorily without compulsion of some kind. But they argued that, even so, it would be a greater evil if the fear of publicity and the fear of compulsion should have the effect of deterring sufferers from seeking treatment and so drive the disease underground.

The National Council of Women, by a substantial majority, at a recent conference in Christchurch, carried a resolution protesting against a proposal to introduce compulsory notification and treatment of venereal diseases, and urging the Government to increase the facilities for free treatment. The President of the Council, however, informed the Committee that most of the nineteen societies affiliated to the Auckland Branch of the National Council are in favour of some form of compulsion, but a number of the southern branches are opposed to it. Speaking as an individual, and not as President of the National Council of Women, she added:

"Personally, I have no first-hand knowledge as to whether the disease is so prevalent in the community as to demand urgent measures, but there is an opinion among women social workers and medical practitioners, whom I have consulted, that something should be done, and they are in favour of compulsion under the Act, provided its administration is satisfactory. There is no doubt that there is a genuine and widespread fear among a large number of women that, although in the Act itself there is no discrimination between men and women, in actual practice there will be, and they fear that the Act will be enforced against women, and particularly immoral women, while the men concerned will be allowed to go free. This fear arises partly from the remembrance, particularly among elderly women, of the old Contagious Diseases Acts, both here and in England, and partly from the reports of the working of compulsion in Western Australia and elsewhere. I am of opinion that there is no serious ground for fear in view of the changed attitude in the public mind in connection with these diseases, the fuller knowledge that people generally have, and the high status of women in our country; also the ready access that all persons have to the protection of the law and the Courts in the event of false information being given, and the safeguards embodied in the Bill as I understand it is drafted. My view is that the objection to the compulsory clauses of the Bill would be removed in the opinion of many women if women patrols or women police were appointed, so that the administration of the Act in its compulsory clauses wherever it treated women could be in the hands of those women officers."

Among the witnesses questioned on this subject there was an overwhelming preponderance of opinion that the time had now arrived for the adoption of notification of all cases of venereal disease by number or symbol, if only for the purpose of getting more accurate statistics; the notification by name of those recalcitrant patients who refused to continue treatment until cured; and compulsory examination of those whom the Director-General of Health had good grounds for believing to be suffering from the disease and likely to communicate it to others, and who refused to produce a medical certificate as to their condition. Only three medical men expressed themselves as being against these proposals. On the other hand, the lady doctors examined (two of them members of the National Council of Women, and the third representing the Young Women's Christian Association) gave evidence in favour of conditional notification, and compulsory examination, and compulsory treatment of recalcitrants. It should be added that all the witnesses who were engaged in rescue work, or other work bringing them face to face with the horrors of venereal disease, were most emphatic in their opinion that compulsory notification and treatment should be adopted.

It is noteworthy that when the notification of ordinary infectious disease was first proposed in England almost exactly the same arguments were brought against the proposal as are now advanced against the notification of venereal disease. Sir W. Foster, member for Ilkeston, and a medical man of standing, speaking in the House of Commons in the debate on the Infectious Diseases Notification Bill, on the 31st July, 1889, said,

"The Bill calls upon medical men to perform something more than the ordinary duties of citizenship by requiring them to become informers of the occurrence of diseases. The relation of a medical men to his patient ought to be one of complete confidence, and anything that comes to the knowledge of a medical man in the practice of his profession is practically an inviolable secret; and I do not like any Bill to interfere with that relationship. I know myself that one of the results of this Bill, if passed into law, will be that in scores of cases medical men will not be called in to attend people suffering from infectious diseases ... I admit the difficulty of the position, but I am anxious that no measure should pass into law which will induce the public to keep these diseases more secret than they have been in the past, with the risk of adding to the spreading of them. We must be very cautious not to do anything which will prevent the public from placing full and implicit confidence in their medical man. I can quite conceive it to be possible that, if an outbreak of infectious disease occurs in a populous part of London, the people may, in order to prevent exposure, refuse to allow a medical man to come in, and in such cases we shall have tenfold more difficulty than at present. Therefore, while I am anxious to promote the notification of disease, I do not want the Government to promote rebellion on the part of the public."

Needless to say, these gloomy anticipations have not been realized. Probably the more enlightened generations to succeed us will wonder how there could ever have been any opposition to the notification of venereal disease, just as we to-day read Sir W. Foster's words and marvel that any person of intelligence could have committed himself to such statements.

Notification of infectious diseases and isolation of patients suffering from such diseases have for many years been compulsory. Isolation, when spoken of by opponents to a similar measure for venereal diseases, is opprobriously described as "compulsory detention." For twenty years it has been the law in New Zealand that an authorized medical practitioner may examine any person suspected to be suffering from any infectious diseases (save venereal diseases), and the Medical Officer of Health may, if he deems it expedient in the interests of the public health, compel the removal to a hospital of any person so suffering. This long-established procedure as referable to venereal diseases is by antagonists termed "compulsory examination" and "compulsory removal."

It is contended by some witnesses that notification will drive these diseases underground; but syphilis and gonorrhoea for generations past have been underground.

Under the present system numbers of unfortunate persons either delay calling in medical assistance until the case has become almost desperate so far as the patient is concerned, or they resort to unqualified persons, with the result that in most cases what was in the first instance a simple attack, capable of treatment, results in serious complications most difficult to deal with. In either case the patient may be communicating diseases to others, and should this come to the knowledge of the Health Department it has no effective means of checking him—no power to warn those who are being endangered by his criminal neglect.

