SOCIAL HYGIENE.

White Ribbon, Volume 24, Issue 280, 18 October 1918, Page 3

SOCIAL HYGIENE.

(The following paper was read at a conference of various bodies on the Social Hygiene question.) At a meeting on May 27th, n>iß, a motion was carried unanimously in favour of legislation for the eradication of venereal diseases on the lines laid down in the following ten paragraphs. We give the pars, and comments upon them: |. ’’Notification of Venereal Diseases to be compulsory on the part of the medical attendant, but <>nl\ if the patient does not satisfy the following conditions, Nos. 2 and 3.” Notification is not a punishment to certain people, who don't care if it were shouted from the house-tops, but to the vast majority, since the diseases carry a moral stigma, notifkattion, however confidential, is a punishment. Then let it be used as such, and kept for those who, by carelessness of their own bodies, or those of others, deserve it. Segregation is not essential for the control of veneleal diseases, as *t is for the control of other infecti<ffis diseases, so long as the sufferer observes certain rules. The use of notification would be that he or she would be compelled to observe these rules, not necessarily that they must be isolated, being only notified if they fail to observe them. 2. “He or she must be efficiently treated.” Venereal disease is only easily or fairly easily amendable to treatment in the early stages, but that treatment must be efficient. One of the principal values of this proposed legislation would be that sufferers would seek treatment early. The kind of treatment that would be looked on as ‘efficient” treatment would have to b“, and can easily be, laid down in the Act. As a matter of fact the enacting of standard lines of efficient treatment would bs of the utmost value as a guide to what is ex pected of the practitioner, and what will cure most effectively. It would have to he laid down how often the sufferer must report to his medical adviser. 3. “They must not expose any person to the danger of infection.” 4. “It is compulsory on the part of the medical attendant to inform the sufferer in writing of the facts contained in 1,2, and 3, namely that he or she has the disease, must be ef-

ficiently treated, and must not infect others, and that notification is unnecessary so long as these rules are observed.” This would involve no more than the ordinary procedure carried out for ordinary notification of disease, in which the guardians or sufferer have to be helped. 5. “It is a criminal act to expose to infection or to infect any other person knowingly, and such intimation on the part of the medical attendant as outlined above, to constitute knowledge of a state of inactivity.” 6. Failure on the part of the sufferer to respect these conditions renders immediate notification necessary o a duly constituted authority.” It will be said that perhaps a doctor might out of mistaken kindliness, fail to notify a patient who ought to he notified. No doubt it will he wise to make the authority some other person than the medical officer of health—perhaps a magistrate— so that the charge may he investigated before action is taken, hut this can be settled easily. Otherwise, the ordinary rules that attach to the notification of ordinary infectious diseases will apply. Under these pen. alties are provided for failing to notify disease, which include suspension from practice for a period of months, if the charge is proved. The medical man would be just as open to such a charge as in the case of diphtheria; he would be just as easily found out, perhaps more easily, and the law will be upheld, if it is made, just as precisely in venereal diseases as in other diseases. lit will be found that medical men will do their duty, and it Is a fact that the great majority of medical men are in favour of some form of notification. 7. “The authority after due investigation of the charge, and after ending it proved, will either place the patient in a special clinique for treatment, or have him or her prosecuted for infecting others, or both, if necessary.” 8. “It must be an offence under the Act for any person except a registered medical practitioner to treat venereal diseases, or to dispense drugs for venereal diseases, except on a registered practitioners’ prescription, or to advertise drugs or treatment for venereal diseases.” The object of this is manifold. There is great danger that unqualified persons, such as druggists, may

tell the sufferer that he has the disease when he has not, or vice versa, that he has not got the disease when he has-or fail to recognise the disease at all, thus denying to the patient the extreme advantage ot earlv treatment, and losing valuabl'* time. In addition, the essential drugs can only be administered by a qualified medical man as the methods of administration are highly technical. <). “Bacteriological and other diagnostic tests must he provided fre by the State.” 10. Free drugs and free treatment, and free specially-qualified doctors must he provided.” They are an integral part of the scheme; these last tw > sections go together. It is obvious that if the State requires a sufferer to be treated, M must provide th<- means free. These should not he in cliniques, which are specifically labelled as venereal, as this is a more or less public advertisement of what a person goes there for. It might be, however, that a person of either sex might he too i>oor to afford the proper skilled treatment, and yet too p-oud to go to a public institution. This is where the provision of free examination of clinical material, free blood and free drugs comes in. In an ordinary case, when giving advice, the doctor is not out of pocket, except for time. In venereal cases it is not so. The clinical and bacteriological tests are very expensive, so also are the drugs. If he has to provide these, he may suffer severe money loss. But if he were able to obtain these free, the treatment of the patient would then resolve itself into such as would (as in ordinary practice) involve only the risk of loss of time Further, the provision of free tests, drugs, and free doctor would do away with any allegation that the doctors were playing into their own hands for profit. It is useless to allege that some would rather go untreated than apply to doctors. If they did so, they must be few. In any case, their sufferings would speedily overcome their reluctance. It is also useless to argue that one is powerless if the disease is concealed, or that if, for instance, an inperson does not complain of being infected, one is stultified. v .»u might just as well say don’t try to