The Committee think there is some force in the argument that notification by name, in the first instance, as in the case of ordinary infectious diseases, would tend to discourage some from coming forward for medical treatment. They recommend, therefore, the adoption of what is known as the system of conditional notification embodied in the West Australia Act. Under this plan the cases are notified by the doctor to the Health Department by number or symbol only. The name is not sent in unless the patient discontinues treatment before he is free from infection and refuses either to go to a clinic or to another doctor. In cases of those who "play the game," the name of the patient is kept confidential, and does not pass beyond the medical man attending him. It is only in cases of those who contumaciously refuse to do what is necessary for their own safety and the safety of others that the name is sent to the Health Department, in order that appropriate steps may be taken in the interests of public health. Even then the name is given only to officers who are pledged to keep it confidential.

Following are the clauses in suggestions for a Bill, drawn up by the Health Department, which in the opinion of the Committee should in substance be adopted:—-

"(1.) Every medical practitioner shall forthwith give notice to the Director-General of Health, in the prescribed form, upon becoming aware that any person attended or treated by him is suffering from any venereal disease in a communicable form. The notice shall state the age and sex and occupation of the patient and the nature of the disease, but shall omit the patient's name and address.

"(2.) Every medical practitioner, other than the medical officer in charge of a public hospital or of a clinic established by direction of the Minister of Health, shall be paid for each such notification a fee to be prescribed by regulation.

"(3.) The provisions of subsection (1) hereof shall apply in the case of a child under the age of sixteen years who is suffering from congenital syphilis.

"(4.) Whenever a patient has changed his medical adviser, in accordance with subsection (2) hereof, the medical practitioner under whose care the patient has placed himself shall notify the Director-General of Health in accordance with subsection (1) hereof, and shall include in such notice the name and address of the previous medical adviser."

Without some such system of preliminary notification no adequate statistics can be collected as to the prevalence of venereal diseases in New Zealand, and no conclusion could be arrived at in the future as to the effect of the whole or any part of the programme for combating these scourges. Again, without such notification, and the attachment thereto of some method of ensuring that the patient is made definitely acquainted with his condition, it is practically impossible to enforce the provisions of section 8 of the Social Hygiene Act for the crime of "knowingly" infecting any other person.

Here the Committee would refer to case 2 quoted above. Of what use is it to provide free clinics if those who make use of them are permitted, as soon as the urgent symptoms are relieved, to disseminate disease broadcast, widening the circle of infection? Again, where is our humanity if no step is to be taken to try to prevent a syphilitic child being born to the man in case 1?

A very valuable result of anonymous notification would be the possibility afforded of observing any unusual "flare-up" or succession of cases, especially in country districts and small towns. Study of case 4 will show the great value it would have been to have a record of an unusual increase of syphilis in that township, giving an opportunity for prompt investigation by the Medical Officer of Health for the district.

(B.) Compulsory Examination and Treatment.

This question obviously presents more difficulty than that of notification, but it is clear that unless some means are provided of bringing under treatment and, if necessary, isolating persons who are suffering from highly contagious diseases, and who will not avail themselves of medical treatment although this is provided free of cost by the State, and who are knowingly or recklessly communicating the disease to others, it will be impossible to keep in check this terrible scourge. Without such provision any abandoned woman, as in case 4, or any male libertine, may continue to sow disease broadcast without any power to stop them. Failing some such measure, table articles and food may continue to be smeared by hands soiled with syphilitic material, as in case 1; section 6 of the Social Hygiene Act remains mere useless verbiage, and the infecting of innocents, as in case 3, may continue unchecked.

Legislation dealing with this subject needs to be carefully framed with suitable safeguards, but the Committee think that an amendment of the Social Hygiene Act on the lines proposed by the Department of Health should be adopted. These provisions are:—

(1.) That whenever the Director-General of Health has reason to believe that any person is suffering from venereal disease, and has infected or is liable to infect other persons, he may give notice in writing to such person directing him to consult a medical practitioner, and to produce within a time specified in the notice a certificate from such medical practitioner to the satisfaction of the Director-General of Health that such person is or is not suffering from venereal disease.

(2.) Should the person not comply with this request, the Director-General of Health may obtain a warrant from a Magistrate ordering such person to undergo examination to prove the existence, or non-existence, of venereal disease.

(3.) Making it possible for a Magistrate, on the application of the Director-General of Health, to order the detention in a hospital or other approved place of a person who is likely to be a danger to other persons until that person is cured of venereal disease.

These provisions are applicable equally to both sexes, and the Committee see no reason to fear that the law would not be carefully and impartially administered. If it should appear that more women than men came under the operation of the law this result would be due to the fact that, as disclosed in the evidence, a much larger proportion of women than men fail to seek treatment, and of those treated a much larger proportion of women fail to continue treatment until no longer infectious.

It is hardly conceivable that a responsible officer, such as the Director-General of Health, would take action under these provisions unless he had strong reason to believe that such action was justified. But, even if he makes a mistake or is misinformed, the worst that can happen to an innocent person wrongfully suspected is that he or she will be required to produce a medical certificate, which can be procured free of cost from any hospital or V.D. clinic. This is wholly different from the provisions of the Contagious Diseases Act, under which a woman suspected of prostitution was liable to be arrested by a constable in the street.

The Committee recommend that the serving of notices, &c., under these sections be done by officers of the Health Department and not by the police. They also recommend that all proceedings taken under any Act having reference to venereal diseases should be heard in private unless the defendant applies for a hearing in open Court.

With regard to the effects of the actual operation of notification, examination, and isolation, the Commissioner of Public Health for West Australia, under date 25th August, 1922, advises the Committee that there is an increase in the number of cases attending public clinics, and that this is regarded not as evidence of increased incidence, but of increased interest and appreciation of early treatment by those suffering from the diseases.

SECTION 7.—MARRIAGE CERTIFICATE OF HEALTH.

The Royal Commission on Venereal Disease reported that there was a vast amount of ignorance as to the dangers arising from the sexual intercourse of married persons one of whom had previously to the marriage contracted syphilis or gonorrhoea. The effect upon the birth-rate, and the misery caused during married life, and in many cases to the offspring who survive, as they pointed out, are most serious, and the fact that the actual cause of the trouble often remains unknown and unrecognized prevents the calamity from serving the purpose of example or warning.

Some of the witnesses heard before the present Committee have urged that a certificate of good health, or at least a certificate of freedom from communicable disease, should be required from each party to a proposed marriage before the Registrar issued a license to marry. The Royal Commission considered that "it would not be possible at present to organize a satisfactory method of certification of fitness for marriage." The National Birth-rate Commission, however, reported that in their opinion the question should be reconsidered with a view to legislation.

There is much to be said in favour of such a proposal from the point of view of national health. If the system were adopted the certificate should, in the opinion of the present Committee, include freedom from mental disease as well as freedom from communicable disease. But there are manifest difficulties in the way, chiefly in regard to the delicate and searching examination which would be required in the case of women before a doctor could certify positively to the absence of communicable disease.

The Committee recommend that instead of a medical certificate each party to a proposed marriage should be required to answer appropriate questions in regard to the presence or absence of communicable and mental disease, and to make a sworn statement before the Registrar as to the truth of the answers. It should be the duty of the Registrar to communicate the contents of the statements to the other party in the event of any admission of the presence of communicable disease.

In addition to the penalty for making a false statement it might be provided, as in the Queensland Act, that venereal disease shall be a ground for annulling a marriage contract when one party is suffering at the time of marriage from such disease in an infectious state, provided the other party was not informed of the fact prior to marriage.

The Committee would also recommend the adoption of a further provision that it should be the duty of a medical practitioner attending a case of venereal disease which is or is likely to become infective, if he has reason to believe that the patient intends to marry, to warn him or her against doing so, and if he or she persists it should be the duty of the doctor forthwith to notify the case by name to the Director-General of Health, whose duty it should be to inform the other party. It should also be provided that bona fide communications made in such a case, either by the Director-General of Health or the doctor, to the other party to the marriage, or to the parents or guardian of such party, shall be privileged.

SECTION 8.—TREATMENT BY UNQUALIFIED PERSONS.

The evidence given before the Committee shows that while reputable chemists refer to a medical man patients coming to them for treatment for venereal disease, and while these constitute the great majority of the profession, there are still far too many cases of venereal disease treated by chemists, herbalists, chiropractors, and other unqualified persons. The treatment of venereal disease has become a specialized branch of medicine, and many general practitioners prefer to refer such cases to experts. The result of trusting to unqualified persons for the treatment of such serious and difficult diseases is that the patient usually drifts on uncured, and serious complications may occur. One specialist in venereal disease informed the Committee that of 200 of his cases whose cards showed particulars, 104 consulted chemists in the first place and received more or less treatment from them. He was able to give details of twenty-three cases showing the type of treatment given. In several cases there were severe complications which could have been avoided by proper treatment. There were also cases in which the patient, after taking medicine for a time, had communicated the infection to others. This witness further stated that some chemists charged consultation fees in addition to charges for drugs applied, and in certain cases charges for drugs were made which were little short of blackmail.

The Committee recommend that, in place of section 7 of the Social Hygiene Act, a more comprehensive clause from the West Australian Act be adopted. This is to the following effect: "No person [other than a registered medical practitioner] should attend or prescribe for any person for the purpose of curing, alleviating, or treating venereal disease, whether such person is in fact suffering from such disease or not."

The Committee would suggest that if the Pharmaceutical Society were to do all in its power to discourage its members from treating these diseases it would have a good effect.

SECTION 9.—MENTALLY DEFECTIVE ADOLESCENTS.

Mr. J. Caughley, Director of Education, stated in evidence: "From a general inquiry made by the Department a few years ago it was ascertained that there were at least six hundred or seven hundred mental defectives in New Zealand under the age of twenty-one. I need scarcely point out the moral danger to the community of so many of these defectives being at large. In particular, the girls are a source of danger to themselves and to the community, since they have little or no will-power or sense of restraint. I am of opinion that all such cases should be registered, and that, unless it can be shown that the mental defective is under thoroughly safe and proper care at home, he should be taken charge of by the State. I am certain that by this means the increasing number of mental defectives would be reduced to a minimum, since mental defectiveness is almost entirely hereditary."

Mr. Beck, Officer in Charge of the Special Schools under the Education Department, cited illustrative cases, one of which may be thus stated: "Two feeble-minded parents in New Zealand have had up to the present time ten degenerate children, all of whom are a lifelong burden on the State. Taking the case of these children, and assessing the cost to the State of maintaining them, the total amount for this family will not be less than L16,000."

The Committee are of opinion that supervision of mentally defective children and adolescents is an important factor in lessening venereal disease, and urge the Government as soon as possible to adopt a system of registration and classification of mental defectives, and of segregation where necessary, either in mental hospitals or in special institutions where these defectives may be suitably taught, and, where possible, usefully employed to defray the cost of their maintenance.



PART IV.—SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS.

SECTION 1.—CONCLUSIONS.

Following are some of the conclusions drawn from the evidence by the Committee:—

There is very general ignorance among the public on the subject of venereal disease, and this has stood in the way of its being grappled with effectively.

Syphilis not only causes loss of life directly, but many deaths ascribed to other causes in the Registrar-General's returns are due to the after-effects of this disease. It is responsible for many still-births and abortions, and its evil effects are seen in such children as survive. These effects may persist until the third generation.

Gonorrhoea, popularly, but quite erroneously, supposed to be a comparatively mild complaint, is regarded by medical men as being as serious a disease as syphilis. It is difficult to cure, especially in women, unless properly treated at the outset. It is a great cause of sterility in both sexes.