obtain any hold over emhczzlers because all embezzlers are not discovered, or b- cause all embezzlers are not handed ever to justice. There is no doub; that the knowledge of the penalties, and* of the occasional embezzlers that are handed over to th*' law, docs act*as a deterrent to others not to sin. So also the knowledge of the penalties would drive the patients to the doctor, and would prevent the infection of others, if not entirely, at any rate to a great degree. While the fart that unqualified persons cannot treat them would make for early and therefore efficient treatment and cure. Such legislation as is outlined above would, if made operative, go far towards stamping out the disease, and every one part is essential to the other. So far as the Social Hygiene Act, 1917, is concerned, it is unworkable because it gives no hold over the individual. The «lause as to employment is not only unjust, but unworkable entirely. It should be 'dropped. It would be for the doctor to decide if iho patient was risking infection to others in his employment. And he would act if it were essential in the public health, and make him stay away from it under throat of notification. Of course, penalties may he provided for falsely accusing anyone, but if notification were only conditional on failure to observe rules .is to treatment and infertivitv, and then investigation carried out before any publicity, individual interests would be conserved. With regard to prophylaxis (prevention) anticipatory to immoral acts, the loathing felt when first told of this issue, the repulsion with wh ch it is heard, are measures of the infamy of the-thing. No special reasoning can make a thing right which innate modesty tells one is wrong. It has been said that the advocates of this course, being sincere, should at least be given the credit of beit'g sincere. Hut one ought not to see this subject through the glasses of the other side. If anticipaton prophylaxis is bad, no question of utility ran n ke it right under any circumstances, from a moral viewpoint. There is no common ground for right ; nd wrong. Then let it be fought with bare hsts, and not with gloves on. The other side don’t understand it. They take the “credits” as a sign of weakness. And why make a credit of sincerity? Of all specious argument in favour

of anything, this is the weakest. Sincerity in a cause is not an argument for its righteousness. 1 he devil is sincere in all his doings. It is not to his credit. If the advocates of anticipatory prophylaxis are sincere, it is not necessarily to their credit, nor is it an argument in its favour. These advocates maintain that no man can be chaste, or if he is so, then it is from fear, not from inclination. If (they say) he is chaste, it is unnatural. They are wrong. It is a certainty that more men are chaste than unchaste, but bet ause impurity is so blatant and purity so reticent, the clamouring of the vile drowns the whispering of the clean. More than that, chastity is the healthiest state, and the state in which both man and animal are more efficient. It is said to be a fact that the greatest obstacle in the path of anticipatory prevention was the opjxisition of prominent medical officers. If it is a fact that every New Zealander proceeding on leave is provided with a prophylactic packet, then it is by order of the combatant officials. However greatly a civilian may be influenced by utility in this matter, he cannot ignore the fact that these medical men opposed it. The aspect from which the problem has been approached in the past has always been that of stamping out the disease. It should continue to be so. No one will expect a doctor to lower himself to making venereal promiscuity safer because it must make it more frequent. But he can, and will make every effort to stamp out the disease, because of its effects on the sufferers, whether innocent or guilty. If this, incidentally, makes sin safer, that cannot be heli>ed. If a man came to a doctor for an anticipatory preventive, he must refuse it from the fact that there can be no guarantee without this protection, the man would sin at all. Such a request practically puts the doctor in the position of a procureur. the proper course is to eradicate f he disease. In the pursuit of this policy of eradication of venereal disease, various and wrong methods have been tried. such as registration and inspection of prostitutes. These have failed, because, for one reason alone, it is not necessarily prostitutes that carry the infection. Hence the gathered power of *he propaganda for prophylaxis in anticipation of immoral acts

But the real reason for the failure of eradicatory methods, in the past, is solely because venereal disease has never be°n treated as other infectious diseases have. Take typhus, or typhoid, or smallpox. We seldom hear of them. Nevertheless, at on»* tin 1 e they were rampant. But just a few more words in reference to the advocates of anticipatory prevention. Not only are they wrong that sexuality is a necessity, and not only is it true that chastity is a healthy, nay, the healthiest state, but also they are wrong when they assume that they can absolutely prevent infection. More than that, temptation may assail the sinner when under the influence of alcohol, or when no prophylactic packet is at hand. If he falls and escapes infection, he will be the readier to risk again, until at last he is infected. They ignore the influence of prophylaxis on marriage, on the birthrate, and on the attitude of the sexes to one another. In fact, one might say, marriage under this code, as with chastity, is only another preventive of infection, and if the prophylactic theory is carried 01# to its logical conclusion married people will be a joke, and children a rarity, and sexual promiscuity will obtain. It is argued in favour 01 prevention that some immoral men fight well. But because a burglar is a good fighter, it is no reason tor providing an escape from punishment, and the same reasoning applies to the unchaste. The Royal Commission «m Venereal Disease did not pronounce against notification, but found that the time was not ripe for it, and that the public must be educated on the subjet t. But misconception has arisen on the part of some on this account, and a large measure of opposition to notification is based upon such misconception. Quite recently, the New Zealand Branch of the British Medical Association pronounced in favour of notification, and many bodies of public men, such as Hospital Boards, have voted for it. The Prisoners’ Detention Act is .1 legislative attempt to deal with the diseases, but is wrong in its principle, since the person suspected has to be arrested on a more or less trumped-up charge. The Social Hygiene Act, 11)17, is a real effort on the part of the Minister

of Public Health to deal with venereal disease, but is unworkable, parti< ularly in the matter of employment. It does not deal with notification at all. The part of it which makes the sale of drugs for venereal disease or the treatment of venereal disease by unqualified people, illegal, is both necessary and good, and is tlm only really practical part. A scheme on the lines outlined in the ten sections which begin this paper, and firmly administered, will effect its purpose, and will meet all obj°etions which can be raised. Anticipatory prophylaxis, if it lessens the percentage of infection, must inevitably widen he scope and increase the incidence of venereal disease in the end.