Owing to the absence of accurate statistics it is impossible to make comparisons between New Zealand and other countries as regards the prevalence of venereal disease, or to say whether it is increasing or decreasing in this country.

There are in New Zealand no fewer than 3,031 persons being treated by registered medical practitioners for venereal disease in some form, or for the effects thereof—1 person in every 428 of our population. At the clinics since their establishment 3,634 patients have been treated—3,038 males, 596 females.

An interesting calculation as to the prevalence of syphilis in New Zealand has been made by Dr. Hay, Inspector-General of Mental Hospitals. Working on what is known as Fournier's Index—the relation of the number of cases of dementia paralytica existing at any one time to the number of concurrent syphilitic infectious—he computes the number of persons in New Zealand now who have or have had syphilis to be 33,000, or 1 to every 38 of the population.

The Committee desire to state, however, that in their opinion there can be no accurate estimate of the prevalence of venereal disease until some system of obtaining accurate statistics has been adopted. One point which has come out clearly in their investigations is that venereal disease is sufficiently prevalent to cause serious concern and to call for energetic action.

Evidence was given to the Committee to show that children with mental and physical defects due to venereal diseases may become a charge on the State; that a proportion of these on being released become parents of defective children, who in their turn have to be supported at the public expense. It was also shown that such defectives have little sexual control, and are usually very prolific.

According to the Commissioner of Police there are only 104 professional prostitutes in New Zealand.

There is, however, a great deal of "amateur" prostitution, and this is chiefly responsible for the spread of venereal diseases.

The evidence points to a good deal of laxity of conduct among young people of all social conditions, especially in the large towns. This is generally attributed by the witnesses to the weakening of home influence and the restlessness of the age.

Apart from the venereal disease among those who indulge in promiscuous intercourse, there are many cases in which innocent wives are infected by their husbands, and other cases (not so frequent) of innocent husbands being infected by their wives.

Children suffer innocently from venereal disease, not only by inheritance from infected parents, but by accidently coming in contact with the germs on towels, &c., which have been used by a patient. There are also cases which come before the Courts where disease has been conveyed directly in crimes of violence by sexual perverts.

The free clinics in the chief centres are conducted by experts, and are doing good work. Their influence for good is greatly impaired, however, by the fact that a proportion of the male patients and the majority of the female patients leave off treatment before they are cured. As the law stands there is no power to compel them to continue treatment, and in many cases they resume promiscuous intercourse and spread the disease.

Evidence has been given of other cases, some of them of a very shocking character, in which persons suffering from venereal disease are not seeking medical treatment and are communicating the disease to others. As the law stands at present there is no power to restrain them from such conduct or to compel them to receive medical treatment.

SECTION 2.—RECOMMENDATIONS.

The Committee stress in the strongest terms the duty of moral self-control.

They urge the cultivation of a healthier state of public opinion. The stigma at present attached to sufferers from venereal disease should be transferred to those who indulge in promiscuous sexual intercourse.

Parents have a great responsibility as regards the instruction and training of their children so as to safeguard them against the dangers resulting from ignorance of sexual laws. There is too little parental control generally in New Zealand. The Committee recommend the training of teachers, and provision for giving appropriate instruction in schools.

Classification and, where necessary, segregation of mentally defective adolescents is recommended.

The following medical measures for preventing and combating the disease are recommended:—

The clinics should be made more available by being open continuously. Every effort should be made to secure privacy. A specially trained nurse should be in attendance at women's clinics, and women doctors should be secured where possible.

The Committee recommend that provision be made at the clinics for prompt preventive treatment of those who have exposed themselves to infection.

Lady patrols should be appointed in other centres to perform the kind of work that is being carried on in Christchurch.

The Committee, having regard to the good work especially of an educational nature which is being done by the Social Hygiene Society, Christchurch, consider voluntary effort of the same kind in other centres would be very helpful.

The Committee are entirely opposed to the Continental system of licensed brothels, or a revival of the C.D. Acts in any shape or form.

They recommend legislation be introduced providing for what is known as conditional notification of venereal disease. It will be the duty of a doctor to notify to the Health Department, by number or symbol only, each case of venereal disease he treats. If a patient, however, refuses to continue treatment until cured, and will not consult some other doctor or attend a clinic, it will then be the duty of the doctor last in attendance to notify the case to the Department by name.

If the patient continues recalcitrant and refuses to allow himself to be examined by the medical practitioner appointed by the Director-General of Health, then the latter should be empowered to apply to a Magistrate for the arrest of such person and his detention in a public hospital or other place of treatment until he is non-infective.

The Committee also recommend further provision to deal with cases in which persons suffering from venereal disease are not under medical treatment and are likely to infect others. If the Director-General of Health has reason to believe that any person is so suffering he may call on that person to produce a medical certificate, which may be procured free of charge from any hospital or venereal-disease clinic. If the person refuses to produce such a certificate he or she may be taken before a Magistrate, who may order a medical examination. Penalties, including detention in a prison hospital, should be provided for recalcitrant cases. The proceedings in all these cases are to be heard in private unless defendant desires a public hearing.

The Committee recommend that before a license to marry is issued the intending parties must sign a paper answering certain questions as to freedom from communicable disease and from mental disease, and must make a sworn statement that the answers to such questions are true.

They recommend the adoption of a provision in the Queensland Act making venereal disease a ground for annulling a marriage contracted whilst one party is suffering from such a disease in an infectious stage, provided the other party was not informed of the fact prior to marriage. Also that it should be the duty of a medical practitioner attending a case of venereal disease, if he has reason to believe that the patient intends to marry, to warn him or her against doing so, and if he or she persists it should be the duty of the doctor to notify the case by name to the Director-General of Health, whose duty it should be to inform the other party, or the parents or guardian of such other party. Such communications made in good faith either by the doctor or the Director-General of Health should be absolutely privileged.

The Committee recommend that the law prohibiting treatment of patients for venereal disease by unqualified persons shall be strengthened, and suggest that the Pharmaceutical Society might assist in preventing such practices.

SECTION 3.—CONCLUDING REMARKS.

The Committee in carrying out their task have been brought into contact with some uninviting aspects of our social life. Some of the facts disclosed are of a character to give serious concern to those lovers of their country who rightly regard it as exceptionally favoured by nature, and desire to see its people healthy and vigorous, clean in body and mind, worthy of their heritage. The late war showed that the pick of our population, physically as well as mentally, were of the finest possible type, the admiration of all who saw them; but the medical examination of the recruits disclosed that of 135,282 examined after the introduction of the Military Service Act—mostly young men in the prime of life—only 57,382, or say, 421/2 per cent., could be accepted as fit for training, unmistakably proving that the nation as a whole was much below the standard of physical fitness which it ought to exhibit.

The investigations of the Committee show that already there is far too large a proportion of mental and physical defectives reproducing their kind. In the absence of accurate statistics it is impossible to say what proportion of these defectives are the direct product of venereal disease, but there is clear evidence that a tendency to lead dissolute lives is especially noticeable in the females belonging to this unfortunate class. "A feeble-minded girl," says Mr. Beck, "has not sense enough to protect herself from the perils to which women are subjected. Often amiable in disposition and physically attractive, they either marry and bring forth a new generation of defectives, or they become irresponsible sources of corruption and debauchery in the communities where they live." Obviously some method of dealing with mental defectives—by segregation or otherwise—must be found as part of the problem of dealing with venereal disease.

As regards the effect of venereal disease on the general health of the community, we have the statement of the late Sir William Osler that he regards syphilis as "third on the list of killing diseases"; while Neisser, a leading authority, says that "with the exception of measles, gonorrhoea is the most widely spread of all diseases. It is the most potent factor in the production of involuntary race suicide, and by sterilization and abortion does more to depopulate the country than does any other cause."

In view of the facts brought out in the course of the inquiry, the Committee are strongly of opinion that it would be criminal neglect to allow the evil to go on without taking energetic steps to check its ravages. They believe that the legislative and other measures which they recommend for the medical prevention and treatment of venereal disease will, if given effect to with the loyal co-operation of the medical profession, have a very beneficial result in reducing the prevalence of disease, and will save an incalculable amount of sorrow and suffering which in too many cases falls upon the innocent. In what is proposed in this report there is nothing approaching a revival of the old Contagious Diseases Acts. To use the words of Dr. Emily Seideberg, the principle of the legislation now proposed is "To improve the health of the community, and not, as in the old Contagious Diseases Acts, to make sexual immorality safe for men of low morals."

The Committee are of opinion that, far from conditional notification and compulsory treatment on the lines proposed being prejudicial to woman in any way, it is they who will reap the greatest benefit from these measures. In fact, sufferers from venereal disease, as a whole, have everything to gain and nothing to lose so long as they will continue under treatment, and to enable them to do this the best medical skill is placed at their disposal free of cost. The only persons in the community who will be penalized by the proposed legislation are those who, having contracted venereal disease, are so reckless and unprincipled that they will take no pains to avoid communicating it to others.

The Committee, it will be seen, regard the legislative and medical measures which they propose as of great importance, but with all the earnestness at their command they desire in conclusion to emphasize the moral and social aspects of the question. With the changing social conditions, especially in the larger towns, we are losing the home influence and home training which are the best safeguards to preserve the young against the temptations and dangers which beset their path in life. The Committee would impress upon parents the paramount duty they owe to their children in this matter. There is also a duty cast upon all leaders of public opinion, and upon the community at large, to do what is possible to bring about better living-conditions, especially for girls in the towns, to encourage all forms of healthy sport and amusement, and to cultivate a higher moral standard. Whatever sanitary laws may be passed, and whatever success may be attained in dealing with bodily disease, there can be no true health if the soul of the nation remains corrupt. If this inquiry should serve to remove some of the popular ignorance regarding venereal disease, and to quicken the public conscience so that appropriate steps may be taken to deal with this dreadful scourge, the Committee feel that their labours will not have been in vain.

W.H. TRIGGS, Chairman. J.S. ELLIOTT, M. FRASER, Members J.P. FRENGLEY, > of JACOBINA LUKE, / Committee. D. McGAVIN, /



APPENDIX.

GRAPH A.

AVERAGE AGES OF BRIDEGROOM AND BRIDE AT MARRIAGE, 1900-1921.



TABLE A.

ILLEGITIMATE BIRTHS, AND BIRTHS WITHIN ONE YEAR AFTER MARRIAGE, IN NEW ZEALAND, 1913-21.

NOTE.—The figures refer to accouchements, not to children born, multiple cases being counted once only (Only live births are included.)

-+ Illegitimate Duration of Marriage (in Complete Months) Year Births + - - - - - - - - -+ 0. 1. 2. 3. 4. 5. 6. 7. 8. + - - - - - - - - - 1913 1,173 96 122 145 241 255 350 398 306 327 1914 1,291 83 122 146 216 247 354 398 294 335 1915 1,137 56 96 158 231 219 288 353 286 336 1916 1,139 63 95 135 170 212 269 326 266 343 1917 1,141 68 66 119 137 184 216 291 264 250 1918 1,169 42 64 99 141 148 215 259 213 212 1919 1,132 52 98 101 125 161 202 258 222 238 1920 1,414 69 125 167 220 295 347 445 377 407 1921 1,245 82 140 177 228 253 341 456 370 382 - - - - - - - - -+ Totals 10,841 611 928 1,247 1,709 1,974 2,582 3,184 2,598 2,830 + - - - - - - - - -

+ + + + Total Legitimate Year + + + First Births Total within One Year Registered 9. 10. 11. after Marriage Births + + + + + + 1913 831 669 462 4,202 27,935 1914 720 642 487 4,044 28,338 1915 769 621 457 3,870 27,850 1916 793 694 512 3,878 28,509 1917 575 505 449 3,124 28,239 1918 443 298 279 2,413 25,860 1919 469 397 314 2,637 24,483 1920 859 802 575 4,688 29,921 1921 979 804 670 4,882 28,567 + + + + + + Totals 6,438 5,432 4,205 33,738 249,702 + + + + + +

MALCOLM FRASER, Government Statistician.

TABLE B.

TABLE SHOWING NUMBER OF CASES TREATED AND ATTENDANCES AT THE VENEREAL-DISEASE CLINICS DURING THE YEARS 1920-21 AND UP TO JUNE, 1922.

- - Auckland - - - 1920 1921 1922 - - - - - - -+ Number of persons dealt with at or in connection with the out-patients' clinic for the first time and found to be suffering from M. F. M. F. M. F. Syphilis 174 30 100 44 81 29 Chancroid 10 .. 25 .. 10 .. Gonorrhoea 81 8 345 24 189 20 No V.D. 59 10 73 25 21 8 Total attendance of all persons at the out-patients' clinic who were suffering from Syphilis 1,875 462 1,759 474 830 313 Chancroid 100 .. 72 .. 37 .. Gonorrhoea 4,702 95 9,232 141 3,384 172 No V.D. 134 26 227 35 53 17 Aggregate number of in-patients' days of treatment given to persons suffering from Syphilis .. .. .. .. .. .. Gonorrhoea .. .. .. .. .. .. -+ - - - - - -

- Wellington 1920 1921 1922 - - - -+ Number of persons dealt with at or in connection with the out-patients' clinic for the first time and found to be suffering from M. F. M. F. M. F. Syphilis 93 34 80 10 41 8 Chancroid 1 .. 8 .. 7 .. Gonorrhoea 190 18 298 11 141 9 No V.D. 40 10 52 25 33 17 Total attendance of all persons at the out-patients' clinic who were suffering from Syphilis 1,388 448 2,089 616 1,156 269 Chancroid 6 .. 16 .. 29 .. Gonorrhoea 13,436 180 19,369 520 10,853 423 No V.D. 40 10 89 35 68 35 Aggregate number of in-patients' days of treatment given to persons suffering from Syphilis 1,624 .. 1,711 .. 790 .. Gonorrhoea 3,024 77 4,098 .. 1,998 .. -+ - - -

- Christchurch - - 1920 1921 1922 - - - - - - + Number of persons dealt with at or in connection with the out-patients' clinic for the first time and found to be suffering from M. F. M. F. M. F. Syphilis 60 25 46 21 25 13 Chancroid 8 .. 6 .. 5 .. Gonorrhoea 120 32 139 35 70 21 No V.D. 20 10 62 31 31 16 Total attendance of all persons at the out-patients' clinic who were suffering from Syphilis 786 450 903 473 632 248 Chancroid 110 .. 45 .. 37 .. Gonorrhoea 2,132 245 3,968 902 2,239 339 No V.D. 186 98 215 187 96 52 Aggregate number of in-patients' days of treatment given to persons suffering from Syphilis 232 80 619 44 310 9 Gonorrhoea 460 216 725 161 221 157 -+ - - - - -

- - Dunedin - - - 1920 1921 1922 - - - - - - -+ Number of persons dealt with at or in connection with the out-patients' clinic for the first time and found to be suffering from M. F. M. F. M. F. Syphilis 54 13 55 11 12 9 Chancroid .. .. .. .. .. .. Gonorrhoea 37 55 9 46 6 No V.D. 6 2 28 2 1 .. Total attendance of all persons at the out-patients' clinic who were suffering from Syphilis 816 143 505 84 432 115 Chancroid .. .. .. .. .. .. Gonorrhoea 465 .. 814 67 638 63 No V.D. 6 2 21 1 1 Aggregate number of in-patients' days of treatment given to persons suffering from Syphilis 74 55 169 106 20 .. Gonorrhoea 66 .. 335 166 28 59 -+ - - - - - -

- Total for Years 1920 1921 1922 - - - -+ Number of persons dealt with at or in connection with the out-patients' clinic for the first time and found to be suffering from M. F. M. F. M. F. Syphilis 381 102 281 86 159 59 Chancroid 19 .. 39 .. 22 .. Gonorrhoea 428 58 837 79 446 56 No V.D. 125 32 215 83 86 41 Total attendance of all persons at the out-patients' clinic who were suffering from Syphilis 4,865 1,503 5,256 1,647 3,050 948 Chancroid 216 .. 133 .. 103 .. Gonorrhoea 20,105 520 33,583 1,630 17,114 1,017 No V.D. 366 136 562 258 218 108 Aggregate number of in-patients' days of treatment given to persons suffering from Syphilis 1,930 35 2,499 150 1,120 9 Gonorrhoea 3,550 293 5,168 327 2,157 216 -+ - - -

-+ -+ -+ Totals Grand according Totals to Sex -+ -+ -+ -+ Number of persons dealt with at or in connection with the out-patients' clinic for the first time and found to be suffering from M. F. Syphilis 821 247 1,068 Chancroid 80 80 Gonorrhoea 1,711 193 1,904 No V.D. 426 156 582 Total attendance of all -+ -+ -+ persons at the 3,038 596 3,634 out-patients' clinic who -+ -+ -+ were suffering from Syphilis 13,171 4,098 17,269 Chancroid 452 .. 452 Gonorrhoea 70,802 3,167 73,969 No V.D. 1,146 502 1,648 Aggregate number of in-patients' days of treatment given to persons suffering from Syphilis 5,549 194 5,743 Gonorrhoea 10,875 836 11,711 -+ -+ -+ -+

TABLE C.

REPLY FORM.—VENEREAL DISEASES.

(Confidential.)

I, the undersigned registered medical practitioner, desire to advise the Committee on Venereal Diseases of the Board of Health that I had under my personal care on Saturday, 16th September, 1922,[A] cases of venereal disease, and of affections attributable to venereal disease, as under:—

NUMBER OF CASES. Male. Female. Total. 1. Cases of recent infection:— (a.) Gonorrhoea (including gonorrhoeal ophthalmia) (b.) Soft chancre (c.) Syphilis, primary and/or secondary 2. Cases of distant infection:— (a.) Chronic gonorrhoeal affections or disabilities directly attributable to gonorrhoea infection—e.g., stricture, gleet, arthritis, abscesses, salpingitis, &c. (b.) Congenital syphilis (c.) Tertiary syphilitic manifestations or disabilities directly attributable to syphilis infection:— (i.) Affecting nervous system—e.g., gumma, locomotor, G.P.I., &c. (ii.) Affecting ear, eye, &c. (special senses)—e.g., optic atrophy, &c. (iii.) Affecting respiratory system—e.g., syphilitic laryngitis, &c. (iv.) Affecting digestive system—e.g., syphilitic stricture of rectum, &c. (v.) Affecting circulatory system—e.g., syphilitic angina, aneurism, &c. (vi.) Affecting spleen (vii.) Affecting skin, bones, joints, muscles (viii.) Affecting genito-urinary system, including abortions, &c.

NOTE.—No case should be recorded under more than one of these headings.

Total number of cases under my personal care

My opinion is that venereal disease in this Dominion has [not] increased in a greater proportion than the population during the last five years.

[Signature of medical practitioner.] Date of posting: Town where practising or name or } names of institutions concerned: }

[A] "Under my personal care on Saturday, 16th September, 1922," is to be interpreted to include all patients suffering from the conditions enumerated whom you are attending or have attended, and who you believe in the event of requiring further attendance would call you in or consult you, in other words, bona fide patients of your own. It is not intended that you are to enumerate only the patients actually seen by you on that date.

Medical superintendents or medical officers in charge of institutions will regard all patients in or attending their institutions as "under my personal care on Saturday, 16th September, 1922," irrespective of whom the actual medical attendant may be.

Please post this Reply Form as soon as possible after 16th September, 1922, and not later than 20th September, 1922.

Additional copies of this form are obtainable from the Medical Officers of Health, or the Secretary of the Board of Health, P.O. Box 1146, Wellington.

TABLE D.

VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.—NUMBERS IN HEALTH DISTRICTS.

- Cases of Recent Infection. Health - District Gonorrhoea Soft Chancre Syphilis Total - - North Auckland 10 .. 1 14 Auckland 279 3 165 447 Hawke's Bay 35 3 17 55 Wanganui 59 2 37 98 Wellington 187 4 114 305 Canterbury 99 2 75 176 Otago 79 .. 104 183 - - + Dominion totals 748 14 516 1,278 -+ -

-+ + + Cases of Distant Infection Grand Health -+ + + +Total District Chronic Congenital Tertiary Total Gonorrhoea Syphilis Syphilis -+ -+ + + + + North Auckland 10 1 5 16 30 Auckland 229 51 239 519 966 Hawke's Bay 32 10 30 72 127 Wanganui 97 10 42 149 247 Wellington 279 56 220 555 860 Canterbury 83 17 111 211 387 Otago 120 23 88 231 414 -+ -+ + + + + Dominion totals 850 168 735 1,753 3,031 -+ -+ + + + +

-+ -+ Expression of Opinion Health + + - District Increase Decrease Not stated -+ + + -+ North Auckland 7 2 11 Auckland 34 53 82 Hawke's Bay 6 19 24 Wanganui 13 16 24 Wellington 29 36 68 Canterbury 16 47 53 Otago 14 30 51 -+ + + - Dominion totals 119 203 313 -+ + + -+

Total replies received, 635.

TABLE E.

VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. TOTALS (ALL FORMS) OF GONORRHOEA, SOFT CHANCRE, AND SYPHILIS, AND PERCENTAGE OF GRAND TOTAL.

- -+ Totals (all Forms) of each Disease Grand Health District -+ Total Gonorrhoea Soft Chancre Syphilis - -+ North Auckland 20 .. 10 30 Auckland 508 3 455 966 Hawke's Bay 67 3 57 127 Wanganui 156 2 89 247 Wellington 466 4 390 860 Canterbury 182 2 203 387 Otago 199 .. 215 414 -+ -+ Dominion totals 1,598 14 1,419 3,031 + - -

- Percentages (all forms) to Grand Total Health District - - Gonorrhoea Soft Chancre Syphilis - - - North Auckland 66.67 .. 33.33 Auckland 52.59 0.31 47.10 Hawke's Bay 52.76 2.36 44.88 Wanganui 63.16 0.81 36.03 Wellington 54.19 0.46 15.35 Canterbury 47.03 0.52 52.45 Otago 48.07 .. 51.93 - - Dominion totals 52.72 0.46 46.82 - - -

TABLE F.

VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922.—INCIDENCE IN CHIEF CENTRES SHOWING RATE PER 1,000 ESTIMATED POPULATION.

- + Cases of Recent Infection + + Gonorrhoea Syphilis Total Estimated + - - - Urban Area Population C Rate C Rate C Rate 1st a per a per a per April, s 1,000 s 1,000 s 1,000 1922 e e e s s s - - - - Auckland 164,450 214 1.30 146 0.89 360 2.19 Wellington 110,680 159 1.44 99 0.89 258 2.33 Christchurch 110,200 79 0.72 59 0.53 138 1.25 Dunedin 73,470 54 0.74 102 1.39 156 2.12 Hamilton 14,950 15 1.01 3 0.20 18 1.20 Cisborne 14,920 7 0.47 .. .. 7 0.47 Napier 17,670 17 0.96 13 0.74 30 1.70 Hastings 13,530 .. .. 2 0.15 2 0.15 New Plymouth 13,510 3 0.22 .. .. 3 0.22 Wanganui 24,170 14 0.58 12 0.50 26 1.08 Palmerston North 17,510 5 0.29 13 0.80 18 1.03 Nelson 10,880 1 0.09 .. .. 1 0.09 Timaru 16,040 6 0.37 1 0.06 7 0.44 Invercargill 19,590 1 0.05 .. .. 1 0.05 - - - -

+ Cases of Distant Infection Grand + - + Total + Chronic Congenital Tertiary Total Gonorrhoea Syphilis Syphilis + - - - Urban Area. C Rate C Rate C Rate C Rate C Rate a per a per a per a per a per s 1,000 s 1,000 s 1,000 s 1,000 s 1,000 e e e e e s s s s s - - - -+ Auckland 147 0.89 42 0.26 194 1.18 383 2.33 743 4.52 Wellington 240 2.17 42 0.38 183 1.65 465 4.20 723 6.53 Christchurch 63 0.57 15 0.14 87 0.79 165 1.50 303 2.75 Dunedin 96 1.31 18 0.25 59 0.80 173 2.35 329 4.48 Hamilton 22 1.47 .. .. 10 0.67 32 2.14 50 3.34 Cisborne 9 0.60 2 0.13 9 0.60 20 1.34 27 1.81 Napier 8 0.45 3 0.17 9 0.51 20 1.13 50 2.83 Hastings 1 0.07 2 0.15 2 0.15 5 0.37 7 0.52 New Plymouth 3 0.22 .. .. .. .. 3 0.22 6 0.52 Wanganui 29 1.20 6 0.25 21 0.87 56 2.32 82 3.39 Palmerston N. 12 0.69 5 0.29 3 0.17 20 1.14 38 2.17 Nelson .. .. 4 0.37 10 0.92 14 1.29 15 1.38 Timaru 5 0.31 .. .. 8 0.50 13 0.81 20 1.25 Invercargill 7 0.36 .. .. 10 0.51 17 0.87 18 0.92 + - - - -

TABLE G.

VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. —PROPORTION OF CASES PER 1,000 OF POPULATION IN EACH HEALTH DISTRICT.

-+ + -+ -+ Total Cases Proportion Cases per 1,000 Health Estimated (all Diseases) Estimated Population District Population+ -+ -+ -+ -+ -+ -+ 1st April, Recent Distant Grand Recent Distant Grand 1922 Infection Infection Total Infection Infection Total -+ + -+ -+ -+ -+ -+ -+ N. Auckland 36,930 14 16 30 0.38 0.43 0.81 Auckland 323,436 447 519 966 1.38 1.60 2.99 Hawke's Bay 80,242 55 72 127 0.62 0.81 1.42 Wanganui 110,866 98 149 247 0.88 1.34 2.23 Wellington 242,830 305 555 860 1.26 2.28 3.54 Canterbury 240,387 176 211 387 0.73 0.88 1.61 Otago 200,574 183 231 414 0.91 1.15 2.06 -+ + -+ -+ -+ -+ -+ -+ Dominion Totals 1,244,265 1,278 1,753 3,031 1.03 1.41 2.44 -+ + -+ -+ -+ -+ -+ -+

TABLE H.

VENEREAL DISEASES IN NEW ZEALAND AS AT 16TH SEPTEMBER, 1922. —SEX NUMBERS AND PROPORTIONS IN HEALTH DISTRICTS.

Key: %% = F. to 100 M.

Cases of Recent Infection Health District Gonorrhoea Syphilis Totals M F %% M F %% M F %% N. Auckland 10 .. .. 3 1 33 13 1 8 Auckland 224 55 25 112 53 47 336 108 32 Hawke's Bay 28 7 25 12 5 42 40 12 30 Wanganui 40 19 48 25 12 48 65 31 48 Wellington 143 44 31 95 19 20 238 63 26 Canterbury 63 36 57 48 27 56 111 63 57 Otago 62 17 27 89 15 17 151 32 21 Dominion Totals 570 178 31 384 132 34 954 310 32

+ -+ Cases of Distant Infection Health + + -+ -+ + District Chronic Congenital Tertiary Gonorrhoea Syphilis Syphilis Totals + -+ -+ + + -+ + + -+ + -+ -+ + M F %% M F %% M F %% M F %% + -+ -+ + + -+ + + -+ + -+ -+ + N. Auckland 8 2 25 .. 1 .. 4 1 25 12 4 33 Auckland 156 73 47 33 18 55 168 71 42 357 162 45 Hawke's Bay 27 5 19 7 3 43 22 8 36 56 16 29 Wanganui 74 23 31 5 5 100 29 13 45 108 41 38 Wellington 225 54 24 31 25 81 156 64 41 412 143 35 Canterbury 65 18 29 7 10 143 81 30 37 153 58 38 Otago 101 19 19 15 8 53 58 30 52 174 57 33 + -+ -+ + + -+ + + -+ + -+ -+ + Dominion Totals 656 194 30 98 70 71 518 217 42 1,272 481 38 + -+ -+ + + -+ + + -+ + -+ -+ +

Health Grand Totals District - - M F %% - - North Auckland 25 5 20 Auckland 693 270 39 Hawke's Bay 96 28 29 Wanganui 173 72 42 Wellington 650 206 32 Canterbury 264 121 46 Otago 325 89 27 - - Dominion Totals 2,226 791 36 - -

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Price 9d.

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